Virginia Premier Health Plan Manager, Medicare Programs in Glen Allen, Virginia

About Us

Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.

By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.

At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.

If this sounds like you, read on!

Overview

This position assists Medicare Program leadership with program activities related to Medicare Advantage and Marketplace lines of business. This position is responsible for working with the operational departments to ensure that all operational activities are optimized and compliant with both state and federal requirements.

Responsibilities

  • Oversees various operational departments to ensure that the Medicare Advantage and Marketplace product performance are consistent with the Department of Medical Assistance Services (DMAS) and the Centers for Medicare and Medicaid Services (CMS) regulatory requirements. Provides functional and technical support regarding MAPD and Marketplace product requirements.

  • Acts as the operational lead to ensure that all state and federal requirements are implemented timely and correctly.

  • Establishes workgroups and works closely with the operational areas to inform them of new requirements and changes to existing requirements.

  • Assists the operational areas with implementation of new requirements.

  • Collaborates with operational departments to effectively oversee projects, identify resources, resolve issues and mitigate risks.

  • Develops and implements plans to identify root causes and actions necessary to resolve identified operational issues.

  • Facilitates development of various reporting tools to monitor operational functions and identify opportunities for improved performance, including development and analysis of reports.

  • Keeps current with changing government regulations as it relates to Medicare and Medicaid.

  • Supports program leadership and other team members to ensure overall department objectives are met.

  • Oversees the timely filing of all submissions with the federal or state governments and ensures that all federal and state regulations and guidance are followed in the process.

  • Works with selected vendors to ensure operational compliance with state and federal requirements.

  • Assumes other ad hoc responsibilities as directed.

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelors degree

  • Preferred: Masters Degree

WORK EXPERIENCE

  • A minimum of three to five years ofexperience in managed care operations, project management, business analysis experience, or related experience.

  • Experience with Health Plan operations and Medicare Advantage policies and procedures preferred

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Proficient in Microsoft Office computer applications such as Excel, Outlook, Word, and Power Point.

  • Previous experience as a lead in a functional area, managing cross functional teams.

  • Experience leading cross functional business teams.

  • Strong analytic skills.

  • Exceptional written, verbal and presentation communication skills.

  • Prior experience in managed care required.

  • Experience with Medicare Advantage and/or Individual Marketplace preferred.

PHYSICAL REQUIREMENTS

  • Physicalhealth sufficient to meet the ergonomic standards and demands of the position

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

Our mission is to inspire healthy living within the communities we serve!

Job ID 2018-4943

As an equal opportunity employer, Virginia Premier is committed to a diverse workforce. To ensure non-discrimination and affirmative action for individuals protected by Executive Order 11246, as amended, Section 503 of the Rehabilitation Act of 1973, as amended, the Vietnam Veterans’ Readjustment Act of 1974, as amended, and Title I of the Americans with Disabilities Act of 1990, as amended, Virginia Premier will consider applicants for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. Applicants who require accommodation in the job application process may contact Recruitment at 804-819-5151 for assistance. It is the policy of Virginia Premier Health Plan, Inc., to comply with the requirements of the Drug-Free Workplace Act of 1988. It is a violation of our drug-free workplace policy to use, possess, sell, trade, and/or offer for sale alcohol, illegal drugs or intoxicants in our workplace. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. Virginia Premier participates in E-verify.