Job Description

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

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Job Summary: The Prominence Product Development Director plays a pivotal role in the development, organization, and facilitation of Prominence Health Plan's commercial and Medicare Advantage products, system and infrastructure improvements, and vendor selection and implementation. Reporting directly to the Chief Development Officer, the Product Development Director will provide essential support to the organizational business teams in the development, implementation, and compliance of new and renewing commercial and Medicare clients, products, and vendors. Your responsibilities encompass three core components of the job:

• Program Delivery

• Bid and AEP Project Management

• Product Development

• Strategic Product Design
• Product Insights and Market Intelligence

• CMS/Regulatory Programming

• SNP Programming
• Regulatory Submissions

Specifically, the role includes:

• Business ownership, leadership, oversight, development, management, implementation, and coordination of all operational elements of Prominence Health Plan's Dual-eligible Special Needs Plan (D-SNP) Model of Care (MOC).
• Responsible for product design, development of growth goals, and maintaining financial performance.
• Ensuring that the D-SNP MOC Program meets or exceeds regulatory and accreditation requirements for the Centers for Medicare and Medicaid Services (CMS), state Medicaid offices (as relevant), and NCQA.
• Developing opportunities to drive Star ratings performance and ensure a positive member experience.  

About Universal Health Services:

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Regulatory Requirements:

• Experience with NCQA or other health plan accreditation standards, State and Federal laws, regulations, policies and practices for the administration of a Medicare Advantage special needs plan.

Education:

• Bachelor's degree in healthcare administration, business, nursing, behavioral health, or a related field.
• Master’s degree in nursing, business management, or healthcare administration preferred.
• Relevant experience may be substituted for educational requirements for exceptional candidates.

Experience:

• Minimum ten (10) years’ experience in health insurance or health care.
• Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes.
• Proven record of accomplishment managing complex projects and or programs that resulted in cost savings.
• Minimum five (5) years’ demonstrated successful experience in accreditation, performance improvement, compliance, administrative, product development, project management, regulatory compliance, and/or operational duties in health care, preferably in a management role in a managed care organization.
• Minimum three years’ (3) experience with special needs plan (I/C/D), CMS bid process, commercial health plan offerings, case and/or utilization management, and/or a Medicaid managed care program that includes dual-eligibles.
• Preferred experience includes working with external healthcare providers and health systems, managing large budgets, project management, and demonstrated negotiation skills.

Language Skills:

• Ability to expertly communicate in English, both verbally and in writing , bi-lingual in English and Spanish desired.

Knowledge, Skills and Abilities :

• Proficiency in gathering and interpreting empirical evidence, formulating recommendations, action plans and interventions to improve th e overall organization strategy.

• Simultaneous action at varying stages—initiation, follow through, and completion—on a number of different projects.

• Demonstrated ability to research, analyze and interpret state/federal regulations related to health insurance and healthcare.

• Demonstrated ability to communicate verbally and with technical writing in a way that effectively conveys project background, objectives, activities, evaluations, conclusions, and recommendations.

• Demonstrated skills in critical thinking, problem solving, and the analysis, interpretation and ev aluation of complex information.

• Demonstrated ability to work independently with minimal supervision.

• Demonstrated ability to maintain effective collaborative wo rking relationships with staff.

• Resourceful, detail-oriented, and able to assimilate and analyze a wide variety of information, often working under deadline pressure with a variety of levels of staff. 

• S trong project management skills.

• Computer Skills: Smartsheet, SharePoint , Microsoft Office (Word, Excel, PowerPoint), and database software.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS

and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

If you would like to learn more about the opportunity, please contact Bridget Gomez at: [email protected]

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