Manages the development of new initiatives and improvement of one or more of the VNSNY CHOICE health plans. Develops and improves workflows and operational support systems in support of product performance goals. Work through process improvement goals. Ensures product meets expectations of external (regulators, providers, members, vendors) and internal customers. Works under general direction.
- Develops a strong understanding of VNSNY CHOICE strategic business objectives and business unit operations in order to manage the end-to-end product life cycle for one or more VNSNY CHOICE products. Drives the development, design, readiness and implementation of new products. Identifies and implements changes to improve existing products. Retires products at end of life.
- Collaborates with CHOICE management to identify and document necessary creation of and changes to policies, workflows, systems, staffing, collateral and product pricing. Facilitates and/or leads teams regarding decision making for the above.
- Keeps abreast of the external environment (competitor offerings, DOH/CMS regulations, coalition/affiliation group positions, provider network, membership needs) to identify new opportunities and requirements for CHOICE products. Serves as subject matter expert regarding competitive products and plan design in the market.
- Defines the business and functional requirements/specifications for system implementations and improvements. Collaborates with IT to ensure system design meets operational needs. Participates in testing, training, and roll out of system changes.
- Develops project plans and schedules which includes defining requirements, tasks, work assignments, resources, project milestones and review points. Monitors project progress through completion, addressing risks and issues effectively and reporting/escalating appropriately.
- Collects and analyzes data to assess and monitor product performance against defined goals and criteria. Prepares and presents summary reports to stakeholders. Identifies opportunities for improvement and works with functional partners to develop strategies to improve results.
- Serves as subject matter expert for cross-functional stakeholders including, but not limited to: benefits definitions, provider network management, medical management, claims, sales, and complex customer service. Participates in oversight activities as requested by health plan departments, governance departments (e.g., Compliance and Regulatory Affairs), and senior management.
- Collaborates with Marketing department in the development of marketing materials, communications, and collateral to ensure it is on message and supportive of the brand and position.
- Performs all duties in a managerial role. Ensures effective staff training, evaluates staff performance, provides input for the development of the department budget, and hires, promotes, and terminates staff and recommends salary actions as appropriate.
- Participates in special projects and performs related duties as assigned.
- Management Consulting experience a plus
- Data analytics experience a plus
Education: Bachelor’s degree in Business Administration, Healthcare Administration, Marketing or related field of study required. Master’s degree in related field desired.
Experience: Minimum three years of experience in a health insurance organization with a focus on one or more of the following product lines: Medicaid managed care, Managed Long Term Care, Commercial,or Special Needs Plans and a minimum of one year of experience in product management required. Experience working with benefit design, provider networks, medical management, marketing strategies and tactics,and claims required. Bid Submission, Bid Redesign, Risk Adjustment process also required. Effective communication, both written and oral, skills and strong skills with common PC software applications (i.e. Microsoft Office) required. Excellent analytical, project management, writing, and presentation skills, required. Knowledge and understanding of Medicare and Medicaid regulations preferred.
The Visiting Nurse Service of New York (VNSNY) is the nation's largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Countries. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost effective healthcare in the home and community. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life. Each day, more than 13,000 VNSNY employees - including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 44,000 patients and members, helping them to live the best lives possible in their homes and communities.