Note: The job is a remote job and is open to candidates in USA. River Oaks Hospital is seeking a Product Development Manager - Health Plan to guide product strategy and development for commercial and Medicare Advantage health plans. The role coordinates with business, technical, actuarial, and external stakeholders; manages product implementation, regulatory filings, vendor initiatives, and plan documents; and supports competitive positioning, growth objectives, and plan optimization.
Responsibilities
- The Senior Manager of Product Development is pivotal to guiding our product strategy by orchestrating collaboration with business leaders, technical teams, actuarial stakeholders, and external partners. The role demands expertise in advancing product design based on market analysis, aligning with the company’s strategic goals, ensuring adherence to regulatory timelines for product filings, and staying updated with ever-evolving industry trends
- This role calls for development, organization, and facilitation of Prominence Health Plan's commercial and Medicare Advantage products, system and infrastructure improvements, and vendor selection and implementation. Reporting directly to the Chief Revenue Officer, the Senior Manager will provide essential support to the organizational business teams in the development, implementation, and compliance of new and renewing commercial and Medicare clients, products, and vendors
- Program Delivery
- Bid and AEP Project Management
- Product Analysis
- Product Insights and Market Intelligence
- Tracking financial and growth impact of benefit changes
- CMS/Regulatory Deliverables
- Regulatory Submissions
- SNP Model of care management
- This role will provide crucial support to the organizational business teams in the development, implementation, and compliance of new and renewing commercial and Medicare clients, products, and vendors. Additionally, you will play a vital role in the development and production of required plan documents and the entry of plan filing documents into SERFF, HPMS, and CMS Bid tools
- The Senior Manager of Product Development is expected to live at both the tactical layer, as well as the strategic layer. In the tactical layer, this role will work directly with internal and external customers to initiate, plan, execute and manage product development and implementation initiatives to accomplish overall business, client, and vendor objectives. In the strategic layer, the Senior Manager is responsible for working with Sales and our executive team on competitive positioning, growth objectives, and plan optimization. The Senior Manager will also assist in training and education for new products, opportunities, and related topics as needed. It requires skillful engagement of stakeholders across the organization, and ensuring deliverables from all teams (as they relate to Commercial and MA product objectives) are being met
Skills
- Strong understanding of the health insurance industry, with a focus on fully-insured and self-funded commercial health insurance products
- Five (5) years of experience in the health insurance industry (e.g., underwriting, product management, actuarial support, claims processing), with a focus on commercial health insurance. Equivalent experience in other related fields (e.g., financial services, consulting) may be considered
- Minimum two (2) years of experience in managing the lifecycle of health insurance products, including product development, pricing, and compliance
- Ability to effectively communicate in English, both verbally and in writing
- Proficiency in gathering and interpreting empirical evidence, formulating recommendations, action plans and interventions to improve the overall organizational strategy
- Simultaneous action at varying stages—initiation, follow through, and completion—on a number of different projects
- Demonstrated ability to research, analyze and interpret state/federal regulations related to health insurance and healthcare
- Demonstrated ability to communicate verbally and with technical writing in a way that effectively conveys project background, objectives, activities, evaluations, conclusions, and recommendations
- Demonstrated skills in critical thinking, problem solving, and the analysis, interpretation and evaluation of complex information
- Demonstrated ability to work independently with minimal supervision
- Demonstrated ability to maintain effective collaborative working relationships with staff
- Resourceful, detail-oriented, and able to assimilate and analyze a wide variety of information, often working under deadline pressure with a variety of levels of staff
- Strong project management skills
- Computer Skills: Health Plan Management System (HPMS), System for Electronic Rates & Form Filings (SERFF), Smartsheet, SharePoint, Microsoft Office (Word, Excel, PowerPoint), and database software
- Familiarity with continuous quality and performance improvement methodologies
- Bachelor's degree in healthcare administration, communications or business preferred
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