Senior Director of Managed Care Plan Compliance

Recruitment #210402-UNCE-128



The Senior Director of Managed Care Plan Compliance is responsible for the oversight activities for the SoonerSelect MCO, SoonerSelect Children’s Specialty Plan and the SoonerSelect Dental Plan for the Oklahoma Health Care Authority (OHCA), the State’s Medicaid program.  The Senior Director manages a professional staff and directs their work, which involves detailed analyses, reporting and monitoring and estimates of MCO performance.  This position is responsible for analyzing trends, presenting findings, monitoring corrective action plans and implementing changes to maximize the use of the agency’s resources.  This individual is recognized as the top technical authority on matters of managed care, law and regulation for the OHCA with respect to these contracts. This position exercises technical authority and control, and may recommend authorizing or disapproving Contractor requests and obligations based on interpretations of MCO contracts, law, regulation or policy. Under the direction of the State Medicaid Director, Chief Operations Officer, the Senior Director of Health Plan Compliance ensures accountability in the SoonerCare program’s oversight of designated contracted MCOs. 

*Monitors and analyzes trends in contractors’ performance; implements changes to ensure the MCO program functions at maximum efficiency and aligns with state and agency goals including the agency’s Strategic Plan.  Assesses changes to certify objectives are met.
*Researches and interprets federal and state laws, managed care regulations and policies; translates information and develops department policy.  Implements and enforces contract amendments in collaboration with the MCO procurement officer. 
*Develops & implements procedures and practices, program evaluation, and problem resolutions.  Constructs internal controls to mitigate risk to agency and state; monitors controls for functionality.  Analyzes workflow & sequence of operations.
*Guides the Health Plan Compliance Team in developing Readiness Review instruments and reporting in order to support all MCO contract operations. Develops additional compliance assessments as warranted. Reviews staff analysis of reports for immediate and long-range program development; participates in top level management meetings involving the formulation and implementation of MCO programs and policies and the development of proposed legislation.
*Collaborates across program and agency boundaries to develop networks, build alliances and maintain strategic relationships. Represents agency at meetings with other governmental entities, public or private sector groups.
*Makes oral and / or written presentations to agency management, OHCA Board, legislative staff and committees regarding agency’s procurement and professional services contracts as well as the financial impacts on Medicaid programs. 
*Acts as the administrator or backup administrator of the Health Plan Compliance Team.
*Manages the Performance Management Process for the Health Plan Compliance Team staff; develops job accountabilities, designates accountability priority, performs employee evaluations, documents performance and conveys such to employee, and creates employee development plans.
*Other duties as assigned.

TRAVEL: Travel on an “as needed” basis.  

Supervises employees in Health Plan Compliance Team.

*Bachelor’s or Master’s degree in Business, Education, Administration or a closely related field AND
*Eight years of professional experience in project management, compliance or Medicaid, including four years in a supervisory capacity.
*No substitution for the educational requirement. 

*Governmental compliance experience 
*Governmental policy experience
*Experience with SoonerCare

Accommodation Statement:
The Oklahoma Health Care Authority complies with applicable Federal civil rights laws and does not discriminate.  All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.


Veteran’s preference points apply only for initial appointment in the classified service.