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||St. Paul, MN United States
|| Government and Policy
Managed Care Contract Specialist|
This position facilitates new and existing health care purchasing strategies and initiatives, along with participating in managed care contract development and negotiations. They will monitor compliance of managed care organizations (MCOs) and provide expertise on managed care policy. As a liaison between the Department of Human Services and the MCOs, this individual will build current and new partner relationships. They will interact and collaborate with a number of policy areas such as eligibility, benefits coverage, rate setting, claims processing, and operations as it relates to managed care policy development, implementation and contract management.
• Assist in the development, implementation and maintenance of Prepaid Medical Assistance or County-based purchasing arrangements for the provision of health care services.
• Collaborate with and participate in the Division’s managed care contract development and negotiations related to purchasing strategies and initiatives.
• Monitor compliance of Managed Care Organizations (MCOs) with state, federal and other managed care contractual requirements.
• Support managed care contract initiatives intended to improve performance, accountability and compliance with federal, state and contract-specified requirements.
• Provide training to agency and county staff on how managed care systems function; including managed care contractual requirements and policy changes.
Qualifications & Requirements
Three (3) years of professional experience working with health care, health administration, social services, human services or a related field demonstrating the following:
• Compliance with State & Federal laws and regulations governing managed care and health care.
• Health care administration, health care policy, managed care, law or directly-related field.
• Contract management.
• Knowledge of County organization structure and the role it plays in eligibility, health care, and continuing care.
***Bachelor’s Degree in Health Policy or related field may substitute for 1 year of experience OR Master’s degree in Health Policy or related field may substitute for 2 years of experience***
• Experience with Minnesota Health Care Programs, Medicaid, managed care policy, and state and federal laws and regulations that govern managed care.
• Knowledge of Medicare Program, health care purchasing, rates development, cost sharing, quality assurance and quality management principles, and health care provider roles and responsibilities is preferred.
• Experience with monitoring or ensuring contract compliance.
• Well-developed verbal and written communication skills.