1

LHP Job Description Categories

Able to follow directions, complete and understand instructions. (APM, WFM, CTM, PHM, CLM, COM, CRM, CCM, DMM, EEM, FAM, HSM, LUM, MPM, MEM, MMM, PEM, PDM, PSM, PRM, MSA, TPM, MTR, USM, PMM) Accountable for the production schedule. Accountable for turnaround service level agreement. (LUM) Adheres to policies, procedures and regulations to ensure compliance and patient safety. Allocates resources accordingly. (PHM, PEM)Analyzes data. (DMM, HSM, MMM)Apply appropriate global business strategies to meet departmental and regulatory goals/requirements. (WFM)Approves purchases of furniture and equipment through Purchasing Department and CER process . (FAM) Assess the various enrollment programs regularly, to determine if the programs are meeting the intended goals. (EEM) Assists Department Head to develop policies, procedures, strategies and goals that support Department/Corporation direction. (MEM)Assists Department Head with the development of the strategic planning for the organization. (MEM)Assists in the development of new recruitment training. (MSA)Assists management with documentation required for accreditation agency audits as needed. (MMM)Attends and participates in professional meetings, development seminars and/or committees. (CTM, CLM, COM, CRM, CCM, DMM, HSM, LUM, MPM, MEM, RAM, PDM, PSM, PRM, MTR, USM, PMM) Attends a variety of meetings. (PDM, PSM, MTR)Attends professional and/or departmental meetings. (LUM, MPM, PMM)Brainstorms on innovative ideas. (LUM) Builds trust/credibility with customers by demonstrating commitment to achieving mutual goals. (EEM) Coaches subordinates to accomplish goals. (APM, PHM, CTM, CLM, COM, CRM, CCM, DMM, EEM, FAM, HSM, LUM, MPM, MMM, RAM, PEM, PDM, PSM, PRM, MSA, TPM, , MTR,USM, PMM)Collaborates with a wide variety of functional areas such as sales, underwriting, marketing, health services, and operations to develop and provide product definitions responsive to customer needs and market opportunities. (PSM) Collaborates with headquarters on special facilities related projects. (FAM) Collaborates with Sales to develop rate action for new and existing groups that support the customer expectation, as well as, corporate goals. (LUM) Collaboratively works with delegated vendors to improve quality of care and outcomes. (MMM)Communicate effectively with internal and external customers. (APM, PHM, WFM, CTM, CLM, COM, CRM, CCM, DMM, EEM, FAM, HSM, LUM, MPM, MEM, MMM, PEM, PDM, PSM, PRM, MSA, TPM, MTR, USM, PMM)

2

Communicate necessary changes. (WFM)Communicate performance gaps to achieve performance improvements to the overall process. (CTM, CLM) Communicate process improvements. (WFM)Communicate short term and long term forecasting, lost-time, compliance, service level, and other necessary reporting to the management team. (WFM) Communicate to the management team. (WFM)Communicates effectively with internal and external customers. (CCM, DMM, EEM, HSM, LUM, MEM, MPM, MSA, MTR, PDM, PEM, PMM, PRM, PSM, TPM, USM)Communicates resolutions. (LUM, PMM) Compile short term and long term forecasting, lost-time, compliance, service level, and other necessary reporting. (WFM)Completes required monthly, quarterly reports accurately and in a timely manner. (MMM)Conducts claims audits using technology to its fullest capability. (CTM, CLM)Conducts coordination of coding and claim reconsiderations. (APM)Conducts maintenance of internal and regulatory Policies and Procedures. (APM)Conducts market research. (PSM)Conducts marketing analysis to develop product definitions. (PSM) Conducts oversight of all Appeal, Grievance, and Hearing functions. (APM)Conducts post-event de-briefings to ensure a continuous process improvement effort is undertaken. (EEM) Conducts presentations. (LUM, PMM) Cooperates and interacts with supervisors, peers, other departments and all customer groups demonstrating commitment to “service”. (PHM, APM, WFM, CTM, CLM, COM, CRM, CCM, DMM, EEM, FAM, HSM, LUM, MPM, MEM, MMM, RAM, PEM, PDM, PSM, PRM, MSA, TPM, MTR, USM, PMM) Coordinates a variety of professional and/or department meetings, presentations and/or committees. (COM, PSM, MTR, PMM) Coordinates all aspects of contract negotiations and agreements. (COM)Coordinates daily operations and activities for assigned area, department and staff. (CTM, CLM, COM, PDM, PSM, TPM, MTR)Coordinates special projects and programs as requested. (WFM) Coordinates a variety of meetings. (PSM, MTR, PDM)Coordinates all training programs. (MTR)Coordinates annual Provider Seminars in conjunction with other key Plan departments. (PRM)

Coordinates as required with the Network Operations Director, and any other key management/departments. (PRM, PSM) Coordinates daily operations and activities for assigned area, department, and staff. (MTR, PDM, PSM TPM)Coordinates daily staff assignments for designated department to include hiring, firing, disciplinary actions, evaluations and training. (RAM)Coordinates in-house moves, adds and changes including system furniture reconfigurations, renovations and new construction. (FAM)Coordinates marketing, sales, operation, and financial plans for product line(s). (PSM)

3

Coordinates on-site and off-site storage activity. (FAM) Coordinates pricing requirements for non-standard benefits through the Actuarial support. (LUM) Coordinates professional and/or departmental meetings. (LUM, PMM)Coordinates projects, reports and meetings. (RAM)Coordinates several projects at the same time to ensure a seamless transition from one event to another. (EEM) Coordinates technical product development, estimates of potential sales profits, and release to production. (PSM)Coordinates the reporting requirements of the state. (MPM)Creates data retention process. (WFM)Creates an environment conducive to providing service excellence. (EEM) Deliver concise and effective executive level presentations and communications. (CTM, CLM) Demonstrates a high level of attention to detail and follow through. (EEM) Demonstrates knowledge of provider network service. (PRM, PSM) Demonstrates knowledge of the principles of growth and development over the appropriate age span of the unit's patients. (EEM) Demonstrates proficient knowledge of healthcare underwriting and managed care products. (LUM, PMM) Designs all training programs. (MTR)Designs and changes employee services programs in order to enhance employee/organization relationships and better serve both the employee and the organization, based on these assessments and de-briefings. (EEM) Determines priorities by working with the business, technology, and operations. (CTM)Develops individuals by assessing their abilities against current/future business priorities. (CTM, CLM)Develops internal and regulatory policies and procedures. (APM, RAM)Develops internal and regulatory spreadsheets and reports. (APM)Develops policies, processes, strategies and goals that support department/corporation direction. (PHM, APM, CTM, CLM, COM, CRM, CCM, DMM, EEM, FAM, HSM, LUM, MPM, MMM, RAM, PEM, PDM, PSM, PRM, MSA, TPM, MTR, USM, PMM)Develops renewal and new case presentations for customers that explain rate actions and expected outcomes. (LUM) Develops subordinates to accomplish goals. (APM, PHM, CTM, CLM, COM, CRM, CCM, DMM, EEM, FAM, HSM, LUM, MPM, MMM, RAM, PEM, PSM, PRM, MSA, TPM, MTR, USM, PMM) Development of internal and regulatory Policies and Procedures. (RAM)Develops (as required) the Provider Reference Guide, Provider Newsletters, annual Provider Satisfaction Survey and any provider communications in collaboration with the Network Operations Director, other internal staff and departments to ensure appropriate updates are made and distributed to the provider network timely. (PRM, PSM)Develops a prioritized list of customer and market requirements for product line(s). (PSM)

4

Develops a variety of analytical and statistical reports to assist with departmental forecasting. (MEM)Develops all aspects of the underwriting process and guidelines to obtain profitability and membership objectives. (USM)Develops and maintains business relationships with organizational departments or community entities as required. (MEM)Develops ASO funding rate presentations. (LUM) Develops business relationships with a variety other departments on product and service development. (PSM)Develops comprehensive plans to satisfy facilities needs using sound financial judgment. (FAM) Develops marketing, sales, operation, and financial plans for product line(s). (PSM) Develops policies, processes, strategies and goals that support Department/Corporation direction. (CCM, DMM, EEM, FAM, HSM, LUM, MPM, MMM, RAM, PEM, PDM, PSM, PRM, MSA, TPM, MTR, USM, PMM)Develops processes and ensure department compliance with all regulatory entities, including NCQA, DOI, HSD, NMMRA, HEDIS. (PRM, PSM)Develops rate structures that offer the ability to enhance market share and maintain profitability according to budget (direct through team responsibility). (LUM) Develops routine reporting packages, ensuring consistency in all deliverables to our clients.

(LUM) Develops staff . (LUM) Develops standard operating procedures as appropriate to ensure efficiency of department processes and compliance with developed policy and procedures. (PRM, PSM) Develops subordinates to accomplish goals. (PSM, LUM, PRM,CCM, DMM, EEM, FAM, HSM, MMM, MPM, MSA, MTR, PDM, PEM, RAM, TPM, USM)Devises process improvements based on findings. (MMM)Distributes (what?) to the management team. (WFM)Distributes short term and long term forecasting, lost-time, compliance, service level, and other necessary reporting to the management team. (WFM) Distributes sales leads for respective Sales Team based on monthly sales performance. (MSA) Emphasizes continuous quality improvement. (LUM) Ensure compliance with pharmacy quality reviews and regulatory standards. (PHM, PEM)Ensure data is entered accurately into applicable formats. (CRM)Ensure objectives conform to the user requirements and line of business. (CTM) Ensure participation in pharmacy quality reviews and regulatory standards. (PHM)Ensure successful achievement of department objectives. (CTM, CLM)Ensure that the files for practitioners due for credentialing/re-credentialing are available for review by the Credentialing Committee each month. (CRM)Ensure the production of all required regulatory reports are timely, accurate, and are produced as needed to ensure department and Health Plan compliance with all regulatory entities. Such reports include but are not limited to HSD reporting, Geo Access and Availability reporting, NCQA reporting, and DOI reporting. (PRM, PSM)Ensure timely and accurate preparation and responses (of what?). (APM)

5

Ensures compliance with all state, federal and other regulatory entities as required. (PRM, PSM)Ensures compliance with city, state and federal codes and regulations. (FAM) Ensures compliance with pharmacy quality reviews and regulatory standards. (PEM)Ensures compliance with State and Federal regulations through daily supervision of staff, monitoring individual sales performance and activities. (MSA)Ensures quality and customer satisfaction by conducting and reviewing call audits. (CCM)Ensures testing is completed within established time. (CTM)Escalates key testing issues. (CTM)Evaluates all training programs. (MTR)Evaluates rate structures that offer the ability to enhance market share and maintain profitability according to budget. (LUM) Implements rate structures that offer the ability to enhance market share and maintain profitability according to budget. (LUM)Forecasts expected outcomes. (LUM) Gain buy-in to improvement recommendations by working with the plan’s CEO, CFO, and COO. (CTM, CLM) Generates statistical and analytical reports and records with departmental systems and/or databases. (CTM, CLM, COM) Generates a variety of reports, records and files. (PDM, PSM)Generates data. (MMM)Identifies areas of improvement and resource requirements. (PMM)Identifies issues or abnormalities not in the normal course of business. (LUM)Identifies market trends. (PSM) Identifies quality consumer/participant care models and competencies related to case management. (TPM)Identifies opportunities for improvement. (CTM, CLM, WFM)Identifies performance gaps to achieve performance improvements to the overall process. (CTM, CLM) Implements approved necessary changes. (WFM, USM)Implements compliance regarding the Medicare Part D Program. (PHM) Implements data retention process. (WFM)Implements process improvements. (WFM)Implementation of safety management procedures. (FAM) Implements rate structures that offer the ability to enhance market share and maintain profitability according to budget. (LUM)Implements all aspects of the underwriting process and guidelines to obtain profitability and membership objectives. (USM)Implements approved changes. (MEM, USM)Implements compliance regarding the Commercial, Medicare and Medicaid Lines of business. (PEM)Implements departmental policies and procedures. (PEM)Implements policies and procedures that will enhance the efficiency and compliance of program and/or organization. (MPM)Implements process improvements based on findings. (MMM)

6

Implements quality consumer/participant care models and competencies related to case management. (TPM)Initiates timely performance feedback. (LUM)Initiates effective channels of communication with providers and related office staffInteracts with supervisors, peers, other departments and all customer groups demonstrating our commitment to “service”. (PHM, APM, WFM, CTM, CLM, COM, CRM, CCM, DMM, EEM, FAM, HSM, LUM, MPM, MEM, MMM, RAM, PEM, PDM, PSM, PRM, MSA, TPM, MTR,USM, PMM)Interfaces with leadership as needed for escalation of service impacting issues. (WFM)Liaison with vendors. (CTM, CLM)Listens effectively with internal and external customers. (APM, CTM, PHM, WFM, CLM, COM, CRM, CCM, DMM, EEM, FAM, HSM, LUM, MPM, MEM, MMM, MPM, MSA, MTR, PEM, PDM, PSM, PRM, MSA, TPM, MTR, USM, PMM)Maintains a variety of files, reports, and records. (WFM, PDM, PSM)Maintains internal and regulatory spreadsheets and reports. (APM)Maintains personnel records for assigned staff. (PHM, PEM)Maintains statistical and analytical reports and records. (CTM, CLM, PHM, COM)Maintains statistical data in an application database in accordance with internal and regulatory requirements. (APM)Maintains effective channels of communication with providers and related office staff. (PRM, PSM)Maintains (as required) the Provider Reference Guide, Provider Newsletters, annual Provider Satisfaction Survey and any provider communications in collaboration with the Network Operations Director, other internal staff and departments to ensure appropriate updates are made and distributed to the provider network timely. (PRM, PSM) Maintains a prioritized list of customer and market requirements for product line(s). (PSM)

Maintains a variety of reports, records and files to ensure compliance. (CCM, PDM, PSM)Maintains a variety of training material, reports, records, and files. (MTR)Maintains business relationships with a variety other departments on product and service development. (PSM)Maintains internal and regulatory Policies and Procedures. (RAM)Maintains monthly sales reports as required. (MSA)Maintains ongoing sales training and education. (MSA)Maintains personnel records for assigned staff. (PEM)Maintains projects, reports and meetings. (RAM)Maintains statistical data in an application database in accordance with internal and regulatory requirements. (RAM)Maintains statistical data, trending and data reporting of case to include but not limited to Mi Via/PCO. (TPM)Maintains statistical reports and records pertaining to operations and activities. (PEM)Maintenance of internal and regulatory Policies and Procedures. (RAM)Makes recommendations to meet service standards. (WFM) Makes recommendations regarding areas of improvement. (CCM)

7

Manages adherence to schedule of customer service representatives. (WFM) Manages all aspects of contract negotiations and agreements. (COM)Manages claims audit, testing, and special processing functions. (CTM, CLM)Manages negotiations and agreements to ensure compliance. (COM)Manages performance of third party vendors. (CTM, CLM) Manages statistical data in an application database in accordance with internal and regulatory requirements. (APM, CCM, DMM, RAM, PRM, PMM)Manages the daily operations and activities for assigned area. (CTM, CLM, COM, PHM, CCM, PEM, PSM, MTR) Manages all operational functions within budget. (LUM) Manages all State/CMS and other regulatory compliance standards. (TPM)Manages daily operations and activities for assigned department and staff. (TPM)Manages daily staff assignments for designated department to include hiring, firing, disciplinary actions, evaluations and training. (RAM)Manages multiple projects, timelines and deliverable using_____________________ .(PMM)Manages overall clinical and non-clinical medical services related to medical utilization management operations, case management and concurrent review activities (HSM, MMM)Manages statistical data in an application database in accordance with internal and regulatory requirements. (RAM)Manages the daily operations and activities of assigned area to include but not limited to the development of disease management, preventive care and member outreach programs to ensure it serves the needs of customers by using clinical resources. (DMM)Manages the daily operations of Provider Servicing to ensure strategic goals and objectives are being achieved and remain compliant with all regulatory entities. (PRM, PSM) Manages the daily operations, educational and personnel activities for Call Center. (CCM)Manages the planning and evaluation of the program/project for assigned area to ensure compliance. (MPM)Manages the reporting requirements of the state. (MPM)Maximize use and functionality of the IEX Software and other department software solutions including but not limited to staff schedule maintenance. (WFM)Meet budget (operating & capital) for assigned areas. (APM, PHM, CTM, CLM, COM, CRM, CCM, DMM, EEM, FAM, HSM, LUM, MPM, MEM, MMM, RAM, PEM, PDM, PSM, PRM, MSA, TPM, MTR, USM, PMM) Meets deadlines. (LUM)Meets deadlines for healthcare underwriting and managed care products. (PMM)Mentors subordinates to accomplish goals. (APM, PHM, CTM, CLM, COM, CRM, CCM, DMM, EEM, FAM, HSM, LUM, MPM, MEM, MMM, RAM, PEM, PDM, PSM, PRM, MSA, TPM, MTR, USM, PMM) Monitors claims audit, testing, and special processing functions. (CTM, CTM)Monitors compliance regarding the Medicare Part D Program. (PHM)Monitors negotiations and agreements to ensure compliance. (COM)Monitors of contracts for maintenance and repair of facilities, furniture and equipment. (FAM) Monitors a variety of analytical and statistical reports to assist with departmental forecasting. (MEM)Monitors a variety of analytics. (LUM)

8

Monitors capital and expense budgets. (FAM)Monitors compliance regarding the Commercial, Medicare and Medicaid Lines of business. (PEM)Monitors overall clinical and non-clinical medical services related to medical utilization management operations, case management and concurrent review activities. (HSM, MMM)Monitors strategic activities to ensure objectives are achieved. (PDM, PSM) Negotiation of contracts for maintenance and repair of facilities, furniture and equipment. (FAM) Orders purchases of furniture and equipment through Purchasing Department and CER process.

(FAM)Oversees a variety of files and records to ensure accuracy. (WFM)Oversees the daily operations for assigned department. (PHM, PEM)Oversees vendors. (CTM, CLM)Oversees all State/CMS and other regulatory compliance standards. (TPM)Oversees daily staff assignments for designated department to include hiring, firing, disciplinary actions, evaluations and training. (RAM)Oversees the daily operations for assigned department. (PEM)Oversees the daily operations of Provider Servicing to ensure strategic goals and objectives are being achieved and remain compliant with all regulatory entities. (PRM, PSM)Oversees the development of strategic plan activities to ensure objectives are achieved. (PDM, PSM)Oversees the planning and evaluation of the program/project for assigned area to ensure compliance. (MPM)Participates in professional meetings and/or committees. (CTM, CLM, COM, CRM, CCM)Participates in the development and implementation of departmental policies and procedures. (PHM, PEM)Participates in a variety of meetings. (PSM, MTR, PDM)Participates in a variety of professional meetings and/or committees. (MEM, USM)Participates in departmental and/or professional meetings. (CCM, PRM) Participates in developing policies and procedures that will enhance the efficiency and compliance of program and/or organization. (MPM)Participates in development and implementation of plan to provide state-of-the-art services enrollment process. (EEM) Participates in key sales situations for the product. (PSM) Participates in meetings and professional development seminars. (DMM, HSM)Participates in new initiatives. (LUM)Participates in pharmacy quality reviews and regulatory standards. (PEM)Participates in professional and/or departmental meetings. (LUM, MPM, RAM, PMM)Participates in the development and implementation of departmental policies and procedures. (PEM)Participates in the development of the strategic planning for the organization.Participates in the strategic planning process for meeting growth and profitability goals. (LUM)Performs duties as assigned by Director, Pharmacy Services. (PEM)Performs other duties as assigned or requested. (LUM)

9

Performs other functions as necessary. (LUM)Plans the development of strategic plan activities to ensure objectives are achieved. (PDM, PSM)Prepares a variety of files and records to ensure accuracy. (WFM)Prepares concise and effective executive level presentations and communications. (CTM, CLM) Prepares written responses to members, providers, attorneys, and regulatory bodies. (APM)Prepares a variety of training material, reports, records, and files. (MTR)Prepares capital and expense budgets. (FAM)Prepares product development objectives and schedules for all phases of product development and introduction to market using a defined product lifecycle management model. (PSM)Presents at professional/departmental meetings. (CRM, PRM)Presents in departmental meetings. (PRM) Presents to internal and external customers. (LUM) Produces a variety of reports, records and files to ensure compliance. (CCM)Produces competitive analysis materials comparing product with its key competitors. (PSM)

Produces comprehensive sales reporting and analysis structures to include metrics which measures leads and sales effectiveness. (MSA)Produces monthly sales reports as required. (MSA)Produces statistical reports. (DMM, HSM, PEM)Provide compliance and productivity data. (WFM)Provide expert advice and guidance regarding the interpretation of contracts and agreements. (COM) Provide feedback to stakeholders. (CTM)Provide input to shape Acceptance Testing Management processes in-line with industry best practices. (CTM) Provide real time, daily, short-term, and long-term staffing forecasts using IEX Total View Schedule Software. (WFM)Provide statistical reports and records pertaining to operations and activities. (PHM)Provide the tools and training to bridge gaps. (CTM, CLM) Provides appropriate support both internally and externally as required. (RAM) Provides direct consumer/participant care management services. (TPM)Provides feedback regarding areas of improvement. (CCM)Provides financial and technical justification for product selection and definition. (PSM) Provides statistical reports and records pertaining to operations and activities. (PEM) Provides technical expertise to other departments in support of product development as well as ongoing product sales and support. (PSM)Provides training to other departments in support of product development as well as ongoing product sales and support. (PSM) Recommends areas of improvement. (DMM, HSM)Recommends changes to policies and procedures when necessaryRecruits staff. (LUM) Trains staff. (LUM)Regularly assess the various enrollment programs to determine if the programs are meeting the intended goals. (EEM)

10

Reports on data. (MMM)Resolve areas of concern and customer complaints/problems. (CRM, CCM, DMM)Resolve outstanding issues prior to committee review. (CRM)Resolves customer complaints. (CCM, DDM, HSM)Resolves customer problems (LUM, PMM)Resolves issues or abnormalities not in the normal course of business. (LUM) Responds to areas of concern. (CRM)Responds to customer complaints. (CCM, DMM, HSM)Responsibility includes quick and courteous interaction with Plan providers. (PRM, PSM)Responsibility includes quick and courteous response with Plan providers. (PRM, PSM)Responsible for all decision making and problem resolution needed to carry out all enrollment events and programs. (EEM) Responsible for conducting Grand Rounds with supporting report on a bi-weekly basis (MMM) Responsible for developing (direct through team) rate structures that offer the ability to enhance market share and maintain profitability according to budget. (LUM)Responsible for employee Ergonomics assessments and evaluation. (FAM) Responsible for managing day to day operations and UW Staff. (USM)Responsible for managing the daily operations for assigned area/department. (PDM, PEM, PSM, MTR)Responsible for operational and administrative management of the Medicaid program for assigned area. (MPM)Responsible for product development regarding the strategic, operational, fiscal and objectives of the department. (PDM, PSM) Responsible for product direction regarding the strategic, operational, fiscal and objectives of the department. (PDM, PSM)Responsible for resolving facilities-related issues including electrical, mechanical, security, janitorial and parking. (FAM) Responsible for supporting the Health Plan and Network Operations by providing consistent and accurate resolution to providers’ inquiries. (PRM, PSM)Responsible for the production schedule. Responsible for turnaround service level agreement. (LUM) Review audits and report findings to practitioners. (CRM)Review coding and claim reconsiderations. (APM)Review negotiations and agreements to ensure compliance. (COM) Reviews and approves invoices pertaining to general office expenses. (FAM) Reviews drawings, specifications and estimates. (FAM) Reviews routine reporting packages, ensuring consistency in all deliverables to our clients. (LUM) Schedules releases by working with the business, technology, and operations. (CTM) Schedules assigned sales team company sponsored seminars and sales activities. (MSA)Schedules ongoing sales training and education. (MSA) Seeks customer feedback to align business strategy with priority customer needs. (EEM) Serve as departmental liaison. (CTM, CLM, APM, PHM, WFM, COM, CRM, CCM, DMM, HSM, MPM, RAM, PDM, PSM, MTR)

11

Serves as liaison ________________________ . (MPM)Shares knowledge. (CTM, CLM, APM, PHM, WFM, COM, CRM, CCM, DMM, EEM, FAM, HSM, LUM, MEM, MMM, PEM, PDM, PSM, PRM, MSA, MPM, USM, TPM, MTR, PMM)Supervises all aspects of contract negotiations and agreements. (COM)Supervises daily operations and activities for assigned area. (CTM, CLM, COM, PDM, PSM, MTR)Supervises all training programs. (MTR)Supervises personnel for security, mail distribution, shipping/receiving, supplies, messenger/courier, reception, conference room, kitchen services. (FAM) Supervises priorities and workloads for assigned professionals within the department to ensure timely and accurate deliverables.(MEM)Supervises the daily operations within assigned area. (PDM, PSM, MTR) Supports the acquisition of stop loss fees. (LUM)Takes ownership of assignments, special projects, pilot programs. (PHM, APM, CTM, WFM, CLM, COM, CRM, CCM, DMM, EEM, FAM, HSM, LUM, MPM, MEM, MMM, RAM, PEM, PDM, PSM, PRM, MSA, TPM, MTR, USM, PMM)Tracks a variety of files and records to ensure accuracy. (WFM)Tracks market trends. (PSM) Tracks processes and ensures department compliance with all regulatory entities, including NCQA, DOI, HSD, NMMRA, HEDIS. (PRM, PSM)Troubleshoots issues or abnormalities not in the normal course of business. (LUM) Understands Lovelace Health Plan business requirements. (FAM)Understands the benefit plans and associated rating methodologies . (LUM)Works in collaboration with Contract and Provider services on issues to improve processes. (CRM)Works with other health plan leaders to streamline processes. (CRM)Works with various team members to develop communication plans and materials. (PMM)