Oversees Product Operations for a line of business, including potentially serving as the official Contract Manager. Serves as the primary day-to-day liaison for the Agency or Vendor, including interpretation and dissemination of agency/vendor guidance, immediate resolution of escalated issues, and proposals from the health plan to agency/vendor. Develops strategies to meet or exceed compliant operations and expansion of products and services within the State. Identifies implementation and operational gaps and leads teams to implement new processes and oversees results. Ensures all operations are in compliance with contractual requirements. Produces operational reporting for executive management. Facilitates problem identification, solution development, and initiative implementation to continuously improve processes to enhance member and provider experience, while driving financial performance of the program.
REPORTS TO: VP, Medicaid Prod & Reg Affairs
- Contract Manager, responsible for the day-to-day relationship with the Agency for Healthcare Administration.
- Oversees the operational aspects of the product/service.
- Assesses market dynamics, competitive position and operational performance, and performs strategic planning and annual forecasting activities for product/service.
- Oversees implementation of initiatives associated with contractual compliance and product improvement and drives to completion.
- Builds and enhances relationships with corporate, providers, members, and external partners in the community to support plan and company mission and create compliant opportunities for growth within the state.
- Serves as subject matter expert on relevant contract(s), proposal(s), and agency/vendor guidance.
- Works closely with the Senior Director, Regulatory Affairs and Compliance Liaison to ensure compliance within all areas of the product/service.
- Evaluates sales, contracting, and operational processes for "best practice" development in all areas of the business.
- Partners with all departments in the organizations, which include, but are not limited to: finance, provider relations, customer service, health services, utilization management, Medicare sales, and community relations.
- Performs other duties as assigned.
- Serve as the subject matter expert on ACHA contract(s), proposal(s) and ACHA guidance.
- Required A Bachelor's Degree in business administration / related field
- Required or equivalent work experience
- Preferred A Master's Degree in a related field
- Preferred or equivalent work experience
- Required 6 years of experience in project management, strategic planning and development, product management, and financial management
- Required 4 years of experience in health care or managed care environment
- Preferred 2 years of experience in working with state reporting and regulatory/government affairs
- Required 2 years experience in leading/supervising others
Licenses and Certifications:
- Intermediate Ability to lead/manage others in a matrixed environment
- Intermediate Ability to influence internal and external constituents
- Intermediate Demonstrated negotiation skills
- Intermediate Demonstrated written communication skills
- Intermediate Demonstrated interpersonal/verbal communication skills
- Intermediate Ability to work in a fast paced environment with changing priorities
- Intermediate Other Ability to network with internal resources as well as external partners and consultants
- Intermediate Other Proven track record of managing through teamwork, collaboration and open communications
- Intermediate Other Strong strategic planning background and the ability to balance market requirements with objectives of the program/service and compliant regulations
A license in one of the following is required:
- Required Intermediate Microsoft Excel Proficient in Microsoft Office including Word, Excel, PowerPoint, and Outlook
- Required Intermediate Microsoft PowerPoint , Quantitative analysis and financial modeling capabilities
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Outlook