Contract Specialist Iv - Austin, United States - Health & Human Services Comm

Health & Human Services Comm

Verified Company

Austin, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Essential Job Functions:

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 onsites, 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 12 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 teamoriented 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.

Knowledge Skills Abilities:

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 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

Registration or Licensure Requirements:

Certified Texas Contract Manager Certification (CTCM) or must obtain within 12 months upon hire. Must maintain CTCM certification.

Initial Selection Criteria:

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 assignment is generally preferred.

Experience and education may be substituted for one another.

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 of experience in using a PC and Microsoft Office Suite including:
Word, Excel, PowerPoint, Outlook.

Additional Information:

Open to Employees of the HHS Enterprise

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MOS Code:

NoneHHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.