PROGRAM MANAGER - SELF-FUNDED HEALTH PLANS (UC HEALTH)
Location: Oakland Job ID: 18442
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UC OFFICE OF THE PRESIDENT
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The University is one of California's largest employers with almost 220,000 faculty and staff. UC Health's self-funded health plans play a significant role in helping the University retain funds spent on health insurance premiums by both the employer (UC) and employees within its own system. In 2014, the University of California launched UC Care, a self- insured PPO health plan. In 2020, UC Care spent only 5% of each premium dollar on administration compared with 15%-20% spent by commercial health plans. This plan provides medical and pharmacy benefits to UC employees, non-Medicare retirees and their families. UC Health is responsible for the administration of the plan. UC Health is responsible for two high-deductible and three additional Medicare plans that will be self-insured for employees. Total membership in all these plans is approximately 89,000.
There is also a flex-funded employee HMO plan with an enrollment of 120,000 that has an ACO relationship with the UC medical centers. UC Health provides administrative oversight, financial management, population health management and strategic thinking for this plan.
UC Health also manages the UC Residents Benefits program for approximately 10,000 members. Benefits includes two self-funded health plans, dental, vision, life, disability and flexible spending account plan.
This position is responsible for the daily administrative management and vendor relations of the UC self-funded PPO and flex-funded HMO health insurance plans, offered each year to UC employees, retirees, non-Medicare retirees, and their families. Serves as a system-wide subject matter expert of the self-funded plans, administering policies and overseeing the resolution of issues with a full understanding of practices and internal and external policies and procedures. Provides guidance in administering the system-wide organization's benefits programs regarding plan options, policy features, enrollment and other requirements. Problems/issues addressed are of a complex and diverse scope with little or no precedent, where management of issues or data requires in-depth evaluation of variable factors. Collaborates with colleagues from disparate disciplines and external business partners in a complex organizational structure. Having wide-ranging experience, this subject-matter expert is creative and effective in using professional concepts and divisional program objectives to resolve complex issues with system-wide impact. Works on complex issues with little or no precedent where analysis of situations or data requires an in-depth evaluation of variable factors. Exercises judgment in selecting methods, techniques and evaluation criteria for obtaining results. As subject matter expert this person, represents unit/management positions to faculty, unions and other interested constituents. Internal and external contacts often pertain to system wide goals, plans and objectives. Erroneous decisions could have a serious financial and legal impact on the overall success of the program.
Having wide-ranging experience, uses professional concepts and program objectives to resolve complex issues with system-wide impact in creative and effective ways. Works on complex issues with little or no precedent where analysis of situations or data requires an in-depth evaluation of variable factors. Exercises judgment in selecting methods, techniques and evaluation criteria for obtaining results. Is considered a subject matter expert and represents unit/management position to faculty, unions and other interested constituents. Internal and external contacts often pertain to system wide plans and objectives. Erroneous decisions will have a serious impact on the overall success of department.
Oversee daily operations of employee self- funded health plans with over 85,000 members, generating over $500 million in claims each year.
Subject matter expert for self-funded plans with local benefit offices and staff across the 10 academic campuses, five medical centers and three national labs regarding day-to-day plan operations, implementation/operational/ administrative issues, benefit interpretation/ application, and high-level customer service concerns; triage issues and consult Director as needed for resolution.
Formulates, builds and establishes objectives and strategic plans with other high level managers to proactively address key program and legislative issues.
Acts as a key team member in the strategic planning process.
Primary point of contact responsible for the daily financial operations and controls for the self-funded plans to ensure program solvency.
Creates timely and accurate reporting systems for executive management. Provides financial analyses and verifies report data to internal and external constituents and stakeholders on a regular basis.
Responsible for stop loss reinsurance claims and policies including filing reinsurance claims recoveries in a timely manner.
Excellent interpersonal skills to effectively lead, motivate and influence others and develop and maintain high standards of customer service.
Creates and ensures timely and accurate reporting to executive management, including the EVP of UC Health and appropriate committees, including the Health Care Task Force (made up of faculty, union representatives, other staff employees).
Identifies and prioritizes key business issues and actively takes initiative on delivering impact and solutions related to plan design and administration.
Ensures that the program tracks to set resources/budget, scope, and timeline and holds others accountable by elevating issues to appropriate divisional leadership.
Employs strategic and analytical thinking, strong capability of project management and problem solving skills, sound judgment and a willingness to resolve issues and problems in a timely manner impacting overall plan efficiency, member experience and plan financials.
Leads the development and maintenance of the provider networks by ensuring adequate network area coverage and identifying provider gaps.
Directs the work of consultants and vendors to determine financial impact and secure appropriate discounts as needed for participation.
Liaison with the UC Medical Centers Managed Care Directors regarding new UCMC affiliates, rate loading, provider changes, and resolution of plan administrator issues.
Responsible for the content maintenance of the plans' micro websites
Leads development and ongoing maintenance of the self-funded plan Program Manual, including program description, goals, all pertinent plan documentation (SPDs/EOCs, Group Applications, banking documents, job descriptions, policies & procedures, etc.).
Vendor Relations Management:
Excellent collaboration and relationship management skills, including influencing without authority, collaborating with senior leaders, facilitation, and working as part of a global team related to periodic system-wide multivendor implementation and transition projects as well as ongoing daily operations.
Manage activities to ensure new programs and plan changes, as well as new and changing state and federal law/regulations, are correctly implemented by vendors.
Highly sophisticated ability to apply and leverage plan design thinking and customer experience strategies to improve effectiveness and transform insights into actionable value-added initiatives, affecting over 45,000 members.
Serve as management interface between UC Office of the President and assigned third party vendors, monitoring vendor performance and communicating with assigned vendors to ensure delivery of efficient and effective service and compliance with contract agreements impacting the 45,000 plan members. Identify pertinent issues and contribute to formulation of system wide policy to support effective contract administration.
Proven expertise and prior experience in new vendor implementation.
Demonstrates ability to identify and efficiently lead cross-functional work groups to equitable resolution.
Highly sophisticated skills in strategy development, benefits program design, systems planning and vendor management
Bachelor's degree in Business Administration, Public Health Administration, Human Resources, Educational Administration, or an allied field.
Ten years of experience managing the implementation and administration of health benefit programs, preferably self-funded plans.
In place of the above requirements, the incumbent may possess any combination of relevant education and experience which would demonstrate the individual's knowledge, skill, and ability to perform the essential duties and responsibilities listed above.
Principles and procedures of fully-insured and self-insured/self-funded health plan administration.Requires interpersonal, service oriented, active listening and critical thinking skills.
Principles and practices required to develop, implement, and evaluate health and welfare benefit programs.Windows and the Microsoft Office suite including word-processing, spreadsheet applications, project management and database programs.
Use original thinking and independent judgment to develop solutions reflecting the legal, policy, and operational needs of the organization. Apply initiative, resourcefulness and creativity in problem-solving.
Apply political acumen to intricate situations occurring in a complex, decentralized organizational structure. Able to establish and maintain trust, confidence, and effective working relationships with colleagues and individuals of diverse occupational and social backgrounds.
Work independently, following through on assignments with minimal supervision and balancing multiple projects simultaneously with demanding timeframes
Organize, coordinate and complete projects effectively and within deadlines, while upholding a penchant for detail and a commitment to accuracy
Principles and processes of project management. Strong organizational skills with demonstrated ability to manage multiple projects and meet deadlines
Ability to lead and pursue projects independently while exercising good judgment and exhibiting a considerable degree of creativity
Highly developed verbal and written communications skills. Concise/precise messaging and executive level presentation material design skills are critical
Excellent ability to quickly evaluate complex issues and identify multiple options for resolution
Strong negotiation, persuasion, and political acumen skills
Experience working in an academic institution desired. Experience working directly in or with health care institutions a plus.Current literature, trends, and developments in the field of benefit program administration.Legal regulations applicable to employee health insurance programs (FERPA, HIPAA, PPACA, etc.).
Must be able to communicate complex information to management in a clear and concise manner, verbally and in writing.
Must be skilled in use of Microsoft Office and common desktop / web applications.
Advanced problem avoidance, recognition and resolution skills.
Strong knowledge of the University environment including its infrastructure, goals, objectives, achievements, rules, regulations and policies.
Strong knowledge of health care delivery and related economics as well as basic working knowledge of clinical issues and practices.
Bachelor's degree in Business Administration, Public Health Administration, Human Resources, Educational Administration, or an allied field.
SALARY AND BENEFITS
Salary: Salary commensurate with experience.
Benefits: For information on the comprehensive benefits package offered by the University visit: Benefits of Belonging
HOW TO APPLY
Please be prepared to attach a cover letter and resume with your application.
APPLICATION REVIEW DATE
The first review date for this job is June 3, 2021. The position will be open until filled.
Smoke Free Work Environment: The University of California, Office of the President, is smoke & tobacco-free as of January 1, 2014. UC Smoke & Tobacco Free Policy
The University of California, Office of the President, is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status. EEO/AA Employer UC Nondiscrimination Policy
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About University of California Office of the President
The Office of the President is the systemwide headquarters of the University of California, managing its fiscal and business operations and supporting the academic and research missions across its campuses, labs and medical centers.