Manager, Product Management

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, Product Management is responsible for Product Management for assigned products within the Government segment and management of direct report(s).

The incumbent is responsible for implementation and ongoing management of a broad portfolio of products for Medica's Government Programs segment, including market success of the products pricing, oversight of CMS and DHS contracts, benefit structure, managing contractual and legislative oversight and profitability. The Manager will set, maintain, document and preserve intent of product and plan design. Manager will work closely with segment leadership, sales, operations, compliance, pharmacy operations, clinical quality and actuarial, to communicate and train staff on product details, and ensure proper administration and understanding of product intent.

The Manager will lead submission of timely and accurate CMS bids for assigned products and will participate in DHS contract negotiations Incumbent must understand implications of benefit changes and product design, and evaluate recommended benefit enhancements, and is accountable for confirming actuarial team assumptions are in sync with plan benefit package submissions, competitive bid pricing, and assumptions on payment rates. Leadership in the bid process is critical to ensure a successful portfolio of products available in the market, meets contractual requirements and is positioned to grow membership and meet financial goals.

Understanding Medicare, Medicaid and Dual products risk, performance and success factors, and government contract requirements is critical in developing future Government programs product models. This role will also have significant interface with Medica's Prescription Drug resources and Pharmacy Benefit Manager (PBM).

Manager is subject matter expert on assigned product plan performance, including membership, income, and operating margin. Role will directly interface with Medica's health management, network, pharmacy operations and pharmacy benefit management provider to continuously improve product competitiveness and market position as applicable.

This role will also contribute to the strategic planning process for Medica's Government product portfolio by identifying, implementing and managing strategic partnerships and external vendors that support Medica's Government product. Manager will also collaborate extensively with governmental agencies such as CMS and DHS regarding contractual obligations. Perform other duties assigned.

Key Accountabilities :

Government Products Leadership & Strategy

• Leads product strategy and project teams in the initiation, planning, development and successful delivery of Government product solutions by collaborating with segment leadership, sales, marketing operations, compliance and service staff to identify, document and resolve product related issues and opportunities for improvement
• Drives product intent and act as a SME on all benefits including pharmacy coverage as appropriate, including interpretation of CMS and DHS guidance and impacts on benefit design
• Researches and interprets DHS and CMS policies and develops / implements appropriate corresponding policies that are in compliance with federal and state laws
• Understands and continuously analyzes elements of Government programs to identify opportunities for improvements including benefits, networks, clinical, & formularies. Collaborates with government finance and actuarial staff to validate and findings and recommend enhancements
• Leads product input into CMS bid and RFP submission processes and participates in DHS contract renewal process- including preparation for contract negotiations. Ensures final benefit designs and rates address market trends and member needs, Medica's sales and financial goals, as well as understanding downstream implications

Government Product & Project Management

Build & Maintain Relationships with Organizations and Key Stakeholders related to Government Programs Policy Development

Staff Supervision

Required Qualifications :

Preferred Qualifications :

This position is an Office role , which requires an employee to work onsite at our Minnetonka MN 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.

Eligibility to work in the US : Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

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

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