Manager Health Plan Operations
Manager Health Plan Operations
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
This role presents an extraordinary opportunity for a missiondriven leader to play an integral role in supporting the finance and health plan operations of a dynamic integrated care delivery program. Responsible for managing and continuously improving our LIFE/PACE Health Plan Operations function which includes but is not limited to TPA management/oversight (claims) utilization management provider network administration and more.
Key Responsibilities:
- Lead and improve Health Plan Operations including claims management provider network administration and utilization management.
- Manage relationships with TPAs PBMs and other key vendors resolving issues and overseeing payables/receivables.
- Support Medicare Part D and Medicaid enrollment processes tracking data and ensuring regulatory compliance.
- Support government relations and regulatory audits maintaining reporting for CMS state requirements and vendor oversight.
- Support development and refining policies for PACE program compliance ensuring seamless operations.
Qualifications :
- Bachelors degree in Healthcare Finance or other relevant field of study.
- Strong understanding of health plan and healthcare provider financial funds flows and regulatory requirements ideally in a PACE Medicare Advantage (MAPD) or Medicare Prescription Drug Plan (PDP) organization
- Strong expertise in health plan operations vendor management and regulatory compliance.
- Excellent leadership communication and mentoring skills.
- 3 to 5 years preferred experience of related experience.
Additional Information :
Benefits
- Depending upon the status of the position Asbury offers generous benefits including medical dental and vision coverage; 401K with match; PTO and paid holidays
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity or expression pregnancy age national origin disability status genetic information protected veteran status or any other characteristic protected by law.
#INDAL
Remote Work :
No
Employment Type :
Fulltime
Employment Type
Full-time
