Job Information

Providence Program Manager - Medicare / Medicaid (Remote: SW WA / OR) in Beaverton, Oregon


Providence is calling a Program Manager: Medicare / Medicaid who will:

  • Be responsible for directly overseeing Providence's Dual eligible special needs plan (D-SNP) and other Medicare / Medicaid arrangements

  • Have responsibility for overall coordination of the D-SNP Model of Care approval and execution, contract execution with the Oregon Health Authority and affiliated Medicaid plans

  • Be responsible for related implementation, development and submission of annual reports to the Oregon Health Authority and affiliated Medicaid plans

  • Serve as subject matter expert in consultation to key operational areas (e.g. sales, product, marketing, quality, compliance, health care services) on dual eligible requirements and strategies

We welcome 100% remote work for residents of SW Washington and Oregon.

Primary Responsibilities:

  • Monitors and takes action on key performance indicators (KPIs) for the Medicare / Medicaid program related to membership, financial performance, medical expense reporting, etc.

  • Collaborates with leaders in operational departments toward the development of performance metrics and the implementation of strategies to ensure effective and sustainable products and services

  • Monitors provider capacity to ensure appropriate access for PHA Medicare / Medicaid membership

  • Assists the Director in the development of agendas, work plans and presentations for various meetings and forums

  • Assists the Director in analyzing and responding to legislation and policy affecting the Medicare / Medicaid program

  • Fosters and maintains the relationship between PHA and DMAP/OHA/Health Share, ensuring positive working relationships

Required qualifications for this position include:

  • Bachelor's Degree in Healthcare Administration, Business, Public Administration, or a related field; obtained through an accredited institution

  • 3 years relevant experience in a leadership role within a health plan or comparable health care entity (Leadership Experience may be inclusive of: Leading teams and or Project management with the following elements - development, leading, follow-up / follow-through, and execution)

Preferred qualifications for this position include:

  • Medicaid and / or Medicare experience

  • Project management experience

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.

We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.

We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.

Requsition ID: 117412
Company: Providence Jobs
Job Category: Member Services Enrollment & Billing
Job Function: Health Plans Services
Schedule: Full time
Shift: Day
Career Track: Business Professional
Address: OR Beaverton 3601 SW Murray Blvd

Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.