Health Plan Quality Program Manager

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Facilitates and supports system/process/people improvement projects involving health plan performance assessment rating systems (Stars) and quality improvement across the Company’s lines of business with an emphasis on government and/or commercial health plans, anticipating risks, managing expectations, and providing change management support.

This position has the option to work fully remote; Ohio residents preferred.

Responsibilities

Health Plan Quality Program Manager

• Facilitates projects to increase Star Ratings involving one or more cross-functional teams through execution and implementation, monitoring project performance and improvements.
• Manages overall Stars initiative project plan for the parent and subsidiary Companies government programs contracts.
• Collaborates with appropriate stakeholders to ensure timely project delivery, anticipates risks, and plans accordingly.
• Leverages Star measures analytics and industry insights to identify opportunities to improve Star Ratings.
• Collaborates and builds relationships throughout the organization to manage expectations and drive customer satisfaction, while educating and promoting a culture of continuous improvement.
• Performs other duties as assigned.
  
  

Senior Health Plan Quality Program Manager

• Leads and/or participates in cross-functional, enterprise-wide teams to improve Star Ratings performance. Formulates detailed project plans that are agile and targeted to meet multiple goals and objectives within timeline. Assures collaboration with internal departments and/or external contacts. Anticipates risks and plans accordingly. Manages the change process with minimal impact to the business.
• Manages overall Stars initiative project plan for the parent and subsidiary Companies government programs contracts.
• Leverages Star measures analytics and industry insights to identify opportunities to improve Star Ratings and drive the evaluation of initiatives.
• Collaborates and builds relationships throughout the organization to manage expectations and drive customer satisfaction, while educating and promoting a culture of continuous improvement.
• Maintains and shares knowledge of regulatory requirements and industry best practices.Attends training sessions and other appropriate industry meetings. Orients, trains, and assists more junior level staff.
• Performs other duties as assigned.
  
  

Qualifications

Health Plan Quality Program Manager

Education And Experience

• Bachelor's degree in business or healthcare administration or related field or equivalent combination of education/training and experience.
• 3 to 5 years progressive experience leading medium to large projects and enterprise-wide process or technology implementations, preferably in health care.
• Experience in Medicare and/or Medicaid preferred.
  
  

Professional Certification(s)

• Project Management certification preferred.
  
  

Technical Skills And Knowledge

• Knowledge of process improvement and/or lean six sigma methodologies.
• Intermediate to advanced Microsoft Office and database reporting skills. Proficiency with Tableau or similar reporting tools.
• Strong facilitation and project management skills.
• Excellent oral, written, interpersonal and presentation communication skills with the ability to communicate with stakeholders at various levels of the organization.
• Ability to interpret data trends and patterns, applying them to business processes.
• Ability to read and interpret government regulations and apply to Company operations.
  
  

Senior Health Plan Quality Program Manager

Education And Experience

• Bachelor's degree in business or healthcare administration or related field or equivalent combination of education/training and experience.
• 5-7 years of experience as a Health Plan Quality Program Manager or equivalent progressive experience leading projects and enterprise-wide process or technology implementations, preferably in health care.
• Experience in Medicare and/or Medicaid preferred.
  
  

Professional Certification(s):

• Project Management certification strongly preferred.
  
  

Technical Skills And Knowledge

• Strong knowledge of process improvement and/or lean six sigma methodologies.
• Advanced Microsoft Office and database reporting skills. Proficiency with Tableau or similar reporting tools.
• Strong facilitation and project management skills.
• Excellent oral, written, interpersonal and presentation communication skills with the ability to communicate with stakeholders at various levels of the organization.
• Ability to interpret data trends and patterns, applying them to business processes.
• Ability to read and interpret government regulations and apply to Company operations.
  
  

A Great Place To Work:

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.
  
  

Excellent Benefits And Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
  
  

An Investment In You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.
  
  

About Medical Mutual:

Medical Mutual’s status as a mutual company means we are owned by our policyholders, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There’s a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We’re not just one of the largest health insurance companies based in Ohio, we’re also the longest running. Founded in 1934, we’re proud of our rich history with the communities where we live and work.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Primary Location

US-Ohio

Job

7 - General Staff

Organization

Clinical Quality & Health Services

Schedule

Regular

Shift

Standard

Employee Status

Individual Contributor

Job Type

Full-time

Job Level

Day Job

Job Posting

Nov 22, 2024, 7:09:15 PM