HMO Managed Care Business Analyst

Company: Gainwell
Location: Madison
Posted on: April 9, 2021

Job Description:

Job Description:Goals & Activities

• As a member of the MCO and HMO Program Administration Team, implement and oversee state-supervised/locally administered managed care organizations and health management organizations.
• Manage the initial MCO and HMO certification and annual recertification processes and facilitate the re-contracting process.
• Facilitate and participate in communications between/among the MCO, HMO and the ADRC, Medicaid managed care enrollment broker and local economic support offices in its service area to assure consumer access to benefits.
• Facilitate and participate in communications between the MCO, HMO and counties in which it operates, and with Tribal agencies and other providers of Department programs and services as needed, in assuring individuals have access to all needed supports and services.
• Oversee, monitor and bring to resolution DHS-required remediation activities of the MCO and HMO.
• Communicate effectively with Department staff and management, other state agencies, county, tribal and municipal governments, MCO, HMO, advocates, and the general public Required Skills/Experience
  • Extensive knowledge of Medicaid managed care and long-term care service delivery systems.
  • Considerable knowledge of acute and primary health care delivery systems.
  • Considerable knowledge of the federal Medical Assistance and Medicare programs.
  • Extensive knowledge of the state and federal statutes, regulations, policies and procedures governing the Medical Assistance program.
  • Considerable knowledge of the state and federal regulations, policies and procedures governing the Medicare program.
  • Extensive knowledge of Wisconsins community based long term support programs and the philosophy and values they are based on.
  • -Considerable knowledge of the principles and process of policy development and analysis.
  • Considerable knowledge of managed care concepts.
  • Considerable knowledge of the principles and values involved in community long term care for older and disabled people and the programs that serve them.
  • Considerable skill in translating the problems and needs of frail and disabled older persons and of the delivery system that serves them into useful program improvements.
  • Considerable knowledge of older peoples needs, values and preferences as well as the functional impairments frequently experienced by older persons.
  • Working knowledge of research methods, fiscal analysis and budget preparation procedures.
  • Effective facilitation skills.
  • Extensive skills in written, verbal and interpersonal communication skills, with the ability to bring people with differing points of view to consensus.
  • Ability to work effectively with many different individuals and professions, since the process will involve interacting with not only human service professionals and administrators, but chief financial officers and IT professionals.
  • Knowledge of operational processes involved in managed care, and of the Family Care rate setting process. This position is located in Madison, WI.

Keywords: Gainwell, Madison , HMO Managed Care Business Analyst, Professions , Madison, Wisconsin