Monitoring of the Magellan Medicaid Administration (MMA) Point of Service (POS)/Preferred Drug List (PDL) Contract to ensure compliance with required service levels and performance standards, internal policies and state and federal regulations. Will manage operations and any ongoing development and changes to the current program requirements. Will also act as liaison to the MMA IT Department for systems related matters.
Management of the MMA Idaho POS/PDL contracts to ensure performance complies with contractually required service levels and performance standards, internal policies and state and federal regulations. Provides recommendations for process improvements to enhance compliance and productivity.
Provides detailed analysis of non-compliant areas and recommends corrective action based on risk of financial penalties, sanctions and breach of contract.
Consults with clients if programs or directives jeopardize the Company’s compliance with federal guidelines. Will manage internal and external audit processes.
Collaborates with State Staff concerning operations of the current program and any changes to program requirements. Liaison to IT Department on any system related requirements or issues.
Interfaces with staff and management within in the Company in support of the program or contract. May work with proposal group to develop proposals and provide recommendations based on knowledge of client account.
Develops and submits required and ad-hoc reports for the program or contract internally or to the client.
Performs other duties as required.
Experience: 3-5 years
Industry: Previous 3-5 year experience in contract compliance, preferably in healthcare or government programs (Medicare/Medicaid).
Job Specific: Experience in claims, bill, or pharmacy benefit management desired.
Equivalent combination of experience and education is acceptable.
Education and/or experiences may run concurrent.
Effective oral and written communication skills for internal and external contracts. Ability to work independently with multiple priorities. Ability to work effectively as a team leader.
Work at Home (ID00)
Work at Home
Magellan Health Services is a leading specialty health care management organization with expertise in managing behavioral health, radiology and specialty pharmaceuticals, as well as public sector pharmacy benefits programs. We deliver innovative solutions to make a positive impact on the cost and quality of health care, keeping the best interests of the people we serve at the center of our decision-making. The breadth of our offerings, depth of expertise, clinical excellence and smart, talented employees is what makes us unique.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment where we value professional growth and development, total health and wellness, rewards and recognition and employee unity. Magellan is a place where you can thrive.
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