LyTorre is The Difference – in step with patients and families to build connections and trust.LyTorre is The Difference
We’re looking for a Contracting Program Manager, someone who’s ready to grow with our company. In this position you will assist with the interpretation of federal, state, and other regulations and requirements related to Medicaid and Children's Health Insurance Program (CHIP) and coordinating/providing the necessary reporting requirements in a timely manner. Frequently reviews processes, workflows, and policies/procedures to ensure they are accurate, current, and meets all regulatory requirements. Works collaboratively with leadership and others from various areas across the health plan to evaluate and implement new ideas and strategies, while ensuring compliance with the above regulations and requirements. Continue development of key strategic initiatives and reporting by partnering with the finance and operating teams to translate strategic analysis into operational decision-making.
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Job Duties & Responsibilities
• Develops strategies, policies, and procedures to ensure regulatory compliance.
• Reviews, interprets, and provides direction on new and changes to existing federal and state regulations and requirements mandated by Health and Human Services Commission (HHSC), Texas Medicaid & Healthcare Partnership (TMHP), Texas Department of Insurance (TDI), and other governing bodies. Remains current on Texas Medicaid Provider Procedures Manual (TMPPM), Uniform Managed Care Contract (UMCC), Uniform Managed Care Manual (UMCM), and other bodies of knowledge that impacts Medicaid and CHIP requirements and have a direct impact on medical policy decisions and potential system configuration changes.
• Partners closely with the Program Support Unit (PSU) within Health and Human Services Commission (HHSC) to understand and implement program and/or reporting changes.
• Develops methodology for analyzing and monitoring departmental operations, internal and State issued Corrective Actions Plans.
• Ensures appropriate communications and partners with others both within and across teams to accomplish goals.
• Provides data and reporting on productivity and other metrics.
• Develops and implements process improvement initiatives.
Skills & Requirements
• Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees unless approved for a medical or religious exemption.
• Required bachelor's degree with a preferred master's degree in business administration or related field
• Required 3 years business operations in a managed care environment with a preferred 3 years of project management or project lead experience
About Texas Children’s