Job Summary
Are you a motivated, service-oriented professional looking to make a meaningful impact in your community? If so, we’d like to hear from you. We are seeking an individual who will be responsible for Administration of the program created by an Intergovernmental Agreement between Franklin and Fulton Counties to oversee the management of the Medicaid HealthChoices Behavioral Health Program.
If you are ready to serve and make a difference, contact us today!
About Us
Franklin County is a great place to live and work! Nestled between the Blue Ridge and Tuscarora mountains in South Central Pennsylvania but not far from DC, Baltimore and the beaches of the mid-Atlantic, Franklin County is one of the fastest growing counties in the Commonwealth. We want the best people working to serve the 155,000+ residents that call this beautiful area "home."
Requirements
EDUCATION/CERTIFICATIONS/TRAINING
Master’s degree in a related field or four to ten years of job-related experience and/or training.
WORK EXPERIENCE
Five years of managerial experience, two years of managed care experience and two years of human services experience, or equivalent combination of education, training and experience.
Job Description
FRANKLIN COUNTY
DIRECTOR OF MANAGED CARE Revised: 11/14/06
Position Description Exempt
OVERALL OBJECTIVE OF JOB
The HealthChoices Managed Care Director is responsible for Administration of the program created by an Intergovernmental Agreement between Franklin and Fulton Counties to oversee the management of the Medicaid HealthChoices Behavioral Health Program. The Director has direct responsibility for all management and administrative functions associated with (1) the contract between the Tuscarora Managed Care Alliance and the Commonwealth of Pennsylvania for the provision of Medicaid covered services and (2) the contract between the Tuscarora Managed Care Alliance and the behavioral health managed care organizations that it chooses as a subcontractor to administer the program to service recipients. The Director will commit his/her full attention to supervising all HC staff functions, activities and products consistent with the goals and policies set forth by the Human Services Administrator and the Board of Directors of the Tuscarora Managed Care Alliance and modified from time to time through regular and special meetings.
ESSENTIAL FUNCTIONS OF JOB
- Provides Leadership in implementation of HealthChoices.
- Supervises staff and oversee the Managed Care departmental functions, to include the hiring, training and developing new Managed Care office staff.
- Oversees the MCO contract and ensures regulatory compliance.
- Oversees the utilization management and strategic planning processes.
- Ensures collaboration between the BHMCO, MCO, program departments, providers and the Community.
- Ensures the development, use and dissemination of all Tuscarora Managed Care Alliance/MCO management reports.
- Assist the Board of Directors of the Tuscarora Managed Care Alliance in proposing and negotiating contract changes and amendments related to HealthChoices managed care.
- Negotiates subcontracts for professional services i.e., Attorney, Auditor, Actuary, MIS Services, Fiscal and Quality consultants.
- Ensures adequate Risk Protection is in place and in amounts as required by DPW and through the contract with the MCO.
- Reviews claims and provider payment reports.
- Collaborates with the Actuaries to provide consultation and recommendations for IBNR adjustments and for rate setting purposes with DPW.
- Participates in completion of the annual audit.
- Writes and implements the County Reinvestment Plan.
- Assures that required DPW policies, HCMU monitoring P&P’s and The Tuscarora Managed Care Alliance P&P’s are implemented and followed.
- Participates in DPW’s Annual Review of the HealthChoices contract.
- Attends monitoring meetings with DPW.
- Prepares Quarterly and Annual Reports.
- Serves as liaison with County agencies, providers and key stakeholders to address deficiencies and gaps in the HealthChoices Program.
- Develops and oversees MCO’s Performance Standards.
OTHER DUTIES OF JOB
- Attends meetings, trainings and in-services as needed.
- Performs other job related duties as required.
SUPERVISION RECEIVED
Receives occasional instructions from the Human Services Administrator and the Steering Committee of the Tuscarora Managed Care Alliance.
SUPERVISION GIVEN
Supervises QA coordinator, Fiscal Coordinator and all other future positions placed under this position.
WORKING CONDITIONS
- Works indoors in adequate workspace, lighting and temperatures, with fluctuations in ventilation and temperature.
- Works with average indoor exposure to noise, stress and disruptions.
- Works with normal exposure to dust, dirt, pollen and mold.
- Travels periodically to trainings and job-related meetings.
- Possesses ability to work extended hours as necessary.
- Practices professionalism at all times.
PHYSICAL AND MENTAL REQUIREMENTS
- Must be able to sit for long periods throughout the workday, with intermittent periods of standing, walking, bending, twisting, reaching and driving as necessary to carry out essential duties of the position.
- Dexterity requirements range from simple to coordinated movements of fingers and hands, feet and legs and torso as necessary to carry out the duties of the position.
- Sedentary work, with occasional lifting and carrying of objects with a maximum weight of up to ten pounds.
- Must demonstrate emotional stability.
- Must be able to cope with the physical and mental stress of the position.
- Must be able to pay close attention to details and work requirements.
Contact Details
We offer an excellent benefit package including medical, dental, vision, prescription, life insurance, paid time off, tuition reimbursement and a retirement plan!
To apply for this position, please complete our online application. Franklin County is an equal opportunity employer.
If you need assistance completing the online application, please contact Human Resources at 717-261-3150.
Franklin County is an Equal Opportunity Employer and provide advancement opportunities to everyone. Our employment practices are not influenced or affected by race, color, religion, sex, national origin, age, disability, veteran's status, or any other categories protected by law.
