Manager, Program Support and Reporting - Pharmacy

Texas Children's Medical Center • Houston, TX

12d

About The Position

We are searching for a Manager of Program Support and Reporting – someone who works well in a fast-paced setting. In this position, you will be responsible for assisting with the interpretation of federal, state, and other regulations and requirements related to Medicaid and Children's Health Insurance Program (CHIP) and coordinating/providing the necessary reporting requirements in a timely manner. Develops, tracks, and reports performance/productivity metrics, and assures direct reports are meeting established metrics. Frequently review processes, workflows, and policies/procedures to ensure they are accurate, current, and meet all regulatory requirements. Works collaboratively with leadership and others from various areas across the health plan to evaluate and implement new ideas and strategies that impact member care coordination and quality of life, while ensuring compliance with the above regulations and requirements. Continue development of key strategic initiatives and reporting by partnering with the finance and operating teams to translate strategic analysis into operational decision-making. Think you’ve got what it takes?

Requirements

• Bachelor's Degree required
• 4 years business operations in a healthcare of insurance environment required

Nice To Haves

• Master's Degree business administration or related field preferred
• Management/leadership experience preferred
• 3 years' experience within TCHP preferred

Responsibilities

• Develops strategies, policies, and procedures to ensure regulatory compliance.
• Reviews, interprets, and provides direction on new and changes to existing federal and state regulations and requirements mandated by Health and Human Services Commission (HHSC), Texas Medicaid & Healthcare Partnership (TMHP), Texas Department of Insurance (TDI), and other governing bodies. Remains current on Texas Medicaid Provider Procedures Manual (TMPPM), Uniform Managed Care Contract (UMCC), Uniform Managed Care Manual (UMCM), and other bodies of knowledge that impact Medicaid and CHIP requirements and have a direct impact on medical policy decisions and potential system configuration changes.
• Ensures that policies/procedures, standard operating procedures, desk-level procedures, and/or guidelines adhere to all Medicaid and CHIP regulatory requirements as they relate to benefits and reimbursement, and staff are adequately trained on them.
• Partners closely with the Program Support Unit (PSU) within the Health and Human Services Commission (HHSC) to understand and implement program and/or reporting changes.
• Develops methodology for analyzing and monitoring departmental operations, internal and State issued Corrective Actions Plans and Liquidated Damages.
• Ensure appropriate communications and partners with others both within and across teams to accomplish goals.
• Provides data and reporting on productivity and other metrics.
• Develops and implements process improvement initiatives.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees