Manager Health Plan Operations

Minimum Qualifications:
* Bachelor's degree or equivalent in Accounting, Finance, or related business field required. Master's degree preferred.
* Valid NJ Driver's License, Registration and Insurance required.
* Minimum of seven (7) years of experience in the healthcare/managed care industry.
* Minimum 1 year experience in working with the frail or elderly population required.
* Significant knowledge of contractual, administrative, healthcare and operational issues related to managed care organizations, CMS/Medicare Part D plan, physician groups, hospitals and/or health insurance benefit plan designs required.
* Experience completing financial statements and budgets in a complex, multi-disciplinary organization required.

 

POSITION SUMMARY
The Manager Serves on the PACE LIFE Connection management team and provides oversight for LIFE Connection finance staff. The Manager, Health Plan Operations-PACE will be responsible for identifying, developing, implementing, monitoring and managing all financial and business related processes that contribute to successful operation and support continued growth for AtlantiCare LIFE Connection. Works with team members to lead risk based revenue process improvements, accomplish overall financial planning, budgeting, accounting and reporting of all monetary transactions and revenue/expense cycles for nonprofit health system affiliates in compliance with State, Federal, and G.A.A.P. guidelines.

 

Has responsibility for initiating and sharing analyses of financial performance and the impact of potential strategic initiatives. Oversees revenue/expense cycles of AtlantiCare LIFE Connection while maintaining compliance with all internal controls. Financial analysis of revenue and expense projections including service utilization and other parameters. Analyze & monitor financial aspect of existing or need for new provider contracts.

 

The Manager of Health Plan Operations also monitors authorization and the claims management process for auditing and process improvement purposes. This position also have oversight for the development and auditing of provider fee schedules. Maintain and distribute provider network participation and development re: signed contracts; contracts under negotiation or plans to not negotiate with provider.

 

In coordination with the Medical Director, Responsible for the development with applicable consultants the Part D Bid submission and reporting to CMS.

 

In conjunction with the LIFE Connection Leadership team, prepares budgets for entities and submits to the respective committees, boards, and governmental agencies in the required format.
Makes cost-savings suggestions related to all operations and implement once approved.
Maintain LIFE Connection client Medicare/Medicaid eligibility/plan membership.
This position supports organizational goals by providing quality customer service, participating in performance improvement efforts and demonstrating a commitment to team work and cooperation.
QUALIFICATIONS
EDUCATION: Bachelor's degree or equivalent in Accounting, Finance, or related business field required. Master's degree preferred.
LICENSE/CERTIFICATION: Valid NJ Driver's License, Registration and Insurance required.
EXPERIENCE: Minimum of seven (7) years of experience in the healthcare/managed care industry. Minimum 1 year experience in working with the frail or elderly population required.
Significant knowledge of contractual, administrative, healthcare and operational issues related to managed care organizations, CMS/Medicare Part D plan, physician groups, hospitals and/or health insurance benefit plan designs required. Experience completing financial statements and budgets in a complex, multi-disciplinary organization required. Previous PACE experience strongly preferred.

 

PERFORMANCE EXPECTATIONS
Demonstrates the competencies as established on the Assessment and Evaluation Tool for this position.

 

WORK ENVIRONMENT
This positon must be able to work effectively within an interdisciplinary team model, interfacing and collaborating with a wide range of clinical and social services disciplines who work together to manage the PACE participants' care. The work setting is in an Adult Day Health Center and primary care clinic environment with moderate noise levels and controlled temperatures.

 

This position also requires corrected vision and hearing to normal range. Incumbents must be able to communicate with all staff, vendors, and clients. Requires manual and finger dexterity and eye-hand coordination; the ability to use department equipment. This position also requires lifting/carrying up to 65lbs.and pushing or pulling 150lbs.using appropriate body mechanics and equipment, with reasonable accommodation if needed.

 

REPORTING RELATIONSHIP
This positions reports to department leadership.
The above statement reflect the general details considered necessary to describe the principle functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.