Medicare Product Solutions Manager III
Company: L.A. Care Health Plan
Location: Los Angeles
Posted on: October 16, 2024
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Job Description:
Medicare Product Solutions Manager IIIJob Category:
Administrative, HR, Business ProfessionalsLocation: Los Angeles,
CA, US, 90017Position Type: Full TimeRequisition ID: 11568Salary
Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00
(Max.)Established in 1997, L.A. Care Health Plan is an independent
public agency created by the state of California to provide health
coverage to low-income Los Angeles County residents. We are the
nation's largest publicly operated health plan. Serving more than 2
million members, we make sure our members get the right care at the
right place at the right time.Mission: L.A. Care's mission is to
provide access to quality health care for Los Angeles County's
vulnerable and low-income communities and residents and to support
the safety net required to achieve that purpose.The Product
Solutions Manager III is responsible for assisting the product
leadership team within the Product Strategy, Sales and Marketing
(PSSM) service area and the enterprise. The Product Solutions
Manager III leads in supporting ongoing operations of the assigned
product lines in bridging the gap between state requirements and
required transformation of future state alternatives. The position
navigates the regulatory/legislative and market environment to
drive desired performance levels to balance short-term business
needs with long-term innovative solutions to ensure achievement of
enterprise strategic goals.DutiesSupports the assigned product
lines in policy and regulatory efforts. Evaluates policy and
regulatory changes to identify impacts to current processes and
supports implementation initiatives. Assesses market strategy white
papers, Legal memos, legislation/mandate language, regulatory
changes and/or regulator model contracts and provides impact
recommendations, feasibility and execution plans.Responsible for
defining product strategy and positioning. Drive design,
feasibility and definition of new innovations and manages the
ongoing evolution, growth, and strategic direction of assigned PSSM
unit and its portfolio.Conducts cost/benefit analyses, needs
assessment and data analysis in order to align strategy, design and
business solutions with business objectives. Leads and documents
requirement sessions/JAD sessions.Manage cross-functional
partnerships with stakeholders responsible for quality measures and
policy initiatives. Reviews data to monitor product performance and
identify areas for cost containment initiatives (i.e. encounters,
utilization, rates) and develops improvement plans.Develop and
design processes and product requirements that support business
needs. Design methods for integrating function and process
including improvement opportunities and development performance
improvement plans with business units.Support business units on
developing and executing process improvement plans, monitoring
programs and enhancements to promote efficiency, quality, and
compliance. Partner with functional areas to involve day-to-day
issues impacting product performance.Orchestrate, plan and execute
end-to-end cycle strategy, including complex development and
implementation efforts for the assigned line of business and their
products (on/off exchange).Identify gaps in operational processes
that impact quality scores, enrollment, revenue and member
retention. Design appropriate mitigation and contingency plans.
Lead efforts to identify best practices to drive product integrity
and efficiency. Validate functional area readiness for effective
administration of benefits and transactions for the upcoming plan
year, including creation, scope and execution for enhancements
and/or product cycle implementations.As a Subject Matter Expert,
develop and conduct training on unit processes for lower-tiered
positions.Perform other duties as assigned.Education
RequiredBachelor's Degree in Public Administration or Related
Field. In lieu of degree, equivalent education and/or experience
may be considered.Education PreferredMaster's Degree in Public
Administration or Related Field.ExperienceRequired: At least 5
years of relevant experience in product development/management.
Risk management and mitigating planning experience. Must have
experience and knowledge with regulatory guidelines governing
product lines; leads regulatory filing process for new/custom
product initiatives.SkillsMust have deep knowledge and ability to
apply principles of the product development life cycle (PDLC)
discipline and process for development and implementation of new
products and/or enhancements. Knowledge of product management and
strategic planning concepts. Able to use advanced features of MS
Office including Excel, PowerPoint, Word, MS Project, Visio.
Ability to manage risk through change control and/or escalation
protocols if necessary. Excellent interpersonal, motivational, and
communication skills. Excellent written and verbal communication
and presentation skills. Ability to serve as member on or lead
cross-functional implementation or project teams. Ability to
interpret data sets and forecast future revenue streams. Working
knowledge of the company's healthcare products, functions and
regulatory guidelines.Licenses/Certifications
RequiredLicenses/Certifications PreferredRequired TrainingPhysical
RequirementsLightAdditional InformationDepartment
Specifics:Medicare:Required: Experience and knowledge in Cal
MediConnect (CMC) / D-SNP policy and product lines of business.
Experience in improving Stars and Quality Measures. Experience in
Medicare Advantage, with experience serving duals population.
Direct experience in Medicare and Duals program administration
including stars, quality, financial performance review, operational
functions (claims, enrollment, readiness).Medi-Cal:Required:
Experience serving Medi-Cal population.Preferred: Understanding of
Medi-Cal managed care model, eligibility requirements, benefits,
enrollment processes, and regulatory requirements governing
Medi-Cal managed care plans. Understanding of managed care
principles and operations.Medi-Cal Plan Partners:Required:
Experience serving Medi-Cal population. Talented in building
relationships with external partners. Service oriented. Talented in
resolving conflict.Preferred: Understanding of Medi-Cal managed
care model, eligibility requirements, benefits, enrollment
processes, and regulatory requirements governing Medi-Cal managed
care plans. Understanding of managed care principles and
operations.Commercial Group:Required: Experience working in
Commercial and Group Product Health Plans.Salary Range Disclaimer:
The expected pay range is based on many factors such as geography,
experience, education, and the market. The range is subject to
change.L.A. Care offers a wide range of benefits including:
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Keywords: L.A. Care Health Plan, Rosemead , Medicare Product Solutions Manager III, Executive , Los Angeles, California
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