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The Mgr Medicaid Performance is responsible for professional and technical planning, design, and coordination of projects and initiatives for Health Plan Medicaid Programs. Works closely with management teams across multiple departments and contracted vendors to ensure that projects and initiatives are implemented timely, accurately, and completely. Responsible for day-to-day management and oversight of one or more Medicaid-contracted vendors.
ESSENTIAL FUNCTIONS OF THE ROLE
Provides program/project leadership and management through the design, planning, and coordination of project implementations.
With direction from leadership, analyzes Medicaid program performance to determine opportunities for improvement, identifying performance gaps, prioritizing opportunities, and implementing improvements that align with organizational goals and result in sustainable gains and outcomes.
Organizes and leads assigned projects and initiatives using methods of team building, data gathering and analysis, process mapping, and problem solving.
Builds and develops working relationships through coaching/mentoring of project team members and business partners to foster a culture of continuous improvement.
Participates in developing and delivering training content in support of improvement strategies.
Establishes appropriate tools to monitor progress of planned improvement implementations and achievement of expected benefits. Engages department leads and develops reporting to track performance across the Plan and provides leadership visibility of key metrics. Collaborates with department and plan leadership to develop reporting to track Medicaid performance; conducts monthly meeting to review performance metrics with leaders.
Develops a collaborative relationship with other regulatory related resources across the company, including the Compliance department.
Resolves common and complex business issues within established guidelines and recommends appropriate alternatives. Provides direction to Plan departments and facilitates information validation and decision-making; handles most unique situations.
KEY SUCCESS FACTORS
Strong working knowledge of laws governing the provision of government subsidized health coverage, including Medicaid and Children?s Health Insurance Programs.
Organization and leadership skills; able to influence others.
Independent thinker with excellent judgment and ability to work in a dynamic environment.
Analytical ability for assessing and resolving business needs via innovative concepts.
Analytical ability to understand complex business rules and apply knowledge to develop and create solutions.
Strong communicator, excellent oral and written presentation skills.
Advanced proficiency in Word, Excel and PowerPoint. Graphic skills helpful.
Consistently demonstrates the ability to recognize, establish and deal with priorities promptly.
Maintains favorable working relationships between outside vendors and the Health Plan.
Demonstrated commitment to serving a diverse population to assist them in meeting their health and social needs.
Able to work in a fast-paced environment with clear focus on program priorities and able to balance the social, cultural and financial challenges of this program.
Five years project management of healthcare projects required.
Our competitive benefits package includes the following - Immediate eligibility for health and welfare benefits - 401(k) savings plan with dollar-for-dollar match up to 5% - Tuition Reimbursement - PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level
- EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!