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SafetyNet Product & Services Manager I/II (Medicaid Experience Needed)

Company: Excellus BlueCross BlueShield
Location: Watertown
Posted on: June 24, 2022

Job Description:

PLEASE NOTE: With limited exceptions, our company is requiring all employees to be vaccinated against COVID-19 by Jan. 1, 2022. We also currently mandate vaccinations for employees who enter our buildings. Please keep this in mind when applying for positions at our organization.

Under the general direction of the Assigned Management, this position is responsible for assuring that all SafetyNet products and services are administered according to approved benefit design, regulatory requirements, and strategic objectives for the line of business. In the DUALS focused role, the incumbent will be knowledgeable in both the Medicare/Medicaid products and services.

The position engages cross-functionally within the health plan to promote strategies and tactics to drive innovation, enhance program efficiency and comply with state mandates and reforms. The incumbent monitors product performance and recommends changes, cost adjustments or resource additions to improve existing programs financial and quality performance, assessing and understanding the market opportunities available and the challenges faced by government programs. Monitors P&L for each product and/or segment. The position identifies and addresses key profitability drivers and develops plans to mitigate business risks. The incumbent creates business plans to meet divisional strategic roadmap goals. Additionally, the incumbent contributes to the overall success of the products including membership growth, margin, customer experience and key operational metrics. This position builds business case for product enhancements and expansion beyond traditional service areas. This position functions as primary SafetyNet line of business liaison for state regulators. The position responds to regulatory inquires and ensures timely, accurate feedback. The incumbent represents the Plan at state agency meetings and advocates for Plan position.

This position acts as corporate resource for interpretation of all SafetyNet state contracts including Medicaid Managed Care, Health and Recovery Program, Child Health Plus, Essential Plan (and Medicaid Advantage Plus upon expansion).

Essential Responsibilities/Accountabilities

Level I

* Supports the development of short and long-term strategic product plans to meet business objectives, benefit administration, regulatory requirements, process improvement, efficiency, and member experience.
* Drives strategic product roadmap taking into consideration competitive markets and regulatory influences.
* Analyzes financial trends and premium rate adequacy by service and/or actuarial class to direct areas of improvement.
* Assesses changes in the state and federal regulatory landscape including NYS Budget actions. Identifies emerging trends and their implications and develops plans to address.

o Monitors programs such as Medicaid Redesign (MRT), Value Based Payment, DSRIP, Infrastructure, and Specialized Managed Care Plans such as Intellectual and Developmental Disabilities or duals).

o Monitors legislation related to services such as Long Term Services and Supports, pharmacy, dental, and behavioral health.

* Engages in issue identification based on research and analysis as well as problem solving to identify and resolve potential improvement opportunities. Interprets and trends member, group, and provider data.
* Engages in product filings and participates in implementing annual product changes and member communications.
* Acts as primary liaison with state agencies and non-governmental entities in support of SafetyNet products and services.
* Responsible for select vendor contracting and oversight in support of segment strategies.
* Oversees mandates affecting SafetyNet Lines of business. Reads and interprets guidance and identifies necessary next steps. Attends state webinars and advocates for plan position, if necessary. Refers mandates to Corporate Compliance and Legal for distribution, counsel, and support, as needed. Works in collaboration with SafetyNet Strategy and Execution to define business requirements and implement changes.
* Serves as Corporate resource for interpretation of SafetyNet state contracts. Provides guidance to stakeholders regarding products, eligibility, benefits, cost-sharing, branding, network and premium.
* Builds strong relationships with internal business partners, working proactively to keep them well-informed about political, legislative, and regulatory developments impacting SafetyNet line of business.
* Encourages innovation and process improvements within the functional business areas that support SafetyNet products.
* Responsible for ongoing state reporting in support of segment management.
* Manages maintenance of business process work item deliverables.
* Formulates contingency plans to address requirement and resource changes.
* Coaches and counsels team members to accomplish projects, meet established schedules, or resolve technical/operational issues.
* Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs.
* Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
* Regular and reliable attendance is expected and required.
* Performs other functions as assigned by management.

Level II - Performs similar functions as the level I and is additionally responsible for:

* Takes on more complex and higher profile projects including but not limited to those with significant external provider, community-based organization, state agency and/or public facing interactions.
* Acts as SN lead for regulatory audits or readiness reviews.
* Acts as divisional lead for multi-faceted state initiatives usually involving more than one state agency such as new waiver programs or significant benefit change (carve ins or carve outs).
* Takes on divisional sponsor role for applicable corporate strategic projects.
* Serves as divisional lead for significant segments of business with strategic importance.
* Guides and mentors more junior Product and Services staff.

Minimum Qualifications

Note

This description includes multiple levels of classification. The levels of classifications are differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making and, in some cases, becoming a resource to others. New hires will be placed in the level for which they are most qualified based on their experience, credentials and skills.

Level I

* Bachelor's degree in relevant field with a minimum of four years of progressive experience in product or project management and considerable operational knowledge of multiple functional areas. In lieu of a degree, a minimum of six years of progressive product/project management/process improvement work experience and operations knowledge is required.
* Must have solid communication skills - both verbal and written.
* Strong product/project management skills and ability to multi-task. Able to lead teams and drive results.
* Strong analytical skills and the ability to recommend solutions to problems.
* Ability to work well with all levels of management
* Has a good understanding of business areas which may include Government Programs, Claims, PFM, Customer Service, and Membership and Billing guidelines, procedures and requirements.

Level II - in addition to qualifications in level one:

* Bachelor's degree and minimum five years of relevant experience in product or project management and considerable operational knowledge of multiple functional areas. In lieu of a degree, a minimum of eight years' experience in product/project management/process improvement work experience and operations knowledge is required.
* Ability to represent the health plan in lead role at state and community forums at reoccurring meetings. Excellent collaboration skills to coordinate activities and ensure appropriate approvals for release of information.
* Ability to organize information for presentation to state agencies from multiple internal stakeholders including clinical, claims, configuration, member services.
* Advanced communications both verbal and written including responses to complex state regulations.
* Demonstrated expertise in state contracts, product/project management.
* Thorough understanding of regulatory environment.

The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Keywords: Excellus BlueCross BlueShield, Syracuse , SafetyNet Product & Services Manager I/II (Medicaid Experience Needed), Executive , Watertown, New York

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