Health Plan Manager

Texas Health & Human Services Commission Austin , TX 78719

Posted 2 weeks ago

Manager II The Health Plan Manager (HPM) is selected by and reports to the Senior Manager located in the Managed Care Compliance and Operations (MCCO) section of the Medicaid/CHIP Services Department. This position performs moderately complex (journey-level) managerial work administering the daily operations and activities of an assigned MCCO team who performs complex monitoring, analysis, and oversight of assigned managed care organizations (MCO) (medical, dental, and/or transportation). This position hires, fires, trains, assigns, prioritizes, evaluates, and supervises the work of a team.

Work involves planning, developing, and implementing major agency program(s) and providing consultative services and technical assistance to program staff, governmental agencies, community organizations, or the public. This position works with all aspects of the Medicaid/CHIP programs, including contracts, policies and/or procedures, Medicaid Managed Care, MCOs, DMOs, and MTOs. This position analyzes legislation and develops policies, guidelines, procedures, and communications.

This position will work under general supervision with considerable latitude for the use of initiative and independent judgment and perform other duties as may be assigned or required. Essential Job Functions:

(30%) Performs managerial work administering the daily operations and activities of the assigned MCCO team to monitor MCO contract compliance and the development, implementation, and monitoring of corrective action. a. Evaluates data on MCO compliance with the contract(s) through review of deliverables, reports from other MCO regulatory entities, reports from HHS/contractors, and data obtained from other sources. b.

Evaluates the performance of each assigned MCO and makes recommendations for improvements. c. Oversees the identification and resolution of contract issues by working with MCOs to improve the performance of contract requirements. d. Coordinates with internal and external stakeholders on MCO contract-related processes, contract monitoring issues and improvements to promote more efficient, innovative, or effective outcomes and processes. (25%) Establishes and maintains effective working relationships and communication with staff from other agencies and organizations, appropriately interacts with others, and provides timely responses to requests and inquiries.

Works with program staff in determining trends and resolving technical problems. Responds to external communications with governmental, commercial, and advocacy organizations regarding Medicaid and CHIP health plan issues. Represents MCCO in a positive manner. (15%) Oversees and conducts desk and on-site reviews, implementations, readiness review, information sessions or other activities as required and prepares reports based on findings.

Assists and provides guidance in the development of managed care contracts, Requests for Proposals (RFPs) and evaluation tools. Participates in the evaluation of RFP responses within assigned timeframes. Reviews, analyzes and evaluates rules, bills and federal/state laws with implications for the Medicaid and CHIP programs as required. (10%) Develops internal policies and procedures for MCCO program operations.

Facilitates teams and manages assigned projects. Effectively manages the development of improvements with other functional area staff on MCO contract-related processes, contract monitoring issues and improvements to promote more efficient, innovative, or effective outcomes and processes. Demonstrates commitment to the goals of the Medicaid/CHIP services, shows initiative to take on new projects, is team-oriented and committed to outstanding customer service, and focuses on promoting efficiencies and accountability. (10%) Performs supervisory functions in accordance with agency policy.

Approves leave through CAPPS within established timeframes. Plans, assigns, and supervises the work of others. Completes assignments in timeframes established by supervisor and quality of the completed assignments in acceptable according to supervisor's expectations. (5%) Apprises supervisor of work related incidents and situations that could be problematic to staff, the department, or the agency in a timely manner and applies proper judgment to ensure action taken is appropriate. (5%) Attends work on a regular predictable schedule in accordance with agency leave policy.

Performs other duties as assigned, timely and accurately. Knowledge Skills Abilities:

Knowledge of subsidized health insurance, including Medicaid, Medicaid Managed Care, and/or CHIP. Knowledge of contract management and compliance principles.

Ability to work under limited direction and to use initiative and independent judgment. Analytical and organizational skills and the ability to conduct investigations or audits; gather, assemble, correlate, and analyze facts and data; and devise solutions to problems. Knowledge of state and federal laws, regulations and processes regarding Medicaid Managed Care and CHIP.

Skill in using personal computer application software such as Microsoft Word, Excel, Power Point, or other similar programs. Skill in written and oral communication, including the ability to make public presentations, write technical information in an understandable format, produce sophisticated research and analytical reports. Ability to research and evaluate policies and procedures.

Skill in establishing and maintaining effective working relationships with managers, co-workers, other agency personnel and the public. Ability to effectively supervise work of staff, ensure accountability, and motivate to build morale. Registration or Licensure


Certified Texas Contract Manager (CTCM) certification, or must obtain within 12 months upon hire. Must maintain CTCM certification. Initial Selection Criteria:

A minimum of 120 semester hours from an accredited college with major course work in a field related to health and human services. Graduation from an accredited four-year college or university with major course work in a field relevant to assignment preferred.

Work experience and education may be substituted for one another. Minimum of three years of relevant experience which indicates understanding of state and federal laws and regulations relevant to health and human services programs and services required. Minimum of three years of relevant experience with Medicare, Medicaid and CHIP managed care programs, policies, procedures, contracts, and service delivery models preferred.

Minimum of three years of experience of contract management and contract principles preferred.

Minimum of three years of demonstrable skills and abilities to research, analyze and create technical reports in an understandable format. Minimum of three years proficient use of PC and Microsoft Office Suite including Word, Excel, PowerPoint, and Outlook.

Minimum of three years supervisory experience preferred. Additional Information:

Note: There may be no military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position. All active duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information see the Texas State Auditor's Military Crosswalk at MOS Code:

HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.

I-9 Form - Click here to download the I-9 form.

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

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Health Plan Manager

Texas Health & Human Services Commission