Medicare Product Solutions Manager III
4 days ago
The Product Solutions Manager III is a key member of the Product Strategy, Sales and Marketing (PSSM) service area and the enterprise. This role is responsible for assisting the product leadership team in supporting ongoing operations of assigned product lines, bridging the gap between state requirements and future state alternatives. The Product Solutions Manager III navigates the regulatory/legislative and market environment to drive desired performance levels, balancing short-term business needs with long-term innovative solutions to achieve enterprise strategic goals.
Duties- Supports assigned product lines in policy and regulatory efforts, evaluating policy and regulatory changes to identify impacts on current processes and implementing initiatives.
- Assesses market strategy white papers, legal memos, legislation/mandate language, regulatory changes, and/or regulator model contracts, providing impact recommendations, feasibility, and execution plans.
- Defines product strategy and positioning, driving design, feasibility, and definition of new innovations and managing the ongoing evolution, growth, and strategic direction of assigned PSSM units and their portfolios.
- Conducts cost/benefit analyses, needs assessments, and data analysis to align strategy, design, and business solutions with business objectives, leading and documenting requirement sessions/JAD sessions.
- Manages cross-functional partnerships with stakeholders responsible for quality measures and policy initiatives, reviewing data to monitor product performance and identify areas for cost containment initiatives and developing improvement plans.
- Develops and designs processes and product requirements that support business needs, designing methods for integrating function and process, including improvement opportunities and development performance improvement plans with business units.
- Supports business units in developing and executing process improvement plans, monitoring programs, and enhancements to promote efficiency, quality, and compliance, partnering with functional areas to involve day-to-day issues impacting product performance.
- Orchestrates, plans, and executes end-to-end cycle strategies, including complex development and implementation efforts for assigned lines of business and their products (on/off exchange).
- Identifies gaps in operational processes that impact quality scores, enrollment, revenue, and member retention, designing appropriate mitigation and contingency plans, leading efforts to identify best practices to drive product integrity and efficiency.
- Validates functional area readiness for effective administration of benefits and transactions for the upcoming plan year, including creation, scope, and execution for enhancements and/or product cycle implementations.
- Bachelor's Degree in Public Administration or related field (in lieu of degree, equivalent education and/or experience may be considered).
- At least 5 years of relevant experience in product development/management.
- Risk management and mitigating planning experience.
- Experience and knowledge with regulatory guidelines governing product lines, leading regulatory filing processes for new/custom product initiatives.
- Master's Degree in Public Administration or related field.
- Experience serving duals population in Medicare Advantage.
- Direct experience in Medicare and Duals program administration, including stars, quality, financial performance review, operational functions (claims, enrollment, readiness).
- Deep knowledge and ability to apply principles of the product development life cycle (PDLC) discipline and process for development and implementation of new products and/or enhancements.
- Knowledge of product management and strategic planning concepts.
- Ability to use advanced features of MS Office, including Excel, PowerPoint, Word, MS Project, Visio.
- Excellent interpersonal, motivational, and communication skills.
- Excellent written and verbal communication and presentation skills.
- Ability to serve as a member on or lead cross-functional implementation or project teams.
- Ability to interpret data sets and forecast future revenue streams.
- Medicare: Experience and knowledge in Cal MediConnect (CMC) / D-SNP policy and product lines of business, experience in improving Stars and Quality Measures, experience in Medicare Advantage, with experience serving duals population, direct experience in Medicare and Duals program administration, including stars, quality, financial performance review, operational functions (claims, enrollment, readiness).
- Medi-Cal: Experience serving Medi-Cal population, talented in building relationships with external partners, service-oriented, talented in resolving conflict.
- Medi-Cal Plan Partners: Experience serving Medi-Cal population, talented in building relationships with external partners, service-oriented, talented in resolving conflict.
- Commercial Group: Experience working in Commercial and Group Product Health Plans.
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