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Regional Health Plan Administration Project Lead

at CareSource

Posted: 7/3/2018
Job Reference #: *BADACFD6B104C9F2

Job Description

Requisition Number

Post Date

Regional Health Plan Administration Project Lead




Role and Responsibility:

  • Organize the various components needed to manage tasks associated with integrated health partners and regional health plans with internal and external parties
  • Facilitate internal and external team meetings to establish and execute on detailed action plans that will drive quality and operational outcomes for new and existing health partners
  • Ensure compliance with state, federal and regulatory body requirements
  • Assist with the development and maintenance of departmental policies and procedures for oversight of integrated health partner relationships at the regional level
  • Collaborates with Enterprise Project Office to identify enterprise level projects
  • Analyze, update, and modify procedures and processes to continually improve operations
  • Perform detailed analysis of Integrated health partner contract and regional metrics, outcome measures, and savings opportunities
  • Handles day to day requirements of medium to large scope projects as it pertains to the regional plan
  • Create and manage financial ROI, quality metrics, and service level agreements to evaluate success of regional plans and all Value Based Reimbursement relationships
  • Identify and manage risk associated with any process change, implement mitigation strategies & communicate/escalate to stakeholders
  • Report health partner success and oversight status to all stakeholders
  • Produce detailed reports, business decision documents and status notifications on assigned projects
  • Participate in Integration Oversight Committee meetings and all subcommittees with business owners and health partners

Perform any other job related instructions as requested


Education / Experience:

  • Bachelor's degree or equivalent years of relevant experience is required
  • Master’s degree in business or health related field is preferred
  • A minimum of three (3) years of experience working collaboratively with external Health Partners is required
  • Project Management experience is required
  • Familiarity of the healthcare field and experience with payer-provider integration is required

    Required Competencies / Knowledge / Skills:

  • Proficient in Microsoft Office tools, including Project, Word, and Excel
  • Thorough understanding of project management processes, techniques and tools
  • In-depth knowledge of regulatory and quality standards and measures including but not limited to State Medicaid programs, Medicare and Quality Accreditation (e.g., ODM, CMS, NCQA, URAC, etc.
  • Proven ability to effectively interact with all levels of management within the organization and strong presentation skills
  • Flexibility during organizational and/or business changes
  • Demonstrates strong analysis and collaboration skills
  • Demonstrate sense of urgency
  • Excellent written and verbal communication skills
  • Strong interpersonal and relationship building skills
  • Ability to work independently and within a team environment
  • Ability to multi-task and prioritize work to meet project deadlines
  • Critical listening and thinking skills
  • Time management skills
  • Customer service oriented
  • Decision making/problem solving skills
  • Excellent planning, negotiating and influencing skillset

    Licensure / Certification:

  • None


    Working Conditions:

General office environment; may be required to sit or stand for long periods of time