Program Manager, Medicaid Operations

Company Name:
Test Company KP
Title: Program
, Medicaid Operations
Location: Rockville, MD
The Medicaid Operations Manager ensures members in the Medicaid programs obtain care and
based on their individual medical, psych/social and behavioral health needs; while improving quality, decreasing disparities and identifying cost across the line of business. Responsible for building and strengthening the internal and external operational infrastructure for Medicaid programs and ensure that KP MAS compliance with state, federal and member expectations. The Medicaid Operations Manager will implement the organization's commitment and participation in Medicaid programs. The activities described below pertain to KP Medicaid programs in
as well as participation in Priority Partners in Maryland.
Essential Functions:
- Operations Coordination: Manage relationships and activities with functional areas such as business, regulatory, operations, care delivery sites, and IT; respond to organizational inquiries regarding Medicaid coverage and care coordination within the KP care delivery system and with external providers/partners; develop, monitor and confirm submission of contractually-required reports; create and maintain state meeting calendar to ensure that KP is represented at stakeholder
and meetings; and, manage business and IT implementation of new contractual requirements with support of PMO.
- Regulatory Analysis: Assist with contract/regulatory interpretation and disseminate regulatory updates to appropriate KPMAS functional areas; coordinate and draft KP responses to proposed changes to state regulation or Medicaid program changes (i.e., notices of proposed rulemaking).
- Policies and Procedures: Create and maintain Medicaid Office policies and procedures; ensure functional area policies and procedures are up-to-date by conducting annual reviews and incorporating necessary changes.
- Communications: Develop periodic communications - either organization-wide or to targeted audiences - to ensure organizational partners understand current program requirements and policies; maintain KPMAS website for VA and MD Medicaid members; manage KP Medicaid mailbox, portal access provided by Delmarva and the KP Medicaid SharePoint site; maintain functional area/department Medicaid contact list; manage inquiries (to/from Medicaid office).
- Training: Ensure appropriate trainings are developed and deployed; ensure new hire and refresher Medicaid trainings are updated and conducted regularly.
Basic Qualifications:
- Minimum three (3) years of management experience in Medicaid, health care or insurance industry
- Minimum five (5) years of experience in health care delivery, case management, Medicaid.
- Bachelor's degree in public health, health care administration, nursing or a related health care field.
License, Certification, Registration
- N/A.
Additional Requirements:
- Experience in working with regulatory agencies and managing a large organization's response to actions.
- Experience with budgeting; state and federal compliance; state and federal policies and laws.
- Experience working within a large multi-disciplinary health care setting.
- Strong background working with Medicaid and/or Special populations and unique health care needs.
- Excellent negotiation skills, verbal/written communication skills.
- Strong analytical and strategic planning skills.
- Excellent public presentation skills.
- Strong persuasive and interpersonal skills.
- Demonstrated ability to work in a highly matrixed environment.
- Strong collaborative and team skills.
- Ability to interpret and communicate laws and regulations related to health care and Medicaid.
- Broad knowledgeable of Medicaid programs and health care delivery systems to support low-income patients.
- Broad knowledgeable of current trends in care management and industry standards related to care delivery to Medicaid population.
Preferred Qualifications:
- Knowledge of KP MAS or other health care organizations preferred.
- Extensive knowledge of Medicaid health care delivery systems preferred.
- Extensive knowledge of current trends in care management and industry standards related to care delivery to Medicaid population preferred.

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