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Managed Care Member/Provider Specialist
Company | State of Iowa - Executive Branch |
Address | Des Moines, IA, United States |
Employment type | FULL_TIME |
Salary | |
Category | Government Administration |
Expires | 2023-06-07 |
Posted at | 1 year ago |
- Implement strong program integrity efforts.
- Reimburse providers.
- Achieve Iowa Medicaid stated physical health, behavioral health and long-term care supports and services outcomes.
- Develop and implement care plans based on Iowa Medicaid standards.
- The development of a comprehensive panel of physical health, behavioral health and long-term care providers including facility and home and community-based services
- Proactively address member and provider issues
- Monitor and assure the provision of quality services.
- Provide member and provider service.
- Manage within a capitated rate.
- Modified CMS service requirements, State regulations and administrative rules.
- Complete in-depth analysis of ad hoc, monthly, quarterly, and annual MCO reports to ensure compliance with contract regarding member and provider requirements.
- Complete special analysis of member and provider data as assigned.
- Prepare monthly, quarterly, and annual MCO member and provider reports to meet state and federal requirements.
- Prepare special reports as assigned.
- Substantiate that MCO plans, operations, manuals and data related to member and providers services are contractually compliant with Readiness Review, where applicable, and ongoing analysis for program outcomes and efficiency. Propose improvements to MCO operations, manuals, and data collection.
- Coordinate and work closely with MCO Account Managers: Provide analysis or other work to support MCO Account Manager in monthly meetings, participate in monthly MCO meetings, as necessary.
- Perform on site monitoring visits as needed to determine program reporting compliance identified through MCO data reports.
- Propose improvements for MCO performance; provide oversight for process improvement implementation.
- Continual analysis of member and provider services to ensure compliance with new or
- Provide member/provider information to relevant Iowa Medicaid staff.
- Research evidence-based quality of care initiatives to provide guidance and direction for future IA Health Link programs or contracts.
- Analyze impact of proposed policy or program changes.
- Research and prepare response to member and provider issues or other related requests for information; track and monitor member and provider issues to ensure solutions toward performance outcome goals.
- Review and provide feedback to Iowa Medicaid policies impacting MCO contract requirements and performance.
- Assist with development of agenda and facilitate meetings for Iowa Medicaid, Health, and Human Services leadership, MCO staff,
- Stakeholders or other identified entities
- Participate in internal and external work groups or meetings as assigned.
- A combination of a total of seven years of education and full-time experience (as described in number one), where thirty semester hours of accredited college or university course work equals one year of full-time experience.
- Current, continuous experience in the state executive branch that includes two years of full-time work as a Management Analyst 2 or two and a half years as a Management Analyst 1.
- Seven years of full-time work experience in management analysis or project management.
- Graduation from an accredited four-year college or university with a degree in any field, and experience equal to three years of full-time work in management analysis or project management.
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