Manager, Medicaid Products

Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Manager, Medicaid Products is a key influencer and contributor in the Medicaid product portfolio by identifying, implementing, and managing strategic partnerships and external vendors. The Manager collaborates extensively with governmental agencies such as CMS and DHS and other regulators in applicable states. The Manager has managerial responsibility for development, implementation, and ongoing management of assigned products, (in addition to possible expansion areas), within the Medicaid segment, as well as management of direct report(s). The Manager leads contract requirement efforts.

This Manager works with numerous Medica functional areas to determine the market need and feasibility for development of new products, enhancements to existing products, all member management initiatives, and all aspects of regulatory filings at both the state and federal level. The Manager is responsible for overall market success of the products, oversight of policy document development, timely and accurate federal and state submissions (and meeting of requirements), and benefit structure. The Manager will set, maintain, document and preserve intent of product and plan design. The Manager works closely with market and segment leadership, sales, operations, compliance, legal, network, finance, pharmacy, operations, clinical, quality, and actuarial, to continuously improve market competitiveness and market position as applicable, communicate and train staff on product details, and ensure proper administration and understanding of product intent. Performs other duties as assigned.

The Manager is subject matter expert on assigned product plan performance and will work on strategies to improve product performance.

Key Accountabilities

• Medicaid Products Leadership & Strategy
• Responsible for analyzing data, evaluating risks, and making informed choices to support the success of the product. Exercises high level of decision making. Supports and influences portfolio strategy with data informed approach.
• Strong ability to influence and negotiate with internal and external stakeholders. Leads product project teams in the initiation, planning, development and successful delivery of Medicaid product solutions by collaborating with segment leadership and functional leaders across the organization, to identify, document and resolve product-related issues and opportunities for improvement.
• Drives product intent and acts as a SME on all benefits including pharmacy coverage as appropriate, including interpretation of CMS and other federal and state regulatory guidance and impacts on benefit design.
• Researches and interprets CMS and other federal and state laws and rules, and develops / implements appropriate corresponding policies that are in compliance with federal and state laws
• Understands and continuously analyzes elements of Medicaid programs to identify opportunities for improvements including benefits, networks, clinical, & formularies. Collaborates with finance and actuarial staff to validate and findings and recommend enhancements
• Leads product input into regulatory filings. Ensures final benefit designs and rates address market trends and member needs, Medica's sales and financial goals, as well as understanding downstream implications.
• Manages or oversees (as appropriate) competitive intelligence gathering, and uses that information as input for strategic decisions
• Medicaid Product & Project Management
• Ensures successful execution and results through the management / control of individual project costs, schedule and scope with established tools processes, tools and metrics including programmatic and policy implementations
• Assures timely submission and response of contractual reporting requirements and information requests from state and federal governments
• Communicates the status and key metrics of projects effectively to all levels of management. Organizes and analyzes data and reports to management as well as external stakeholders (e.g., ACO partners)
• Leads cross-functional teams to quickly develop new programs, tools, and processes to enhance service or solve complex operational problems related to products or consumer demand, including driving appropriate priorities and recommendations regarding NCQA measures
• Independently prepares and maintains project documentation (e.g. project plans, business models, white papers, executive summaries and presentations and closure / transition documents)
• Reports / summarizes / analyzes results data and project status data to senior level management
• Uses strong business acumen, analytical abilities and problem-solving skills to review data and trends to creatively identify and implement effective solutions for Medica and our vendors
• Manages the annual renewal letter process
• Build & maintain relationships with organizations and key stakeholders related to Medicaid programs policy development
• Develops and maintains partnerships with key external customers as identified as well as internal customers.
• Represents segment on product related workgroups throughout Medica
• Participates in external work groups with entities such as state regulators, and brokers as needed
• Staff Supervision
• Supervises direct reports
• Coaches for employee growth
• Works with staff to develop yearly goals that align with the strategic initiatives of the segment

Required Qualifications

Skills and Abilities

This position is an Office role, which requires an employee to work onsite at our Madison, WI, office, on average, 3 days per week.

The full salary grade for this position is $98,400 - $168,600. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $98,400 - $147,525. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and / or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.