Health Choices Program Director

County of Berks•Reading, PA

25d•Onsite

About The Position

POSITION SUMMARY: The HealthChoices Program Director is responsible for the administration of the HealthChoices Program for Berks County and oversight of its subcontract with a Pennsylvania-licensed Managed Care Organization (MCO) for authorization and payment of services. POSITION RESPONSIBILITIES: Essential Functions The duties and responsibilities of this position include, but are not necessarily limited to: Administer the daily operations of the HealthChoices Program, ensuring that requirements under contract with the Department of Human Services (DHS) are met. Serve a key role in the DHS rate-setting process. Serve as the liaison to DHS regarding any HealthChoices administrative matters, including review of the HealthChoices Agreement and rate setting, along with draft regulations and other documents issued by DHS. Monitor the MCO’s performance in relation to contract requirements. Collaborate with MCO on budget development, including review and approval of timely filing requests and monitoring of such. Oversight of MCO’s utilization, network, quality, and risk management. Oversight of project development on initiatives such as Value-Based Purchasing, Regional Accountable Health Council, among others. Review and approve any provider enrollment/expansion as well as provider rate increases. Analyze utilization data to identify system gaps and collaborate with the MCO on service development to fill any existing gaps. Review and approve MCO policies/procedures. Develop and oversee the implementation of reinvestment plans. Establish and monitor contracts with vendors from actuarial, auditing, data analysis, and legal disciplines. Act as a liaison and resource on HealthChoices for County departments, behavioral health providers, community service agencies, and members. Train and supervise HealthChoices staff. Complete mandatory trainings and clearances as required. Complete Emergency Behavioral Health certification. Attend and participate in MH/DD staff and provider meetings as well as website administration/updates.

Requirements

Master’s degree in social or human services.
Five years of progressive behavioral health administrative experience, including budget development and program oversight.
Any equivalent combination of experience and training that provides the required knowledge, skills, and abilities.
Valid Pennsylvania driver’s license with a good driving record.
Knowledge of project and quality management, including data collection and analysis.
Knowledge of utilization and risk management.
Knowledge of the healthcare and insurance industries.
Knowledge of budget development.
Ability to establish and maintain positive working relationships.
Ability to use diplomacy in interactions with other professionals and members.
Ability to work independently with minimal supervision.
Ability to organize and properly manage time and workload.
Ability to communicate effectively both orally and in writing.
Skill in operating a variety of computer software programs.
Ability to handle stress
Physical presence in the office is required

Responsibilities

Administer the daily operations of the HealthChoices Program, ensuring that requirements under contract with the Department of Human Services (DHS) are met.
Serve a key role in the DHS rate-setting process.
Serve as the liaison to DHS regarding any HealthChoices administrative matters, including review of the HealthChoices Agreement and rate setting, along with draft regulations and other documents issued by DHS.
Monitor the MCO’s performance in relation to contract requirements.
Collaborate with MCO on budget development, including review and approval of timely filing requests and monitoring of such.
Oversight of MCO’s utilization, network, quality, and risk management.
Oversight of project development on initiatives such as Value-Based Purchasing, Regional Accountable Health Council, among others.
Review and approve any provider enrollment/expansion as well as provider rate increases.
Analyze utilization data to identify system gaps and collaborate with the MCO on service development to fill any existing gaps.
Review and approve MCO policies/procedures.
Develop and oversee the implementation of reinvestment plans.
Establish and monitor contracts with vendors from actuarial, auditing, data analysis, and legal disciplines.
Act as a liaison and resource on HealthChoices for County departments, behavioral health providers, community service agencies, and members.
Train and supervise HealthChoices staff.
Complete mandatory trainings and clearances as required.
Complete Emergency Behavioral Health certification.
Attend and participate in MH/DD staff and provider meetings as well as website administration/updates.