Medicaid Program Manager 2 (Medicaid Provider Enrollment Manager)

State of Louisiana; Baton Rouge (LA); Vor Ort; USD 90.000 - 125.000; Vollzeit

Zusammenfassung

The Louisiana Department of Health seeks a Provider Enrollment Manager to oversee Medicaid's provider enrollment program, ensuring compliance with federal and state requirements. You will work with CMS, licensing boards, and MCOs to optimize enrollment operations and policy guidance.

Qualifications include experience in Medicaid operations, contracts, and program management, with strong analytical and communication skills. Location: East Baton Rouge Parish, Baton Rouge, LA.

Qualifikationen

• Seven years of experience in developing, managing, or evaluating health or social service programs.
• Experience in Medicaid, healthcare administration, provider enrollment, or related healthcare operations.
• Knowledge of Medicaid provider enrollment requirements and healthcare regulatory compliance.
• Experience managing contracts, vendor relationships, and complex operational programs.
• Excellent written and verbal communication skills.
• Ability to interpret regulations and implement policy.

Aufgaben

• Provide oversight of Louisiana Medicaid's provider enrollment program and contracted enrollment vendor.
• Monitor compliance with federal and state provider enrollment requirements, including screenings and disclosures.
• Develop, interpret, and implement provider enrollment policies, procedures, and operational guidance.
• Oversee contractor performance, SLAs, operational metrics, and corrective actions.
• Coordinate implementation of provider enrollment initiatives and policy changes.
• Collaborate with program integrity, legal, audit, compliance, managed care, and operations teams.
• Serve as a liaison with CMS, providers, managed care organizations, licensing boards, and stakeholders.
• Analyze operational data and trends to improve efficiency, compliance, and provider experience.
• Prepare reports, presentations, and executive briefings for agency leadership.
• Supervise professional staff, set performance expectations, conduct evaluations, and coaching.
• Manage special projects and other duties to support the Section.

Kenntnisse

Healthcare program management

Medicaid/provider enrollment knowledge

Contract/vendor management

Policy interpretation

Analytical skills

Staff coaching

Jobbeschreibung

The mission of the Louisiana Department of Health is to protect and promote health and to ensure access to medical, preventive, and rehabilitative services for all residents of the State of Louisiana.

Learn more about Louisiana Department of Health

the Provider Enrollment Manager is responsible for overseeing Louisiana Medicaid's provider enrollment program and ensuring compliance with federal and state provider enrollment requirements. This position provides operational oversight of the State's contracted enrollment vendor and Medicaid staff responsible for provider screening, enrollment, revalidation, disclosures, and provider maintenance activities. The position serves as a subject matter expert on Medicaid provider enrollment policy and works closely with CMS, providers, managed care organizations, licensing boards, and internal stakeholders to ensure efficient provider enrollment operations.

• Seven years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR
• Six years of full-time work experience in any field plus four years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR
• A bachelor’s degree plus four years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR
• An advanced degree or a Juris Doctorate plus three years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services.

Experience Substitution

Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.

The official job specifications for this role, as defined by the State Civil Service, can be found here.

Job Duties

• Provide oversight of Louisiana Medicaid's provider enrollment program and contracted enrollment vendor.
• Monitor compliance with federal and state provider enrollment requirements, including provider screening, disclosures, revalidation, enrollment moratoria, and program integrity initiatives.
• Develop, interpret, and implement provider enrollment policies, procedures, and operational guidance.
• Oversee contractor performance, service level agreements, operational metrics, and corrective action activities.
• Coordinate implementation of provider enrollment initiatives, system enhancements, federal mandates, and policy changes.
• Collaborate with program integrity, legal, audit, compliance, managed care, and operational teams on provider enrollment issues and investigations.
• Serve as a liaison with CMS, providers, managed care organizations, licensing boards, and other stakeholders.
• Analyze operational data and performance trends to improve efficiency, compliance, and provider experience.
• Prepare reports, presentations, policy memoranda, and executive briefings for agency leadership.
• Supervise professional staff, establish performance expectations, conduct evaluations, and provide ongoing coaching and development.
• Manage special projects and perform other duties as assigned to support the goals and operations of the Section.

Preferred Qualifications and Skills

• Experience in Medicaid, healthcare administration, provider enrollment, program integrity, or related healthcare operations.
• Knowledge of Medicaid provider enrollment requirements and healthcare regulatory compliance.
• Experience managing contracts, vendor relationships, and complex operational programs.
• Strong analytical, organizational, and problem-solving skills.
• Ability to interpret regulations, develop policy, and implement operational improvements.
• Excellent written and verbal communication skills.
• Experience managing projects, stakeholders, and professional staff.
• Commitment to improving program performance and provider experience

Position Specific Details

Location: Medical Vendor Administration / Program Operations and Compliance / East Baton Rouge Parish

Appointment Type: This position may be filled as a Probationary appointment, Promotional appointment, Job appointment, or Detail to Special Duty

Cost Center: 3052020600

Position Number(s): 171563

Contact Information

Shambrielle Pooler

[e-mail]

LA Department of Health (LDH)

Division of Human Resources

PO Box 4818

Baton Rouge, LA 70821

225-342-6477

This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.

LDH supports Louisiana’s commitment to being a State as a Model Employer (SAME) by promoting the recruitment, hiring, and retention of individuals with disabilities.

LDH is an equal opportunity employer and seeks to recruit a highly productive and diverse workforce and will provide equal employment opportunities to all employees and prospective employees. Employment decisions shall be based strictly on merit and without regard to religious or political beliefs, sex, race, or any other non-merit factor.