The Manager, HS Program Mgmt and Strategic Planning operates in a cross-functional role and has specific expertise in functional areas such as project management, healthcare/data analytics, business process outsourcing management, business analysis and process improvement management. The Project Manager is responsible for managing the entire life cycle of strategic initiatives and ad-hoc projects and ensuring that projects meet or exceed the success criteria as set forth by the business users. This position is also responsible for report development and distribution, either through code development or end-user generation. Report development includes defining business needs and interfacing with technical teams to develop end product.
Work Experience: Five years health plan experience with varied clinical experience. Minimum of 5 years direct health plan experience in the following areas: healthcare information analysis; understanding of health care quality, claims and operations data, data collection and reporting to support health care improvement activities. Proficiency in computer and software programs: Microsoft Word, Excel, Powerpoint, and SharePoint.
Education, Certificates, Licenses: Maintains current clinical and technical knowledge base and related functions. PMP preferred. Undergraduate or masters required.
Knowledge: Understanding of health insurance as it relates in Medicare, Medicaid and Commercial lines of business as well as payment methodologies (fee for services, capitation, and blended). Understanding of health care operations in various clinical settings: primary care, specialty, hospital, ambulatory and post-acute. Experience with HEDIS, QIM, NCQA and other quality initiatives. Knowledge of data analysis, utilization patterns and reporting.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 30% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.