Senior Product Specialist

Corewell Health • $80K — $110K *
Grand Rapids, MI 49504In-Person
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's Degree or equivalent in health care or 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
  • Ability to read and interpret complex statutes and regulations.

Responsibilities

  • Develop and manage product lines, focusing on analysis of pricing and market positioning.
  • Stay current with CMS requirements and serve as an organizational resource.
  • Identify operational impacts of regulatory changes and facilitate timely implementations.
  • Manage data entry into the CMS system and coordinate updates with the Technical Administrator.
  • Support marketing activities and coordinate regulatory site visits for product compliance.
  • Identify financial savings opportunities with Priority Health pharmacists for the Medicare formulary.
  • Conduct annual reviews of competitor drug benefit design for integrated strategy development.

Benefits

  • Full-time hours with Monday to Friday schedule from 8 a.m. to 5 p.m.
  • Work in a collaborative environment with clear operational oversight.
  • Opportunities for involvement in shaping product direction and strategy.
  • Engagement with regulatory bodies and industry trends for professional growth.
Full Job Description
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.


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

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About Corewell Health

Corewell Health Careers

Joining Corewell Health presents an unparalleled opportunity to become part of a leading team of healthcare professionals dedicated to excellence. Corewell Health is renowned for its commitment to innovation, leadership, and providing superior healthcare services.

Explore Job Opportunities

Corewell Health is actively seeking talented individuals who are eager to contribute to a dynamic healthcare environment. The company offers a variety of job opportunities that cater to a range of skills and experiences. Whether you're a seasoned professional or a recent graduate, Corewell Health has a position that could be the perfect fit for your career ambitions.

Internship Programs

For those just starting their professional journey, Corewell Health provides robust internship programs designed to foster skills development and offer real-world experience in the healthcare industry. Internships at Corewell Health are a stepping stone to full-time employment and offer invaluable networking opportunities within the healthcare sector.

Growth and Development

Career growth is a cornerstone of employment at Corewell Health. The company supports its team members' professional development through comprehensive training programs, including leadership training and diversity training. These initiatives ensure that every team member has the tools and knowledge necessary to excel in their roles and advance within the company.

Benefits and Culture

Corewell Health is committed to creating a workplace culture that values diversity and inclusion. Employees enjoy a competitive package of benefits that supports both their professional and personal lives. The company's culture promotes teamwork and respect, making it an ideal environment for those who value collaboration and innovation.

Hiring Process

The hiring process at Corewell Health is designed to be transparent and efficient. Candidates are encouraged to submit a resume and may be invited for an interview to discuss their qualifications and career goals in more detail. Corewell Health values a thorough approach to ensure that all potential team members align with the company’s values and vision for the future.

Networking and Professional Development

Corewell Health believes in the power of networking and encourages its employees to engage with one another and the broader healthcare community. This engagement fosters a sense of community and collaboration, which is critical in the fast-paced world of healthcare.

Join the Team

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Learn more about Corewell Health
Industry
Hospitals & Medical Centers
* Ladders Estimates

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