CCO Contract Director of Medicaid Operations (remote)

Description

GOBHI has an immediate opening for a remote CCO Contract Director of Medicaid Operations and we are flexible on the home office location within the State of Oregon.

The CCO Contract Director of Medicaid Operations provides direction to staff by remaining current with mandated changes, system enhancements, administrative guidelines and contractual requirements. Serves as primary contact and coordinates Oregon Health Authority and regulatory audits. Establishes operational goals, develops written procedures and provides direction to ensure contractual compliance and adherence to GOBHI, EOCCO, and OHA deliverable timelines.

Essential duties include:

• Serves as a member of GOBHI Executive Leadership Team (ELT).
• Attends monthly Board of Director meetings upon request.
• Oversight of all elements of CCO contract delegated to GOBHI.
• Oversight of Non Emergent Medical Transport (NEMT), Contract and Project Management teams as well as individual career development by establishing dedicated weekly check-ins with all direct reports.
• Partners with Chief Compliance Officer, Chief BH Officer and Data Analytics Director to meet regulatory requirements regarding Medicaid Operations.
• Ensures cross training of all staff to align with short and long-term strategic goals of Medicaid operations.
• Responsible for daily leadership to staff, including timekeeping, PTO processing, monitoring performance, conducting performance appraisals, mentoring, staff development, and recruitment and retention.
• Oversees the implementation of claims system updates, database enhancements, network programming, and adding, changing, and maintaining annual updates.
• Facilitates problem solving for providers, employees, and internal customers by answering operations related questions and coordinating with claims systems and contract interpretation related to benefits and administrative guidelines.
• Remains apprised of any changes affecting OHP, communicates industry standards regarding OHP benefits administration, and provides direction accordingly.
• Participation and leadership role in completion and preparation for annual EQR activities and audits.
• Engages with OHA workgroups as it relates to CCO operations, encounter data, rate setting, and others as needed.
• Works with Moda/EOCCO to develop or modify member communication materials, documents, and materials including, but not limited to member handbooks, member welcome packets, notification postcards, and other documents as needed in collaboration with Marketing.
• Introduces Medicaid Operations to innovations in member engagement, communication, and health literacy to drive better health outcomes.
• Diversification and utilization of non-traditional member communication and engagement strategies.
• Ensures OHP Medicaid policies, procedures, quality assurance, and turnaround standards are being followed. This includes performing reviews to verify accuracy, identifying corrective action and work to create and/or modify existing policies to ensure compliance.
• Responsible for updating any policies as assigned.
• Drives to meetings or other GOBHI locations as needed.
• Other duties as assigned.

Requirements

What is needed to succeed in this role:

• Experience - 5+ years’ experience managing the CCO contract including physical, behavioral health, and dental care.
• 5+ years’ demonstrating the knowledge, skills, and abilities to perform the above essential job functions.
• Strong written and verbal communication skills; effectively presents information.
• Influence skills; effectively coaches and mentors others.
• Interpersonal skills; works well with people at all levels of the organization.
• Flexibility; initiates change and uses good judgment when responding to change.
• Resourceful, able to network and connect people to appropriate resources.
• Maintains good driving record and required vehicle insurance.
• Education – Bachelor’s Degree in a related field required, Master’s degree preferred.

What we offer:

• Competitive salary – starting at $120,000
• Medical, dental and vision insurance for you and dependents
• Generous paid time off
• Company paid life and long-term disability
• EAP
• FSA
• Triple AAA insurance
• Mileage reimbursement
• Professional Development funds
• Wellness benefits
• 401k match

About GOBHI:

Founded in 1994, Greater Oregon Behavioral Health, Inc. is an innovative behavioral health organization that serves communities across Oregon. GOBHI is a 501(c)(3) nonprofit corporation that is charged with administering the behavioral health Medicaid benefit, non-emergent medical transportation and community engagement in 12 rural and frontier counties in Oregon.

GOBHI is a co-owner of the Eastern Oregon Coordinated Care Organization, along with Moda Health, and also provides various direct services statewide. GOBHI is committed to better health, better care, and lower costs. Please visit www.gobhi.org to learn more about our mission and services.