Health Plan Manager
Jordan Valley Health (JVH) is a mission-driven organization dedicated to improving the health of individuals and families in underserved communities. We provide comprehensive healthcare services including primary medical, dental, vision, and behavioral health. Our mission is simple: Improve our community's health through access and relationships. By working collaboratively with partners and continually innovating, JVH strives to be a leader in providing essential healthcare for the underserved, ensuring everyone in our community has access to quality healthcare.
The Health Plan Manager is responsible for the comprehensive oversight and management of all health plan operations within Jordan Valley Senior Care (PACE). This position serves as the primary point of accountability for Medicare Part D oversight, financial performance, claims adjudication and processing, and regulatory contracting compliance. The Health Plan Manager ensures that Jordan Valley Senior Care operates in full compliance with applicable federal and state regulations while achieving financial and operational excellence in service delivery to enrolled participants. The Health Plan Manager frequently collaborates with the Finance and Compliance departments. The Health Plan Manager receives final direction and oversight from the Executive Director.
Key Responsibilities
- Medicare Part D Pharmacy Benefit Oversight
- Financial Management & Plan Performance
- Claims Administration & Adjudication
- Contracting & Network Management
- Regulatory Compliance & CMS Oversight
- Quality Improvement & Reporting
- Leadership & Staff Management
Benefits Overview:
- Medical and Prescription Drug Coverage
- Health Savings Account (HSA)
- Flexible Spending Account (FSA)
- Dental and Vision Coverage
- Retirement Plan
- Life and Disability Insurance
- Employee Assistance Program (EAP)
- Additional Voluntary Benefits
Nine paid holidays per year.
All employees are required to provide proof of vaccination for Flu, Hepatitis B and Tuberculosis (TB) as part of our commitment to maintaining a safe and healthy workplace.
Interested applicants should submit a resume and cover letter through the JVH career portal at Careers & Education - Jordan Valley. Applications will be accepted on a rolling basis until the position is filled.
Jordan Valley Health is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.
Required Qualifications:
- Bachelor's degree in health administration, business administration, public health, or nursing preferred, or equivalent work experience required
- Minimum of 1-2 years of progressive experience in health plan operations
- Two years in a supervisory or management capacity
- Direct experience with Medicare Advantage, Medicare Part D, Medicaid managed care, or PACE programs required
- Demonstrated experience in health plan contracting, claims operations, or regulatory compliance
- Two years work experience in accounting/finance.
- Either one year of experience working with a frail or elderly population or, in the absence of such experience, receive appropriate training from the JVSC on working with a frail or elderly population upon hire.
- BLS Certification required within 90 days of hire
Preferred Qualifications:
- Master's degree preferred