Special Needs Plan (SNP) Program Manager

Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

Medica's Special Needs Plan (SNP) Program Manager is responsible for providing a high level of program management and product-specific expertise to ensure program and product performance, quality, regulatory adherence, and Centers for Medicare & Medicaid Services (CMS) audit readiness.

Our Program Manager carefully monitors performance and compliance with CMS regulatory requirements and Medica's approved Models of Care (MOCs). Leads projects for implementation of program enhancements as well as changes based on regulatory updates. Performs other duties as assigned.

Key Accountabilities

• Assist with maintenance and submission of Medica's SNP MOCs
• Ongoing monitoring and oversight of SNP MOC implementation, including performance evaluation based on key metrics
• Develop and conduct training for internal teams, external delegates, and providers participating in Medica's SNPs
• Prepare for and coordinate responses to audit requests
• Perform audits of care coordination activities to ensure compliance with CMS and State requirements
• Analyze and translate regulatory requirements into operational processes and monitor implementation and ongoing operational compliance

Required Qualifications

• Bachelor's degree or equivalent experience in related field
• 5+ years of related work experience beyond degree

Preferred Qualifications

• 2+ years care coordination experience
• Experience with Government Programs (Medicare, Medicaid, SNP)
• Ability to interpret and operationalize regulatory or accreditation requirements
• Strong program and project management skills
• Experience developing training resources and delivering presentations
• Experience working with external regulators and managing audit requests
• Clinical experience as an RN, LPN, or social worker (LSW or equivalent) preferred
• Ability to work independently and make decisions with minimal supervision
• Detail-oriented and solution-focused
• Proficiency in Microsoft Word, PowerPoint, and Excel
• Strong analytical skills with the ability to synthesize information and recommend actions
• Excellent collaboration and influencing skills to drive contributions from non-direct reports
• Exceptional written and verbal communication skills for internal and external stakeholders
• Experience with regulatory reporting

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI.

The full salary grade for this position is $88,800 - $152,300. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $88,800 - $133,245. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.