Managed Care Contract and Oversight PS IV
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. 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. • Determines the effectiveness of MCO operational and contractual compliance by utilizing a standard set of assessment tools. • 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. • Assesses remedies for noncompliance with contractual requirements. • Collaborates with HPM Research and Resolution 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 HHS staff and other stakeholders. • Participates in the evaluation of Requests For Proposals (RFP) responses within assigned timeframes. Requirements • 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. • The Certified Texas Contract Manager Certification (CTCM) must be obtained within 12 months of the date of hire. Benefits • 100% paid employee health insurance for full-time eligible employees • Defined benefit pension plan • Generous time off benefits • Numerous opportunities for career advancement Apply tot his job