Staff Manager

4 weeks ago


Santa Fe, New Mexico, United States State of New Mexico Full time

Job Summary

The Staff Manager / Medicaid Managed Care Contract Manager will provide direct oversight, monitoring, and compliance of the Medicaid Managed Care Organization (MCO) contracts. This position is responsible for leading and directing oversight and monitoring activities of the MCOs, providing ongoing feedback and identifying trends as part of ongoing contract oversight activities.

Key Responsibilities

  • Leading and directing oversight and monitoring activities of the MCOs;
  • Providing ongoing feedback and identifying trends as part of ongoing contract oversight activities;
  • Participating in site visits, readiness reviews, and evaluations of the MCO as requested;
  • Cultivating productive, effective work relationships with the MCO clinical and administrative staff to achieve contract goals and objectives;
  • Serving as a resource for healthcare assistance providing information to consumers, consumer advocates, providers, and the general public regarding the Medicaid managed care program;
  • Collaborating with MCO clinical staff, which may include medical directors, to facilitate resolution of member issues as needed;
  • Triaging consumer and provider calls based on judgment;
  • Assisting the provider community in their interactions with the MCOs and the Medicaid managed care delivery system;
  • Evaluating the urgency of health situation and directing the consumer or provider to the most appropriate healthcare resource for resolution;
  • Participating in the enhancement or revision of contract amendments, policy manual, and the development of regulatory language as needed;
  • Actively participating in the managed care procurement process, waiver renewal process, state plan amendment process, NMAC regulation revisions, and audits as needed and requested.

Requirements

  • A Bachelor's Degree in any field of study from an accredited college or university and five (5) years of professional level experience operating within parameters and guidelines directly related to the purpose of the position defined by the agency at the time of recruitment.
  • Experience with Medicaid programs and contracts;
  • Experience working high-level contract management and oversight;
  • Experience implementing program policies and procedures;
  • Experience providing technical assistance and training;
  • Experience working with social service programs or community outreach organizations.

Working Conditions

Work is performed in an office setting with exposure to Visual/Video Display Terminal (VDT) and extensive personal computer and phone usage.


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