Managed Care Contracting and Rates

Managed Care Contracting And Rates (MccR) DirectorJob Class: Human Services Manager 4Agency: Human Services DeptLocation: St. PaulTelework Eligible: YesFull/Part Time: Full-TimeRegular/Temporary: UnlimitedWho May Apply: Open to all qualified job seekersDivision/Unit: Health Care Administration / Managed Care Contracting and RatesWork Shift/Work Hours: Day Shift / 8:00am - 5:00pmDays of Work: Monday - FridayTravel Required: NoSalary Range: $50.25 - $71.95 / hourly; $104,922 - $150,231 / annuallyClassified Status: ClassifiedBargaining Unit/Union: 220 - Manager/UnrepFLSA Status: Exempt - ExecutiveDesignated in Connect 700 Program for Applicants with Disabilities: YesThe Department of Human Services is unable to provide sponsorship for work visas. Applicants must be eligible to work in the United States at the start of employment. DHS does not participate in E-Verify.The work you'll do is more than just a job. At the State of Minnesota, employees play a critical role in developing policies, providing essential services, and working to improve the well-being and quality of life for all Minnesotans. The State of Minnesota is committed to equity and inclusion, and invests in employees by providing benefits, support resources, and training and development opportunities. This position is eligible for telework for applicants who reside in Minnesota or in a bordering state, with supervisory approval and satisfactory performance. If you live in a state bordering Minnesota, you must live within 50 miles or less from the primary work location to be eligible for telework.This position exists to direct all aspects of the Managed Care contracting, rate setting, and compliance functions for the department. Approximately 85% of the Medicaid and MinnesotaCare enrollees receive their health care services through managed care. As the director of this large business area, the Managed Care Contracting and Rates (MccR) Director, in conjunction with Health Care Administration (Hca) and DHS executive leadership, oversees procurement, contracting, coverage policies, and capitation rate setting with the Managed Care Organizations (MCOs) for multiple MCO contracts covering Medicaid Families and Children and MinnesotaCare and Special Needs Purchasing (SNP) populations.The incumbent provides strategic leadership and direction, is the primary negotiator for the state, represents DHS internally and externally regarding the purchasing strategies employed by the state's public health care programs, collaborates with leadership from other state agencies including MDH, Commerce, and MNSure. This position is also responsible for coordinating the MCO coverage policies, rate development impacts, and contract compliance with other areas across DHS, including those within other administrations. This position manages three sections, the Special Needs Purchasing section, the Managed Care Contracting and Service implementation section, and the Managed Care rates section, as well as an administrative assistant who supports the entire unit.Responsibilities may include:Direct the Managed Care Contracting and Rates teams to oversee the development, execution, and administration of managed care contracts and rates for all products, including traditional Medicaid services, MinnesotaCare, and Medicare and Medicaid integrated products.Develop, implement, and expand use of new purchasing strategies, including representing DHS in the development of managed care purchasing strategies that integrate additional policy areas or social services.Oversee the procurement process for all managed care products and leads contract negotiations for contract awards and renewals.Minimum Qualifications3 years of leadership experience managing health care organizations/areas, including strategic planning and directing the work of staff. Experience demonstrates:Working with and an understanding of health care benefits policy, including the relationship between services, disparities in health outcomes and issues related to access.Knowledge of health care delivery system and health care marketplace, including financingUnderstanding of fee-for-service vs. managed care concepts with ability to optimize funding through the effective management of both payment options.Preferred QualificationsStrong oral and written communication skills, with the ability to bring groups to consensus, broker agreements, and clearly state and defend a position.Strong analytical, problem solving, and organizational skills with the ability to produce and measure performance and results.Understanding of the complexity of Minnesota's federal and state relationship and funding sources.Experience and skills needed to research, develop, and recommend resource acquisition, utilization, and management strategies.Knowledge of and ability to interpret state and federal level policies impacting Hca's programs, policies, health care purchasing strategies, and operations.Skills to manage large-scale contract operations, manage relations with health plans, and ensure that negotiated contracts will produce intended results at a cost acceptable to the state.A background as a contract or healthcare attorney.Experience in legislative policy-making.Variety of experiences working effectively with others from different backgrounds and cultures.Additional Requirements:To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held.Reference/Background Checks - The Department of Human Services will conduct reference checks to verify job-related credentials and criminal background check prior to appointment.An Equal Opportunity Employer Minnesota State Colleges and Universities is an Equal Opportunity employer/educator committed to the principles of diversity. We prohibit discrimination against qualified individuals based on their race, sex, color, creed, religion, age, national origin, disability, protected veteran status, marital status, status with regard to public assistance, sexual orientation, gender identity, gender expression, or membership in a local commission as defined by law. As an affirmative action employer, we actively seek and encourage applications from women, minorities, persons with disabilities, and individuals with protected veteran status. Reasonable accommodations will be made to all qualified applicants with disabilities. If you are an individual with a disability who needs assistance or cannot access the online job application system, please contact the job information line at 651-259-3637 or email careers@state.mn.us. Please indicate what assistance is needed.