Program Manager, SCO

The Program Manager, SCO, will be primarily responsible for implementing key SCO initiatives, and supporting SCO product strategy development and bid filing. The Program Manager is responsible for supporting strategy development and coordinating execution efforts for the SCO business. The role works closely with colleagues in Sales & Marketing, Actuarial, Network Contracting, Clinical Services, IT, and Operations to develop and execute new initiatives that will support the SCO business objectives, including membership growth, revenue optimization, and cost containment. The Program Manager also supports implementation of SCO product strategy through collaboration with the Director of Product Strategy/Bid Implementation and other internal and external stakeholders including vendors. In addition, the Program Manager, SCO Product will represent THP or support interactions with the State EOHHS as well as with the implementation of Medicaid Contracts and other State mandates affecting the SCO business.Job DescriptionProduct Strategy Support

• Support development of SCO product strategy and annual bid for Massachusetts
• Partner with the Bid Implementation team, Compliance, and Sales & Marketing to ensure SCO product offerings and member materials are compliant with CMS and MassHealth rules and regulations
• Support SCO Head of Sales to foster effective execution and realization of sales objectives / goals (e.g., operations, product, network, etc.)
• Assess changes in the external environment including state and federal regulations, identify implications and support development of plans to address
• Support analysis and content development to advance strategic discussions with key business partnersProduct Management
  • Business Performance Support, as needed, including the development and implementation of business performance plans and medical cost improvement initiatives that deliver on our revenue and margin targets
  • Collaborate with Business Performance to track key SCO product management metrics and align reporting infrastructure
  • Manage SCO vendors, including facilitating vendor performance review meetings, resolving vendor related issues, completing vendor-related Corrective Action Plans (CAPs), etc.
  • Work with stakeholders as necessary to address day-to-day SCO related issues.
  • Monitor / Manager / Oversee operational functions supporting product and any corrective action plans, as neededBusiness Case Development / Vendor Implementation
    • Support development of business cases for SCO product improvement, including for benefits / vendor partnerships that will drive growth, retention, revenue management and margin goals
    • Partner cross-functionally to support development and implementation of business cases that will improve Product positioningInteractions with State Medicaid Agency
      • Support THPs Executive-level representation and support of day-to-day interactions with the State EOHHS, including monthly conference calls or ad hoc calls/meetings to discuss matters affecting SCO business
      • Manage the State Medicaid Contract renewal process in partnership with stakeholders including Medicaid Compliance team, and work with stakeholders to implement new mandates included in such contracts
      • Manage or support implementation of all other State mandates and processes such as participation in Consumer Advisory Board meetings and establishment and management of SCO Member Governing Board, as well as any related reporting to Corporate or State entitiesSupport SCO financial and other reporting requirements as necessaryRequirements EDUCATION: (Minimum education & certifications required)
        • Bachelors degree is required, Masters preferred.EXPERIENCE: (Years of experience)
          • 5-8 years of experience in strategic / business planning or product / new business development, including project management and data analysis / reporting with demonstrated execution of business case development and leadership of strategic initiatives. Experience developing and owning new initiatives in a dynamic environment preferred. Prior health industry experience is essential. Health insurance and / or provider / network experience preferred; experience with Dually eligible populations and plans preferred.SKILL REQUIREMENTS: (Include interpersonal skills)
            • Problem solving across a wide range of business situations
            • Ability to understand and use data to inform decisions
            • Ability to perform basic analysis and create appropriate reports as needed to help deliver insights
            • Ability to understand the divisions end-to-end business model and key performance metrics
            • Excellent written and oral communication skills
            • Comfort with ambiguity and change
            • Ability to prioritize and work on multiple projects simultaneously
            • Ability to manage projects, priorities, and ensure timely execution
            • Ability to interact and develop relationships with stakeholders in a matrixed organizational settingCONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!Please note: As of January 18, 2022, all employees including remote employees must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.About Us:Point32Health is a leading health and wellbeing organization, delivering an ever-better health care experience to everyone in our communities. Building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, 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.At Point32Health, were working to reshape the world of health care by pushing past the status quo and delivering even more to the diverse communities we serve: more innovation, more access, more support, and healthier lives. And we want people like you on our side to make it even better.This job has been posted by TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost 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: R4781

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