Vice President Medicaid - Oklahoma City

Company: Mostly Medicaid
Location: Oklahoma City
Posted on: May 28, 2023

Job Description:

Position: Vice President Oklahoma Medicaid
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is invested in your future!

Job Summary

This position is responsible for leadership and oversight of the Oklahoma Medicaid program operations directly at HCSC or through subcontractors. Responsible for serving as direct th Care Authority (OHCA), managing Oklahoma Medicaid operations including profit and loss management and ensuring compliance with terms of the Contract including securing and coordinating resources. This position is authorized and empowered to represent the MCO regarding all matters pertaining to the Contract prior to such Representation and act as liaison between MCO and the OHCA.

This position also supervises the BCBSOK Medicaid Operations personnel which includes staff that perform state reporting and delegated oversight reporting, compliance activities, medical management oversight, quality management oversight, project management and member services oversight of applicable vendors and directly performed company activities. Leverages matrix relationships with key departments at BCBSOK for network development, provider data, credentialing, IT, finance, actuary, Enterprise Government Programs, marketing and communications, and budget.

Responsibilities

Responsible for leadership, direction and oversight of Oklahoma Medicaid program operations directly at HCSC or through subcontractors.

Ensure compliance with terms of the Contract including securing and coordinating resources necessary for compliance.

Provide oversight, coordination or directly responsible for financial, clinical, IT, quality improvement, reporting, claims processing, member services, and network management. Build and maintain relationships across the company.

Accountable for contract compliance and works under the review of the Oklahoma Health Care Authority. Become familiar and keep abreast of contractual obligations through the OHCA.

Maintain business relationship with state agency personnel and federal agency personnel (as applicable) and serve as the primary point of contact in Oklahoma for those agencies as well as for HCSC Enterprise Government Programs.

Direct project activities related to new or revised regulations.

Develop processes and procedures and coordinate with various internal and external personnel. Responsible for ensuring a robust Medical Policy and Procedure Manual is developed and maintained which includes policies mandated by state and federal agencies as well as policies to guide the running of the business.

Receive and respond to or provide guidance and interpretation of impacted areas for all inquiries and requests made by made by the OHCA related to the Contract and in the time frames specified by OHCA.

icipate in regular OHCA and MCO Executive Director meetings or conference calls.

Make best effort to promptly resolve any issues identified by HCSC, vendors or federal/state agencies that may arise and are related to the Contract.

Meet with OHCA representatives on a periodic or as needed basis to review HCSC's performance and resolve issues. Includes meeting with OHCA e requested by OHCA if OHCA determines that HCSC is not in compliance with the requirements of the Contract.

Responsible for P & L of the line of business which includes budget, reporting and systems.

Build and maintain relationships with subcontractors.

Ensure direct internal and subcontractor staff are trained on all state, federal and business requirements and meet/exceed goals and initiatives.

Responsible for presentations to upper management and governmental agencies.

Job Requirements:

Bachelor degree.

10 years in a leadership/management position.

10 years health care/managed care experience.

Experience with government contracting.

Knowledge of managed care practices, utilization and care management, accounting, provider networking and member services.

Experience to lead multifunctional business unit.

PC proficiency including Word, Excel and PowerPoint.

Presentation skills.

Verbal and written communications skills including interpersonal skills to interface ls of the organization and represent the company to subcontractors and government agency.

Preferred

Requirements:

Masters Degree.

Experience working with OHCA or Medicaid Populations.

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We encourage people of all backgrounds and experiences to apply.

Even if you don't think you are a perfect fit, apply anyway - you might have qualifications we haven't even thought of yet.

Are you being referred to one of our roles? If so, ask your connection t our Employee Referral process!

HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer---

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