- Reading, interpreting, and responding to Managed Care regulatory bodies and contracts.
- Project Management experience in healthcare with the ability to communicate confidently and reliably. Experience in compliance, quality, accreditation, government affairs/lobbying a plus.
- Resourcefulness, problem solving, and critical thinking highly desired.
- Experience reading, understanding, following state/federal contracts, rules, policy and law.
- Experience presenting to and sharing with all levels of leadership.
- Solid, steady work history.
- 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 coordinating, conducting and/or responding to research requests pertaining to government healthcare programs; preparing and submitting regulatory reports for filings; reviewing Plan submissions for quality, accuracy, and timeliness; and ensuring Plan meets contractual and regulatory requirements.
- Reviews Provider Agreement, EOC/ Member Handbook, Provider Directory, marketing materials, and other contract reporting deliverables for compliance with contractual and regulatory requirements prior to submission.
- Assesses information received from government contracting agencies and regulators and disseminates to impacted Plan staff.
- Participates in meetings related to Molina government run programs with State agencies and Molina Corporate departments and disseminates relevant information to staff and management.
- Oversees/maintains the department's documentation and archive system, ensuring submitted reports are archived for historical and audit purposes. Ensures system is updated and complete.
- 3 years' experience in a managed care environment.
- Experience demonstrating strong:
- Proficient in compiling data, creating reports, and presenting information, using Crystal Reports (or similar reporting tools), SQL query, MS Access, and MS Excel.
- Project Management experience in healthcare with the ability to communicate confidently and reliably. Experience in compliance, quality, accreditation, government affairs/lobbying a plus.
- Resourcefulness, problem solving, and critical thinking highly desired.
- Experience reading, understanding, following state/federal rules, policy and law.
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Managed Care, Gov Contracts Sr. Specialist - Las Vegas, United States - Molina Healthcare
Description
Molina Healthcare of Nevada is hiring for a
Managed Care, Gov Contracts Sr. Specialist . This role can be worked remotely from anywhere in the state of Nevada.
The Sr.
Specialist role will involve coordination of all Government Contracts deliverables, primary focus will be to improve and standardize priorities, initiatives.
This position works with state regulators to exceed requirements and performance expectations in the execution of the company's Medicaid contract.
It will also be preparing, tracking, and delivering health plan reports to state for primarily Medicaid line of business with oversight of reporting requirements for Medicare and Marketplace.
Highly Qualified Candidates Will Have The Following Experience:
KNOWLEDGE/SKILLS/ABILITIES
JOB QUALIFICATIONS
Required Education :
High School diploma or equivalent
Preferred Education :
Bachelor's Degree in Business Administration, Healthcare, or related field.
Required Experience:
Preferred Experience:
To all current Molina employees:
If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range:
$40, $88,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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