Product management advisor
Location
Bloomington, MN | United States
Job description
Product Management Advisor - Centene Operations Management
This is a hybrid role and will require the ability to work in person.
The job profile for this position is Product Management Advisor, which is a Band 4 Senior Contributor Career Track Role.
The Regulated Markets Centene Operations Management team is responsible for ensuring the execution of key operations accountabilities associated with all regulated lines of business including Medicare, Medicaid, and Marketplace (Exchange / Health Care Reform). The team supports Pharmacy Benefit Management (PBM) delegated responsibilities associated with regulatory audit support, issue management, adjustment processing, Prescription Drug Event ( PDE)/encounters reporting and regulatory communications.
The Advisor will oversee process to support analytics of operational data, specific to claims processing, adjustments, and PDE/Encounters for the client. Additionally, will provide ancillary support to other operational responsibilities delegated to the team within audits, issue management, and communications. The role will also manage the team toward the primary objectives of meeting member/client satisfaction, aligning with client contractual support and client retention. When necessary the advisor also provide functional SME support to client facing discussions.
Key Responsibilities:
- Provides expert content/professional leadership on complex assignments/projects
- Interacts with clients and account team to provide SME operations guidance
- Develop and support analytics of claims, adjustment, and PDE/Encounter data to support client initiatives
- Oversee the timely completion of all adjustments aligned with client specific request processes and accurate delivery, response management and correction of client PDE (Medicare) and Encounter (Medicaid) reporting
- Manage the timely notification to Express Scripts of client audit needs, facilitation of Client/Express Scripts preparation and support for audit scope and documentation and completion of all audit deliverables and findings
- Manage all aspects of issue management processes (intake, triage, root cause analysis, mitigation, impact analysis and closure) of all client issues associated with regulatory compliance
- Ensures the appropriate tracking and documentation of all team activities in associated systems
- Supports the client Project Management Office (PMO) and Account Teams with function specific communications needs via account team/client inquiry requests, Field Alert development, deliverable reports and presentations
- Collaborates with PMO and other functional stakeholders to develop product requirements and specifications, functional policies and process documentation
- Exhibits proven ability to work cross-functionally in development and execution of operational plans aligned to enterprise goals and in support of the needs of our clients.
- Exercises considerable creativity, foresight, and judgment in conceiving, planning, and delivering initiatives.
- Uses deep professional knowledge and acumen to advise functional leaders.
- Focuses on providing thought leadership within Regulated Markets operations but works on broader projects, which require understanding of wider business.
Ideal Candidates will offer:
- Bachelor's Degree with a preferred focus of Health Care Administration or Business
- 5-7+ years of experience in a health plan or PBM setting. Medicare, Medicaid and Healthcare experience a plus.
- Technical knowledge of relational database concepts, querying, data warehouses and decision support tools, including but not limited to: SQL, Excel, and Tableau.
- Alteryx experience is a plus.
- Able to balance high priority, long-term projects with short-term, immediate deadlines
- Creative thinker and exceptional problem solving skills
- Expert communicator and collaborator
- Able to translate technical data concepts to business partners for understanding and alignment
Proven ability to function in a heavily matrixed environment.
- Extensive knowledge of Microsoft Office products (particularly Excel, Word, Power Point, etc.).
- Experience leading projects and working with cross functional teams, especially Business and
Other Essential skills - Excellent process mapping and analysis skills: role does require oversight and continuous improvement of business processes.
- Ability to work effectively in dynamic, rapidly changing, team-based environment across multiple functions and in support of diverse regulatory obligations.
- Critical thinker and creative problem solver, who exercises good judgment in resolving difficult situations, prioritizes and can balance needs with enterprise objectives
- Ability to work in a fast-paced deadline-driven environment, and juggle multiple, sometimes competing, priorities and requirements
- Ability to motivate, influence and connect others
- Ability to influence direction and action; build and leverage internal relationships
- Goal oriented and personally accountable; resourceful and self-directed
- Adaptable and flexible; open minded, innovative and creative - seeks 'out of box' solutions
- Open communicator; excellent oral and written communication skills
This is a hybrid role and will require the ability to work in person.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email:
[email protected] for support. Do not email
[email protected] for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
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