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Posting Type: Open to All Applicants

Category:FLSA

Exempt/Non-Exempt:Exempt

Agency:Health & Human Services Comm

Department:MCS Chief Office

Job Title:Deputy Executive Commissioner, MCS Operations

Full Time/Part Time :Full Time

Regular/Temporary:Regular

Job Location:4601 W GUADALUPE ST City:AUSTIN Contact:Access HR Service Center

Telephone:888-894-4747

Salary Range:$11,836.00 – $20,017.83

Travel:10%

Closing Date:06/28/2024

Job Description:The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Deputy Executive Commissioner (DEC) for Operations. MCS is driven by its mission to deliver quality, cost-effective services to Texans. The DEC for Operations is a key senior leadership position with a broad range of responsibilities related to the operational elements that support the Texas Medicaid Enterprise Systems (MES) and Medicaid program. This position has major accountability for the achievement of key goals of the program, thus making a significant contribution to MCS’s mission.Reporting to the Chief Medicaid and CHIP Services Officer/State Medicaid Director, the DEC for Operations provides both day to day leadership and long-term vision related to ensuring the most efficient infrastructure for Medicaid operations that cross both the managed care and fee-for-service delivery models. This includes overseeing all planning, implementation, and evaluation of administrative, and operational activities for system operations, contract compliance and oversight, claims administration, provider enrollment, 1915(c) interest list management, PACE, Medicaid modernization and Vendor Drug programs. The combination of these various aspects requires oversight of 7,000+ contracts.The functions under the DEC for Operations rely on multiple complex MES systems and contractors to enroll providers, administer claims payments, manage long-term care provider contracts and claims, and administer the Vendor Drug Program. This role requires strong leadership to ensure process improvements and technology changes can be leveraged to achieve strategic business objectives.The ideal candidate for this role is a self-directed leader versed in managing multiple programs, dealing with ambiguity, and providing vision and strategic leadership in a public environment. The DEC for Operations must have excellent communication skills and be adept at cultivating strong stakeholder relations and working collaboratively across complex, diverse subject areas and agency divisions.Works under minimal supervision with extensive latitude for the use of initiative and independent judgment.

Essential Job Functions:• Ensures both insourced and outsourced operations perform efficiently and effectively while meeting or exceeding stakeholder expectations and also meeting regulatory requirements.• Institutes measures to understand operational performance and drives improvement through the implementation of best practices.• Provides day to day leadership, directing, aligning and overseeing the staff who manage the various Medicaid operations functions.• Provides guidance and direction in the management and oversight of Medicaid contracts to ensure state and federal compliance, high quality performance and outcomes.• Collaborates with the leadership team to develop strategic direction for the department including priority setting, policy formation, and decision-making.• Advises the State Medicaid Director and other leadership team members of changes in operations and business practices, or issues that arise.• Drives the implementation of new initiatives, resolving problems that cross multiple departments, reducing any downstream negative impacts to clients, providers, and MCOs.• Evaluates and strategically responds to developments/changes affecting operations in order to sustain and/or adjust plans or initiatives.• Uses data and financial information to inform decisions and strategy.• Engages in various meetings and represents Medicaid to members of the legislator to present the agency position on issues relating to aspects of the Medicaid program.• Provides thought and strategic leadership in procurement of new business implementations, integrations, application enhancements and performance improvements.• Represents the State Medicaid Director and HHSC while engaging with key stakeholders and legislators.• Provides legislative testimony representing the agency on relevant subject matter areas.• Performs related work as assigned.  Knowledge Skills Abilities:• Strong knowledge and application of key contracting concepts and oversight methods.• Strong knowledge of Medicaid and government programs.• Ability to establish effective internal controls that promote adherence to applicable state/federal laws and HHSC Medicaid/CHIP program requirements.• Advanced verbal and written communication skills to assure complex Medicaid issues are easily understood.• Demonstrated skill in using good judgment to a) seek and use information to support decision-making; b) anticipate the consequences of decisions and actions; c) communicate information; d) interact constructively with others both within and outside the organization; e) maintain confidentiality, as appropriate; and f) choose actions that are beneficial to, and consistent with, the mission, goals, and culture of the organization.• Ability to take initiative, think independently, and contribute constructively to long-term planning, priority setting and decision-making.• Demonstrated ability to use creativity and resourcefulness to a) conceptualize and implement new policies, programs and procedures; b) set priorities for self and others; and c) achieve maximum functioning with available resources.• Ability to apply systems thinking inclusive of critical analysis, forecasting, and measurement related to strategic objectives and business goals.• Ability to promote a culture of high performance and continuous improvement that values a commitment to quality through coaching and managerial oversight of staff performance and development.• Skill in public speaking in the media and with legislators or public officials.

Registration or Licensure Requirements:N/A

Initial Selection Criteria:Minimum of 10 years of relevant government, consulting, or health industry experience with 5+ years being senior level experience.Related degree preferred but years of relevant work experience will be considered in determining most qualified candidate.

The Department for Medicaid Services (DMS) provides health care access for eligible low-income residents of Kentucky including children, families, pregnant women, the aged and the disabled as well as a number of programs and services directed at specific eligibility and medical needs. DMS strives each day to meet the mission of the Cabinet for Health and Family Services to be a diverse and inclusive organization providing programs, services and supports that protect and promote the health and well-being of all Kentuckians and their communities.As Chief of Staff for the Department of Medicaid Services, you will provide executive-level support to the Commissioner and other senior-level staff within our department. You will oversee human resource issues and staff training across the department, ensuring that our team members have the support and resources they need to succeed. Additionally, you will develop and advise on departmental policies, working closely with the Commissioner to execute a broad and complex set of assignments.Key Responsibilities:

• Provide executive-level support to the Commissioner and senior-level staff.
• Oversee human resource issues and staff training across the department.
• Develop and advise on departmental policies.
• Execute a broad and complex set of assignments delegated by the Commissioner.
• Direct and coordinate the work of the Commissioner’s Office staff.
• Conduct performance appraisals and approve leave for assigned staff within the Commissioner’s office.
• Hold routine meetings with Division Directors and provide updates to the Commissioner.
• Prepare routine and complex data requests, develop reports and presentations for the Commissioner, and review reports to ensure consistency and reduce redundancies within Department reporting parameters.

Qualifications:

• Strong leadership and management skills.
• Excellent communication and interpersonal abilities.
• Ability to multitask and prioritize effectively in a fast-paced environment.

The Cabinet for Health and Family Services (CHFS) participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in U.S. CHFS will only use E-Verify once you have accepted a job offer and completed the Form I-9.For more information on E-Verify, or if you believe that CHFS has violated its E-Verify responsibilities, please contact Department of Homeland Security (DHS) at 888-897-7781 or https://dhs.gov/e-verify

Title: Regulations and Guidance Documents Supervisor

State Role Title: Policy Planning Manager I

Hiring Range: $85,000 – $98,123

Pay Band: 5

Agency: Dept of Med Assistance Services

Location: Dept of Medical Asst Services

Agency Website: www.dmas.virginia.gov

Recruitment Type: General Public – G

Job Duties

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Regulations and Guidance Documents Supervisor. The selected competitive candidate will provide exceptional delivery of services to the agency’s Policy, Regulation, and Member Engagement Division. Job responsibilities will include, but are not limited to: Motivate and manage an interdisciplinary team to identify, process, and track agency regulatory actions and guidance document projects, including provider manuals, memos, and bulletins. Provide hands-on support to manage the team’s workload (including handling complicated regulatory and guidance document projects).Ensure quality output that meets deadlines. Responsible for updating and maintaining the agency’s count of regulatory and guidance document requirements and serving as the point of contact for the Governor’s Office of Regulatory Management (ORM).Ensure team members are trained, coached, and continuously growing in their skills. Support the sustainment of a culture of teamwork and high expectations for employees. Work collaboratively with other staff in the Policy Division to ensure continuity of operations and continuously improve processes and procedures.

Learn more about this position.

Under direction of the Director of the Division of Medical Assistance and Health Services (DMAHS), the individual selected will serve as Deputy Division Director, assisting in all aspects of the administration of DMAHS and the NJ Family Care program.

Key responsibilities include (but are not necessarily limited to):

• Assist the Director in providing leadership to the Senior Management team;
• Assume primary ownership of multiple complex policy and program initiatives, working with internal and external partners, taking accountability for timely and successful completion;
• Serve an expert on key areas of Medicaid program operations, and make detailed, actionable recommendations on policy and program options;
• Represent the Division in public-facing forums, and serve as a principal contact for key external advocates and partners;
• Support the Division Director in developing Division capacity and systems for project management, issue tracking, and staff development;
• Serve as a critical reviewer and quality check on Division public-facing or other critical documents;
• Serve as Division Director, when Division Director is out-of-office or unavailable;
• Directly manage staff and vendors.

Learn more about the position and apply.

The Department of Health Care Services (DHCS) is looking for a highly skilled, exceptionally motivated individual to serve as an Assistant Deputy Director (ADD), Behavioral Health (BH), Career Executive Assignment (CEA) B. The ADD, BH, alongside another ADD, BH, assists the Deputy Director (DD), BH, in providing leadership to the Department’s BH program. The ADD, BH, also provides management and support in implementing BH initiatives designed to achieve equitable health care outcomes and ensure consistent access to high-quality mental health and substance use disorder care.

The ADD, BH, acts on behalf of the DD, BH, and collaborates with DHCS Executive Staff, program partners, and external stakeholders, including but not limited to, the California Health and Human Services Agency (CalHHS), the Legislature, state and federal agencies, as well as members of the public and media.

For additional information, including how to submit your application package, please review the posting on CalCareers.

As the Behavioral Health Quality Metrics Manager of HPA’s Behavioral Health Quality Metrics (BHQM) team, you will oversee the strategic direction and staff. You will cultivate strong, productive relationships with the Behavioral Health Division (BHD). The BHQM team is responsible for providing coordination, facilitation, technical, and data support to develop accountability metrics for Oregon’s behavioral health system. This will also involve close collaboration with other managers within the Office of Health Analytics in HPA. The primary focus is to support the Behavioral Health Committee established under 2021 HB 2086 and assist BHD leadership in developing performance measures to track service effectiveness and reduce health inequities.

You will work with analytic and program staff across the Office of Health Analytics, other Offices in the Health Policy & Analytics Division, other OHA divisions such as Medicaid, Public Health, and Behavioral Health, and the Office of Information Systems and Oregon Department of Human Services.

The role demands strong project management, analytical, and interpersonal skills, sound judgment, and exceptional self-direction. The ability to prioritize tasks in a fast-paced environment with diverse stakeholders is crucial. You will have the latitude to recommend changes to policies and procedures and will regularly engage with committees, CCOs, community mental health programs, behavioral health providers, health plans, clinics, and other external partners.

The BHQM Manager must recognize and value individual and cultural differences and foster a work environment that supports and encourages diverse talents and views.

Work Location: Optional 100% remote, 100% in-person or hybrid options are available, with office space in Salem or Portland.

Learn more.

Presbyterian Health Plan (PHP) seeks to continue to be a national leader in serving the complex and diverse needs of Medicaid members and in working with State and Federal agencies on designing and implementing new and innovative programs and services to meet the unique needs of this population.

The Vice President of Medicaid reports to the President of PHP and is accountable for all aspects of our Medicaid program including as the sole Contractor for Children in State Custody. This leader provides strategic and thought leadership to include best practices, emerging practices and innovations on a national scale that are intentionally connected to a deep understanding and solutioning for the needs of New Mexicans across a diverse set of communities including rural, frontier, Native American sovereignties, and urban centers. The Medicaid program includes provisioning for all the physical, behavioral health, and long-term services and supports (LTSS) of Medicaid members, including dental, vision, pharmacy, etc., and the full spectrum of social determinants of health, to include transportation, and supporting health equity across and within our unique populations.

The position offers an exciting opportunity to lead and shape Medicaid programs that have a significant impact on the health and well-being of vulnerable populations. The ideal candidate will possess a combination of strategic vision, operational expertise, leadership skills and government relations experience to drive positive outcomes and advance Presbyterian’s mission of ensuring all our members can achieve their best health.

Qualifications

• Bachelors degree in healthcare administration, public health, business administration or related field.
• Extensive experience (10+ years) in healthcare management, with focus on Medicaid programs.
• In-depth knowledge of full array of Medicaid programs, regulations, policies, best practices, and emerging innovations at Federal and State level.
• Extensive government relations experience is required, preferably within the New Mexico market.
• Strong leadership skills with proven track record of driving organizational change and achieving results through influencing and collaboration.
• Excellent communication, negotiation, and relationship-building skills.
• Strategic thinker, ability to analyze complex issues, and develop innovative solutions.
• Demonstrated ability to collaborate effectively with diverse stakeholders and manage cross-functional teams.
• Experience in budgeting, financial management, and performance measurement.
• Commitment to equity, diversity, and inclusion
• Must live in the New Mexico area.

Responsibilities

• Developing and executing strategic plans that meet the needs and expectations of Medicaid members, relevant State of New Mexico agencies including the Healthcare Authority (HCA) and Children, Youth and Families Department (CYFD), CMS and key stakeholders.
• Forming, collaborating with and leading diverse teams across PHP, to ensure effective delivery of Medicaid services while maintaining compliance with regulations and achieving organizational strategies, goals and metrics, as well as the strategies, goals and metrics of HCA and CYFD.
• Providing ongoing surveillance of national and state market changes and developments to ensure that PHP remains competitive and viable in the future.
• Leading the design, development and enhancement of Medicaid programs to meet the evolving needs of beneficiaries and stakeholders, to include for example, evidence-based models applicable to unique populations such as those specific to Children in State Custody and Behavioral Health.
• Provide thought leadership and input on the State’s strategy for achieving their vision and objectives and fostering alignment with Presbyterians capabilities and new business models, to include for example improving access to behavioral health and substance use disorder services and supports and expanding availability of models and services to serve Children in State Custody.
• Overseeing day to day operations for Medicaid programs working in collaboration with executive leaders and operational leaders.
• Leading functional teams to serve our Medicaid members and meet and exceed the needs and expectations of stakeholders without direct reporting relationships, to include for example, network contracting and development, claims, population health inclusive of pharmacy, etc.
• Aligning Medicaid to the Dual Special Needs Plan (D-SNP) requirements to support optimal performance and outcomes.
• Proactively monitoring changes in Medicaid waivers, state plan amendments, policy and legislation to mitigate risks, inform strategies, and maintain program integrity.
• Engaging fully in the government relations process to influence a positive perception of PHP’s Medicaid program.
• Provide strategic direction and alignment with key stakeholders over quality initiatives to improve the quality, efficiency and effectiveness of Medicaid services, including performance measures, outcome evaluation, and continuous process improvement.
• Establishing and overseeing strategic workstreams and deliverables, scorecard metrics including quality, experience, and financial measures, to measure achievement of effective outcomes while maximizing value for members and stakeholders.
• Build and maintain relationships with key stakeholders, including government agencies, healthcare providers, advocacy groups, community organizations, and policymakers.
• Develop and lead high performing teams, providing leadership, guidance and mentorship over a high-functioning team fostering a culture of accountability, innovation, and excellence.
• Leads all Medicaid procurement activities including ongoing market and technology assessments, preparation efforts and resource planning, market positioning, consultant sourcing, marketing and branding, and the response development cycle

Benefits

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

https://www.phs.org/careers/why-work-with-us/benefits

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers’ markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian’s story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state’s largest private employer with nearly 14,000 employees – including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About Our Regional Delivery System

Presbyterian’s Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state’s largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

We are part of New Mexico’s history – and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico

New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture – from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it’s all available among our beautiful wonders of the west.

To Learn more and to apply click here or reach out to emcguill@phs.org.

Principal analysts are seasoned technical experts who lead MACPAC’s analytic work on key policy issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP). They work under the direction of the executive director and policy directors, but are expected to conceptualize and manage significant bodies of work, often involving other team members.

Qualified candidates have knowledge and expertise in Medicaid access to coverage and care policies.. This could include experience in policy areas such as enrollment and eligibility, redeterminations, covered benefits, access to care in fee for service and managed care delivery systems, and related issues for populations including children, pregnant people, parents, and adults.

To Learn more and to apply click here.

Principal analysts are seasoned technical experts who lead MACPAC’s analytic work on key policy issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP). They work under the direction of the executive director and policy directors, but are expected to conceptualize and manage significant bodies of work, often involving other team members. Qualified candidates have knowledge and expertise in Medicaid payment and financing policies. This could include experience in policy areas such as fee-for-service base and supplemental payments, managed care capitation rates and directed payments, state approaches to provider payment, and payment and rebates for prescription drugs.

To Learn more and to apply click here.

Senior analysts focus on one or more aspects of the Medicaid and State Children’s Health Insurance Program (CHIP). They work collaboratively with other members of the policy team under the direction of policy directors. Qualified candidates have knowledge and expertise in Medicaid payment and financing policies. This experience could include familiarity in policy areas such as fee-for-service base and supplemental payments, managed care capitation rates and directed payments, state approaches to provider payment, and payment and rebates for prescription drugs.

To Learn more and to apply click here.

ORAU is seeking a Fully Remote, Senior Advisor on Medicaid to work with CMMI as an ORAU employee. This exciting work will last one or more years, and the successful candidate will become a temporary employee of ORAU assigned to the Centers for Medicare and Medicare Services Innovation Center (CMMI). This position is 30- 40 hours per week.

CMMI is seeking assistance in the design and support of current research and development activities related to healthcare delivery and payment reform, in support of Section 1115A(a)(3) of the Social Security Act. Specifically, for CMMI models focused on Medicaid populations, a subject matter expert with extensive expertise in Medicaid is needed to provide CMMI staff with consultative Medicaid policy expertise during new model design and launch during calendar year 2024. This subject matter expert will also assist CMMI leadership and teams as they develop strategies to achieve multi-payer alignment between Medicaid and Medicare, and develop strategies for effective engagement of states in the CMS Innovation Center’s newest models. Additionally, this subject matter expert will use their extensive Medicaid background and experience to assist CMMI SPHG leadership in collaborating-with the Center for Medicaid & CHIP to better identify and foster best practices for cross-component alignment.

This position will provide Medicaid finance and policy expertise during the pre-implementation period of the AHEAD Model. This is to include technical expertise and innovation in Medicaid finance, especially in the construction of Medicaid hospital global budgets (HGB) and treatment of supplemental payments; provide technical assistance to states on potential legal pathways to implement Medicaid HGBs and Medicaid advanced primary care (APC) payment and care delivery models; provide guidance to states on Medicaid considerations in the construction of state all-payer cost growth benchmarking. In addition, serves as a SME for the AHEAD Model team on Medicaid issues and reviews model policy and legal documents that pertain to Medicaid program requirements or policy.

Learn more about this position and apply.