Pccm & Tailored Care Management Program Manager

State Of North Carolina Raleigh , NC 27611

Posted 1 week ago

Description of Work

NOTE: If you are a current NC State Government employee, you will not be considered for a temporary assignment. Temporary Solutions cannot accommodate dual employment.

This temporary position is located in the NC Department of Health and Human Services, Division of Health Benefits in Raleigh - Wake County. There are no leave or retirement benefits offered. This position is currently remote but will be expected to work on Dix Campus in Raleigh, NC when normal business operations resume.

Hourly Rate: $39.39 (Hourly Rates are based on education, experience, equity, and budget)

The primary focus of the Primary Care Case Management (PCCM) and Tailored Care Program Manager will be on the design, development, and implementation of care delivery/care management and other population health programs in both fee for service and a managed care environment with specific focus on PHP DHHS/Medicaid roles/responsibilities. This position will be fully integrated into the design, development and implementation of the 1115 Waiver and other components of Medicaid Reform to include managing and coordinating processes and collaborating with consultants, stakeholders, contractors etc.

This position will work closely with the DHHS Secretary's Office, staff from other DHHS agencies, staff from national and state advocacy organizations, and representatives of Medicaid beneficiaries and other providers of medical care.

In the NC Medicaid managed care, the PCCM/Tribal Option serves as a primary care case management entity utilizing a whole-person care model integrating medical, nutritional, behavioral, pharmacy, and social needs. This integration supports the care concentration of preventive health, chronic disease management primary care, and care management services. This position is integral to the success of the population health implementation and monitoring of the care management components of NC Medicaid's transition to Managed Care. This position will serve to continue the design and implementation of the care management program in support of the PCCM/Tribal Option's integrated care model as well as the BH/IDD Tailored Care management program.

Responsibilities include, but are not limited to, the following:

  • Overseeing the Population Health/Care Management or Care Delivery programs, policies and processes relative to PCCM (Tribal Option), FFS PCCM (CCNC) and BH/IDD Tailored Care Management.

  • Creating dashboards and other reports to monitor utilization and outcomes across programs. Serve as SME for any program evaluation design and implementation. Makes program recommendations based on data and evaluation results.

  • Designing and implementing program requirements, business processes and PHP and PCCM requirements in all assigned areas above.

  • Supporting development of all vendor monitoring protocols.

  • Researching federal and state laws and regulations to identify impacts on the current and future operation of both Medicaid and Health Choice and support compliance activities.

  • Building effective relationships with stakeholders to include providers, PCCM entities/LME-MCOs/PHPs, providers, beneficiaries, advocates and associations to ensure open lines of communications.

Knowledge, Skills and Abilities / Competencies

To receive credit for all of your work history and credentials, you must list the information on the application form. Any information listed under the text resume section or on an attachment will not be considered for qualifying credit. Qualified applicants must document on the application that they possess all of the following:

  • Demonstrated experience in population health models, care delivery models, care management models, clinical program innovations, system redesign, and using data for program design and oversight.

  • Broad knowledge of health insurance, operations, programs, policy and procedure along with experience or insight into provider contracting and operations

  • Experience researching and implementing federal and/or state laws and regulations.

  • Ability to interpret complex data, data sets and other information and to identify and communicate trends and probable outcomes

  • Excellent critical thinking, problem solving, and project management skills

  • Demonstrated ability to communicate complex material in a clear and concise manner both verbally and in writing

  • Demonstrated skill in creating and maintaining collaborative working relationships with internal and external stakeholders

  • Ability to multitask and work on projects with minimal supervision

  • Strong proficiency in Microsoft Office products, including Excel, Outlook, PowerPoint, and Word

Manager's Preferences (if applicable):

  • Master's degree in Social Work, Nursing, Health Administration, Public Health, Public Administration, Health Sciences, and/or a related field and a minimum of two years' experience in the delivery and oversight of care management/population programs

  • Clinical licensure as LCSW or RN

Minimum Education and Experience Requirements

Bachelor's degree from an appropriately accredited institution and three (3) years of program experience related to the area of assignment, including one year of supervisory program experience; or an equivalent combination of training and experience.

Supplemental and Contact Information

The North Carolina Medicaid and NC Health Choice programs (NC Medicaid), managed by the Division of Health Benefits (DHB), helps North Carolinians improve their health and well-being by providing access to services and supports for low-income parents, children, seniors, people with intellectual / developmental disabilities, behavioral health needs or substance use disorders. With a budget of more than $14 billion per fiscal year, Medicaid ensures that 69,000 enrolled providers are reimbursed for delivering covered services to more than two million beneficiaries. On Sept. 23, 2015, the North Carolina General Assembly passed Session Law 2015-245, as amended, directing NCDHHS and DHB to lead the transformation of the Medicaid and NC Health Choice programs from a predominantly fee-for-service delivery system to managed care.

Pre-Employment criminal background checks are required for all positions with the Division of Health Benefits.

Due to the volume of applications received, we are unable to provide information regarding the status of your application over the phone. To check the status of your application, please log in to your account. You will either receive a call to schedule an interview or an email notifying you when the job has been filled.

For technical issues with your application, please call the NeoGov Help Line at 855-524-5627. Applicants will be communicated with via email only for updates on the status of their application. If there are any questions about this posting other than your application status, please contact us at Medicaid.Recruitment@dhhs.nc.gov.

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Pccm & Tailored Care Management Program Manager

State Of North Carolina