Program Manager

nashville, Tennessee

Our client is seeking a Program Manager to join their team in Nashville, TN.

Client is requiring greater Medicare-Medicaid integration, which for stand-alone plans means having a contract with each state in which sharing requirements are specified by the respective state as it pertains to hospital and Skilled Nursing Facility (SNF) admissions as well as other state-interpreted integration requirements.

Such integration will have three components:

  1. Indication as to how the Client must share certain admission and discharge data.
  2. Requirements about how to assist Client members with obtaining Medicaid services and, when Medicaid denies or limits the requested services, the plan must offer to assist members with filing an appeal or grievance of Medicaid’s determination.
  3. Heightened care coordination requirements and FDR data sharing.

Each state is interpreting their own needs of this integration along with the DSNP requirements for facilitation of those needs. As it pertains to DSNP plans, that means Client expects to receive 12 different sets of requirements that are similar, but have individual specifics all with compliance requirements.

Qualifications

  • Program Manager or Large Project experience
  • Medicare Advantage, Medicare/Medicaid experience
  • Prefer 10+ years PM experience
  • Prefer PMP – not a hard requirement
  • Healthcare experience preferred
  • Budget Management experience
  • Executive level exposure
  • Prefer someone who has performed in a Structured Program Mgmt Office (PMO)

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