Nexlogica · 3 months ago
Lead Product Solutions Manager
United States
Full-time
Remote
Senior Level
6+ years expNexlogica is seeking a Lead Product Solutions Manager who will provide program support for the ongoing operations of the product line annual cycle. The role requires extensive healthcare knowledge and experience, partnering with various stakeholders to lead and facilitate complex projects that align with business objectives and enhance product retention and growth.
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Responsibilities
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 IT 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 improvementation
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
Responsible for leading daily operational activities including staffing, productivity, and quality of work
Participates in hiring, coaching, training, counseling, and provides feedback on staff performance
Qualification
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
5+ Commercial annual rate setting experience
5+ Commercial risk adjustment experience
8+ year of leading large-scale cross-functional initiatives
Experience with DMHC & Covered CA contractual requirements
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
5-7 years Medi-Cal managed care experience
Experience serving Medi-Cal population
Understanding of Medi-Cal regulatory and program requirements
Bachelor's degree
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
Preferred
Minimum of 10 years of direct experience
Six Sigma Training
Product Management Professional Training
Company
Nexlogica
Nexlogica is a business navigator that offers digital enterprise transformation and management consulting services.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase