About this role
Role Overview
- Serves as the Managed Care Program Compliance Monitor by organizing, planning, and evaluating the Statewide Managed Care Organizations (MCO) Medical Compliance Program
- Evaluates the disposition of MCO complaints, including the review of documentation, drafting reports, and tracking systems
- Plans and organizes the registration and approval of MCO providers
- Serves as Bureau liaison
- Investigates, analyzes, tracks and responds to payment issues by MCOs
- Organizes, plans, and evaluates the research of MCO requests for disenrollment’s for cause
- Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above
Requirements
- Requires knowledge, skill and mental development equivalent to completion of four (4) years of college, preferably with courses in business or public administration
- Requires two (2) years of responsible administrative experience in a public or business organization
- One (1) year of experience researching and analyzing statistical data and drafting reports with outcomes
- One (1) year of experience performing contract oversight of mandatory managed care organizations or similar types of health care programs or plans
- One (1) year of experience explaining Medicaid or contract policy to outside entities including vendors, such as providers
- One (1) year of experience creating, maintaining, and updating extensive Word documents, such as contracts or policies, and complex Excel spreadsheets with formulas
Benefits
- Health, Life, Vision, and Dental Insurance
- Pension Plan
- Paid Parental Leave
- Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
- Employees earn (12) paid Sick Days annually.
- New Employees earn (10) paid Vacation Days their first year of service and can earn up to (25) paid Vacation Days annually.
- Employees earn (3) paid Personal Days annually.
- (13-14) paid holidays annually (based on start date)