Job ID# 1008735 – Posted 12/14/22 – Remote, CA

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 IT, 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.

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.

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

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.

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 DMHC & Covered CA contractual requirements

CMC/ D-SNP:
Required:
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

Minimum of 10 years of direct experience.

Bachelor’s degree 

Six Sigma Training, Product Management Professional Training

Position is 100% remote, but candidates must live local to LA to be able come into the office once a month or quarter. 

Please send your resume and any additional information to our recruitment team at recruitment@nexlogica.com