Program Manager - Priority Partners Managed Care Organization (PPMCO)

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The Priority Partners Managed Care Organization (PPMCO) Program Manager's responsibility includes supporting oversight of PPMCO contractual agreement for the Health Choice Program which includes managing the required reporting requirements, supporting operations and other vendor relations functions. Works with the Sr. Director of Priority Partners Administration to ensure that all transmittals and fee schedules are configured and implemented by internal and external supported functions including but not limited to Enrollments, Claims, Customer Service, UM, Appeals, Complaints& Grievances, Provider Relations, and UM. Primary contact for MDH inquiries and requests. Maintains PPMCO internal SharePoint site. Also ensures PPMCO maintains the highest possible standards of quality and operational compliance in line with JHHP's business direction, regulatory and COMAR. The role provides critical support for enhanced benefits vendors ensuring they meet operations performance expectations per the contract.

REQUIREMENTS:

EDUCATION:

Bachelor's degree required, with a concentration in Business Management preferred. Master's Degree in a related field is a plus.

KNOWLEDGE:

Work requires the ability to work in a rapidly changing managed care environment while maintaining MDH and COMAR requirements. Must be familiar with managed care products, operations, delivery systems, process improvement, organizational development and assessing customer expectations. Knowledge of COMAR, HealthChoice Program desired.

Work requires excellent writing and verbal communication skills and excellent analytical skills. Work requires excellent leadership, teamwork, interpersonal, influence and communication skills to allow incumbent to interact effectively with all levels of personnel and external contacts; demonstrated ability to persuade, communicate clearly, and cooperate with other managerial staff to achieve overall organizational objectives. Ability to work independently with direction from the supervisor and work within aggressive time frames; manage multiple projects simultaneously. Work with multi-disciplinary teams.