Responsibilities:
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. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.
Learn more at: https://prominence-health.com/

JOB SUMMARY:

The SNP Program Manager serves as the SNP-Subject Matter Expert (SME) and is accountable for the contractual, oversight, development, reporting, and coordination of all SNP operational functions and deliverables and execution of Prominence Health Plan’s Special Needs Plan (SNP) Model of Care (MOC). The SNP Program Manager will connect and align functional areas with cross departmental collaboration to ensure success. They will work closely with the SNP care management team, Compliance, and other involved business leaders in the development and implementation of the MOC aligned with the plan’s clinical, operational, quality, and performance improvement strategies. Responsibilities include ensuring that the SNP MOC Program meets or exceeds regulatory requirements for the Centers for Medicare and Medicaid Services (CMS), state Medicaid offices (as relevant), and leads all efforts associated with the successful operation of a SNP. Coordinates with business partners to oversee provider network structure, quality, clinical outcomes and care management delivery. Develops opportunities to drive Star ratings performance and a positive member experience. This position reports to the SNP Program Director. This is a highly visible role in Prominence’s priority growth area with exposure to internal and external leaders and with growth potential as the business expands. This position can be fully remote and may require some travel up to 10% travel.

QUALIFICATIONS AND REQUIREMENTS:

• BS, business management, healthcare administration or relevant experience may be substituted for educational requirements.
• Minimum ten (10) years’ experience in health insurance or health care.
• Minimum five (5) years’ demonstrated successful experience in healthcare compliance, accreditation, performance improvement, compliance, administrative 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) and/or a Medicaid managed care program that includes dual-eligibles.
• Minimum three (3) years proven experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes.
• 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.
• Strong Project Management experience with a proven record of accomplishment managing complex projects and or programs that resulted in cost savings.
• Ability to manage numerous ongoing projects from initiation and follow through to completion
• Experience managing large budgets.
• Ability to expertly communicate in English, both verbally and in writing,
• Demonstrated ability to communicate verbally and with technical writing that effectively conveys project background, objectives, activities, evaluations, conclusions, and recommendations.
• Demonstrated negotiation skills.
• Proficiency in gathering and interpreting empirical evidence, formulating recommendations, action plans and interventions to improve the overall organization strategy.
• Demonstrated ability to research, analyze and interpret state/federal regulations related to health insurance and healthcare.
• 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.
• Computer Skills: Smartsheet, SharePoint, Microsoft Office (Word, Excel, PowerPoint), and database software.

Please refer the Job description for details