Leads the day-to-day operations as well as integration of Medicaid reform initiatives into operational processes. Manages an expanding managed care population and implements enhanced capabilities for accountability and integrity of daily operations. Adheres to fraud and abuse prevention and/or detection policies and programs according to regulatory requirements.
This position is exempt from Career Service under the CCH Personnel Rules.
Leads the day-to-day operations and integration of Medicaid reform initiatives into operational process
Identifies and makes recommendation to support contract and compliance management
Takes corrective action as necessary to address disciplinary concerns; makes recommendations to diminish the impact on productivity
Manages and oversees the expanding Managed Care population
Implements enhanced capabilities for accountability and integrity of daily operations
Plans and directs all aspects of the operations for assigned products and programs
Oversees all aspects of assigned products and programs, establishing objectives, policies and procedures
Measures key performance indicators to analyze the success of program implementation
Participates in the evaluation of financial performance for the Managed Care department
Facilitates operational oversight for product and program functions and identifies opportunities for improving efficiency and cost reduction
Ensures operational processes and policies are compliant with corporate standards and applicable local, state and federal regulations
Oversees the research and development of any system, product and/or business implementation
Takes a comprehensive approach to evaluate and constructively improve current processes supporting expansion of the managed care operations
Reviews and assesses managed care contracting requirements and standards relating to industry and regulatory issues with any potential market implications
Provides resolutions to managed care contractual issues pertaining to contract interpretation and coding with payers
Adheres to confidentiality standards and HIPAA compliance programs
Adheres to fraud and abuse prevention and/or detection policies and programs according to regulatory requirement
Reports to the Director of Program Management and Performance Excellence, Health Plan Services
Bachelor's degree from an accredited college or university is required. (Must provide official transcripts at time of interview.)
Three (3) years of experience in a private sector health plan, Medicare/Medicaid health plan, or health system with health plan experience including aspects of operations oversight, administration and management is required.
Two (2) years of experience in a Medicaid Managed Care role with direct product/program experience in claims, contract compliance, payment methodology, government relations, provider network and day to day operations is required.
Two (2) years of experience developing reports for Healthcare and Family Services is required.
Prior experience managing or supervising staff in a large hospital or healthcare environment is required.
Proficiency with Microsoft Office Suite (Access, Excel, PowerPoint and Word) is required . A skills test may be administered to assess abilities.
Master's Degree from accredited college or university is preferred.
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.
KNOWLEDGE, SKILLS, ABILITIES AND OTHER CHARACTERISTICS
Knowledge of the principles of Medicaid Managed Care principles and management practices
Knowledge and familiarity with Medicare and/or Medicaid insurance payment systems, inpatient and outpatient reimbursement, such as Diagnosis-related group (DRG) reimbursement and/or Enhanced Ambulatory Patient Groupings (EAPG) reimbursement structures
Knowledge of Microsoft Office Suite (Access, Excel, PowerPoint and Word)
Knowledge and understanding of implementation, startups and operationalizing Managed Care programs
Excellent interpersonal, verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
Excellent program development, management and leadership skills
Demonstrates good computer and typing skills
Demonstrate good phone and email etiquette skills with strong response times
Demonstrate analytical and organizational, problem-solving, critical thinking and conflict management/resolution skills
Demonstrate attention to detail, accuracy and precision to support research and presentation skills
Ability to prioritize, plan and organize projects and tasks
Ability to multi-task and meet deadlines in a fast paced and stressful environment
Ability to maintain a professional demeanor and composure when challenged
Ability to function autonomously and as a team member in a multidisciplinary team
Ability to train by presenting concepts and demonstrating tasks
Ability to perform accurate and reliable mathematical calculations to support reimbursement analysis and measure financial performance
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must :
Meet the minimum qualifications for the position.
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, "Are you a Military Veteran?"
Attach a 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 one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable
A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.
Medical, Dental, and Vision Coverage
Basic Term Life Insurance
Pension Plan and Deferred Compensation Program
Employee Assistance Program
Paid Holidays, Vacation, and Sick Time
You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.
Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
*Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.
*CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.
COOK COUNTY HEALTH AND HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER
Internal Number: 264483
About Cook County Health
ABOUT COOK COUNTY HEALTH (CCH)
The Cook County Health’s mission is to deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies that promote the physical, mental and social wellbeing of the people of Cook County.
CCH is comprised of two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital, a robust network of more than a dozen community health centers, the Ruth M. Rothstein CORE Center, the Community Triage Center, the Cook County Department of Public Health, Cermak Health Services, which provides health care to individuals at the Cook County Jail and the Juvenile Temporary Detention Center, and CountyCare, a Medicaid managed care health plan.
The system cares for more than 300,000 patients each year and its physicians are experts in their fields, committed to providing their patients with comprehensive, compassionate and cutting-edge care. Today, CCH is transforming the provision of health care in Cook County by promoting community-based primary and preventive care, growing an innovative, ...collaborative health plan and enhancing the patient experience.
COOK COUNTY HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER