Managed Care Contract and Oversight PS IV

Texas Health & Human Services Commission•Austin, TX

55d

About The Position

The HHSC Medicaid CHIP Services (MCS) division seeks a highly qualified candidate to fill the position of Program Specialist IV. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS's mission by ensuring that Managed Care Contracts and Oversight (MCCO) meet statutory requirements and implement audit recommendations within prescribed timeframes. The Program Specialist IV is selected by and reports to the Health Plan Manager (HPM)located in the MCCO Division of the MCS Department. This position will be assigned to a team responsible for ensuring compliance with contracts between MCOs and the agency. This position performs complex analysis and continuous monitoring of MCOs to determine the effectiveness of operations and contract compliance. This position evaluates MCO performance and manages corrective actions. This position participates in the development and evaluation of MCCO policies as they affect the MCO contracts and makes recommendations for changes as needed. This position works under limited direction with some latitude for the use of initiative and independent judgment and performs other duties as may be assigned or required.

Requirements

Knowledge of Medicaid Managed Care, and/or CHIP
Knowledge of contract management and compliance principles
Knowledge of state and federal laws, regulations, and processes regarding Medicaid Managed Care and CHIP
Skill in using personal computer application software such as Microsoft Word, Excel, PowerPoint, or other similar programs.
Skill in written and oral communication, including leading meetings, writing technical information in an understandable format, and producing sophisticated research and analytical reports.
Ability to research and evaluate policies and procedures.
Ability to work under limited direction and use independent judgment.
Ability to conduct investigations or audits; gather, build, correlate, and analyze facts and data; and plan solutions to problems.
Graduation from an accredited four-year college or university with major coursework in Health Care Management, Health Care Information Technology, or Health Care Administration is generally preferred.
Minimum of one year of experience with Medicaid/CHIP, Medicaid/CHIP dental, and managed care programs, policies, procedures, contracts, and service delivery mechanisms is required.
A minimum of one year of experience in contracts, contract management, or contract principles is required.
A minimum of one year of experience in using a PC and Microsoft Office is required.

Responsibilities

Ensures compliance with contract standards and assesses MCO performance by reviewing MCO contract deliverables, performance measures, and MCO compliance with state and federal regulations.
On a prompt and regular basis, determines the effectiveness of MCO operational and contractual compliance by utilizing a standard set of assessment tools.
Promptly informs the HPM of significant MCO compliance and performance issues and provides recommendations for action.
Works collaboratively with other Health Plan Management staff, the MCO, and other external or internal stakeholders to ensure contractual compliance by developing, monitoring, and updating action plans.
Works promptly and collaboratively to assess remedies for noncompliance with contractual requirements.
Collaborates with HPM Research and Resolution promptly and in a timely manner on escalated MCO-related issues.
Responds to legislative, open records, and audit requests within specified timeframes.
Facilitates or participates in functions related to operational on-sites, desk reviews, implementations readiness reviews, information sessions or other activities as required.
Manages or facilitates special research/issues projects as assigned within timeframes.
Establishes and maintains effective working relationships and communication with Health and Human Services (HHS) staff, as well as other internal/or external stakeholders, and provides timely responses to requests and inquiries. a. Receives no more than 1-2 justified complaints per annual review period from internal or external customers regarding professional conduct, appropriate interactions with others, and/or timely responses to requests or inquiries.
Demonstrates commitment to the goals of MCS the, shows initiative to take on new projects, is team-oriented and committed to outstanding customer service, and focuses on promoting efficiency and accountability.
Communicates with the HPM in a timely manner regarding problematic situations and applies proper judgment to ensure that the action taken is appropriate.
Attends work on a regular, predictable schedule in accordance with agency leave policy. Performs other duties as assigned, timely and accurately.
Participates in the evaluation of Requests For Proposals (RFP) responses within assigned timeframes. Reviews, analyzes, and evaluates rules, bills, and federal and state laws with implications for the Medicaid and CHIP programs as required.

Benefits

Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more.

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