Responsible for the strategic development and administration of contracts with State and/or Federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide health care services to low income, uninsured, and other populations.
• Responsible for managing the plan's State healthcare contracts, reviewing and implementing new program requirements and ensuring the plan complies with all health plan contractual and regulatory reporting requirements.
• Serves as the Plan's lead for State healthcare program contractual and regulatory requirements, including performing the initial assessment and overseeing the implementation of all proposed and new contractual and regulatory standards, ensuring the Plan meets all filing requirements and ad hoc reporting requests, in a timely manner and with quality deliverables.
• Manages the plan's State and plan partner contract renewal activities
• Leads project teams involving staff from across the Plan to implement new standards for which the Government Contracts department is accountable or otherwise involved.
• Chairs committees and leads workgroups to carryout assigned responsibilities.
• Assesses proposed State laws and regulations to determine potential impact, and provides written reports of findings to requesting Plan and or MHI corporate staff.
• Supervises department staff in meeting assigned goals and job duties.
• Develops department staff to serve as product line SMEs in order to research standards and clarify program requirements for requesting staff.
• Serves as a key liaison with State healthcare agencies and regulators.
• Coordinates Plan responses/reports to State healthcare agencies, regulators and partners regarding contractual and regulatory issues.
• Identifies potential new business and bid opportunities for the Plan.
Bachelor's Degree in related field or equivalent combination of education and experience.
• 3-5 years experience in a managed care environment, with at least 2 years supervisory or management experience.
• Knowledge of State Health Department mandated laws and rulings.
• Comprehensive knowledge of Medicaid policies and programs.
Required License, Certification, Association
Bachelor's Degree in Business Administration, Healthcare or related field.
Preferred License, Certification, Association