Medicaid Contract Manager at PacificSource

Clipped from:



 Vida, OR Full Time

Job Posting for Medicaid Contract Manager at PacificSource

PacificSource is anything but a typical health insurance company. Founded in 1933, we’re an independent, not-for-profit organization that puts our members, and their communities first—across Idaho, Oregon, Montana, and Washington. It’s our 1,700 employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care. So yes, with PacificSource, you get to do great things. In our effort to put members first—more than 500,000 of them—initiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement. Benefits: Flexible telecommute policy, medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account. We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work. Here’s what else we feel good about: A mission with a real sense of shared values Competitive wages and outstanding benefits, including telecommuting Opportunities for learning development and career advancement Organizational leadership style rooted in servant and transformational leadership A commitment to support the communities we serve A belief in the importance of work-life balance PacificSource is an equal opportunity employer and a company that loves helping people. We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that. In 2021 alone we had 240 internal promotions! Top Workplace 2022 for Idaho | Idaho Press Top Workplace 2022 for Oregon and SW Washington | The Oregonian #4 Healthiest Employer of Oregon 2021 | Portland Business Journal Healthy Worksite 2021 | Design Coalition in Montana PacificSource is an equal opportunity employer. Click here to review our AAP Policy Statement. If you have questions about working at PacificSource or need help with your application, please email Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age. Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Position Overview: This position will manage key Medicaid contracts with external entities, providers, and payers, including the Oregon Health Authority. The Medicaid Contract Manager will advise and coordinate PacificSource activities to ensure contract deliverables are met. Working closely with CCO leadership and other stakeholders, the Medicaid Contract Manager will create contract management plans, schedules, timelines, and oversight/monitoring plans. This role informs project planning and resource deployment both internally and externally to improve PacificSource’s overall Medicaid performance efforts. The Medicaid Contract Manager will serve on critical work groups to monitor contract changes, participate in rule advisory committees, and provide feedback to the Oregon Health Authority, as applicable. This role coordinates internal and external stakeholders, including PacificSource subcontractors, interacts with PacificSource departments, and oversees key contract monitoring activities. Essential Responsibilities: Responsible for oversight, management, development, implementation, and communication of department programs. Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports. Develop annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective action where needed. Coordinate business activities by maintaining collaborative partnerships with key departments. Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize dashboards and daily huddles to monitor key performance indicators and identify improvement opportunities. Actively participate as a key team member in Manager/Supervisor meetings. Actively participate in various strategic and internal committees to disseminate information within the organization and represent company philosophy. Develop contract management and project plans to ensure priority Medicaid objectives are consistently accomplished and to escalate quickly when objectives are not being met. As assigned, lead internal work groups to ensure performance of PacificSource’s Medicaid initiatives, with an emphasis on contract deliverables and related initiatives. Participate in external work groups, including rules advisory committees, contract development committees, service integration work groups, and community governance committees, as assigned. Work directly with department leaders to ensure knowledge, priorities, and actions accomplish line of business aims on behalf of PacificSource members and community partners. Align contracting activities in each CCO region and among lines of business. Maintain collaborative partnerships with key PacificSource departments and leaders. Actively participate as a key team member in cross-departmental meetings. Actively participate in internal committees to disseminate information within the organization, representing company philosophy, and ensuring line of business visibility within the community and the organization. Serve as responsible manager for hiring, coaching, staff development, staff corrective action, and termination of any direct reports. Provide feedback, including regular one-on-ones and performance evaluations, for any direct reports. Build/maintain relationships with PacificSource’s Medicaid community governance partners, providers, community leaders, and other external stakeholders. Align PacificSource and community partner interests toward the accomplishment of common, community-level goals. Collaborate to ensure the success of community partners who serve the Medicaid line of business to the extent such partnerships also improve the PacificSource Medicaid performance goals. Assume a supporting role in working with providers, county health departments, the State of Oregon, and other partners. Help to ensure internal PacificSource operations synergize with the core competencies of external community partners, including partners and subcontractors. Improve Medicaid member experience and quality of care by effectively leveraging both PacificSource’s core competencies, and those of its partners, through contract management and project planning. Supporting Responsibilities: Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned. SUCCESS PROFILE Work Experience: Minimum of 7 years of experience in the health care industry, managed care, or public health administration. Relevant experience in the following areas: managing large-scale contracts, relationships with regulators and state agencies, interpreting state and federal regulations and guidance, healthcare operations, government relations, and population health improvement. Experience in managing complex contracts and contract/project deliverables, or healthcare compliance is desirable. Demonstrated organizational skills, financial analysis and modeling comprehension, and proven negotiations experience. Demonstrated ability to develop and execute contract management plans and strategies. Education, Certificates, Licenses: Bachelor’s degree or equivalent prior work experience required. Master’s in healthcare administration, Business, or related field strongly desired. Knowledge: Excellent public relations, presentation, and interpersonal skills. Demonstrated successful communication skills, including public presentation, training, meeting facilitation. Maintain high level of knowledge of company products, health reform trends at the federal and state levels, and the insurance industry. Demonstrated skills with the following software: Microsoft Word, PowerPoint, Excel, and Visio. Strong analytical and problem-solving skills. Competencies Building Trust Building a Successful Team Aligning Performance for Success Building Partnerships Customer Focus Continuous Improvement Decision Making Facilitating Change Leveraging Diversity Driving for Results Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 25% of the time, most often to Salem or Portland. Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

View More

 Apply for this job

 Receive alerts for other Medicaid Contract Manager job openings