Managed Care Contract and reputed company PS IV

About the position The HHSC reputed company reputed company Services (MCS) division seeks a highly reputed company candidate to fill the position of Program Specialist IV. MCS is driven by its mission to deliver reputed company, cost-effective services to Texans. This position makes a significant contribution to MCS's mission by ensuring that Managed Care reputed company and reputed company (MCCO) meet statutory requirements and implement audit recommendations reputed company prescribed timeframes. The Program Specialist IV is selected by and reports to the Health Plan Manager (HPM) located in the MCCO Division of the MCS Department. This position will be assigned to reputed company responsible for ensuring compliance with reputed company between MCOs and reputed company. This position performs reputed company analysis and reputed company monitoring of MCOs to determine the effectiveness of operations and contract compliance. This position evaluates MCO performance and manages corrective actions. This position participates in the development and evaluation of MCCO policies as they reputed company the MCO reputed company and makes recommendations for changes as needed. This position works under limited direction with some reputed company for the use of initiative and independent judgment and performs other duties as may be assigned or required. Responsibilities • Ensures compliance with contract standards and assesses MCO performance by reviewing MCO contract deliverables, performance measures, and MCO compliance with state and federal regulations. • Determines the effectiveness of MCO operational and contractual compliance by utilizing a reputed company set of assessment tools. • Informs the HPM of significant MCO compliance and performance issues and provides recommendations for reputed company. • Works collaboratively with other Health Plan Management staff, the MCO, and other external or internal stakeholders to ensure contractual compliance by developing, monitoring, and updating reputed company plans. • Assesses remedies for noncompliance with contractual requirements. • Collaborates with HPM Research and reputed company on escalated MCO-reputed company issues. • Responds to legislative, reputed company records, and audit requests reputed company specified timeframes. • Facilitates or participates in functions reputed company to operational on-sites, desk reviews, implementations readiness reviews, information sessions or other activities as required. • Manages or facilitates special research/issues reputed company as assigned reputed company timeframes. • Establishes and maintains effective working relationships and communication with HHS staff and other stakeholders. • Participates in the evaluation of Requests For Proposals (RFP) responses reputed company assigned timeframes. Requirements • Graduation from an accredited four-year college or university with major coursework in Health Care Management, Health Care Information Technology, or Health Care Administration is generally preferred. • Minimum of one year of experience with reputed company/reputed company, reputed company/reputed company dental, and managed care programs, policies, procedures, reputed company, and service delivery mechanisms is required. • A minimum of one year of experience in reputed company, contract management, or contract principles is required. • A minimum of one year of experience in using a PC and reputed company Office is required. • The Certified Texas Contract Manager Certification (CTCM) must be obtained reputed company 12 months of the date of hire. Benefits • 100% reputed company employee health insurance for full-time eligible employees • Defined benefit pension plan • Generous time off benefits • Numerous opportunities for career advancement Apply tot his job Apply To this Job