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Healthcare Client Services Manager

3 months ago

Sunrise, United States Community Care Plan Full time

Position Summary:

As a Healthcare Client Services Manager, you will be responsible for ensuring that all CCP Contracted Delegates adhere to regulatory requirements, internal policies, and industry standards related to healthcare contract compliance and reporting. You will monitor accounts, assess contractual compliance risks, and implement controls to mitigate potential issues. This role requires strong leadership, analytical skills, and a deep understanding of CCP’s Medicaid/Florida Healthy Kids contracts.

Essential Duties and Responsibilities:

  • Team Leadership: oversee all subcontractors, providing oversight, guidance, and support to ensure compliance with CCP’s contracts, regulatory requirements, and company policies.
  • Contractual Compliance Monitoring: Implement processes and procedures to monitor subcontractor processes, performance, reports, and documentation, identifying and addressing compliance issues in a timely manner.
  • Regulatory Analysis: Stay informed & knowledgeable about changes in contracts/amendments, report changes, regulatory requirements, and best practices related to contract compliance, and ensure that the subcontract and CCP remain compliant.
  • Policy Development: Develop and maintain policies, procedures, and guidelines to ensure subcontractors comply with relevant processes and internal controls.
  • Risk Assessment: Conduct risk assessments and ongoing performance reviews to identify potential areas of non-compliance or vulnerability and develop strategies to mitigate risks.
  • Reporting and Documentation: Review all subcontractor reports; prepare and maintain accurate records, reports, and documentation and coordinate with CCP Depts. for accurate final reports for the CCP clients.
  • Internal and External Audits: Coordinate and facilitate subcontractor audits, corrective action plans providing support, documentation, and explanations as needed to ensure compliance with contractual audit requirements and escalate risks to the Executive team and report the audit results to CCP’s Quality Improvement Committee.
  • Collaboration: Collaborate with each subcontractor on monthly Joint Operations Committee meetings as well as ad-hoc meetings with cross-functional departments to address contractual compliance issues, resolve discrepancies, and support initiatives.
  • Continuous Improvement: Identify opportunities for process improvement and efficiency gains in compliance-related activities, implementing best practices and solutions to enhance effectiveness.

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Skills and Abilities:

  • Proficient in Microsoft Word, Excel, and PowerPoint
  • Knowledge of Regulatory environment
  • Experience in a high-growth business environment
  • Working knowledge of health plan policies and procedures
  • Strong analytical and statistical skills
  • Ability to work in a fast-past environment and reprioritize
  • Effective problem-solving skills with attention to detail
  • Ability to develop, prioritize and accomplish goals
  • Strong communication skills (both written and verbal)
  • Strong interpersonal skills & high level of professionalism
  • Ability to work independently and within a team environment
  • Effective active listening and critical thinking skills
  • Display a customer service, member-focused orientation

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee may occasionally be required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.

Qualifications

Qualifications:

  • Bachelor’s degree in healthcare, Business Administration, or related field or 10 years’ experience in Managed Care dealing with subcontractors and delegates.
  • Proven experience in Medicaid, subcontractor oversight and auditing, with at least 3 years in a supervisory or managerial role related to the Florida Medicaid Line of Business.
  • Strong understanding of managed care regulatory requirements, oversight frameworks, and best practices related to Florida Medicaid (MMA and LTC) and Florida Healthy Kids/Chip Program requirements.
  • Excellent analytical skills with the ability to interpret regulatory reports, identify compliance risks, and develop appropriate controls and solutions.
  • Leadership abilities with a track record of coordination with high-performing teams.
  • Excellent communication and interpersonal skills, with the ability to collaborate effectively with stakeholders at all levels of the organization.
  • Detail-oriented with a commitment to accuracy and quality in compliance-related documentation and reporting.
  • Proficiency in Microsoft Office Suite, Excel, and other relevant tools.
  • Ability to prioritize tasks, manage multiple projects simultaneously, and meet deadlines in a fast-paced environment.
  • High level of integrity, professionalism, and ethical conduct.