Program Manager, Medicare Special Needs Program

Are you the superstar who can lead the implementation of one of the most important disease management initiatives in the country?

A rapidly growing Healthcare Company that is redefining the way that consumers manage their health seeks a:

Program Manager - Houston, Texas Medicare Special Needs Program

This is a unique Medicare Advantage Part D (MA-PD) health plan exclusively designed to meet the specific needs of Medicare beneficiaries living with diabetes, heart failure, and/or end stage renal disease (ESRD). As such, the program offers a unique combination of a customized health plan, prescription drug coverage, and nursing support. The program is 100% NCQA certified.

The Program Manager will have overall general management responsibilities for daily operations as directed by the Regional Vice President, Texas. Adhering to the strategic goals and processes, the Program Manager will creatively pull together the resources of the local market to ensure achievement of program objectives as defined for the assigned patient population.

General Responsibilities:

• Day-to-day management of the care managers.
• Responsible for beneficiary engagement and retention.
• Responsible for the clinical outcomes in designated market.
• Coordinates physician collaboration with market provider services reps.
• Coordination of activities between the call center, care managers, and preferred vendors.
• Ongoing evaluation and training of care managers.
• Key contact for management team, physicians and patients.
• Day-to-day oversight of clinical interventions of call center and preferred vendors in designated market.
• Serve as expert on operations and clinical matters in designated market.
• Assists with external accreditation of the program.
• Responsible for operation of the market offices including but not limited to personnel and administrative oversight, creation and adherence to budgets and compliance with all policies and procedures.
REQUIREMENTS
Required Education & Experience

• Minimum of eight (8) years relevant clinical experience
• Minimum of 3 years supervisory experience required
• B.A. or B.S. in nursing or equivalent preferred
• Current Texas R.N. License
• Certification by CMSA preferred
• Minimum five (5) years of supervisory experience within a healthcare delivery setting is required
• Relevant experience in disease management preferred

Required Knowledge, Skills, and Abilities

• Managed Care experience preferred.
• Excellent interpersonal, verbal and written communication skills, be a good listener and have the ability to present views and ideas in a clear and concise manner.
• An existing network of relationships with local hospitals, physicians and other caregivers is desirable.
• Sound computer skills, including a thorough knowledge of Microsoft office.
• Strong team building and motivational skills.
• Strong background in the application of evidence based medicine.
• Preference given to Spanish/English bilingual candidates

We offer a comprehensive benefits package including health and dental benefits that begin on the 1st day of employment, a bonus pay program, company stock options, as well as an exciting entrepreneurial company environment.

Email word.doc resume to [Click here for email] in reference to position #2412.

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