Prominence Health · 8 hours ago
Director of Product Development
United States
Full-time
Remote
Director/Executive
$119K/yr - $179K/yr
10+ years exp
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Hiring Manager
Bridget Gomez
Insider Connection @Prominence Health
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Responsibilities
Business ownership, leadership, oversight, development, management, implementation, and coordination of all operational elements of Prominence Health Plan's Dual-eligible Special Needs Plan (D-SNP) Model of Care (MOC).
Responsible for product design, development of growth goals, and maintaining financial performance.
Ensuring that the D-SNP MOC Program meets or exceeds regulatory and accreditation requirements for the Centers for Medicare and Medicaid Services (CMS), state Medicaid offices (as relevant), and NCQA.
Developing opportunities to drive Star ratings performance and ensure a positive member experience.
Qualification
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Required
Experience with NCQA or other health plan accreditation standards, State and Federal laws, regulations, policies and practices for the administration of a Medicare Advantage special needs plan.
Bachelor's degree in healthcare administration, business, nursing, behavioral health, or a related field.
Minimum ten (10) years’ experience in health insurance or health care.
Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes.
Proven record of accomplishment managing complex projects and or programs that resulted in cost savings.
Minimum five (5) years’ demonstrated successful experience in accreditation, performance improvement, compliance, administrative, product development, project management, regulatory compliance, and/or operational duties in health care, preferably in a management role in a managed care organization.
Minimum three years’ (3) experience with special needs plan (I/C/D), CMS bid process, commercial health plan offerings, case and/or utilization management, and/or a Medicaid managed care program that includes dual-eligible.
Ability to expertly communicate in English, both verbally and in writing.
Proficiency in gathering and interpreting empirical evidence, formulating recommendations, action plans and interventions to improve the overall organization strategy.
Simultaneous action at varying stages—initiation, follow through, and completion—on a number of different projects.
Demonstrated ability to research, analyze and interpret state/federal regulations related to health insurance and healthcare.
Demonstrated ability to communicate verbally and with technical writing in a way that effectively conveys project background, objectives, activities, evaluations, conclusions, and recommendations.
Demonstrated skills in critical thinking, problem solving, and the analysis, interpretation and evaluation of complex information.
Demonstrated ability to work independently with minimal supervision.
Demonstrated ability to maintain effective collaborative working relationships with staff.
Resourceful, detail-oriented, and able to assimilate and analyze a wide variety of information, often working under deadline pressure with a variety of levels of staff.
Strong project management skills.
Computer Skills: Smartsheet, SharePoint, Microsoft Office (Word, Excel, PowerPoint), and database software.
Preferred
Master’s degree in nursing, business management, or healthcare administration preferred.
Preferred experience includes working with external healthcare providers and health systems, managing large budgets, project management, and demonstrated negotiation skills.
Bi-lingual in English and Spanish desired.
Company
Prominence Health
Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
David Hsieh
CFO
Patrick Koltz
Chief Operating Officer
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