Manager - Managed Care Plan Compliance

Recruitment #210413-UNCE-144

Introduction

 

This position is open only to current OHCA staff and contractors.

POSITION PURPOSE:
This position is responsible for design, implementation strategies, monitoring, and administration of a managed care plan audit process that will include program assessment, response implementation and verification of results. Also, responsible for the design, overseeing the implementation strategies, contract monitoring, coordination and administration of all applicable SoonerSelect initiatives.  These include, but may not be limited to, Readiness Reviews, reporting processes, compliance monitoring, oversight of corrective action plans and recommendations for contract modifications for the SoonerSelect MCO program. This position is responsible for the coordination, contract monitoring, and administration of oversight functions for SoonerSelect, under the direction of the Senior Director of Managed Care Plan Compliance.

PRINCIPLE ACTIVITIES
*Supervises the state monitoring functions of SoonerSelect plans. Leads all tasks of the on-site Readiness Reviews and other compliance activities.
*Supervises the collection of reports, the review of reported data, Contractor errors or deficiencies and reconsiderations. Provides for follow-up of Corrective Action Plans and other state-directed remedies to bring contracted plans into compliance with SoonerSelect requirements.
*Coordinates, plans, directs, and manages all activities of the compliance tasks, including activities with other agency units and other state agencies responsible for process components. 
*Responsible for a comprehensive end of the contract year report, monitoring status reports throughout the year, and will represent the unit in communication of team’s status, activities, and outcomes to OHCA and external parties.
*Coordinate efforts with all applicable stakeholders and ensure the Contractor is compliant with all provisions.
*Responsible for identifying and reporting areas/findings that could have major impact on the program to agency officials.
*Oversees the selection and/or promotion process and completes the performance evaluation (PMP) tool for all staff positions according to Human Resources procedures.
*Other duties as assigned.

SUPERVISORY RESPONSIBILITIES
This position requires the supervision of staff in the performance of responsibilities and oversight of the SoonerSelect Program. 

EDUCATION AND/OR EXPERIENCE:
Bachelor’s degree in business administration, education, IT or Health Care Administration or a related field AND 4 years of professional experience in auditing, project management, project lead or compliance. No substitution is allowed for the educational requirement. 

PREFERENCE MAY BE GIVEN TO CANDIDATES WITH:
*Experience in project management
*SoonerCare work experience
*Supervisory experience
*Advanced education

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.

Conclusion

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