Clinical Contract Admin

Location
Virginia Beach, VA
Salary
Competitive
Posted
Oct 18, 2018
Closes
Dec 19, 2018
Ref
115291BR
Function
Other
Industry
Other
Hours
Full Time
Overview:

Optima Health is hiring a Contract Compliance Admin to join our Government Programs Administration team in Virginia Beach, VA.

Hours/Shift:

Monday - Friday, 8am-5pm

Department/Position Overview:

Optima Health is a service of Sentara Healthcare and offers creative and innovative services and solutions to help members, providers, and employers get the most out of their health plan and life!

The Contract Compliance Manager functions as a liaison between operational departments, government programs administration and compliance departments to include monitoring the State Medicaid website and assists with maintaining compliance.

This role is dynamic and comprehensive encompassing functions and active participation in:
  • Regulatory Oversight and Management: monitors and interprets policy and regulatory issues, develops reports, serves on regulatory committees
  • Contracting Compliance and Reporting: Reviews Medicaid amendment changes, manages quarterly requirement, primary contact to IT department for reporting.
  • Advertising, Enrollment & Member Communication and Compliance: Reviews member handbook, member letters and all member communication in accordance with contractual standards.
  • Vendor Compliance: manages implementation and ongoing relationships with outstanding vendors, contracted by Government Programs department and monitors and manages subcontractor financial performance
  • Regulatory Audit Compliance: Works in close collaboration with the Optima Health Compliance Director and ensures that the compliance plan in audited and congruent with contractual requirements
  • Project Management: Identifies improvement opportunities, manages change processes, monitors performance
  • Leadership: Serves as a Medicaid subject matter expert to other departments, answers inquiries and develops and maintains strategic and routine relationships with DMAS.

Division Highlights:

Optima Health offers a full suite of commercial health insurance products including employee-owned and employer-sponsored plans, as well as Individual and Family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services.

As a nationally recognized provider of health plan coverage and innovative wellness programs, we live our mission "to improve health everyday." This same commitment and dedication directs our philosophy as an employer. When you join Optima Health, you will experience our deep passion for heal and service excellence while benefiting from a culture of opportunity, learning, career growth, and support --every day. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.


Sentara Benefits:

Sentara employees strive to make our communities healthier places to live. We’re setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, CLICK HERE!


Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!

Other
Keyword: contract, regulatory, Medicaid, health plan, managed care, auditing, compliance.

Equal Opportunity Employer

Responsibilities:

This position acts as a liaison between Medicaid and all internal departments to interpret and apply Medicaid contract /regulatory requirements. Ensures departmental policies and procedures are compliant with the Medicaid contract and state and federal regulations.

Qualifications:

Education Level
Bachelor's Level Degree

Experience
Required: Managed Care - 5 years

Preferred: None, unless noted in the "Other" section below

License
None, unless noted in the "Other" section below

Skills
Required: Microsoft Excel, Microsoft PowerPoint, Microsoft Word

Preferred: None, unless noted in the "Other" section below

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