Medicaid Product Manager

Location Address:

Compensation Pay Range:

Summary:

Responsibilities:

Provides direction and support to functional areas to achieve optimal performance and program compliance. Identifies and implements requirements / changes to ensure regulatory and contractual compliance under the Medicaid contract. Represents the organization at Health Care Authority (HCA) / MCO meetings, builds effective working relationships with internal partners, HCA and MCO representatives, and recommends solutions to influence decisions.

Some key responsibilities include

• Accountable for product administration and operations that comply with regulatory and contractual requirements under the Medicaid contract.
• Proactively engages functional areas to achieve optimal performance and program compliance as it relates to HCA deliverable and reporting requirements.
• Develops, generates, presents and maintains a variety of statistical reports and records for senior leadership and recommends areas of improvement.
• Works with management to assess product/program needs and objectives. Assists in the data-driven decision-making process when faced with uncertainty.
• Ability to correctly frame a business question then determine valid and reliable data elements needed for the best available answer.
• Accountable for all aspects of HCA Deliverable process management including, efficient allocation of resources, collaborating resources and working with Finance to estimate budget impacts.
• Directs various business area teams through the definition, development and implementation of critical processes and systems solutions.
• Effectively represents PHP at HCA / MCO meetings, builds effective working relationships with HCA and MCO representatives, and recommends solutions to influence decisions.

Qualifications:

• Bachelors Degree in related field or a minimum of 6 years experience in application, development and/or implementation of benefit plans associated with HMO, ASO, PPO, and/or Government programs or work with government agencies required in lieu of degree.
• Plus three to five years health plan experience, product or project management, or other directly related experience. Excellent organizational skills with the ability to manage multiple priorities with keen attention to detail. Excellent written and oral communications skills are required, specifically to communicate with government agencies. Must be able to work closely with other team members and function effectively under pressure.

Preferred Qualifications:

• Experience with Medicaid contract and regulations Knowledge of Medicaid and health plan operations

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
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Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.