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Senior Health Plan Admin
Under the direction of the President of PHC, the incumbent will have direct responsibility for plan management of PHC group health plans. Functions of the position include, but are not limited to ensure legal compliance for health plan development and implementation, develop and maintain ongoing utilization review including retrospective analysis of plan design changes, develop and coordinate participant appeal process, evaluate and liaison with vendors regarding various wellness, prevention and disease and case management initiatives, coordinate communications laterally and vertically across MPTN organization with respect to health plan issues. Ability to perform health data analyses on claims, clinical, authorization/referral data. Position requires knowledge of self funded employer sponsored plans. BA/BS required. M.A. in Business Administration, Public Administration or Health Care preferred. Five (5) to eight (8) years Plan Administration experience with a background in Managed Health Care; strong demonstrated background in health care economics and plan design a plus. Nursing or Clinical background preferred.
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