Managed Care, Gov Contracts Sr. Specialist (Nevada Remote)
Company: Molina Healthcare
Location: Sparks
Posted on: April 23, 2024
Job Description:
Molina Healthcare of Nevada is hiring for a Managed Care, Gov
Contracts Sr. Specialist. This role can be worked remotely from
anywhere in the state of Nevada..
The Sr. Specialist role will involve coordination of all Government
Contracts deliverables, primary focus will be to improve and
standardize priorities, initiatives. This position works with state
regulators to exceed requirements and performance expectations in
the execution of the company's Medicaid contract. It will also be
preparing, tracking, and delivering health plan reports to state
for primarily Medicaid line of business with oversight of reporting
requirements for Medicare and Marketplace.
Highly Qualified Candidates Will Have The Following Experience:
-
- Reading, interpreting, and responding to Managed Care
regulatory bodies and contracts. -
- Project Management -experience in healthcare with the ability
to communicate confidently and reliably. Experience in compliance,
quality, accreditation, government affairs/lobbying a
plus.
- Resourcefulness, problem solving, and critical thinking highly
desired.
- Experience reading, understanding, following state/federal
contracts, rules, policy and law.
- Experience presenting to and sharing with all levels of
leadership.
- Solid, steady work history.
KNOWLEDGE/SKILLS/ABILITIES
- Responsible for the strategic development and administration of
contracts with State and/or Federal governments for Medicaid,
Medicare, Marketplace, and other government-sponsored programs to
provide health care services to low income, uninsured, and other
populations.
- Responsible for coordinating, conducting and/or responding to
research requests pertaining to government healthcare programs;
preparing and submitting regulatory reports for filings; reviewing
Plan submissions for quality, accuracy, and timeliness; and
ensuring Plan meets contractual and regulatory
requirements.
- Reviews Provider Agreement, EOC/ Member Handbook, Provider
Directory, marketing materials, and other contract reporting
deliverables for compliance with contractual and regulatory
requirements prior to submission.
- Assesses information received from government contracting
agencies and regulators and disseminates to impacted Plan
staff.
- Participates in meetings related to Molina government run
programs with State agencies and Molina Corporate departments and
disseminates relevant information to staff and management.
- Oversees/maintains the department's documentation and archive
system, ensuring submitted reports are archived for historical and
audit purposes. Ensures system is updated and complete.
JOB QUALIFICATIONSRequired Education: High School diploma or
equivalentPreferred Education: Bachelor's Degree in Business
Administration, Healthcare, or related field.
Required Experience:
- 3 years' experience in a managed care environment.
- Experience demonstrating strong: communication and presentation
skills; analytical/reasoning ability; detail orientation;
organizational and interpersonal skills.
- Proficient in compiling data, creating reports, and presenting
information, using Crystal Reports (or similar reporting tools),
SQL query, MS Access, and MS Excel.
Preferred Experience:
- Project Management -experience in healthcare with the ability
to communicate confidently and reliably. Experience in compliance,
quality, accreditation, government affairs/lobbying a
plus.
- Resourcefulness, problem solving, and critical thinking highly
desired.
- Experience reading, understanding, following state/federal
rules, policy and law.
To all current Molina employees: If you are interested in applying
for this position, please apply through the intranet job
listing.
Molina Healthcare offers a competitive benefits and compensation
package. Molina Healthcare is an Equal Opportunity Employer (EOE)
M/F/D/V Pay Range: $40,851.44 - $88,511.46 / ANNUAL
*Actual compensation may vary from posting based on geographic
location, work experience, education and/or skill level.
Keywords: Molina Healthcare, Reno , Managed Care, Gov Contracts Sr. Specialist (Nevada Remote), Other , Sparks, Nevada
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