Senior Product Specialist

Job Summary

Responsible for the development and management of the product suite. Will partner closely with the Director in identifying market opportunities and will take the lead on implementing new products ideas and variations. Responsibilities also include coordinating operational oversight of products, specifically related to CMS regulatory modifications. Upon research and assessment of CMS guidance, partner with appropriate matrix department to ensure action taken when required. Organize and maintain open lines of communication with internal and external customers to ensure that product information is up-to-date and accurate.

Essential Functions

• • Responsible for the management of product lines which includes, but not limited to:
  o Analysis of product positioning and pricing in the market
  o Knowledge of competitor products and pricing
  o Development of product strategies and oversight of tactics
  o Monitoring of business outcomes
  o Subject matter expertise on the products’ plan designs.
• • Maintains current knowledge of CMS requirements, plan benefits, and systems and procedures. Serves as resource to the organization related to this information.
  • Reviews regulatory changes to identify and analyze operational impact to the Medicare products then communicates this information to the appropriate staff/departments within the organization. Facilities timely implementation.
  • Identifies opportunities for improvement; accountable for implementing business/system changed required to support products. Assists with development of or revision to processes to improve quality, efficiency and cost effectiveness of the products.
• • Ensures completion of required data entry into the CMS system (HPMS) including, but not limited to, plan updates, bids and benefits in collaborate with the Technical Administrator.
  • In collaboration with the Director provides continuous support and information to facilitate and improve understanding, acceptance and integration of the Medicare products throughout the organization (i.e. oversight of Products Documentation Processes).
  • Assists with coordination of regulatory site visits.
• • Works with relevant staff to coordinate marketing activities to support the products.
  • Participates in and assists with coordination of special projects and activities as needed.
  • Manage the updates for prescription drug formulary.
• • Work closely with Priority Health pharmacists and pharmacy leadership to identify financial savings opportunities related to the Medicare formulary.
  • Maintain/manage relationship with PBM (Part D), ensure delegated PBM functions comply with CMS guidelines, and act as main point of contact around Medicare issues (participate in vendor calls, etc.).
  • Assure organizational readiness (Part D) prior to the start of each plan year.
• • Complete annual review of competitor prescription drug benefit design and for MAPD
  • Assist actuarial review.
  • Work with marketing and sales to develop integrated strategies
  • Assist with the seamless conversion process where applicable

Qualifications

Required

• Bachelor's Degree or equivalent in health care of business

• 5 years of relevant experience in managed care  
• Solid understanding of the senior market and Medicare regulations  
• Familiarity with state and federal regulatory and legislative processes
• Must be able to read and interpret complex statutes and regulations.  

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

#CorewellHealthCareers

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids

Department Name

Product Administration Medicare - PH Managed Benefits

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 a.m. to 5 p..m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.