Program Manager III - Bridgeport, United States - Harvard Pilgrim

Harvard Pilgrim Bridgeport, United States

1 week ago

Description

Program Manager III - Quality - Delegated Provider Oversight

Company: Point32Health

Point32Health, a leading health and wellbeing organization, is dedicated to providing a personalized healthcare experience. By leveraging the expertise of Tufts Health Plan and Harvard Pilgrim Health Care, Point32Health offers a range of health plans and tools to promote healthier living.

Job Summary:

The Delegated Provider Oversight Program Manager (Program Manager) is responsible for managing complex programs and projects supporting providers delegated for Utilization Management (UM) and/or Care Management (CM) activities. Key responsibilities include overseeing large projects, conducting policy and impact analysis, and leading program change initiatives.

Key Responsibilities:

Manage Care Management (CM) and Utilization Management (UM) Oversight Programs
Lead day-to-day operations related to delegated providers for UM and CM activities
Collaborate internally and externally on new/existing processes and initiatives
Ensure program compliance with CMS Medicare and State Medicaid requirements
Prepare for internal and external audits and site visits
Provide solutions-oriented management of program operations and integration issues
Conduct data analysis and prepare necessary documentation
Manage cross-functional projects and initiatives
Utilize project management skills for successful program implementation
Identify risks, concerns, and escalate issues as needed
Lead cross-functional meetings and ensure deliverables are met

Qualifications:

Education: Bachelor's Degree required, Master's or Advanced degree preferred
Experience: 8-10 years of industry experience, program management experience
Skills: Data analysis, communication, leadership, negotiation, conflict resolution, and presentation

This role offers the opportunity to work in a dynamic environment, collaborating with various stakeholders to drive program success and ensure compliance with healthcare regulations.

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