Martin’s Point Health Care Hiring For Health Plan Administration Program Manager at Portland, ME, United States Full Time

Job Description

Join Martin’s Point Health Care – an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of “people caring for people,” Martin’s Point employees are on a mission to transform our health care system while creating a healthier community. Martin’s Point employees enjoy an organizational culture of trust and respect, where our values – taking care of ourselves and others, continuous learning, helping each other, and having fun – are brought to life every day. Join us and find out for yourself why Martin’s Point has been certified as a “Great Place to Work” since 2015.

Please note that all Martin’s Point Health Care employees must be fully vaccinated against COVID-19 as a condition of employment.
Position Summary

The Program Manager facilitates collaboration across subject matter experts and Health Plan leadership to execute Health Plan Administration strategy and work streams – including policy development, review, and implementation. The Program Manager will support the above through analysis & research, evaluation of regulatory requirements, benchmarking against industry best practices, integrating stakeholder priorities, and aligning organizational policies with systems and operations.
The Program Manager is also responsible for all US Family Health Plan Records (paper and electronic) to ensure that Martins Point Health Care meets all federal and DHA contract requirements.

Key Outcomes:

• Effectively compiles and presents data and analysis to all levels of leadership to inform business decisions relating to benefit and payment policy and implementation
• Drives benefit and payment policy creation by facilitating communication and building consensus between subject matter experts and Health Plan Leadership around complex business and technical decisions.
• Ensures all Health Plan Administration policies are compliant with relevant regulations, industry best practices, and are consistent across all lines of business, when appropriate.
• Works closely with Health Plan Leadership in planning, evaluation, and implementation of benefit and product design for Generations Advantage.
• Oversees policy, workflow, and system implementation of new regulatory and product design changes for Medicare and USFHP lines of business
• Translates contract (CMS/DoD, vendor) language and updated payment methodologies into system and operational requirements.
• Applies project management techniques to policy and regulatory implementation, including (but not limited to) detail planning, task management, risk identification, issue escalation and resolution, and contingency planning.
• Leads timely and consistent communication, decision-making, and implementation of health plan administration & policy
• Builds and maintain key internal and external relationships, including within industry groups, to ensure successful development, implementation and operation of arrangements related to benefit and payment policy
• Represents Health Plan Product Management team on committees or teams, internally and externally.
• Establishes quality control mechanisms for policy development and workflow implementation/updates.
• As TRICARE Records Manager, develop and implement internal audits, promote standard work, and coordinate materials and subject matter experts for DHA on-site Records Management audits.
• Thoroughly understands and utilizes all available tools and reference materials, including Martin’s Point and CMS databases, business applications, CMS and DHA manuals, and industry communications.
• Develops and maintains Health Plan Administration platform (LINK) that promotes collaboration, documentation, audit trail, reporting, and reference files.

Education/Experience:

• Bachelor’s degree or combination of relevant education and experience
• 4 years of experience in health administration policy development and/or implementation overseeing projects in matrix environment
• Experience interpreting regulatory guidance and explaining related concepts in easy-to-understand way to various audiences
• PMP a plus

Skills/Knowledge/Competencies (Behaviors):

• Broad knowledge of managed care and health plan functions; Medicare Advantage and USFHP/TRICARE knowledge and experience highly preferred
• Strong ability to build consensus around complex business and technical decisions
• Demonstrates an understanding of and alignment with Martin’s Point Values.
• Oversee multi-disciplinary workgroups in achieving team objectives, without direct authority.
• Demonstrated project management skills overseeing complex projects in matrix environment.
• Strong attention to detail and the ability to multitask.
• Excellent communication and presentation skills, oral and written.
• Strong organizational skills including the ability to work independently and prioritize work.
• Ability to review, interpret and present information to Health Plan Leadership and external partners.
• Ability to lead change
• Competence with computers and business applications: Microsoft Excel, Word, PowerPoint, Outlook, SharePoint/Link.

Requirements
Terms of employment may require the applicant/incumbent to qualify, obtain and maintain a Position Level of Trustworthiness from the U.S. Government Office of Personnel Management. Additionally, this position may require the applicant/incumbent to be a U.S. citizen.
Required to travel to required DHA Record Management events.
There are additional competencies linked to individual contributor, provider and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martin’s Point Health Care? Contact us at:
[email protected]