Leads the day-to-day operations as well as integration ofMedicaid reform initiatives into operational processes. Manages an expanding managed care populationand implements enhanced capabilities for accountability and integrity of dailyoperations. Adheres to fraud and abuseprevention and/or detection policies and programs according to regulatoryrequirements.
This position is exempt from Career Service under the CCHHSPersonnel Rules.
Leadsthe day-to-day operations and integration of Medicaid reform initiatives intooperational process
Identifiesand makes recommendation to support contract and compliance management
Takescorrective action as necessary to address disciplinary concerns; makesrecommendations to diminish the impact on productivity
Managesand oversees the expanding Managed Care population
Implementsenhanced capabilities for accountability and integrity of daily operations
Plansand directs all aspects of the operations for assigned products and programs
Overseesall aspects of assigned products and programs, establishing objectives,policies and procedures
Measureskey performance indicators to analyze the success of program implementation
Participatesin the evaluation of financial performance for the Managed Care department
Facilitatesoperational oversight for product and program functions and identifiesopportunities for improving efficiency and cost reduction
Ensuresoperational processes and policies are compliant with corporate standards andapplicable local, state and federal regulations
Overseesthe research and development of any system, product and/or businessimplementation
Takesa comprehensive approach to evaluate and constructively improve currentprocesses supporting expansion of the managed care operations
Reviewsand assesses managed care contracting requirements and standards relating toindustry and regulatory issues with any potential market implications
Providesresolutions to managed care contractual issues pertaining to contractinterpretation and coding with payers
Adheresto confidentiality standards and HIPAA compliance programs
Adheresto fraud and abuse prevention and/or detection policies and programs accordingto regulatory requirements
Reports to Director, Managed CareOperations
Bachelor'sdegree is required. (Must provide official transcripts at time of interview.)
Five (5) years of health plan experience in a privatesector health plan, Medicare health plan, or health system including aspects ofoperations oversight, administration and management is required.
Two (2) years of experience in a Medicaid ManagedCare role with direct product/program experience in claims, contractcompliance, payment methodology, government relations, provider network and dayto day operations is required.
Priorexperience managing or supervising staff in a large hospital or healthcareenvironment is required.
Proficiencywith Microsoft Office Suite (Access, Excel, PowerPoint and Word) is required. A skills test may beadministered to assess abilities.
Must bewilling to travel to work sites throughout Cook County. Travel is required.
Must bewilling to work flexible hours.
Master'sDegree is preferred.
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.
Knowledge,Skills, Abilities and Other Characteristics
Knowledge of the principles of MedicaidManaged Care principles and management practices
Knowledgeand familiarity with Medicare and/or Medicaid insurance payment systems, inpatientand outpatient reimbursement, such as Diagnosis-related group (DRG) reimbursementand/or Enhanced Ambulatory Patient Groupings (EAPG) reimbursement structures
Knowledgeof Microsoft Office Suite (Access, Excel, PowerPoint and Word)
Knowledgeand understanding of implementation, startups and operationalizing Managed Careprograms
Excellent interpersonal,verbal and written communication skills necessary to communicate with alllevels of staff and a patient population composed of diverse cultures and agegroups
Excellent program development,management and leadership skills
Demonstratesgood computer and typing skills
Demonstrategood phone and email etiquette skills with strong response times
Demonstrateanalytical and organizational, problem-solving, critical thinking and conflictmanagement/resolution skills
Demonstrateattention to detail, accuracy and precision to support research andpresentation skills
Abilityto prioritize, plan and organize projects and tasks
Abilityto multi-task and meet deadlines in a fast paced and stressful environment
Abilityto maintain a professional demeanor and composure when challenged
Abilityto function autonomously and as a team member in a multidisciplinary team
Abilityto train by presenting concepts and demonstrating tasks
Ability toperform accurate and reliable mathematical calculations to supportreimbursement analysis and measure financial performance
When applying for employment with the Cook County Health & HospitalsSystem, preference is given to honorably discharged Veterans who have served inthe Armed Forces of the United States for not less than 6 months of continuousservice
To take advantage of this preference aVeteran must:
Meetthe minimum qualifications for the position.
Identifyself as a Veteran on the employment application by answering yes to thequestion by answering yes to the question, "Are you a Military Veteran?"
Attacha copy of their DD 214, DD 215 or NGB 22(Notice of Separation at time of application filing.Please note:If you have multiple DD214s, 215s, or NGB 22S, Please submit the onewith the latest date.Coast Guard mustsubmit a certified copy of the military separation from either the Department ofTransportation (Before 9/11) or the Department of Homeland Security (After9/11). Discharge papers must list andHonorable Discharge Status. Dischargepapers not listing an Honorable Discharge Status are not acceptable
Acopy of a valid State ID Card orDriver's License which identifies the holder of the ID as a Veteran, mayalso be attached to the application at time of filing.
Ifitems are not attached, you will not be eligible for Veteran Preference
VETERANSMUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARDOR DRIVER'S LICENSE AT TIME OF INTERVIEW.
Medical,Dental, and Vision Coverage
BasicTerm Life Insurance
PensionPlan and Deferred Compensation Program
PaidHolidays, Vacation, and Sick Time
Youmay also qualify for the Public Service Loan Forgiveness Program(PSLF)
MUSTMEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.
Degreesawarded outside of the United States with the exception of those awarded in oneof the United States' territories and Canada must be credentialed by anapproved U.S. credential evaluation service belonging to the NationalAssociation of Credential Evaluation Services (NACES) or the Association ofInternational Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
*Please noteall offers of Employment are contingent upon the following conditions:satisfactory professional & employment references, healthcare and criminalbackground checks, appropriate licensure/certifications and the successfulcompletion of a physical and pre-employment drug screen.
*CCHHS is strictlyprohibitedfromconditioning,basingorknowinglyprejudicingoraffectinganytermoraspectofCountyemploymentorhiringuponorbecauseofanypoliticalreasonorfactor.
COOKCOUNTY HEALTH AND HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER
As one of the largest public health systems in the country, the Cook County Health and Hospitals System (CCHHS) cares for more than 300,000 individuals resulting in over 1 million patient visits each year. Our mission to care for all, regardless of their ability to pay, dates back to 1835. In that time, we have cared for millions of patients and trained thousands of doctors, nurses and health pro...fessionals. We conduct important research making substantial contributions to current practices. With a patient-centric focus, we look to our teams to provide a commitment to leading edge practices and approaches, collegial relationships and the CCHHS mission.