Conduent Contract Manager, Medicaid Managed Care in Cranston, Rhode Island
Contract Manager, Medicaid Managed Care
Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.
We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.
Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at www.conduent.com .
Conduent is seeking a motivated and creative individual to join its team of professionals providing management and technical services to the Rhode Island Medicaid program within the Executive Office of Health and Human Services (EOHHS). Working closely with Conduent and EOHHS staff, this person will play a key role on the Managed Care Oversight team while managing the day to day operational relationships with the Plans.
REPRESENTATIVE PRINCIPAL DUTIES AND RESPONSIBILITIES*
The responsibilities of the successful candidate will include:
Oversee the operational aspects of the RI Medicaid / EOHHS contractual relationship with the State’s Managed Medicaid Care Organizations
Planning, designing, implementing and evaluating AE pilot;
Identifying and assessing health care delivery system and Medicaid agency needs especially as related to access
Engage various internal and external stakeholders regarding proposed changes to the provider network or benefit plan for Medicaid beneficiaries
Develops and maintains a personal professional network that includes representatives from plans, providers, AEs, regulators and lawmakers
The Senior Contract Manager applies a broad knowledge of managed care, alternative payment arrangements, health care programs, policy, process and administration. Incumbents will work under the direction of senior Conduent and Medicaid officials to perform a full range of analytical and/or professional activities. The incumbent must be able to manage and complete multiple tasks simultaneously with considerable self-direction.
Provides MCO/MCO contract related internal input on various committees or as otherwise needed.
Reviews required financial, utilization, quality, membership and AE performance reporting from Plans for timeliness and accuracy and posts briefings to senior staff on any significant findings
Provides contract based input and support to existing and new health care service programs including implementation, operation and contract compliance.
Works with MCOs to assure minimal impact on members through timely and effective transition of significant sub contractor relationships
Monitors industry developments that may impact applicable health care services offerings including legislative/legal developments at the local, state and federal level.
Identifies failures in contract compliance and provides appropriate documentation and escalation to senior staff
Reviews quarterly Plan filings and provides senior staff with anything noteworthy.
Master’s degree in health care related field (e.g. public health, health care management/administration, social work, nursing) preferred; applicable medical certifications/licenses required (e.g., R.Ph).
Demonstrated interest in furthering the Triple Aim especially for an underserved population.
Ability to think creatively.
Ability to work collaboratively as part of team to achieve client objectives; able to initiate and sustain successful working relationships with Medicaid Managed Care Organizations, associates, community stakeholders, regulators and public and private agencies.
Thorough knowledge of and experience with managed care contracts, publicly financed health care delivery systems (e.g. Medicaid managed care), accountable care organizations, value based purchasing and alternative payment arrangements
Maintains current working knowledge of related federal and state legislation and/or regulation
Membership in a related professional organization preferred.
All other duties as assigned
Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form .
Job Service Delivery Healthcare
Primary Location United States-Rhode Island-Cranston
Organization Public Sector
Unposting Date Ongoing
Req ID: 18005311