Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Medicaid Growth, Retention & FQHC Strategy, Manager

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Manager & Professional
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191CU Requisition #
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Work with key stakeholders (Sales, Marketing, Network, etc.) to develop, implement, and manage a comprehensive growth strategy for all State Sponsored Programs, ensuring that growth targets are met.  Understand the community and market forces that drive growth.  Participate in development of, and revise, strategies as necessary when required to meet growth targets.  Identify strategic partners to facilitate growth including Federally Qualified Health Centers (FQHC), provider groups, and community-based organizations.  Design, develop, and implement strategic FQHC position as a pillar of Medicaid growth/expansion.  Report on program metrics, collecting all data needed.

Responsibilities:
  • Work with Sales, Marketing, Network and other key stake-holders to identify strategic growth partners that can include provider groups, IPAs, FQHCs, and community-based organizations.
  • Lead meetings with potential growth partners; identify and document growth strategies; develop targets related to each strategy; work with internal partners to ensure proper implementation of agreed-upon strategies.
  • Work with strategic partners to get agreement to place sales team onsite; ensure that agreements are implemented. 
  • Monitor and ensure that growth targets are achieved from each strategy, and that strategies are revised as needed to achieve growth. 
  • Work with data, providers, and internal stakeholders to analyze and determine root causes for dis-enrollments. 
  • Identify strategies to reduce dis-enrollments and improve member retention. 
  • Work with internal stakeholders to implement and monitor strategies to ensure results are achieved. 
  • Revise strategies as required to optimize results. 
  • Work with provider groups and strategic partners to improve member retention at their practices. 
  • Design and maintains FQHC provider matrix (provider profile, footprint, aligned PCPs/specialists, lives, etc.).
  • Develop individual FQHC-specific value propositions and growth targets for internal and FQHC partner communication.
  • Lead meetings with FQHCs to discuss value propositions and contracting, in collaboration with the network team. 
  • Collaborate with Medical Economics and Reporting and Analytics to determine FQHC rates for plan strategy.
  • Ensure growth targets are met.
  • Support innovations that incorporate FQHCs into overall VBP strategy.
  • Develop and implement programs in collaboration with Neighborhood Cares and other internal stakeholders to increase community engagement and drive growth. 
Qualifications:
  • Bachelor’s Degree in healthcare, business, finance, mathematics, applied stats/economic, or related analytical fields 
  • Master’s preferred
  • Project Management Certification preferred
  • Minimum 5-8 years’ experience in the healthcare or managed care industry, or related field required
  • Experience with and knowledge of Medicaid Managed Care, VBP/NYS VBP Roadmap, DSRIP, HEDIS/QARR quality measures, contracting processes and payment methodologies required
  • Highly proficient in analyzing data and using metrics/analytics; ability to interpret data and present findings required
  • Ability to effectively communicate (verbal, written, presentation) with all types and levels of audiences required
  • Proficient in Microsoft Office (Word, PowerPoint, Excel, Access) required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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