Job Description

Position Purpose: The Lead, Health Plan Development is responsible for planning and implementing health plan development-related activities, as follows:

Provide leadership and direction related to health plan development activities, including:

• Determine business requirements for health plan program, and work with team members throughout the enterprise to plan for and implement program elements that meet the business requirements

• Identify key milestones to meet internal and external deadlines

• Manage stakeholders across the enterprise to build and implement health plan development-related projects, including key vendor contracts

Coordinate with Project Management Office (PMO) and Medicaid PMO lead to drive project, including:

• Set deadlines for milestones and interim tasks; monitor progress toward completion

• Develop and deliver executive reports on project status, in coordination with PMO

• Manage competing priorities and limited resources

Manage regulatory interfaces related to health plan development, including the Division of Insurance and the Executive Office of Health and Human Services. Review and approve all regulatory-facing deliverables prior to executive sign-off and submission.

Manage financial components related to both health plan development and the Medicaid program overall, including:

• Budget development, management, and oversight

• Contract management

• Financial reporting

Other ad hoc duties related to Medicaid program development or implementation as assigned.

Education / Experience / Other Requirements

• Bachelor's Degree, Masters in Health Care field preferred.

Years of Experience:
• Minimum of 5 years of experience in health care, ideally with experience in large program implementations

Specialized Knowledge:
• Possesses strong background in health plan business, program and operational functions.
• Creative, flexible, self-motivated, professional able to navigate complex, matrixed environments
• Demonstrates critical thinking skills.
• Possesses strong interpersonal written and oral skills
• Possesses excellent time management skills with proven ability to effectively manage multiple tasks and priorities at one time.
• Demonstrates knowledge of managed care concepts for various health plan and capitated programs.
• Collaborates with multiple providers to provide quality and cost effective care for risk members.
• Accepts flexibility in work schedule willingly. (e.g. periodic early morning or evening meetings)
• Requisite poise, judgment, and trustworthiness to represent Steward to internal and external groups
• Maintains information in a confidential manner according to policy

Physical and Mental Demands:

These physical and mental demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Manages concurrent projects with competing priorities and aggressive deadlines.
• Must be able to effectively communicate with internal and external stakeholder in person, via telephone and email.
• Able to accurately receive information through oral communication.
• Able to accurately review data and figures both in hard copy and electronic formats.
• Utilize a computer (including but not limited to a mouse and keyboard) and telephone intermittently throughout entire shift, for periods of up to four (4) hours at a time.
• Able to accurately sort through data and think through issues in a time?pressured environment.
• Able to focus on a specific event or activity for up to four (4) hours at a time without interruption.
• Able to maintain a calm and collected presence while addressing the concerns from internal and external stakeholders
• Able to accurately learn and retain new information, knowledge and skills.
• Able to efficiently manage multiple tasks, with varying degrees of priority, at the same time.

Application Instructions

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