Grants Administrator I (MCO Contract Monitor) / 60015416

Full Job Description

Are you the One? We are looking for a Grants Administrator I (MCO Contract Monitor) who will serve as a Contract Manager supporting the oversight and accountability of Medicaid and Medicare Managed Care Plans operating in South Carolina. This position plays a vital role in safeguarding quality care and program integrity for members by ensuring contractual and regulatory compliance by Managed Care Organizations (MCOs). This is a regulatory oversight position that involves reviewing, analyzing, and monitoring health plan performance, ensuring adherence to federal and state requirements, and collaborating across internal and external stakeholder groups to improve outcomes for Medicaid/Medicare members.

Serves as subject matter expert on all aspects of MCO contract by providing knowledge and expertise to internal partners, vendors, and external stakeholders.

Provides guidance and direction to internal staff, vendors and external stakeholders on interpreting and operationalizing contract requirements.

Clarifies contractual obligations to ensure all impacted stakeholders understand their roles in implementing deliverables as written in the contract.

Assists with planning, coordination, administration and execution of new contracts, contracts amendments, change notices and bulletin updates as needed.

Archives and maintains supportive documentation, communications, and reports to ensure accountability and accessibility of historical contract activities and decisions.

Provides input, serves as liaison, and prepares communications for publication to vendors, internal departments, stakeholders, and/or administration, as well as facilitates internal and external meetings with partners to assist with the execution of the contract as written.

Serves as the primary point of contact for escalations, assisting internal/external partners in resolving issues that impact contract execution.

Monitors and evaluates MCO performance against contract deliverables as outlined in the contract and report companion guide, including the collection and storage of data required to monitor, analyze, and report compliance.

Measures, tracks, and reports regularly on contract activity, contract compliance, contractor performance and agency satisfaction as defined in internal policies and procedures.

Assists in the development and maintenance of procedural documentation, tools, reports, FAQs, monitoring protocols and operational tools necessary for consistent and accurate evaluation of contract and vendor deliverables.

Collaborates with cross functional teams (policy, finance, quality, provider management and legal) to support managed care policy enforcement and continuous improvement.

Conducts detailed reviews and validation of contractual reports, documentation, corrective action plans (CAPs), and performance metrics as defined in the report companion guide and internal policies and procedures.

Prepares written analyses, issue summaries, and formal presentation for agency leadership and stakeholders to communicate managed care plans compliance status, identified risks and trends, and recommended actions for improvement.

Provides day-to-day oversight, follow-up, and maintenance of assigned contract/vendor related escalations, and collaborates with appropriate parties to render resolution.

Measures, tracks, and reports regularly on contract/vendor related escalations for assigned contracts and archives documentation as defined in internal policies.

Develops and submits after action review documents to management to address repetitive escalation topics.

Creates trend analyses of repeated escalations and submits after action review documents to keep leadership aware of repetitive topics.

Identifies and proposes improvement recommendations to leadership. and report on a trend analysis of repeated escalations and devise technical assistance to address ongoing challenges.

Utilizes critical thinking skills to optimize on the best solutions to execute resolutions to escalations and all related concerns regarding the contract as written.

Attends and participates in relevant opportunities for professional development and training. Demonstrates utilization and application of new skills learned to improve effectiveness and efficiency within assigned responsibilities.

Leads or supports other projects proactively or as assigned by Agency leadership.

Continuously engages in process improvement to support Agency, Division, and Bureau-wide strategies, objectives, and initiatives.

Collaborates with other managed care team members in research, development, implementation, and evaluation activities for services, projects, and agency initiatives as assigned.

Performs other related duties as required.

• Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
• 15 days annual (vacation) leave per year.
• 15 days sick leave per year.
• 13 paid holidays.
• State Retirement Plan and Deferred Compensation Programs.

Requirements

A bachelor's degree in Public Administration, Health Policy, Social Work, Business Administration, or a related field and a minimum of two (2) years of experience in contract management, program compliance, Medicaid/Medicare operations, or regulatory oversight in a healthcare setting.

Additional Requirements:

• Valid driver's license.
• Occasional overnight travel.
• Overtime and/or weekend work with Deputy approval.
• Sitting or standing for long periods of time.
• Lifting requirements: 20 lbs.

Qualifications

• Demonstrated competencies related to contract procedures, functions, and compliance.
• Competent in use of protocols, policies, procedures, and tools.
• Experience in interpreting and applying laws, regulations, policies, and/or procedures required.
• Ability to work independently; to organize and complete work assignments with minimal guidance.
• Ability to maintain a positive working environment with internal and external relationships.
• Capable of following oral and written policies/regulations.
• Proficient in serving as point person for day-to-day oversight of assigned programs.
• Experience working with Microsoft Excel.
• Experience with Medicaid and/or Medicare.

Additional Information

Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.