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Lead Product Solutions Manager

Job Category:  Administrative, HR, Business Professionals
Department:  Commercial and Group Product Management
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  8735

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.

Job Summary


The Lead Product Solutions Manager provides program support (end to end) for the ongoing operations of the product line annual cycle.  This role is cross functional.  The Lead Product Manager must partner closely with key stakeholders including but not limited to  IT, Operations, Health Services, Marketing & Sales to develop, organize, and execute the department priorities, resource commitments and deliverables.  The ideal candidate has extensive healthcare knowledge and experience (Commercial, Cal MediConnect and/or D-SNP, Medi-Cal) and will work independently to lead and facilitate complex projects, initiatives that ensure deliverables are aligned with the line of business objectives, on time, and aligned with product retention and growth objectives. 

Duties

Provides organizational representation in policy workgroups and stakeholder meetings and summits. Evaluates policy and regulatory changes to identify impacts to product and current business processes. Develops impact assessments and execution plans for implementation of new guidance.

 

Provides support by identifying opportunities and leading improvement projects to drive quality, membership and revenue and enhance the member experience. Identifies, provides solutions and executes projects to maximize enrollment and growth opportunities allowed by regulation/regulators. Manages and leads cross-functional partnerships with stakeholders responsible for improving stars and quality measures to improve effectuation and monthly payments. Reviews current program data to identify areas for cost containment initiatives (i.e. encounters, utilization, rates) and influences process improvement plans.

 

Leads annual cycle work: identifies lessons learned, product roadmap, product / benefit design, coordinates with IT and other cross functional teams to develop critical cycle pathways. Ensures excellent service delivery and experience.   Builds an understandable and scalable process for continued product cycle development and improvementation. Leads full annual cycle work. Supports business units on developing and executing process improvement plans, monitoring programs and enhancements to promote efficiency, quality and compliance. Partners with functional areas to resolve day-to-day issues impacting product performance.

 

Responsible for leading daily operational activities including staffing, productivity, and quality of work. Participates in hiring, coaching, training, counseling, and provides feedback on staff performance.

 

Performs other duties as assigned.

Education Required

Bachelor's Degree
In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Master's Degree in Public Health or Related Field

Experience

Required:
At least 6-8 years in managed care (Medicare, Commercial, and/or Medi-Cal)  Direct experience in managed care functions including stars, quality, financial performance review, operational functions (claims, enrollment, readiness). Risk management and mitigating planning experience.

 

At least 3-4 years of lead experience.

 

Preferred: 
Minimum of 10 years of direct experience.

Skills


Required:

Knowledge of product management and strategic planning and packaging concepts.

 

Ability to lead, manage, conclude and recommend using data and experience driven decisions. 

 

Ability to lead, mentor and coach cross functional team through ambiguity.

 

Ability to make decisions to drive towards and accomplish team objectives. 

 

Strategic thinking skills and ability to create messaging to influence desired outcomes.

 

Ability to anticipate future demands of initiatives related to people, technology, budget and business within your department and design/implement solutions to meet these needs.

 

Able to communicate results and business impacts to stakeholders within and outside of the company.

 

MS suite - Word, Power Point, Visio, Project

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Preferred:
Six Sigma Training, Product Management Professional Training

Additional Information


Department Specific

 

Commercial Product:
Required:

5+ Commercial annual rate setting experience
5+ Commercial risk adjustment experience
8+ year of leading large-scale cross-functional initiatives
Experience with DMHC & Covered CA contractual requirements

 

CMC/ D-SNP: 
Required:

CMS annual rate setting experience
CMS risk adjustment experience
8+ year of leading large-scale cross-functional initiatives
Experience CMS guidelines & regulatory policy
Medicare Advantage, D-SNP and CMC quality & star rating
Ability to access, review and interpret CMS communications including memos, guidance, Advanced call letter and Final Call letter for impacts to Medicare product management..

 

Medi-Cal Product:
Required:

5-7 years Medi-Cal managed care experience
Experience serving Medi-Cal population
Understanding of Medi-Cal regulatory and program requirements

 

L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)

 

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.


Nearest Major Market: Los Angeles

Job Segment: Risk Management, Medicare, Public Health, Claims, Finance, Healthcare, Insurance

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