This Program Manager position will be a part of NMHC's Managed Care team and will be responsible for managing programs within the team's Value Based Programs portfolio, reporting directly to the Manager overseeing relevant portfolio of Value Based Care Programs. Programs will cover a broad range of content including but not limited to value-based and bundled payment model contracting and implementation with associated requisite care model transformation, population health management care delivery programs, and value based delivery product development. Other job responsibilities and competencies include:
Responsible for providing Leadership to an assigned portfolio of projects/ initiatives through active engagement of NM Executives (Project Sponsors) and all stakeholders consistently applying NMHC standard project management and process improvement methodologies throughout the project lifecycle of analysis/planning, design, execution, closing as well as value measurement definition.
Lead activities including project proposal/charter definition, budget development, resource allocation and management, information distribution and meeting facilitation as well as a comprehensive the planning efforts necessary to establish measure, enhance and report organizational management performance.
Works closely with all relevant stakeholders to set program goals, clearly define operational dependencies, develop appropriate performance standards, metrics and reporting tools required for successful program design.
Participate in regular project review meetings where status on milestone performance, issues, project changes and budgets; provide proactive, clear, concise and timely communications regarding project status and overall performance reporting among team members, NM Executives (project sponsors) and vendor partners; facilitate continuous exchange of ideas, information and project developments.
Demonstrate the ability to deal with the changing environment and to lead/facilitate and manage change efficiently and effectively where appropriate.
Unquestionable integrity, credibility and character with demonstrated high moral, ethical behavior.
Support the development of executive level presentations that are related to initiatives.
Be responsible for understanding vendor contracts with NMHC to ensure vendor compliance to project schedules, contractual agreements and compliance with NMHC standards.
Develops and maintains productive and cordial relationships with clients and team members, serving as a link between multiple parties and entities; effectively manages project risks, issues and problems that arise within the program and recommend mitigation strategies, as needed, to achieve the desired results.
Analyzes large data sets to identify program opportunities and provides performance updates for cross-departmental initiatives and executive oversight.
Maintains deep understanding of relevant program design and/or governmental policy implications of portfolio, with ability to articulate such implications to key administrative and clinical leaders across the organization.
Demonstrates knowledge of health system operations, managed care, payor relations, clinical integration and physician alignment as well as the strategic priorities and goals of the organization; recommends solutions that add value, strengthen project or operational outcomes; exhibits and understanding of stakeholder needs; acts as a key interface with internal clinical and operational areas that support new care (and associated reimbursement) models.
Participates in, and represents Managed Care and the Value Based Program portfolio at key internal NHMC operational and planning meetings.
Collaborates within Managed Care team for interdepartmental learning and identify opportunities to connect initiatives.
Other duties as assigned.
- Oversees general contract management support for NMHC's Commercial Value Based Program Portfolio contracts. Serves as the main contact of payers within designated portfolio as needed. This includes meeting/corresponding with payers, responsibility over understanding contract structure and operational requirements, relaying information and updates from the payer to the appropriate stakeholders, and escalating issues to the payer for prompt resolution as needed.
- Complete regular and ad hoc analyses, trending and reporting around key contractual components that affect reimbursement, incentives or general compliance. Monitor and communicate contract performance to Manager and Managed Care leadership.
- Manage contract networks and support narrow network products.
- Leads development, deployment and maintenance of new tools/technology necessary to maintain and improve productivity, effectiveness, quality, customer service, reduce risk and/or reduce costs in managing portfolio, including but not limited to standardized reporting program to track financial and resource utilization outcomes of the various contracts.
- Responsibility over day-to-day health plan operations functions of various contracts, including partnering with program coordinator to escalate and address obstacles or issues, and working with CMF or other internal or external stakeholders to resolve as needed. Perform other duties as assigned.
- Bachelor Degree in Business Administration, Healthcare Management, Communications or related field.
- Minimum 8-10 years project or program management related experience.
- Strong Knowledge of Microsoft: Word, Excel, Power Point, Project
- Demonstrated project management and organizational skills, demonstrated analysis and problem solving skills, excellent oral and communication skills, demonstrated ability to effectively establish and maintain working relationships with peers and constituents at all levels of the organization.
- Demonstrated leadership capabilities.
- Master's degree, MBA or MHA (or) Professional Certification in area of expertise.
- Previous clinical experience delivering patient care is preferred but not required.