Manager PACE Health Plans Ops

Inspire health. Serve with compassion. Be the difference.

Job Summary

Essential Functions

• Oversees the fiscal and health plan functions- including Prescription Drug Event Data, Risk Adjustment Processing, enrolments and claims processing for Prisma Health SeniorCare PACE with annual revenue exceeding $20 million.
• Provide human resource management at PACE Midlands and PACE Upstate by evaluating qualifications, implementing and monitoring staffing plans, providing orientation, in-service training and continuing education to assigned employees in the department in accordance with Prisma Health Human Resource policies and procedures for associates.
• Develops annual forecast including volumes, revenues, FTEs, salary, supply and other expenses in accordance with system profitability targets.
• Compiles data for extensive annual bid process to ensure proper payment from Medicare Part D services for over 300 participants.
• Maintains all vendor contracts for services provided outside of the PACE Center in both the Midlands and the Upstate to ensure proper service delivery for all participants as well as correct compensation to all vendors.
• Leads the CMS 1/3 financial audit by organizing collection and analysis of all required data as well as interfacing with CMS audit team to ensure smooth operation of CMS visit. Creates and implements corrective action plan for the PACE Midlands and PACE Upstate financial department for any issues identified during the audit.
• Responds to monthly financial variance report provided by corporate accounting and tracks trends in fiscal data month to month as well as year over year. Makes recommendations regarding any budget variances.
• Represents PACE Upstate and PACE Midlands at monthly financials meeting of Post-Acute Directors to present accurate financial information to the VP of Post-Acute Services for both affiliates.
• Assists with supporting revenue producing consulting activity on an on-going basis; has responsibility for supporting consulting clients in areas of Health Plan activities to include Pace finance/budgeting, Part D bid preparations, Part D compliance activities and claims processing.

Supervisory/Management Responsibilities

• Job has direct and/or indirect supervision of team members that may include final budget authority, hire/termination authority, performance appraisal responsibility and disciplinary authority. Job will be considered a member of management staff at Prisma Health Company or affiliate and will have direct reports.

Minimum Requirements

• Education - Bachelor's Degree in Finance, Accounting, Business or Healthcare Management preferred
• Experience - 5 years - Management/Leadership experience in health care setting

In Lieu Of

• NA
  

Required Certifications, Registrations, Licenses

• NA
  

Knowledge, Skills and Abilities

• Strong understanding of Medicare/Medicaid - Preferred
• Strong understanding of Microsoft Excel - Preferred
• Experience working in a health care organization or health plan
• Basic computer skills
• Knowledge of office equipment (fax/copier)
• Proficient computer skills (word processing, spreadsheets, database)
• Data entry
• Mathematical skills

Work Shift

Location

Facility

Department

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.