Medicare Product Solutions Manager III

Company: L.A. Care Health Plan
Location: Los Angeles
Posted on: October 31, 2024

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:

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
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