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General Information

Req ID
New York
Work Type

Description and Requirements

The Program Manager oversees and manages vendor(s) who support risk adjustment and quality gap activities for Healthfirst. Act as primary point of contact for vendor(s) and also for Healthfirst personnel related to status of vendor programs and issues. Develop and maintain relevant relationships throughout Healthfirst and at vendor(s). This is a hybrid opportunity - work schedule consists of reporting to our office 3 days per week located at 100 Church Street, NYC.

Job Description

  • Effectively manage programs by setting clear milestones and deliverables, clearly communicating goals, objectives and responsibilities, keeping the programs focused in terms of deliverable management and meeting targeted time lines. Set and continually manage program expectations with team members and other stakeholders. Effectively communicate program expectations to Healthfirst and vendor stakeholders in a timely and clear fashion.
  • Act as primary point person for delegated vendor oversight activities. This includes managing regular QA processes related to communications sent on Healthfirst's behalf to member and providers, as well as facilitating scheduled or ad hoc audits done by Healthfirst or other external experts. Develop and maintain Healthfirst policies and procedures related to vendor oversight.
  • Develop and track measures showing vendor effectiveness and quality results. Share these results with the vendor and relevant Healthfirst stakeholders on a regular basis. Identify areas in need of improvement and work with stakeholders to propose solutions.
  • Assist in managing contract renewals or other contract negotiations. Support Legal, Finance, and relevant business areas to ensure a smooth negotiation and implementation process.
  • Assist in developing and managing the budget and product line allocations for vendor(s) on an annual basis. Assist in tracking expenses vs budget monthly.

Minimum Qualifications:

  • Must have a bachelor’s degree from an accredited institution.
  • Experience with Risk Adjustment Methodologies (CMS-HCC, HHS-HCC, CDPS, 3M CRG) or Value based healthcare methodologies.
  • Analytical work experience within the healthcare industry.  with competencies in SQL script development and expert proficiency in MS Excel (Pivot Tables, Advanced Formulas)
  • Able to present information to senior and executive leadership on the progress of activities related to risk score accuracy.
  • Accountable to executive sponsors for schedule, budget, and quality of all program elements
  • Able to provide project management for managing projects across multiple departments.

Preferred Qualifications:

  • Prior experience within the healthcare industry specifically supporting hospitals, vendor or payer networks is a plus.
  • Development Experience in Data Visualization Platforms (i.e. Tableau, Power BI).

Hiring Range*:

  • Greater New York City Area (NY, NJ, CT residents): $114,000 - $164,730

  • All Other Locations (within approved locations): $97,800 - $145,520

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.