Operations and Readiness Review Specialist

Texas Health & Human Services Commission • Austin, TX

27d

About The Position

The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Operational and Readiness Review Specialist. 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 Managed Care Organization's (MCOs) meet contract, state, and federal regulations through Operational and Readiness reviews. This position requires the necessity to travel monthly for operational reviews and as well as at a moment's notice based on significant MCO non-compliance. Position will perform highly complex consultative services and technical assistance work. Work involves leading operational and readiness initiatives such as readiness reviews, operational reviews and targeted reviews. Work involves planning, developing, and implementing major agency program(s) and providing consultative services and technical assistance to program staff, governmental agencies, community organizations, or the general public. 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. The Operational and Readiness Review Specialist reports to the Manager of the Operational and Readiness Review Team in the Managed Care Contracts and Oversight (MCCO) MCS Division. Work also includes research and developing tools for reviews. Position will work in partnership with HHS program staff and contracted MCOs. Work includes evaluating MCO adherence to contracts, policies, programs, other government assistance and programs and private sector resources. Position will contribute to the development of the monitoring teams within MCCO. Position will apprise manager of work-related incidents or situations that could be problematic to staff, the department or the agency. Position will communicate with manager on a timely basis with regard to problematic situations and apply proper judgment to assure action is appropriate. Position works under limited supervision and with considerable latitude for the use of initiative and independent judgment.

Requirements

• A minimum of 120 semester hours from an accredited college with major course work in a field related to health and human services. Graduation from an accredited four-year college or university with major course work in a field relevant to healthcare administration, health information technolgy, or management is generally preferred. Experience and education may be substituted on a year for year basis.
• Minimum of two years of experience with Medicaid and CHIP managed care programs, policies, procedures, contracts, and service delivery models.
• Minimum of two years of experience of contract management and contract principles.
• Minimum of two years in/with research, analysis and creating technical reports in an understandable format.
• Minimum of two years of experience in using a PC and Microsoft Office Suite including: Word, Excel, PowerPoint, Outlook.
• Knowledge of subsidized health insurance, including Medicaid, Medicaid Managed Care, and/or CHIP.
• Knowledge of contract management and compliance principles.
• Ability to work under limited direction and to use initiative and independent judgment.
• Analytical and organizational skills and the ability to conduct investigations or audits; gather, assemble, correlate, and analyze facts and data; and devise solutions to problems.
• 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, Power Point, or other similar programs.
• Skill in written and oral communication, including the ability to make public presentations, write technical information in an understandable format, produce sophisticated research and analytical reports.
• Ability to research and evaluate policies and procedures.
• Certified Texas Contract Manager Certification (CTCM), or must obtain within 12 months upon hire. Must maintain CTCM certification.

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.
• Lead and facilitate functions related to operational on-sites, desk reviews, implementations, readiness reviews, information sessions, or other activities as required.
• Establishes and maintains effective working relationships and communications with HHS staff, and other internal/external stakeholders, and provide timely responses to requests and 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

• comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees
• defined benefit pension plan
• generous time off benefits
• numerous opportunities for career advancement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Administration of Human Resource Programs
• Number of Employees: 1,001-5,000 employees