SafetyNet Product & Services Manager I/II (Medicaid Experience Needed)
Company: Excellus BlueCross BlueShield
Posted on: June 24, 2022
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
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
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).
* Supports the development of short and long-term strategic product
plans to meet business objectives, benefit administration,
regulatory requirements, process improvement, efficiency, and
* 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
* 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
* Builds strong relationships with internal business partners,
working proactively to keep them well-informed about political,
legislative, and regulatory developments impacting SafetyNet line
* Encourages innovation and process improvements within the
functional business areas that support SafetyNet products.
* Responsible for ongoing state reporting in support of segment
* Manages maintenance of business process work item
* Formulates contingency plans to address requirement and resource
* 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
* 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
* Takes on divisional sponsor role for applicable corporate
* Serves as divisional lead for significant segments of business
with strategic importance.
* Guides and mentors more junior Product and Services staff.
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
* 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
* 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
* 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
* 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
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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