Job Description:

Los Angeles, CA | Hybrid

Job Summary

• The Lead Product Solutions Manager provides program support (end to end) for the ongoing operations of the product line annual cycle. This role is cross functional. The Lead Product Manager must partner closely with key stakeholders including but not limited to Information Technology ( I.T.), Operations, Health Services, Marketing & Sales to develop, organize, and execute the department priorities, resource commitments and deliverables. The ideal candidate has extensive healthcare knowledge and experience (Commercial, Cal MediConnect and/or D-SNP, Medi-Cal) and will work independently to lead and facilitate complex projects, initiatives that ensure deliverables are aligned with the line of business objectives, on time, and aligned with product retention and growth objectives. Responsible for the daily workflow and leading the work of assigned staff. This role will mentor, coach, act as a resource and provide feedback on performance of assigned staff

Duties

• Provides organizational representation in policy workgroups and stakeholder meetings and summits. Evaluates policy and regulatory changes to identify impacts to product and current business processes. Develops impact assessments and execution plans for implementation of new guidance.
• Provides support by identifying opportunities and leading improvement projects to drive quality, membership and revenue and enhance the member experience. Identifies, provides solutions and executes projects to maximize enrollment and growth opportunities allowed by regulation/regulators. Manages and leads cross-functional partnerships with stakeholders responsible for improving stars and quality measures to improve effectuation and monthly payments. Reviews current program data to identify areas for cost containment initiatives (i.e. encounters, utilization, rates) and influences process improvement plans.
• Leads annual cycle work: identifies lessons learned, product roadmap, product / benefit design, coordinates with I.T. and other cross functional teams to develop critical cycle pathways. Ensures excellent service delivery and experience. Builds an understandable and scalable process for continued product cycle development and improvement. Leads full annual cycle work. Supports business units on developing and executing process improvement plans, monitoring programs and enhancements to promote efficiency, quality and compliance. Partners with functional areas to resolve day-to-day issues impacting product performance.
• Resposible for leading daily operational activities including staffing, productivity, and quality of work. Participates in hiring, coaching, training, counseling, and provides feedback on staff performance.
• Performs other duties as assigned.
• Duties Continued

Education Required

• Bachelor's Degree
• In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

• Master's Degree in Public Health or Related Field

Experience

Required:

• At least 6-8 years in managed care (Medicare, Commercial, and/or Medi-Cal) Direct experience in managed care functions including stars, quality, financial performance review, operational functions (claims, enrollment, readiness). Risk management and mitigating planning experience.
• At least 3-4 years of lead experience.

Preferred:

• Minimum of 10 years of direct experience.

Skills

Required:

• Knowledge of product management and strategic planning and packaging concepts.
• Ability to lead, manage, conclude and recommend using data and experience driven decisions.
• Ability to lead, mentor and coach cross functional team through ambiguity.
• Ability to make decisions to drive towards and accomplish team objectives.
• Strategic thinking skills and ability to create messaging to influence desired outcomes.
• Ability to anticipate future demands of initiatives related to people, technology, budget and business within your department and design/implement solutions to meet these needs.
• Able to communicate results and business impacts to stakeholders within and outside of the company.
• MS suite - Word, Power Point, Visio, Project

Licenses/Certifications Required

• Licenses/Certifications Preferred
• Required Training

Preferred:

• Six Sigma Training, Product Management Professional Training

Additional Information

• Department Specific

Commercial Product:

Required:

• 5+ Commercial annual rate setting experience
• 5+ Commercial risk adjustment experience
• 8+ year of leading large-scale cross-functional initiatives
• Experience with Department of Managed Health Care (DMHC) & Covered CA contractual requirements

Cal MediConnect (CMC)/ D-SNP:

Required:

• Centers for Medicare and Medicaid Services (CMS) annual rate setting experience
• CMS risk adjustment experience
• 8+ year of leading large-scale cross-functional initiatives
• Experience CMS guidelines & regulatory policy
• Medicare Advantage, D-SNP and CMC quality & star rating
• Ability to access, review and interpret CMS communications including memos, guidance, Advanced call letter and Final Call letter for impacts to Medicare product management..

Medi-Cal Product:

Required:

• 5-7 years Medi-Cal managed care experience
• Experience serving Medi-Cal population
• Understanding of Medi-Cal regulatory and program requirements

Job Type: Full-time

Salary: $120,000.00 - $150,000.00 per year

Benefits:

• Health insurance
• Paid time off

Work Location: One location

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