Managed Care Contract and Oversight PS IV

About the position 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 Apply To this Job