Skip Navigation

Search Jobs

Search Jobs

Compliance / Privacy / Regulatory Jobs

QHP Recertification and Exchange Program Manager

Location: Portland, Oregon;

Job ID : 3686745


Accountable for managing the planning, sequencing and execution of tasks and timelines for Qualified Health Plan (QHP) recertification and binder submissions for the Individual and Small Group lines of business. Understand and drive the coordination of tasks and timelines among multiple departments and national stakeholders to achieve regulatory and insurance marketplace requirements. Work effectively with senior leaders, departmental leaders and individual contributors to communicate and understand deliverables, dependencies and interdependencies to identify gaps or conflicts in the plan. Facilitate and consult with stakeholders to assist in the resolution of scheduling conflicts or disagreements about deliverables. Direct work of Regulatory QHP Coordinator(s) to successfully meet annual filing requirements for each product line, including medical and dental lines of business. Accountable for understanding state and federal requirements and ensuring our plans and deliverables meet ACA/QHP requirements. Coordinate with Program Office stakeholders (HP-REO and Legal) to ensure our region meets federal requirements and integrates national business requirements and milestones for deliverables. Provide project plan management and reporting to inform both regional and national leaders on our region's progress in achieving QHP recertification, delinquency responses and filing deadlines for Oregon and Washington jurisdictions. Resolves varied and complex issues involving departments throughout MSBD, HPOS, Permanente and National Shared Services. Identify and consult to mitigate risks that could disrupt the plan and schedule. Serves as the primary point of contact for both Oregon Health Insurance Marketplace (ORHIM) and the Washington Benefit Health Exchange (WAHBE). Supports national and regional strategy by engaging and advocating the exchanges. Coordinates completion and communication around regional exchange contract requirements. Partners with state, federal and program office entities on monitoring and implementing health care reform changes within the region.

Essential Responsibilities:
- Manages and participates in the completion and submission of the annual QHP binder filings within the region. Coordinates and aggregates required data and non-core templates among regional partners. Schedules and gathers resources for annual QA process related to binder submissions. Develops annual timelines and collaborates with the ProMAT Manager to ensure alignment with the broader product to market schedule. Tracks and assists in developing responses for state and federal delinquencies and objections related to binder filings.Partners with regional and national stakeholders on developing required justifications (network adequacy, ECP, service areas etc.). Facilitates the completion and submission of the QHP recertification process.
- Single point of contact for state exchange relationship (including production and advocacy). Participates in state exchange advisory activities and works with Government Relations, NW Regulatory and HP-Regulatory & Exchange Operations to build annual advocacy plans. Partners with MSBD leaders on developing strategies to grow exchange membership. Supports the development of exchange related marketing materials.
- Leads and organizes work groups and projects for major changes related to health care reform. Partners with Government Relations and HP-REO on monitoring federal legislation and rules which impact ACA requirements. Acts as the Health Care Reform business lead.

Qualifications: Basic Qualifications:
- Minimum three (3) years of Program or project management or experiencing developing and/or leading large-scale initiatives
- Minimum six (6) years of experience in health care, business administration, training, sales, consulting, or related field
- Master's degree or six (6) years of experience in healthcare, business administration, training, sales, consulting or a related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A

Additional Requirements:
- Influence & Negotiation skills - ability to negotiate timelines and agreements and to influence others to achieve an outcome
- Collaboration skills - ability to collaborate with various stakeholders to reach group/team agreements
- Gather business requirements, dependencies, workflow durations and priorities and translate to deliverables, plans and schedules
- Ability to effectively deploy and organize resources, develop timetables and targets and check progress against them.
- Ability to create a clear, logical and realistic plan of activities
- Demonstrated ability to collaborate with multiple stakeholders to reach consensus on outcomes, deliverables or other agreements
- Demonstrated ability to translate customer requirements into process deliverables
- Demonstrated ability to manage multiple tasks and timelines to achieve a targeted outcome
- Demonstrated ability to collaborate with process 'owners', managers and other leaders to achieve a business outcome
- Excellent writing and communication skills, ability to communicate fluently with all executive levels
- Strong problem solving ability; ability to sort through issues, interests and requirements in order to develop options for solutions, and to work with stakeholders to identify the best solution for achieving customer and organizational requirements

Preferred Qualifications:
- Minimum two (2) years of experience implementing a large-scale project, product or program through multiple functional areas
- Minimum one (1) year of experience in a KPNW Account Management role or Product Implementation Role
- Minimum five (5) years of experience related to sales, development or support of insurance products
- Expertise and/or Exposure to small group and individual lines of business
- Knowledge of our small and individual product lines for both dental and medical products
- Strong understanding of our products, benefits and our sales/renewal cycles
- Thorough knowledge QHP and broader ACA (Affordable Care Act) requirements
- Knowledge of KPNW marketplace

Primary Location:Oregon,Portland,Kaiser Permanente Building 500 NE Multnomah St.

Scheduled Hours (1-40):40


Working Days:Mon, Tue, Wed, Thu, Fri


Job Type:Standard

Employee Status:Regular

Employee Group:Salaried, Non-Union, Exempt

Job Level:Individual Contributor

Job:Compliance / Privacy / Regulatory

Public Department Name:Regulatory Services & Contract Administration

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
Click here for additional requirements

Recent kaiser permanente jobs