Network Analyst (Program Coordinator II) / 60019194 Position Available In Richland, South Carolina

Network Analyst (Program Coordinator II) / 60019194 State of South Carolina – 2.9 Richland County, SC Job Details Full-time $52,100 – $88,600 a year 1 day ago Benefits Paid holidays Disability insurance Health insurance Dental insurance Tuition reimbursement Vision insurance Flexible schedule Life insurance Retirement plan Qualifications Contract management Managed care SAS Word processing Writing skills Mid-level Master’s degree Driver’s License Bachelor’s degree Business Administration 1 year Care plans GIS Full Job Description Job Responsibilities The Agency’s mission is to be boldly innovative in improving the health and quality of life for South Carolinians. This is position is located in the Bureau of Managed Care , Richland County. Are you the One? We are looking for a Program Coordinator II who will serve as the Medicaid Provider Network Analyst for the South Carolina Department of Health and Human Services in the Bureau of Managed Care. Acts as the lead analyst and performs independent, complex work providing coordination of managed care plan provider network activities within the Bureau of Managed Care. This work consists of reviewing administrative policies, procedures, guidelines, and related directives impacting managed care plan contract compliance issues and problems; interpreting network analysis results and identifying areas of opportunity; and recommending appropriate action. The Provider Network Analyst performs program monitoring activities for Medicaid managed care plans, including analysis of managed care plan provider network activities to identify managed care plan compliance issues and problems. Completes network analysis activities to determine managed care plans’ compliance include: analyzing provider network reports for managed care plans, coordinating and conducting “secret shopper” activities, conducting in-depth follow-up investigation and assessment of managed care plans’ provider network activities, maintaining records, preparing reports, and correspondence with managed care plans. The Provider Network Analyst assists in the completion of programmatic reports of secret shopper and other activities for improvement and resolution of provider network compliance as required. The Provider Network Analyst proposes and maintains requirements for managed care plan provider network reports/outputs to be used for compliance with contract standards. The Provider Network Analyst identifies potential changes/upgrades to requirements and recommends changes and upgrades to technical staff in accordance with established procedures. Provides feedback to Fee for Service program area for potential provider recruitment to expand options for Managed Care plan network gaps. The Provider Network Analyst works as a member of an interdisciplinary team to develop optimum resolutions and carries out the implementation of solutions related to managed care plan provider networks, consulting with team members to develop solutions to ensure compliance with federal regulations, statutes, administrative rules, South Carolina State Medicaid State Plan, contract requirements, and Medicaid policies and procedures. The Provider Network Analyst investigates, assesses, analyzes compliance, and makes recommendations to resolve issues and problems identified in managed care plan provider network activities. The Provider Network Analyst provides direction, guidance, and counsel to the Agency contract managers for assigned managed care plans, Plan Management leadership, and their staff to address non-compliance issues related to managed care plan provider network activities. The Provider Network Analyst coordinates and participates in meetings within the Agency, managed care organizations, and other stakeholders. The Provider Network Analyst prepares and delivers speeches and presents programs to managed care organizations and other stakeholders. The Provider Network Analyst represents Medicaid on health care related committees, task forces, and special projects as assigned. The Provider Network Analyst participates in meetings, conferences, and workshops on federal and state health care related programs and managed care programs. The Provider Network Analyst participates in strategic planning activities to improve access and quality of care, and increase the efficiency and cost-effectiveness of the Medicaid programs. The Provider Network Analyst conducts program training and provides technical assistance related to Medicaid managed care programs, compliance with contract provisions, including provider network requirements, to ensure consistency in program operation and conformity with goals and objectives of the Agency and state and federal laws, rules, regulations and guidelines. Works with managed care organizations(MCO) to identify and resolve network challenges impacting individual members with unique circumstances. The Provider Network Analyst maintains up-to-date knowledge concerning the South Carolina Medicaid program, including pertinent federal regulations, state statutes, administrative rules, South Carolina Medicaid State Plan, and Medicaid program manuals. The Provider Network Analyst remains informed about managed care contracts, as well as Medicaid systems and technology, and Medicaid-related activities of the Department. The Provider Network Analyst remains informed about South Carolina Medicaid provider network guidelines. The Provider Network Analyst maintains knowledge about Agency operating procedures and processes. Serves as a point of contact for internal agency stakeholders and external contractors and vendors. Conducts formal and informal communications through the course of contract administration and management. Administers contract monitoring program to ensure performance conforms to contract requirements in terms of quality, quantity, timeliness, and cost as these terms are defined within the contracts and to agency satisfaction in accordance with established policies. Performs Contract Administration and Monitoring duties for all assigned contracts as required. Identifies, researches, and resolves contractual issues and disputes by developing and implementing a plan of action, tracking plan progress, and adjusting course where necessary to facilitate a mutually agreeable resolution. Addresses contractor deficiencies. Assists with contract and RFP creation and negotiations. Facilitates Contract Change Orders, Amendments, and Renewal documents. Ensures significant events are well-documented and records of monitoring results are maintained, to include all correspondence, amendments, and meetings. Thoroughly documents vendor performance standards that do not meet the contractual requirements. Reviews invoices and verifies contractors have demonstrated satisfactory delivery of services as agreed to in the contract and approves payment if deemed satisfactory. Tracks spend as defined through awarded Contract, Purchase Order, and Contractor Invoices; ensures compliance with the contract terms; identifies and reduces fiscal or program risk. Performs other related duties as required. Covers tasks and responsibilities of other team members during periodic or extended absences. Ensures assigned tasks are completed thoroughly and within the time allotted. Takes appropriate training as required. The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes: Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children. 15 days annual (vacation) leave per year. 15 days sick leave per year. 13 paid holidays. State Retirement Plan and Deferred Compensation Programs. Minimum and Additional Requirements A bachelor’s degree in a health, administration, or data management/analysis field and at least three (3) years of relevant professional experience in social service programs, business administration, general administrative management or A master’s degree in health, administration, or data management/analysis field and at least one (1) year of relevant professional experience in social service programs, business administration, general administrative management.

Additional Requirements:

Occasional overnight travel. Overtime and/or weekend work with Deputy approval. Sitting or standing for long periods of time.

Lifting requirements:

10 lbs. Valid driver’s license Preferred Qualifications Experience and knowledge of Grant/Contract Management or Administration preferred; Knowledge of Medicaid Program and Managed Care or health insurance preferred; Ability to work cooperatively as a member of the team; Ability to understand and apply applicable statutes, rules, regulations, policies, and procedures; Ability to determine work priorities and ensure proper completion of work assignments in a timely manner; Knowledge of methods necessary for efficient compiling, organizing, and analyzing data; Ability to collect, analyze, and evaluate data quickly, develop reports, and make recommendations; Knowledge of, and experience with, word processing, spreadsheet and/or database software; Knowledge and understanding of GIS networks; Ability to communicate effectively, both verbally and in writing; Knowledge of provider types and specialties preferred; Rudimentary understanding of SAS or other programming language preferred but not required. Additional Comments Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail. The South Carolina Department of Health and Human Services 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.