Manager, Interplan Programs and Policy

<strong>At Emergent Holdings, we&rsquo;re creating an innovative environment where our employees belong authentically, contribute meaningfully, and thrive intentionally &mdash; both personally and professionally.</strong>

Southfield, USA

Emergent Holdings

<p class="p1"><strong>Emergent Holdings is driven by a singular goal &mdash; improving the health and safety of our customers and our communities. How do we do that? We create innovative insurance products, technology solutions, and services to support our key stakeholders &mdash; individuals, employers, providers, and strategic partners &mdash; improving the health and safety of the people and places we serve.</strong></p>

keywords: summary,job description,management,solutions,performance,other duties,education & experience,proficiency,skills

Mid-level Manager

Competitive Compensation and Benefits Package

Overview: <br />Manager, Medicare Advantage (MA) Inter-Plan programs and policies&nbsp;is responsible for providing oversight of Inter-plan MA Coordination of Care (COC) program and oversight of Blue Cross Blue Shield Association (BCBSA) MA Policies.&nbsp;Duties of this position involve leading implementation of COC initiatives and other related projects. Monitoring of the overall programs/projects progress and compliance with BCBSA MA policies across the enterprise. This role collaborates with multiple functional areas&nbsp;requiring a combination of leadership, focus and flexibility.
Responsibilities: <br /> <ul> <li>Integrate, align and grow the capabilities of programs and work across business units and teams to identify opportunities, drive improvements, and ensure program/project timelines and policies are met.</li> <li>Oversight of BCBSA Medicare Advantage Policies across the enterprise, including home and host plans, to ensure compliance, including coordination of BCBSA compliance attestations,&nbsp;reconciliation of internal and BCBSA reporting and providing executive updates.</li> <li>Manage plan-to-plan, BCBSA Government Program Department, vendor and internal communications to drive operational outcomes for the MA COC program.</li> <li>Manages vendor Statement of Work for adherence, renewal and amendments.</li> <li>Manages, in coordination with Finance and Accounting, program finances to include plan fee payments and financial reconciliation.</li> <li>Leads program meetings and drives key decisions with all stakeholders to define project initiation requirements, ongoing monitoring, success criteria and facilitates conflict resolution and prioritization of implementation/production issues.</li> <li>Establishes a refined body of metrics related to intake, execution, and delivery of initiatives in the project portfolio.</li> <li>Proactively follows up on open issues with leadership, as well as other relevant parties (e.g., BCBSA), in order to implement solutions in a timely and quality fashion</li> <li>Identify, create, establish and maintain reporting deliverables for budget, performance and project status to be shared with executives.&nbsp;</li> <li>Research and resolve discrepancies in existing BCBSA and internal reporting deliverables.</li> </ul>
Requirements: <br /> <ul> <li>Six (6) years of experience with multi-faceted experience in the healthcare industry, project and/or program management environment or a related field with demonstrated technical knowledge.</li> <li>Three (3) years of leadership experience in previous managed care or healthcare experience preferred.</li> <li>Bachelor's degree in&nbsp;business, healthcare, or a related field.</li> <li>Excellent oral and written communication skills.</li> <li>Excellent presentation and facilitation skills.</li> <li>Demonstrated leadership and project management abilities.</li> <li>Ability to make competent, independent decisions.</li> <li>Ability and proficiency in the use of computers and Company standard software specific to position.</li> <li>Understands multiple perspectives of health care, government programs, operational issues and their impact on programs and policies.</li> <li>Knowledge of Medicare Advantage processes and Centers for Medicare &amp; Medicaid Services (CMS) guidelines.</li> <li>Strong analytical skills with a high attention to detail.</li> <li>Ability to effectively present budgetary, cost information, and respond to questions as appropriate.</li> <li>Must demonstrate leadership ability and team building skills to effectively lead professional project teams and interact with all levels of management.</li> </ul>