PROGRAM MANAGER I
Manager of Plan Management
|Department||MD Health Benefit Exchange|
|Date Opened||4/24/2018 11:59:00 PM|
|Filing Deadline||5/10/2018 11:59:00 PM|
|Salary||$53,193.00 - $85,401.00/year|
|HR Analyst||Shadrick Phillips|
LOCATION OF POSITION
750 E. Pratt Street, 6th Floor, Baltimore, MD 21202
Main Purpose of Job
**This posting has been reopened, current applicants do not need to reapply**
The Manager of Plan Management Programs, under general direction of the Director of Policy and Plan Management, is responsible for the day-to-day management, operational strategy, policies, and procedures of the Plan Management functional area. The Manager of Plan Management Programs will have overall responsibility for plan certification approval for Marketplace qualified health and dental plans, management of issuer partnerships, and oversight over federal and state reporting/data reconciliation processes germane to plan data. The Manager of Plan Management Programs will interface heavily with key stakeholders such as issuers, other State agencies, and regulatory bodies. The Manager of Plan Management Programs will supervise the work of the Partner Data Specialist and will coordinate across internal agency stakeholder for analysis, data requests, and reports.
- Given stakeholder input, create strategy, design, develop, and implementation approaches for Plan Management Programs (including Qualified Health Plan, Qualified Dental Plan, and Managed Care Organization). Develop and improve processes, standards and procedures to create efficiencies in plan management programs including: plan certification, plan compliance, plan data reconciliation, and policy-based payments.
- Serve as an agency representative for implementing new mandates with issuers in coordination with the Director of Policy and Plan Management.
- Administer the responsibilities of the Marketplace, under federal regulation, with Plan Certification.
- Coordinate and engage with MHBE IT Development to shepherd required changes/enhancements to the HBX Plan Management/Plan Shopping Module.
- Oversight of the MHBE HBX Plan Shopping Interface including data display, functionality verification, improvements in interface aesthetic and compliance with federal/state standards.
- Manage issuer data and ensure the MHBE HBX utilizes the correct underlying plan data to perform eligibility and enrollment functions.
- In concert with the Director of Policy and Plan Management develop policies, procedures and best practices for the department
- Responsible for oversight of relationships with Marketplace-certified issuers to ensure continual satisfaction, training, compliance and long term participation with the Marketplace.
- Act as liaison between issuers and the Marketplace IT department.
- Meets regularly with carrier decision makers to discuss partnership and performance issues.
- Provides training on Marketplace policies and procedures.
- Monitor and communicate potential operational risk to the Director of Policy and Plan Management and/or senior management
- Coordinate with different MHBE functional groups and the Director of Policy and Plan Management to triage and address problems associated with partner issuers from an enrollment, EDI, or regulatory perspective.
- Updates internal Marketplace stakeholders as appropriate.
- Represent Maryland Health Benefit Marketplace – Plan Management at meetings involving key stakeholders including high-level health insurance representatives, the Office of the Insurance Commissioner, issuers, and other external stakeholders.
- Develop, interpret, and effectively communicate policies, procedures, and regulations, resulting in the need for minimal clarifications.
- Serve as Chair on the Plan Management Stakeholder Committee.
Education: Possession of a bachelor's degree from an accredited four-year college or university.
Experience: Four years’ experience in professional work.
1. Candidates may substitute additional experience in administrative staff or professional work on a year-for-year basis for the required education.
2. Candidates may substitute U.S. Armed Forces military service experience as a commissioned or non- officer involving staff work that included the regular independent judgment and analysis in applying and interpreting complex administrative plans, policies, rules or regulations or analysis of operational programs or procedures with recommendations for improvement on a year to year basis for the required education and experience.(up to 4 years of education) and (2 years of experience).
DESIRED OR PREFERRED QUALIFICATIONS
1. Facility with health insurance company business processes and functions. Knowledge of health insurance policy.
2. Excellent verbal and written communication skills with a focus on customer service oriented and problem solving communication.
3. The ability to work with a high degree of initiative and self-reliance and to coordinate tasks with other team members.
4. Knowledge of the Affordable Care Act.
5. Experience in the health insurance industry.
LICENSES, REGISTRATIONS AND CERTIFICATIONS
Please make sure that you provide sufficient information on your application to show that you meet the qualifications for this recruitment. All information concerning your qualifications must be submitted by the closing date. We will not consider information submitted after this date. Successful candidates will be ranked as Best Qualified, Better Qualified, or Qualified and placed on the employment (eligible) list for at least one year.
Applications will not be accepted after the close of business on the closing date of the announcement. Resumes will NOT be accepted in lieu of completing the online or paper application. The online application process is STRONGLY preferred. If online access is not available, you may submit a paper application, supplemental questionnaire and resume to:
Maryland Health Benefit Exchange
Attn: Shadrick Phillips,
750 E. Pratt Street, 16th Floor Baltimore, MD 21202
TTY Users: call via Maryland Relay 1-800-735-2258
We thank our Veterans for their service to our country, and encourage them to apply.
As an equal opportunity employer, Maryland is committed to recruiting, retaining and promoting employees who are reflective of the State’s diversity.