Product Manager

Department: Operations
Reports To: Vice President, Operations

Position Overview:

The Product Manager will support the VP of Operations on all benefit and product implementation, including providing assistance with the monitoring of changes in regulatory requirements impacting operational processes and effectuating those changes such as product administration, benefit set-ups, claims processing rules, etc.  The incumbent will provide support to implement these changes and track product performance.

The Product Manager will inform the VP of program progress, any breakdown in processes and help make necessary process improvements to enhance the overall operational performance of respective product and avoid any adverse situations.  The individual works on various day-to-day operational tasks and interacts as needed with the VP and other Operational staff members, in addition to Executive Leaders, as requested.

Duties and Responsibilities:

  • Support Product Development and successful Implementation of new products, from benefit development, member materials, operational and system readiness, etc.
  • Reviews all regulatory notices, memos and updates for respective products and ensures Operational Compliance, keeps VP abreast of all changes and status of effectuating those changes.
  • Assists in the annual Medicare product and benefit implementation, annual bid submission and assisting in assuring benefit changes are communicated internally and to all vendors.
  • Ensures accuracy of product benefit changes and timely production of all implementations prior to the January 1st “go-live” deadline.
  • Maintains and updates product Benefit Grids, maintains list of services while communicating to matrix partners of any changes.
  • Acts as a Subject Matter Expert (SME) of various products, benefits, exclusions, and systems and assists business areas as needed with related inquiries and interdepartmental training.
  • Assists in the planning, development and execution of workflows and operational support systems in support of achieving product performance goals. Supports decision making and completion of activities through established communication forums and development and implementation of policies and procedures.
  • Assists in the identification and provides support in the implementation of product program/administration changes (i.e., FIDA, Medicaid, etc) program in order to ensure compliance and regulatory reporting, to improve member satisfaction.
  • Assist with delegated vendor oversight, ensuring vendors are meeting service level agreements. Performs ad hoc audits to ensure compliance of regulatory requirements and meeting Service Level Agreement levels. Oversees completion of vendor Performance Improvement Plan if one is issued.
  • Attend and participate in staff meetings, one-on-one meetings with VP, regulatory meetings and any additional meetings as directed by VP.
  • Lends support with analyses and reporting functions.
  • Assist with other projects and assignments as directed by VP.
  • All other duties as assigned.

Qualifications:

  • A minimum of 3 – 5 years’ experience in a health care organization and/or relevant experience in areas of managed care operations and/or product development/management required.
  • Bachelor’s Degree required, Master’s preferred.
  • Must possess strong quantitative, analytical and problem-solving skills with experience with Microsoft Excel-V-Look-ups and Pivot Tables preferred.
  • Ability to handle broad-based complex information and synthesize to short, concise actionable items, where applicable.
  • Ability to handle multiple projects simultaneously and adjust to changes quickly while meeting all deadlines.
  • Ability to exercise judgement and discretion with sensitive or confidential matters.
  • A self-starter; who works well both independently and collaboratively as a team player.
  • Requires knowledge of state and federal laws and regulations, including Medicare and Medicaid requirements. Knowledge of Medicare Advantage Part C and Part D programs a plus.
  • Excellent organizational skills and attention to detail required.
  • Effective verbal, written and interpersonal communication skills required.
  • Excellent computer skills with knowledge of Microsoft Word, PowerPoint, and Excel required.

Requirements of All Positions:

  • All employees shall meet PHP’s Compliance and Privacy Regulations, and attend at a minimum of one (1) hour of Compliance and Privacy educational training annually;
  • All employees shall master PHP’s Model of Care and complete all training requirements within the first thirty (30) days of employment and annually thereafter, or as required by state and federal regulations;
  • All employees are required to maintain confidentiality, protect privacy, comply with Protected Health Information regulations, and report violations;
  • Perform functions as they relate to “Improving Health Care Quality” as defined in the National Association of Insurance Commissioners Supplemental Health Care Exhibit that:
    1. Improve health outcomes;
    2. Prevent hospital readmission;
    3. Improve patient safety and reduce medical errors, and
    4. Provide wellness and health promotion activities.

Physical Demands and Work Environment:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel utilize objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl.

The employee must occasionally lift and/or move up to 25 pounds, and infrequently up to 50 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision, and the ability to adjust focus. The noise level in the work environment is usually moderate.

Equal Opportunity Employer