Program Manager, Appeals & Greivances

Point32Health hiring for Program Manager, Appeals & Greivances jobs in Johnston, RI, US

The Program Manager II is responsible for projects and initiatives with significant cross-functional interface that support assigned programs and/or vendors. Responsibilities include managing major departmental programs with significant cross functional interface with moderate complexity, risk and/or cost. Responsibility may include development of new programs as well as management of ongoing programs. Changes to programs require some negotiation and change management skills to implement. By using knowledge of the company, the Program Manager II should be able to resolve most roadblocks to ensure success and progress. The Program Manager II should make recommendations for change by performing cost/benefit analysis and by using basic analytical and problem-solving capabilities to support the recommendation.

Key Responsibilities/Duties - What You Will Be Doing

• Manage ongoing assigned program operations and/or vendors. This may include working with multiple areas within the organization and directly with clients and/or vendors to ensure effective, accurate, timely processes and workflows. Use analytic skills to develop or improve programs including business opportunity definition and research
• Perform detailed policy and impact analysis as it relates to the current programs, clients and/or vendors; make recommendations for process and/or policy change; present to various levels of the organization and the client the findings and summary options. This includes determining data scope, consulting with many THP staff, performing analyses, and determining both quantitative and qualitative business implications.
• Lead and/or manage projects and/or initiatives by representing program operations during planning and implementation phases. This may include support of other company programs and coordinating issue resolution with relevant functional business areas, and leading and/or facilitating planning and review sessions
• Lead regular cross functional informational or working meetings, including effective agenda planning, facilitation, and tracking/follow up on deliverables until closed.
• Other duties and projects as assigned.

Qualifications - What You Need To Perform The Job

EXPERIENCE (minimum years required):

• 3-5 years of health plan experience with 6-8 years working experience
• Program management or equivalent experience leading significant department level initiatives
• Medicare and Medicaid experience
• Compliance experience preferred

SKILL REQUIREMENTS:

• Excellent verbal and written communication skills generally acquired through college or other advanced education is required Well developed verbal and written skills, ability to facilitate planning and review sessions.
• High level presentation skills including ability to interface effectively with external contacts and/or clients
• Ability to exercise sound judgment and raise issues to appropriate team members or management for resolution
• Ability to conceptualize the impact of change and propose new methods of conducting business
• Ability to use analytical skills to develop new or implement change to existing program functions
• Ability to interpret and explain the implications of planned changes to current state business units
• Ability to problem solve and overcome obstacles to ensure successful program operations

Technical skills:

• Proficiency with MS Office applications (Word, Excel, PowerPoint)
• Ability to utilize multiple applications simultaneously
• Interpersonal skills
• Requires the ability to work cooperatively as part of a team.
• Must be able to effectively communicate with all internal departments in verbal and written formats.
• Requires some presentation experience
• Must be able to work in a matrix environment with minimal supervision

Security Clearance (if applicable):

• The position may require a background investigation and fingerprint form on file with the US Office of Personnel Management. Questionnaire For Public Trust Position (standard form 85P) must be completed and approved.
• Access to several secure government websites may be needed.

Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID: R7492