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Job Description

Job Summary

Responsible for the development and management of the product suite. Will partner closely with the Director in identifying market opportunities and will take the lead on implementing new products ideas and variations. Responsibilities also include coordinating operational oversight of products, specifically related to CMS regulatory modifications. Upon research and assessment of CMS guidance, partner with appropriate matrix department to ensure action taken when required. Organize and maintain open lines of communication with internal and external customers to ensure that product information is up-to-date and accurate.

Must be available to meet onsite, at least one day per week, if needed.

Essential Functions

• • Responsible for the management of product lines which includes, but not limited to:
  o Analysis of product positioning and pricing in the market
  o Knowledge of competitor products and pricing
  o Development of product strategies and oversight of tactics
  o Monitoring of business outcomes
  o Subject matter expertise on the products’ plan designs.
• • Maintains current knowledge of CMS requirements, plan benefits, and systems and procedures. Serves as resource to the organization related to this information.
  • Reviews regulatory changes to identify and analyze operational impact to the Medicare products then communicates this information to the appropriate staff/departments within the organization. Facilities timely implementation.
  • Identifies opportunities for improvement; accountable for implementing business/system changed required to support products. Assists with development of or revision to processes to improve quality, efficiency and cost effectiveness of the products.
• • Ensures completion of required data entry into the CMS system (HPMS) including, but not limited to, plan updates, bids and benefits in collaborate with the Technical Administrator.
  • In collaboration with the Director provides continuous support and information to facilitate and improve understanding, acceptance and integration of the Medicare products throughout the organization (i.e. oversight of Products Documentation Processes).
  • Assists with coordination of regulatory site visits.
• • Works with relevant staff to coordinate marketing activities to support the products.
  • Participates in and assists with coordination of special projects and activities as needed.
  • Manage the updates for prescription drug formulary.
• • Work closely with Priority Health pharmacists and pharmacy leadership to identify financial savings opportunities related to the Medicare formulary.
  • Maintain/manage relationship with PBM (Part D), ensure delegated PBM functions comply with CMS guidelines, and act as main point of contact around Medicare issues (participate in vendor calls, etc.).
  • Assure organizational readiness (Part D) prior to the start of each plan year.
• • Complete annual review of competitor prescription drug benefit design and for MAPD
  • Assist actuarial review.
  • Work with marketing and sales to develop integrated strategies
  • Assist with the seamless conversion process where applicable

Qualifications

• Required Bachelor's Degree or equivalent in health care of business

• 5 years of relevant experience in managed care Required
• Solid understanding of the senior market and Medicare regulations Required
• Familiarity with state and federal regulatory and legislative processes required; must be able to read and interpret complex statutes and regulations. Required
• Project Management experience preferred
• Vendor management experience preferred
• Experience using data visualization tools preferred
• Communications or Publication experience preferred
• Microsoft Publisher, Sharepoint, or Salesforce experience preferred

Primary Location

SITE - Priority Health - 1231 E Beltline - Grand Rapids

Department Name

PH - Health Plan Innovations

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 a.m. to 5 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

Spectrum Health requires all team members to receive the COVID-19 vaccinations subject to certain exclusions based on the team member’s job category. Spectrum Health is committed to granting reasonable accommodations in accordance with applicable laws.

Accommodation Notice: If you are a qualified individual with a disability, you may request a reasonable accommodation in Spectrum Health's application process. Contact us at 616-486-SHHR (7447).

Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected

category. See more here.