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Award-winning: Sentara Healthcare is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering more than 500 sites of care including 12 hospitals, PACE (Elder Care), home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!
When you join Sentara in a professional or management role, you become part of a progressive team of business leaders and operational experts. Our organization and our people are highly respected for the knowledge and innovation that we demonstrate each day. Working with us is an opportunity to have a positive influence on our growth and the communities we serve.
Overview
Responsibilities
Qualifications
Overview
Virginia Premier, a division of Sentara Health Plan is currently seeking a Manager for Medicaid Product Performance. The Product Performance Medicaid Manager will have experience in data analytics and Managed Care. Specifically, they will analyze complex business problems and issues using data from internal and external sources to provide insight to decision makers. They would identify and interpret trends and patterns in datasets to locate drivers and influences.
Product Performance Medicaid Managers will construct forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Must be able to collaborate with internal business areas to modify or tailor existing analysis to meet specific needs. They may participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. The role will work with multiple types of business data, including claims, clinical, eligibility and financial.
Minimum Qualifications:
- Bachelor’s Degree or equivalent experience
- Master’s Degree preferred
- 5+ years in a managed care organization
- Medicaid experience preferred
- MS SQL Server experience required
Sentara Health Plan is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier.
Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans, and plans serving Medicare and Medicaid enrollees.
With more than 30 years’ experience in the insurance business and 20 years’ experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services – all to help our members improve their health.
Benefits: Sentara offers an attractive array of full-time benefits including Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B with matching funds, 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks, and more.
Along with competitive salary we also offer the following benefits:
Adoption, Infertility, and Surrogacy Reimbursement
Educational Assistance Programs, including Tuition Assistance
Emergency Back-Up Care
Financial Wellness Tools, including extra student debt payments on your student loans.
Medical, Dental, and Vision Benefits
Paid Annual Leave (PAL)
Paid Parental Leave
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
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Responsibilities
The Product Performance Medicaid Manager will have experience in data analytics and Managed Care. Specifically, they will analyze complex business problems and issues using data from internal and external sources to provide insight to decision makers. They would identify and interpret trends and patterns in datasets to locate drivers and influences. Product Performance Medicaid Managers will construct forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Must be able to collaborate with internal business areas to modify or tailor existing analysis to meet specific needs. They may participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. The role will work with multiple types of business data, including claims, clinical, eligibility and financial. Job Requirements Manage and mentor staff of analysts Collaborates with Finance, Analytics, Cost of Care and Clinical teams in support of the Director of Product Performance to ensure all products in Government Programs are performing at or above established financial and operational targets. The position leverages existing reporting and performs ad hoc analysis to provide visibility into emerging trends and areas of opportunity that need the attention of the business. Working with leadership to define and stratify analysis requirements enabling leadership to meet strategic goals and tactical objectives. Lead and/or support margin improvement initiatives by working with internal business areas and vendors to ensure identified opportunities are implemented Collaborate and lead discussion with business area leadership to ensure issues and high priority projects have accountable owners and satisfactory progress to ensure financial, operational and compliance performance objectives are met Candidates must also have experience with identifying potential problems or opportunities to avoid issues and maximize opportunities by understanding what reporting/data is needed to monitor performance of Government Programs to identify and engage appropriate business owners. Using knowledge of organizational informatics infrastructure, analytical tools, information systems, and other data stores to construct analytical models to support program evaluation, operational and clinical analyses, and reporting for responsible business units or organizations. Designing and implementing analytical solutions to improve processes, measure clinical quality goals, and meet regulatory reporting and analysis requirements. Manage dedicated production and support resources. Qualifications: Education Bachelor’s Degree or equivalent experience Master’s Degree preferred Experience 5+ years in a managed care organization Medicaid experience preferred MS SQL Server experience required
Qualifications
License/Certification
Education
- Master’s Level Degree
- Bachelor’s Level Degree
Experience
- Managed Care 5 years
- Medicare Previous Experience
Skills
Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.