Health Economics Program Manager - PCHP

Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family. PCHP is a Medicaid Managed Care Organization servicing Texas Medicaid and CHIP in the Dallas Service Area. PCHP works to fulfill of our mission by empowering members to live healthier lives. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day.

Primary Purpose

Parkland Community Health Plan's (PCHP's) Health Economics Program Manager monitors cost trends, identifies performance improvement opportunities and develops strategies to support value-based care contracting initiatives across PCHP's health plan networks. Develops contract pricing models, contract performance models, key performance indicators/metrics and other ad hoc analyses to support continuous network development and performance improvement.

Minimum Specifications

Education

• Bachelor's degree in Business Administration, Healthcare Administration, Healthcare Analytics, Finance, Statistics or a related field.
• Master's degree in a related field is preferred.

Experience

• Four (4) years of experience in a health plan or Medicaid Managed Care Organization.
• Two (2) years of experience in medical/health economics, and network decision support.
• Experience with value based/accountable care data analytics is preferred.

Equivalent Education and/or Experience

• May have an equivalent combination of education and experience to substitute for both the education and the experience requirements
• Certification/Registration/Licensure
• Six Sigma or Project Management certification is preferred.
• Required Tests for Placement

Skills or Special Abilities

• Knowledge of managed care contracts and principles and concepts of statistical analysis.
• Must have demonstrated skill in complex modeling, pro forma, projections and metric reporting.
• Must have demonstrated ability to support and develop performance improvement strategies.
• Excellent verbal and written communication skills including the ability to influence, negotiate and interact effectively with a range of business stakeholders
• Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization.
• Excellent analytical and problem-solving skills.
• Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities.
• Ability to write clearly and succinctly with a high level of attention to detail.
• Proficient computer and Microsoft Office skills.
• Ability to learn new software programs.
• Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual is preferred.

Responsibilities

Operational Support

• Develops standardized and ad-hoc models to support contract pricing and contract and network performance.
• Develops actionable data driven recommendations and supports the strategic decision-making process.
• Prepares, supports, and presents materials for the contract negotiation process.
• Supports and facilitates health plan budgeting, forecasting and cost-containment initiatives.
• Supports and facilitates new product and new network development initiatives.

Reporting and Analysis

• Develops and maintains the library of management information reports to support Network Development and Provider Relations.
• Monitors cost trends.

Quality and Performance Improvement

• Identifies performance improvement opportunities and facilitates initiates, both internally and externally.
• Creates and implements performance improvement initiatives for PCHP.
• Develops and maintains key performance indicators and performance measurement reports.
• Integrate health literacy principles into all communication including Members and Providers.
• Support strategies that meet clinical, quality and network improvement goals.
• Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed.
• For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination.

Regulatory

• Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements.

Professional Accountability

• Promotes and supports a culturally welcoming and inclusive work environment.
• Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
• Adheres to organizational policies, procedures, and guidelines.
• Completes assigned training, self-appraisal, and annual health requirements timely.
• Adheres to hybrid work schedule requirements.
• Attends required meetings and town halls.
• Recognizes and communicates ethical and legal concerns through the established channels of communication.
• Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
• Maintains confidentiality at all times.
• Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies.

Job Accountabilities

1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Community Health Plan (PCHP) prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.