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Accountable Care Organization/Managed Care Organization Contract
QUINCY MA 02170
Category: Other
  • Your pay will be discussed at your interview

Job code: lhw-e0-90654414

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  Job posted:   Thu Jun 7, 2018
  Distance to work:   ? miles
       
  9 Views, 0 Applications  
 
Accountable Care Organization/Managed Care Organization Contract
The mission of MassHealth is to improve the health outcomes of our diverse members, their families and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence and quality of life.
_Duties and Responsibilities (these duties are a general summary and not all inclusive)_:
* Serve as the Key Contact and primary interface for Accountable Care Organizations (ACOs) integrated with Managed Care Organizations (MCOs). Work closely with the Managed Care staff, the Behavioral Health Program, Finance, Payment and Care Delivery Innovation Unit, MassHealth Legal, Office of Clinical Affairs, Program Integrity/Compliance Office and other MassHealth units to manage contracted entities.
* Monitor the performance of integrated ACO/MCOs to ensure compliance with contractual requirements including but not limited to all contractual reporting requirements, grievance and appeals processes, and the resolution of individual appeals, complaints and denied claims.
* Work closely with the Office of Providers and Plans leadership team and quality staff to oversee quality management and program evaluation.
* Coordinate the research of answers and issue resolution related covered benefits, member access to care and other program related items.
* Maintain open lines of communication with internal, external and interagency stakeholders to ensure ongoing collaboration, coordination and input.
_Preferred Qualifications:_
* Five years of program or contract management experience in a health care environment with emphasis on managed care programming.
* Experience with health care quality improvement processes.
* Ability to work independently.
* Strong analytic and problem solving skills.
* Excellent interpersonal, project management, organization skills.
* Ability to communicate effectively, both orally and in writing.
* Strong presentation skills.
* Experience with managing multiple tasks.
* Ability to maintain accurate records and experience handling confidential information.
* Proficiency in Excel, Word, Microsoft Outlook, ACCESS and Visio.
* Experience in the healthcare industry, in a managed care environment.
* Knowledge of MassHealth and federal laws governing the operation of Medicaid managed care programs.
* Knowledge of managed care reimbursement principles, state and federal Medicare/Medicaid financing rules and regulations.
* Familiarity with existing healthcare payment and system reform efforts in Massachusetts.
_Special Requirements_:
Based on assignment, possession of a current and valid Massachusetts Class D Motor Vehicle Operator's license or the equivalent from another state may be required.
_Pre-Hire Process_:
A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit
Education, licensure and certifications will be verified in accordance with the Human Resources Division's Hiring Guidelines
* Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth's website.
As part of the hiring process, the Office of Human Resources will be verifying any college-level degrees conferred to the selected candidate. Additionally, any licensure required for the position will be verified. Information provided as part of the hiring process is subject to the Massachusetts Public Record Law and may be published on the Commonwealth's website.
For questions, please contact the CYF Office of Human Resources at 1-800-510-4122 and select option #2.
*This requisition will remain open until filled; however, first consideration will be given to those applicants that apply within the first 14 days.*
MINIMUM ENTRANCE REQUIREMENTS: Applicants must have at least (A) four years of full-time, or equivalent part-time, professional, administrative or managerial experience in business administration, business management or public administration the major duties of which involved program management, program administration, program coordination, program planning and/or program analysis, and (B) of which at least one year must have been in a supervisory capacity, or (C) any equivalent combination of the required experience and the substitutions below.
Substitutions:
I. A Bachelor's degree with a major in business administration, business management or public administration may be substituted for a maximum of two years of the required (A) experience.*
II. A Graduate degree with a major in business administration, business management or public administration may be substituted for a maximum of three years of the required (A) experience.**
III. A Bachelor's or higher degree with a major other than in business administration, business management or public administration may be substituted for a maximum of one year of the required (A) experience.*
*Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed.
NOTE: No substitutions will be permitted for the required (B) experience.
*An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.*
**Job:** **Administrative Services*
**Organization:** **Exec Office Of Health and Human Services*
**Title:** *Accountable Care Organization/Managed Care Organization Contract Manager*
**Location:** *Massachusetts-Quincy - 100 Hancock Street*
**Requisition ID:** *180003IS*

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