Top 44630 Utilization Manager Jobs

Product Manager lll - HYBRID 3 days in the office- Health Plan Product experience
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Product Manager lll - HYBRID 3 days in the office- Health Plan Product experience

Fallon Health -
Worcester, MA

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Job Details

Full-time
$110,000 - $120,000 a year

Qualifications

Managed care
Finance
Managed care organization experience
Health insurance policy knowledge
Bachelor's degree
Insurance regulation
Medicare regulations
Project management experience in healthcare
Managing projects
Healthcare compliance

Full Job Description

Overview:

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose:

Under the direction of the Director of Product Management, the Product Manager III works independently and collaboratively with both internal customers and external stakeholders. The Product Manager III will take high profile and strategic projects from development through implementation. responsible for managing the product portfolio for a specific market segment. This includes developing new product features, enhancements, portfolio revisions and overall product lifecycle management. The position requires a high level of operational as well as strategic focus. The Product Manager III will make recommendations to the Director of Product Management and Product Owner on product changes that will improve competitive positioning, mitigate cost for the member or Fallon Health, streamline or increase integrity of internal processes and that ultimately enhances the overall consumer experience

Responsibilities:

Primary Job Responsibilities:

Demonstrated ability to lead cross-functional teams, facilitate decision-making, and maintain end-to-end accountability for successful product implementations and enhancements.
Collaborate with product ownership and the Actuarial team on the development and submission of annual rate filings.
Strong knowledge of federal and state regulatory requirements, with direct experience engaging with the Massachusetts Health Connector
Comprehensive understanding of Fallon Health systems, including key interdependencies and the dependencies between products, internal platforms, and external vendor partners
Act as the primary subject matter expert and responsible leader for product filings, including product oversight of Evidence of Coverage (EOC), SERFF plan and benefit templates, HIOS submissions, and connector seal of approval submission
Serve as Fallon Health’s lead or key contributor for new product development and implementation initiatives, and partner with product ownership to support the design and execution of customized product solutions
Function as a central liaison across Fallon Health departments, external regulatory bodies, and third-party vendors to address product-related inquiries and resolve issues
Partner with Corporate Communications and regulatory to develop and maintain product collateral; ensure all materials—member, and provider-facing—accurately reflect product design, operational processes, and applicable policies, and benefits.
Develop and deliver internal and external product training to ensure alignment and understanding across stakeholders
Oversee and report on product portfolio performance, including financial results, membership growth and retention, operational effectiveness, clinical utilization, and overall customer experience

Qualifications:

Education:

Bachelor's Degree

License/Certifications

Experience:

5 - 10 years in a healthcare setting and 5+ years as Product/Project Manager. Managed care experience with knowledge of plan operations, IT, finance, actuarial, compliance, product implementation, corporate communications, customer service, provider network management, federal and state health insurance regulations, marketing, product management. government agencies including the Massachusetts Health Connector. Considerable knowledge of Medicare and Subsidized Connector Commercial products is important. Experience with M/S Office, PowerPoint, Excel, SharePoint, and One Drive preferred.

Resources:

Outlook, Microsoft Office Suite, Microsoft PowerPoint, Visio, Sharepoint

Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $ 110,000-$120,000 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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