Medicaid Contract Director

Company :

Job Description : 

JOB SUMMARY

This job is responsible for the oversight of the Medicaid contract and is available for prompt response to direct inquiries from the state regulators. The incumbent will be readily available to the state regulator for both planned and ad hoc meetings, reports and requests. Will work collaboratively with multiple stakeholders and various cross-functional teams, locations and departments to meet or exceed state contractual performance requirements, overall profitability, member satisfaction and state regulator satisfaction. Lead efforts to capture plan performance, work with vendor partners to identify opportunities for improvement. Work with vendor partners to design, implement and execute strategies and work with cross-functional clinical, pharmaceutical, operational, IT and other teams to ensure overall goals of the organization are met and to optimize outcomes. The incumbent will collaborate with the organization’s government markets and Medicaid leadership committees to coordinate the implementation of new programs and projects including the report development to ensure these initiatives remain on track.  The incumbent will be responsible the oversight of all state regulatory contractual requirements and to help achieve the Organization's overall performance objectives. The incumbent will be responsible for escalating cross-portfolio dependencies, project risks, and items for management attention to the executive leadership group.

ESSENTIAL RESPONSIBILITIES

• Manage and oversee the state’s managed care organization (MCO) contractual performance as specified in the contract and to help achieve the Organization's goals and objectives.
• Directly accountable to leadership and the state regulator(s) to review and approve contractual deliverables and to respond to regulator ad hoc requests.
• Partner with external vendors in the management of a portfolio of key initiatives through a disciplined, customer focused, program management approach; identifies and resolves project and program issues and risks.
• Manage and review performance metrics, compliance standards, policies, and procedures; monitor implementation of remediation steps and corrective action plans necessary to address compliance issues and risks.
• Develop and maintain local and state relationships and affiliations, which promote the success of the organization’s business interests.
• Other duties as assigned or requested. ​

EXPERIENCE

Required

• 5 years healthcare payer (insurance) or related experience.
• 5 years of experience in an operations area.
• 2 years in program oversight management/executive role.
• Experience supporting internal and/or external regulatory audits
• Medicaid experience

Preferred

• None
   

SKILLS

• Leadership experience in functional and matrix aligned organizations
• Previous consulting in a principle/manager/director role; portfolio management experience
• Strong communication and interpersonal skills
• Strong understanding of software development life-cycle methodology
• Strong understanding of portfolio management methodology

EDUCATION

Required

• Bachelor’s degree in business, marketing, health administration of related field OR relevant experience and/or education as determined by the company in lieu of bachelor's degree.   

Preferred

• Master degree business or health administration

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

Language (Other than English):

None

Travel Requirement:

25% - 50%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Frequently

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally