MCCO Program Specialist V

TX-HHSC-DSHS-DFPS • Austin, TX

4d

About The Position

The HHSC Medicaid CHIP Services (MCS) division seeks a highly qualified candidate to fill the position of Program Specialist V. 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 meets statutory requirements and implements audit recommendations within prescribed timeframes. The Program Specialist V is selected by and reports to the Health Plan Manager located in the Managed Care Contracts and Oversight (MCCO) Division of the Medicaid/CHIP Services Department. This position will be assigned to a team responsible to ensure compliance with contracts between managed care organizations (MCOs) and the agency. This position will participate in the training and mentoring of team members. This position performs highly complex analysis and continuous monitoring of MCOs to determine the effectiveness of operations and contract compliance. The position will evaluate MCO performance and manages corrective actions. This position coordinates the development and evaluation of MCCO policies as they affect the MCO contracts and makes recommendations for changes as needed. This position will work under limited direction with considerable latitude for the use of initiative and independent judgment and perform other duties as may be assigned or required.Demonstrates commitment to MCS goals, shows initiative to take on new projects, is team-oriented and committed to outstanding customer service, and focuses on promoting efficiencies and accountability. The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy.

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.
• A minimum of one year of experience with Medicaid/CHIP and Managed Care programs is required.
• A minimum of one year of experience in using a PC and Microsoft Office is required.

Nice To Haves

• A minimum of one year of experience in contract management or contract monitoring principles is preferred.

Responsibilities

• Ensure compliance with contract standards and assess MCO performance by reviewing MCO contract deliverables, performance measures and MCO compliance with state and federal regulations.
• On a prompt and regular basis determine the effectiveness of MCO operational and contractual compliance by utilizing a standard set of assessment tools.
• Promptly inform the Health Plan Manager (HPM) of significant MCO compliance and performance issues and provide recommendations for action.
• Facilitate collaboration with other Health Plan Management staff, the MCO, and other external/internal stakeholders to ensure contractual compliance by developing, monitoring, and updating action plans.
• Work promptly and collaboratively to assess and review recommended remedies for noncompliance of contractual requirements.
• Collaborate with HPM Research and Resolution promptly and timely on escalated MCO related issues.
• Respond to and review legislative, open records and audit requests within specified timeframes.
• Lead and facilitate functions related to operational on-sites, desk reviews, implementations, readiness reviews, information sessions, or other activities as required.
• Manage or facilitate special research/issues projects as assigned within timeframes.
• Develops materials and prepares reports based on findings from readiness reviews.
• Establishes and maintains effective working relationships and communications with HHS staff, and other internal/external stakeholders, and provide timely responses to requests and inquiries.
• Receive 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 the Medicaid/CHIP services, shows initiative to take on new projects, is team-oriented and committed to outstanding customer service, and focuses on promoting efficiencies and accountability.
• Communicates with manager in a timely manner regarding problematic situations and applies proper judgment to ensure 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 development of RFPs and the evaluation of RFP responses within assigned timeframes.
• Reviews, analyzes, and evaluates rules, bills and federal/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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees