|DAILY DUTIES / RESPONSIBILITIES:|
SCDHHS is seeking a Program Manager to manage and oversee current functions of the Quality Improvement Organization (QIO) Contract for Fee-for-Service Medicaid as well as maintain oversight of the consolidation of Provider Policy Manuals. Such functions include, but are not limited to, contract compliance and interpretation, prior authorization requirements, adherence to programmatic updates and concerns, generation of change order requests, oversight of the request for proposal process, resolving provider discrepancies, management of reporting requirements, facilitation of conference calls and meeting requests, review and approval of monthly invoices for payment, scheduling and coordination of provider education training sessions, utilization of data to detect opportunities for new PA requirements for cost savings, and facilitation of efforts to eliminate fraud, waste and abuse as it is identified by the Contractor or Agency. Utilize the vendor portal as a resource tool to research issues. Create Medicaid Alerts/Bulletins to inform the provider community of updated information as it relates QIO agency modifications.
Manage all functions of Scope of Work with the Contractor that involves the consolidation of all provider policy manuals. Process will include the review of policy language, validation of federal and regulatory requirements, and identification of duplicate or overlapping policies. The goal is to provide an infrastructure that communicates policies in an easy to navigate and understand manner as well as support ongoing manual maintenance. Provide information, direction and cooperation to vendor team in its performance of services. Review deliverables for approval and or additional information. Assist vendor with the distribution of an environmental survey to be conducted to designated DHHS providers and affiliates. Facilitate the DHHS project team with on-going meetings to continue internal communication relative to consolidating policies.
REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):
Bachelors level degree
10 years' experience in Medicaid policy and procedures,
5 years' experience working with policy documentation review and process improvements
Knowledge QIO rules & regulations
Ability to effectively communicate to executive management, line management, project management, and team members.
PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):
Claims processing systems experience.
Knowledge of Microsoft Office (Word, Excel, PowerPoint) or other applicable software programs.
REQUIRED EDUCATION: 4-YEAR COLLEGE DEGREE IN ANY FIELD
BILL RATE: $113.77