Manager, Product Management

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to
be there in the moments that matter
most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm, and every member feels valued.

The Manager, Product Management is responsible for Product Management for assigned products within the Government segment and management of direct report(s).

The incumbent is responsible for implementation and ongoing management of a broad portfolio of products for Medica's Government Programs segment, including market success of the products pricing, oversight of CMS and DHS contracts, benefit structure, managing contractual and legislative oversight and profitability. The Manager will set, maintain, document and preserve intent of product and plan design. Manager will work closely with segment leadership, sales, operations, compliance, pharmacy operations, clinical quality and actuarial, to communicate and train staff on product details, and ensure proper administration and understanding of product intent.

The Manager will lead submission of timely and accurate CMS bids for assigned products and will participate in DHS contract negotiations Incumbent must understand implications of benefit changes and product design, and evaluate recommended benefit enhancements, and is accountable for confirming actuarial team assumptions are in sync with plan benefit package submissions, competitive bid pricing, and assumptions on payment rates. Leadership in the bid process is critical to ensure a successful portfolio of products available in the market, meets contractual requirements and is positioned to grow membership and meet financial goals.

Understanding Medicare, Medicaid and Dual products risk, performance and success factors, and government contract requirements is critical in developing future Government programs product models. This role will also have significant interface with Medica's Prescription Drug resources and Pharmacy Benefit Manager (PBM).

Manager is subject matter expert on assigned product plan performance, including membership, income, and operating margin. Role will directly interface with Medica's health management, network, pharmacy operations and pharmacy benefit management provider to continuously improve product competitiveness and market position as applicable.

This role will also contribute to the strategic planning process for Medica's Government product portfolio by identifying, implementing and managing strategic partnerships and external vendors that support Medica's Government product. Manager will also collaborate extensively with governmental agencies such as CMS and DHS regarding contractual obligations. Perform other duties assigned.

Key Accountabilities:

• Government Products Leadership & Strategy

• Leads product strategy and project teams in the initiation, planning, development and successful delivery of Government product solutions by collaborating with segment leadership, sales, marketing operations, compliance and service staff to identify, document and resolve product related issues and opportunities for improvement

• Drives product intent and act as a SME on all benefits including pharmacy coverage as appropriate, including interpretation of CMS and DHS guidance and impacts on benefit design
• Researches and interprets DHS and CMS policies and develops/ implements appropriate corresponding policies that are in compliance with federal and state laws
• Understands and continuously analyzes elements of Government programs to identify opportunities for improvements including benefits, networks, clinical, & formularies. Collaborates with government finance and actuarial staff to validate and findings and recommend enhancements

• Leads product input into CMS bid and RFP submission processes and participates in DHS contract renewal process- including preparation for contract negotiations. Ensures final benefit designs and rates address market trends and member needs, Medica's sales and financial goals, as well as understanding downstream implications

• Government Product & Project Management

• Ensures successful execution and results through the management/control of individual project costs, schedule and scope with established tools processes, tools and metrics including programmatic and policy implementations.

• Assures timely submission and response of contractual reporting requirements and information requests from state and federal governments
• Communicates the status and key metrics of projects effectively to all levels of management. Organizes and analyzes data and reports to management
• Leads cross-functional teams to quickly develop new programs, tools, and processes to enhance service or solve complex operational problems related to products or consumer demand including driving appropriate priorities and recommendations regarding Medicare Star measures and DHS quality measures and withhold metrics
• Independently prepares and maintains project documentation (e.g. project plans, IRAADS, business models, white papers, executive summaries and presentations and closure/transition documents)
• Reports/summarizes/analyzes results data and project status data to senior level management.

• Uses strong business acumen, analytical abilities and problem solving skills to review data and trends to creatively identify and implement effective solutions for Medica and our vendors

• Build & Maintain Relationships with Organizations and Key Stakeholders related to Government Programs Policy Development

• Develops and maintains partnerships with key external customers including CMS and DHS, internal customers and other county departments for government programs products.

• Represents segment on product related workgroups throughout Medica
• Leads Medica's participation in external work groups with entities such as CMS, DHS, Council of Health Plans and counties.

• Manages alternative payment arrangements through joint contract ownership with network management and maintain regulatory ICSP

• Staff Supervision

• Supervises direct reports

• Coaches for employee growth
• Works with staff to develop yearly goals that align with the strategic initiatives of the segment

Required Qualifications:

• Bachelor's degree or equivalent work experience, plus 10 years of work experience
• Prior experience with MN Medicaid
• Prior experience with Managed Care
• Experience with Special Needs Plan product administration

Preferred Qualifications:

• Medicare Cost, Medicare Advantage, Special Needs Plans, Medicaid and Part D administration
• Government programs plan benefit design & implementation
• Monitoring product lifecycles & establishing metrics to measure product success
• CMS and DHS compliance and health plan regulatory environment understanding
• Understanding of health plan operations
• Cross-functional team and project management
• Analytical ability in business planning and financial management/acumen

This position is an Office role
, which requires an employee to work onsite at our Minnetonka MN office, on average, 3 days per week.

The full salary grade for this position is $98,400 - $168,600. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $98,400 - $147,525. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US:
Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.