This job was posted by https://illinoisjoblink.illinois.gov : For more information, please see: https://illinoisjoblink.illinois.gov/jobs/11948880

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, clickhere{target="" _blank\"\"=""}.

Job Summary

The Program Manager II is responsible for projects and initiatives with significant cross-functional interface that support assigned programs. Responsibilities include managing major departmental programs with significant cross functional interface with moderate complexity, risk and/or cost. Responsibility may include development of new programs as well as management of ongoing programs. Changes to programs require some negotiation and change management skills to implement. By using knowledge of the company, the Program Manager II should be able to resolve most roadblocks to ensure success and progress. The Program Manager II should make recommendations for change by performing cost/benefit analysis and by using basic analytical and problem-solving capabilities to support the recommendation. Will also directly interact with Point32Health leadership.

Key Responsibilities/Duties what you will be doing

• Manage ongoing Care Management (CM) and Utilization Management (UM) Oversight Program operations. This may include:

  • Monitoring all relevant UM and/or Member Appeals and Grievances internal plan documents, processes, and systems against CMS Medicare, State contract, and State Medicaid Agency compliance requirements.

  • Developing and maintaining the appropriate auditing, monitoring, and tracking tools.

  • Performing auditing and monitoring of internal UM and/or Member Appeals and Grievances files.

  • Analyzing audit results and collaborating with partnering business areas to identify and prioritize opportunities for improvement and implement action plans that meet Medicare and Medicaid program and health plan objectives.

  • Compensation & Total Rewards Overview

    As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company\'s sole discretion and may be modified at the Companys sole discretion, consistent with the law.

    Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

    • Medical, dental and vision coverage

    • Retirement plans

    • Paid time off

    • Employer-paid life and disability insurance with additional buy-up coverage options

    • Tuition program

    • Well-being benefits

    • Full suite of benefits to support career development, individual & family health, and financial health

    For more details on our total rewards programs, visithttps://www.point32health.org/careers/benefits/{target="" _blank\"\"=""}

    * ommitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity*

    ?Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we dofrom product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team\'s strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.