Product Solutions Specialist II

Job Summary

The Product Solutions Specialist II is focused on providing end to end development and management for product line initiatives. This position is focused on applying  technical healthcare contract expertise in performing in the development and management of product line initiatives.  This position  supports contract-related inquiries, initiatives, and projects that support the overall product strategy and lifecycle. Works closely with leadership and participate in cross functional groups.

Duties

Responsible for identifying  product management best practices,. Identify impacted parties, business partners, and resources required. Collaborate and support in implementing best practices cross functionally.

Recommend and participate in the design of processes and product requirements that support business needs. Designs methods for integrating function and processes including applicable dependencies inclusive of enterprise initiatives.

Identify risk and help troubleshoot resolution of issues.

Participate in the Product Development Lifecycle and or initiatives through the management of contracts and regulatory filings.

Collaborate with leadership to develop the regulatory filing schedule for cycle documents.

Prepare and ensure regulatory filing documents according to timeline.

Support all product contracts regarding benefits, quality performance measures, penalty risks, etc.  Monitoring of the tactics for compliance/contractual requirements.

Develop the technical product requirements according to contractual obligations to ensure compliance.

Facilitate the coordination of responses from partners for ad-hoc requests and develops responses according to established timeline.

Facilitate effective cross-functional meetings to adequately support new strategic implementations.

Primary contact for technical requirements, development and execution.

Develop a sustainable and repeatable process for the technical adaptation and validation of product initiative.

Evaluate and support the remediation efforts of member grievance or plan partners.

Perform other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 3 years of Commercial Medicare/Medi-Cal Product Experience (Product & Benefit knowledge) and of California Health Insurance Exchange (Covered CA)/Centers for Medicare and Medicaid Services (CMS)/Department of Health Care Services (DHCS) requirements experience.

Skills

Required:
Knowledge of product strategy.

Knowledge of product management and strategic planning and packaging concepts.

Ability to conclude and recommend using data and experience driven decisions.  

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

Ability to partner in the ingestion, consumption and distribution of information from regulators with potential impacts on product. 

Ability to effectively work closely with project team leaders and under the guidance of leadership. 

Strong skills in MS suite - Word, Power Point, Visio, Project.

Strong knowledge of Department of Managed Health Care (DMHC), Covered CA, Centers for Medicare and Medicaid Services (CMS), and DHCS contractual requirements.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information

Department Specifics:

Medicare:

Preferred: 

Experience in Health Care with Commercial products specifically in Qualified Health Plan (QHP) and/or Benefits related definition and requirements for LA Care Covered (LACC), L.A. Care Covered Direct (LACCD), PASAC lines of business.

Medi-Cal Plan Partners:  

Required:

Experience serving Medi-Cal population. Skilled in building relationships with external partners. Service oriented. Skilled in resolving conflict.

Preferred:

Understanding of Medi-Cal managed care model, eligibility requirements, benefits, enrollment processes, and regulatory requirements governing Medi-Cal managed care plans. Understanding of managed care principles and operations.

Medi-Cal:

Required:

Experience working in Medi-Cal managed care and serving the Medi-Cal population. Knowledge of Medi-Cal regulatory requirements and program guidelines.

Commercial Product:

Required:

At least 3 years of Commercial regulatory filing experience (e.g. DMHC).

Strong Adobe Analytics and other analytics tools skills.