Director of Managed Care

State of South Carolina; Cayce (SC); In loco; USD 120.000 - 180.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health insurance

Retirement plan

Paid time off

Descrizione del lavoro

SC Department of Behavioral Health and Developmental Disabilities (BHDD) seeks a Director of Managed Care to lead Medicaid and managed care activities. You will serve as Finance’s principal expert and liaison with SCDHHS, oversee enrollment, reimbursement, and revenue cycle operations, and coordinate cross-functional responses to payer issues.

The role requires a Master’s degree and substantial Medicaid experience, with leadership responsibilities and experience in behavioral health or large

Competenze

• Master’s degree in business, healthcare administration, public administration, finance, or related field.
• Significant experience with Medicaid, preferably South Carolina Medicaid.
• Experience with Medicaid reimbursement methodologies, payer contracting, provider enrollment, and revenue cycle operations.
• Experience working with a state Medicaid agency or Medicaid managed care organizations.
• Experience within behavioral health or large healthcare delivery systems.
• Prior supervisory or leadership experience.

Mansioni

• Develop and maintain subject matter expertise on SC Medicaid programs for BHDD.
• Liaise with SCDHHS, MCOs, and stakeholders on Medicaid policy and reimbursement.
• Coordinate managed care contracting and enrollment requirements with Legal and leadership.
• Evaluate reimbursement methodologies and identify revenue-improvement opportunities.
• Provide dashboards and reporting on Medicaid performance and risks for executive leadership.
• Lead cross-functional responses to Medicaid/audits and payer inquiries.

Conoscenze

Medicaid expertise

Healthcare administration

Payer contracting

Leadership

Formazione

Master’s degree in business/healthcare/finance

Descrizione del lavoro

Are you passionate about making a real difference in people's lives? Join our team at the SC Department of Behavioral Health and Developmental Disabilities (BHDD) where we are dedicated to providing compassionate and accessible care to our community. We are seeking a Director of Managed Care who is motivated to help individuals and families navigate life's challenges and achieve long-term wellness.

This position is located at the SC Department of Behavioral Health and Developmental Disabilities (BHDD) – Central Office, 400 Otarre Parkway, Cayce, SC 29033.

The Director of Managed Care provides strategic and operational leadership for BHDD’s Medicaid and managed care activities. The position serves as Finance’s principal subject matter expert and primary liaison with the South Carolina Department of Health and Human Services (SCDHHS) for Medicaid matters affecting BHDD and is responsible for maintaining a comprehensive understanding of Medicaid policy, reimbursement, program requirements, and operational processes. The Director serves as BHDD’s primary Finance liaison with Medicaid managed care organizations and is responsible for ensuring the agency effectively manages the intersection of Medicaid policy, managed care requirements, reimbursement, enrollment, and revenue cycle operations. The position identifies and resolves systemic payer issues, evaluates Medicaid and Managed Care Organization (MCO) changes for financial and operational impact, and coordinates organizational responses across Finance, Revenue Cycle, clinical operations, information technology, legal, compliance, and other agency functions.

Responsibilities for the Director of Managed Care

• Develop and maintain comprehensive subject matter expertise regarding South Carolina Medicaid programs applicable to BHDD services, including reimbursement methodologies, covered services, eligibility requirements, authorization requirements, billing rules, provider requirements, and program changes. Monitor Medicaid policy, State Plan amendments, provider bulletins, manuals, reimbursement changes, waivers, managed care requirements, and other developments affecting BHDD. Evaluate the financial and operational impact of Medicaid changes and coordinate implementation across affected BHDD functions.
• Serve as the primary Finance liaison between BHDD and SCDHHS on Medicaid reimbursement, policy, billing, enrollment, managed care, and related financial matters. Serve as the primary Finance liaison with Medicaid managed care organizations and other significant third-party payers. Develop and maintain productive working relationships with SCDHHS, MCO leadership, payer representatives, and other external stakeholders. Lead resolution of significant or systemic Medicaid and MCO issues involving reimbursement, claims, denials, authorization, enrollment, eligibility, payment, or payer policy. Represent Finance on internal and external workgroups involving Medicaid, managed care, reimbursement, and payer operations.
• Coordinate managed care contracting, contract implementation, amendments, reimbursement changes, and operational requirements in partnership with Legal and agency leadership. Ensure MCO contract requirements and reimbursement arrangements are consistent with applicable Medicaid policy and understood by affected BHDD functions. Monitor payer performance and identify trends affecting reimbursement, accounts receivable, denials, claims processing, and cash collections.
• Evaluate reimbursement methodologies and identify opportunities to improve revenue realization, reimbursement accuracy, and financial performance. Develop financial models and analyses related to Medicaid reimbursement, managed care arrangements, payer changes, and proposed policy changes.
• Maintain executive visibility into enrollment status, payer participation, outstanding applications, revalidations, and enrollment-related financial risks. Develop dashboards and executive-level reporting regarding Medicaid and managed care performance, significant payer issues, enrollment status, financial exposure, and emerging risks. Advise the Controller, Chief Financial Officer, and executive leadership regarding significant Medicaid and managed care developments and their financial implications.
• Coordinate organizational responses to Medicaid and managed care audits, reviews, inquiries, and data requests involving Finance. Coordinate cross-functional projects involving Finance, clinical operations, information technology, compliance, legal, and external payers. Establish standardized processes, controls, documentation, and accountability for managed care activities across BHDD.
• Evaluate reimbursement methodologies and identify opportunities to improve revenue realization, reimbursement accuracy, and financial performance. Establish standardized processes, controls, documentation, and accountability for managed care activities across BHDD. Supervise staff assigned to managed care and enrollment functions. Perform other related duties and strategic assignments as directed by the Controller or Chief Financial Officer.

Additional Requirements:

• Extensive knowledge of Medicaid reimbursement, policy, managed care, and healthcare payer operations.
• Ability to develop expert-level knowledge of South Carolina Medicaid programs and requirements applicable to BHDD.
• Strong knowledge of managed care contracting, reimbursement methodologies, provider enrollment, claims operations, and revenue cycle processes.
• Ability to interpret complex Medicaid regulations, policies, manuals, contracts, reimbursement methodologies, and payer requirements.
• Strong financial and analytical skills, including the ability to quantify the impact of reimbursement and policy changes.
• Ability to identify systemic operational and financial issues and lead cross-functional resolution.
• Ability to establish effective relationships with Medicaid agencies, MCOs, executive leadership, and other external stakeholders.
• Strong negotiation, communication, presentation, and relationship-management skills.
• Ability to translate complex Medicaid and payer matters into clear financial and operational implications for executive leadership.
• Ability to lead complex initiatives across multiple organizational functions without direct supervisory authority over all participants.

• Master’s degree in business, healthcare administration, public administration, finance, or related field.
• Significant experience with Medicaid, preferably South Carolina Medicaid.
• Experience working directly with a state Medicaid agency or Medicaid managed care organizations.
• Experience within behavioral health, developmental disabilities, hospital, or large healthcare delivery systems.
• Experience with Medicaid reimbursement methodologies, payer contracting, provider enrollment, and revenue cycle operations.
• Prior supervisory or leadership experience.

Post Hire, Employee Must:

• Have the knowledge of an agency's mission, programs, and objectives.
• Have the knowledge of management principles.
• Have the knowledge of an agency's organizational structure, the people who manage the work and the processes applicable to government work.
• Be able to interpret and apply rules and regulations.
• Be able to manage work and provide guidance to employees.
• Be able to make presentations and prepare reports.

The Department of Behavioral Health and Developmental Disabilities offers an exceptional benefits package for full time (FTE) employees:

• Health, dental, vision, long-term disability, and life insurance for employees, spouse, and children. Click here for additional information.
• 15 days annual (vacation) leave per year
• 15 days sick leave per year
• 13 paid holidays
• Paid Parental Leave
• S.C. Deferred Compensation Program available (S.C. Deferred Compensation)
• Retirement benefit choices*
  1. State Retirement Plan (SCRS)
  2. State Optional Retirement Program (State ORP)

*Enrollment in one of the listed plans is required for all FTE employees; please refer to the contribution section of hyperlinked retirement sites for the current contribution rate of gross pay.

The Department of Behavioral Health and Developmental Disabilities 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.

Supplemental questions are considered part of your official application.

Any misrepresentation will result in your disqualification from employment.

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