Contract Compliance Manager

Company: State of Indiana
Location: Indianapolis
Posted on: September 23, 2022

Job Description:

Contract Compliance Manager Date Posted: Sep 11, 2022 Requisition ID: 369843 Location: Indianapolis, IN, US, 46202 Work for Indiana Grow your career with the State of Indiana! With more than 50 executive branch agencies, the State of Indiana is a diverse workforce offering employees stimulating and challenging projects across a broad scope of career opportunities. As a State of Indiana employee, you impact the well-being of Indianas communities every day.At the State of Indiana, we dont just talk about diversity and inclusion Our goal is to create a welcoming, accessible, and equitable workplace, with a workforce that is representative of the State of Indiana population. As a proud equal opportunity employer, reasonable accommodations may be available to enable individuals with disabilities to interview and to perform the essential functions of a role.About the Family & Social Services Administration: The Office of Medicaid Policy and Planning (OMPP) is a division within the Family and Social Services Administration, which receives around 13 percent of the state's budget to ensure vital health care coverage to approximately 1 in 5 Hoosiers. OMPP strives to build programs and processes that enable Hoosiers to live in fully engaged communities and reach their greatest emotional, mental and physical well-being. Our mission is to support individual and community well-being with effective and efficient programs, remarkable collaborations, measurable impact on individuals and communities, and an energized staff that is fully engaged with this mission. Salary: The annual minimum starting salary for this position is $ 41,574.00. Salary may be commensurate with relevant experience/education. Next level benefits at the State of Indiana are here! Be sure to review our expanded benefit package offerings below. About the Job: As a Program Director, you will administer a program within a state agency and serve as the specialist in a specific area. This role is responsible for overseeing multiple state contracts for the delivery of health care services to low income Hoosiers eligible for Indiana Medicaid provided through the Indiana Health Coverage Programs which includes the Healthy Indiana Plan (HIP), Hoosier Healthwise (HHW) and Hoosier Care Connect (HCC). These three programs provide a wide range of health services through a risk-based managed care delivery system established with Managed Care Entities (MCEs). A Day in the Life: The essential functions of this role are as follows:

• Establish and maintain an extensive knowledge of all assigned contracts; serve as a subject matter expert on managed care programs and contract compliance within the Indiana Health Coverage Programs (IHCP); enforce compliance provisions as permitted by the contract
• Represent the agency as the primary contract compliance liaison with the executive staff of the managed care entities (MCEs) and assigned contract vendors; act on behalf of FSSA and OMPP leadership
• Assess all MCE operations performance in a consistent manner based on contract requirements, performance metrics, established IHCP manual policy and procedures and the MCE Policy and Procedures Manuals
• Complete an in depth analysis of ad hoc, monthly, quarterly, and annual MCE reports to ensure compliance with contract requirements of reporting requirements and performance metrics; recommend improvements or changes as needed to align with FSSA objectives
• Assist, as a assigned, with procurements, contract negotiation, and subsequent implementations/readiness reviews
• Review and analyze contract drafts timely to ensure FSSA goals and Medicaid initiatives are accurately reflected in document; design operations, policy modifications and subsequent readiness review or implementation documents when contracts are awarded
• Coordinate and respond to issues identified through assessment of MCE reports and constituent inquiries; consult with FSSA legal counsel and work with legislators, the Office of the Governor and other state agency partners as needed to respond to constituent issues
• Assist with the development of an annual schedule and topics for monthly onsite visits with MCEs and other contractors based on contract requirements and performance metrics; assist with development of monthly onsite tool with in depth questions of the onsite topic in advance; analyze the MCE responses in the onsite tool, reports, constituent inquiries, member/provider complaints and other resources
• Review MCEs reporting, onsite presentations, provider and member documents, provider network, grievance and complaints to ensure members are receiving quality care, access to care and medically necessary care
• Develop agenda and facilitate meetings for on-sites with MCEs/vendors to ensure in depth discussion of non-compliant issues, performance expectations, and action items for follow up to ensure compliance
• Review Managed Care Entity generated communication and marketing materials on an ongoing basis to ensure compliance with program guidelines and State and Federal regulations
• Collaborate with other compliance managers, OMPP staff, and units to coordinate communication, bulletins, newsletters, change requests, data requests and ongoing day-to-day functioning; analyze the impact of proposed policy or program changes, seek clarification from MCEs as needed and seek guidance from supervisor when appropriate
• Evaluate access, quality and cost-effectiveness of the Indiana Health Coverage Programs (Hoosier Healthwise, the Healthy Indiana Plan, and Hoosier Care Connect) and other support service contracts
• Other assigned dutiesThe job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time. What You'll Need for Success: This person must have the following requirements to be considered for employment:
  • Bachelors degree in public health, public administration, business, or similar with three plus years of experience required, a masters degree preferred
  • Working knowledge of rules, regulations and procedures related to Medicaid managed care plans, public procurements, contracts, compliance and enforcement, and reporting requirements;
  • Extensive knowledge of state and federal laws, policies and procedures concerning the Medicaid Programs
  • Broad knowledge of divisional and agency objectives, programs, operations and procedures
  • Working knowledge of reporting systems and ability to accurately interpret complex statistical data and reports
  • Ability to anticipate and evaluate problems that would create barriers to achieving goals and initiate corrective action measures
  • Ability to establish priorities, set deadlines and carry out periodic reviews; high degree of self-motivation and independent working
  • Ability to develop and conduct presentations to diverse groups of people including Chief Executive Officers of contractors
  • Ability to establish and maintain meaningful work relationships with professional groups, legislators, media and the public
  • Proficient with Microsoft Office suite, including SharePoint; advanced experience with Excel preferred
  • Must communicate effectively, both orally and in writing; must be able to interact with diverse populations, communicate effectively and appropriately with each and to maintain a high level of professionalism
  • Be innovative and persuasive, and be cognizant of the need to improve or initiate new policies/procedures that will allow service to Medicaid members to be delivered effectively and efficiently while managing fiscal responsibility. Supervisory Responsibilities/Direct Reports: This role may serve as a team lead for an assigned work group.Benefits of Employment with the State of Indiana: The State of Indiana offers a comprehensive benefit package for full-time employees which includes:
    • Three (3) medical plan options (including RX coverage) as well as vision and dental plans;
    • Wellness program (offers premium discount for the medical plan and gift cards);
    • Health savings account, which includes bi-weekly state contribution;
    • Flexible work scheduling options, including the potential for hybrid remote work for employees whose work may be performed outside state facilities;
    • Deferred compensation 457B account (similar to 401k plan) with employer match;
    • Two (2) fully-funded pension plan options;
    • A robust, comprehensive program of leave policies covering a variety of employee needs, including but not limited to:
    • 150 hours of paid new parent leave;
    • Up to 15 hours of paid community service leave;
    • Combined 180 hours of paid vacation, personal, and sick leave time off;
    • 12 paid holidays, 14 on election years;
    • Education Reimbursement Program;
    • Group life insurance;
    • Referral Bonus program;
    • Employee assistance program that allows for covered behavioral health visits;
    • Qualified employer for the Public Service Loan Forgiveness Program;
    • Free Parking for most positions;
    • Free LinkedIn Learning access;Equal Employment Opportunity: The State of Indiana is an Equal Opportunity EmployerCurrent Employee? Click here (https://performancemanager8.successfactors.com/sf/careers/jobsearch?bplte_company=indianaoff) to apply.

Keywords: State of Indiana, Indianapolis , Contract Compliance Manager, Executive , Indianapolis, Indiana