SNP Program Manager

TMC Bonham Hospital

  • Reno, NV
  • Permanent
  • Full-time
  • 1 day ago
Job Description:ResponsibilitiesProminence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.Learn more at:Job Summary:The SNP Program Manager serves as the SNP-Subject Matter Expert (SME) and is accountable for the contractual, oversight, development, reporting, and coordination of all SNP operational functions and deliverables and execution of Prominence Health Plan’s Special Needs Plan (SNP) Model of Care (MOC). The SNP Program Manager will connect and align functional areas with cross departmental collaboration to ensure success. They will work closely with the SNP care management team, Compliance, and other involved business leaders in the development and implementation of the MOC aligned with the plan’s clinical, operational, quality, and performance improvement strategies. Responsibilities include ensuring that the SNP MOC Program meets or exceeds regulatory requirements for the Centers for Medicare and Medicaid Services (CMS), state Medicaid offices (as relevant), and leads all efforts associated with the successful operation of a SNP. Coordinates with business partners to oversee provider network structure, quality, clinical outcomes and care management delivery. Develops opportunities to drive Star ratings performance and a positive member experience. This position reports to the SNP Program Director. This is a highly visible role in Prominence’s priority growth area with exposure to internal and external leaders and with growth potential as the business expands. This position can be fully remote and may require some travel up to 10% travel.Benefit Highlights:
  • Loan Forgiveness Program
  • Challenging and rewarding work environment
  • Competitive Compensation & Generous Paid Time Off
  • Excellent Medical, Dental, Vision and Prescription Drug Plans
  • 401(K) with company match and discounted stock plan
  • SoFi Student Loan Refinancing Program
  • Career development opportunities within UHS and its 300+ Subsidiaries! · More information is available on our Benefits Guest Website: benefits.uhsguest.com
About Universal Health Services:One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.
QualificationsQualifications and Requirements:
  • BS, business management, healthcare administration or relevant experience may be substituted for educational requirements.
  • Minimum ten (10) years’ experience in health insurance or health care.
  • Minimum five (5) years’ demonstrated successful experience in healthcare compliance, accreditation, performance improvement, compliance, administrative and/or operational duties in health care, preferably in a management role in a managed care organization.
  • Minimum three years’ (3) experience with special needs plan (I/C/D) and/or a Medicaid managed care program that includes dual-eligibles.
  • Minimum three (3) years proven experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes.
  • Experience with NCQA or other health plan accreditation standards, state and federal laws, regulations, policies and practices for the administration of a Medicare Advantage special needs plan.
  • Strong Project Management experience with a proven record of accomplishment managing complex projects and or programs that resulted in cost savings.
  • Ability to manage numerous ongoing projects from initiation and follow through to completion
  • Experience managing large budgets.
  • Ability to expertly communicate in English, both verbally and in writing,
  • Demonstrated ability to communicate verbally and with technical writing that effectively conveys project background, objectives, activities, evaluations, conclusions, and recommendations.
  • Demonstrated negotiation skills.
  • Proficiency in gathering and interpreting empirical evidence, formulating recommendations, action plans and interventions to improve the overall organization strategy.
  • Demonstrated ability to research, analyze and interpret state/federal regulations related to health insurance and healthcare.
  • Demonstrated ability to work independently with minimal supervision.
  • Demonstrated ability to maintain effective collaborative working relationships with staff.
  • Resourceful, detail-oriented, and able to assimilate and analyze a wide variety of information, often working under deadline pressure with a variety of levels of staff.
  • Computer Skills: Smartsheet, SharePoint, Microsoft Office (Word, Excel, PowerPoint), and database software.
EEO StatementAll UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.We believe that diversity and inclusion among our teammates is critical to our success.Avoid and Report Recruitment ScamsAt UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHSand our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

TMC Bonham Hospital