Managed Care Regulatory Specialist.

State of Colorado; Colorado; Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

PERA retirement benefits

Medical insurance

Dental insurance

Vision insurance

Disability coverage

Life insurance

FSA

PFML

Holidays

Sick leave

Hybrid work

RTD EcoPass

CSU Global tuition

Credit Union

Job summary

State of Colorado is seeking a Managed Care Regulatory Specialist for the ACC Delivery System Division within CCQI to interpret and apply federal and state Medicaid rules across contracts.

The role focuses on regulatory oversight, contract drafting, policy guidance, and coordinating with management and external stakeholders; hybrid work with potential in-person onboarding in Denver.

Responsibilities

• Serves as the Staff Authority for interpretation and application of federal and state laws, regulations, and rules governing Medicaid managed care across the ACC Division and CCQI Office. HCPF management and program teams rely on this position's authoritative regulatory guidance when determining broad managed care policy and program direction.
• Provides regulatory oversight and federal compliance for the Medicaid managed care contracts.
• Staff authority on federal and state managed care requirements and provides essential advice and counsel to management on policy direction, implementation of policy decisions, responses to federal and state government, and the Department's positions with internal and external stakeholders.
• Provides authoritative interpretation when managed care policy and regulatory requirements must be applied to operational circumstances, establishing the compliance framework Department teams and contractors use to proceed.
• Serves as a resource for physical and behavioral health managed care contract activities.
• Drafts, negotiates, processes, and implements contracts, amendments, policy guidance, and waivers.
• Drafts and implements rule changes, requests for proposals (RFPs) and other contract related documents.
• Manages member, external stakeholder, or other governmental body concerns and questions.
• Responds to internal and external information requests and assists with identifying and resolving information system issues that impact program operations.
• Reviews and monitors contractor compliance with program requirements and state and federal regulations.
• Evaluates contractor performance and develops corrective action plans if a contractor needs to improve performance.

Job description

State Of Colorado Residency Required At Time Of Application

Note: This announcement may be used to fill multiple openings.

Envision Yourself Working at HCPF

The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness. The State is resolute in non-discriminatory practices in everything we do, including hiring, employment, and advancement opportunities.

Department Information

The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.

We are looking for a Managed Care Regulatory Specialist for the Acc ountable Care Collaborative (ACC) Delivery System Division of the Cost Control and Quality Improvement Office (CCQI) !

The ACC Delivery System Division of CCQI is responsible for the design, administration, and oversight of the Medicaid managed care delivery system. The Program Management Section within the ACC/Delivery Systems Division was created to more efficiently manage the Regional Accountable Entity (RAE) and Managed Care (MCO) contracts for the ACC. The Program Management Section contributes to the Division goals through managing and driving performance in the RAE and MCO contracts and overseeing the implementation of programs and initiatives that improve member access, limit duplication and gaps in service and improve quality and cost effectiveness of services. The Managed Care Unit in the section oversees the MCOs and the Dual Special Needs Program (DSNP) contracts.

We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.

As part of the State of Colorado, HCPF offers a competitive benefits package:

• PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans
• Medical , Dental , and Vision insurance coverage
• Automatic Short-Term and Optional Long-Term Disability Coverage
• Life and AD&D Insurance
• Flexible Spending Accounts (FSAs)
• Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)
• 11 Paid Holidays Annually and Accrued Annual and Sick Leave
• Accrued Sick Leave for State of Colorado Temporary Employees
• Flexplace and Flextime work arrangements
• Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program
• Free RTD EcoPass to all eligible State Employees
• Reduced college tuition through CSU Global
• Credit Union of Colorado Membership Eligibility
• Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, go to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs . https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs

We are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements. Depending on the business need and description of the position, we have options that range from hybrid to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage.

Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment.

Description Of Job

What You’ll Be Doing as Managed Care Regulatory Specialist

• Serves as the Staff Authority for interpretation and application of federal and state laws, regulations, and rules governing Medicaid managed care across the ACC Division and CCQI Office. HCPF management and program teams rely on this position's authoritative regulatory guidance when determining broad managed care policy and program direction.
• Provides regulatory oversight and federal compliance for the Medicaid managed care contracts.
• Staff authority on federal and state managed care requirements and provides essential advice and counsel to management on policy direction, implementation of policy decisions, responses to federal and state government, and the Department's positions with internal and external stakeholders.
• Provides authoritative interpretation when managed care policy and regulatory requirements must be applied to operational circumstances, establishing the compliance framework Department teams and contractors use to proceed.
• Serves as a resource for physical and behavioral health managed care contract activities.
• Drafts, negotiates, processes, and implements contracts, amendments, policy guidance, and waivers.
• Drafts and implements rule changes, requests for proposals (RFPs) and other contract related documents.
• Manages member, external stakeholder, or other governmental body concerns and questions.
• Responds to internal and external information requests and assists with identifying and resolving information system issues that impact program operations.
• Reviews and monitors contractor compliance with program requirements and state and federal regulations.
• Evaluates contractor performance and develops corrective action plans if a contractor needs to improve performance.