PACE Health Plan Manager (Central Valley PACE - Ceres Whitmore)

Golden Valley Health Centers • Modesto, CA

80d • $82,347 - $86,464

About The Position

Responsible for providing oversight and coordinating the daily operations of health plan objectives including contracts, compliance, credentialing, communication, authorizations/claims, and disputes in a manner that meets established turnaround, quality and production goals, and regulatory standards. Located at Central Valley PACE - Ceres, CA. Schedule is Monday - Friday, working from 8:00am - 5:00pm. Compensation: $82,347.20 - $86,464.56 Annually.

Requirements

• Work is varied and moderately complex, and requires a moderate degree of discretion and independent judgment.
• Valid California Driver's License, acceptable driving record and vehicle insurance.
• Ability to direct and manage staff in multiple disciplines.
• Must have strong communication and presentation skills, both oral and written.
• Bilingual: Spanish/English preferred.
• Proficient in Microsoft Office applications; advanced Microsoft Excel experience required.
• Strong interpersonal skills, analytical and team leading skills.
• Identify and solve problems; collect, correlate and analyze data.
• Detail oriented, precise and well organized.
• Able to meet short deadline projects with quality work.
• Meet a standardized set of orientation and/or individual competencies for the specific position description established by Central Valley PACE and approved by CMS before working independently.

Nice To Haves

• Master's degree preferred.
• Familiarity with CMS/HPMS information technology within CMS and/or HPMS is preferred.

Responsibilities

• Plans and assigns work; monitors department workload to ensure mandated turnaround times are met; makes timely and effective adjustments.
• Identifies, monitors and analyzes appropriate metrics; develops timely and effective corrective action plans based on findings.
• Develops, implements and maintains department policies and procedures; makes recommendations for revisions; communicates changes to appropriate individuals in a timely and effective manner.
• Facilitates relationships with contracted third part administrators and other first tier, downstream and related entities (FDR's).
• Monitors communications with the California Department of Health Care Services (DHCS) and the Centers for Medicare and Medicaid Services (CMS).
• Coordinates the compliance and fraud, waste and abuse program with direction from the PACE Medicare Compliance Officer and Executive Director.
• Responds to and resolves or facilitates resolution of complex issues including enrollments/disenrollments, authorizations/claims, appeals, provider disputes, and third party liability cases.
• Assists with the development and implementation of department-related upgrades and enhancements of transaction system and other tools.
• Identifies, monitors and analyzes transaction system processing issues; corrects or escalates as required.
• Works closely with interdepartmental units to improve workflow and processes: identifies issues and opportunities; initiates meetings; resolves issues or makes recommendations as required.
• Prepares for and participates in regulatory audits: compiles audit packets, provides information, develops and monitors timely and effective corrective action plans.
• Executes and monitors business plans; assists in the development and monitoring of department budget.
• Identifies training needs and opportunities; develops and delivers routine and ad hoc department training.
• Promotes and maintains an environment that supports GVHC's strategy, vision, mission and values.
• Hires, supervises and retains staff.
• Oversee outreach, enrollment and marketing.
• Assists in developing department objectives and business plans.
• Other duties as required.

Benefits

• Compensation: $82,347.20 - $86,464.56 Annually

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees