The Deputy Chief Operating Officer (Deputy COO) for Medicaid Operations is a new position that will serve as the operational leader for the Medicaid Operations (MO) division of the Office of Information Management (OIM).
Reporting directly to the agency COO, the Deputy will join a small team of OIM technology and operations leaders charged with executing the transformation strategy articulated by agency leadership and the federal Centers for Medicare and Medicaid Services (CMS). Working together, transformation leadership team members shall conduct all functional planning, operations management, project oversight, progress monitoring, risk management, and issue remediation activities necessary to ensure a smooth transition to the Medicaid-as-a-Service (MaaS) model. Demonstrates sound supervisory personnel actions through efforts to promote equal opportunity. Planning Documents must be submitted to the Office of People Operations within one (1) month of the beginning of an employee's review period. Evaluation Documents must be submitted to the Office of People Operations prior to the end of the employee's review period. Ensure employee staff development and training are included on all assigned employees' Planning Documents 100% of the time. Personnel actions must be submitted to the Office of People Operations within at least five business days of the proposed effective date. The Deputy COO is directly responsible for developing, operating, and incrementally improving a catalog services related to all operations functions within the agency, including beneficiary enrollment in health care plans, provider enrollment and engagement, payments to managed care organizations (MCOs) and for provider fee-for-service (FFS) claims, reference file administration, Health Information Technology (HIT) program administration, and performance improvement activities. The articulation of these services shall adhere to the Medicaid Information Technology Architecture (MITA) 3.0 business architecture. While the MO service catalog is expected to mature, initially it shall include the following service categories:
Provider Enrollment and Management
Claims Escalation and Reconsideration
MCO Capitation Payments
Nursing Home Payments
Administrative Services Organization (ASO) Management
Non-Emergency Medical Transportation (NEMT) Management
Reference Administration Services
Health Information Technology Services (HIT) Meaningful Use Payments and Audit Services
The Deputy COO will work with other transformation leadership team members to ensure that all MO service categories and services are comprehensive, mission-focused, and can be implemented in an efficient and cost-effective manner. The Deputy COO is expected to prioritize the catalog of Medicaid Operations services for automation by the Information Systems Operations (ISO) division of OIM, as well as manage and modify a broad range of operational activities to ensure accurate and efficient Medicaid service delivery to beneficiaries and providers. Each of the services in the MO service catalog will have key performance indicators (KPIs) measuring the effectiveness of service operations management and outputs. These KPIs shall be monitored as part of an agency-wide performance improvement effort, and the Deputy COO shall participate in this monitoring process to support the performance improvement effort within MO. The Deputy COO shall also participate in agency-wide data management efforts and collaborate with agency executives focused on measurement of operations efficiency and accuracy. The Deputy COO shall maintain an effective organizational team and create a performance-driven climate to motivate staff to accomplish mission critical operations and objectives. This includes promoting workforce engagement, supporting and directing innovation, and performing all fundamental supervisory functions in accordance with Equal Employment Opportunity Commission (EEOC) standards. The Deputy COO shall set high expectations for customer service within MO for internal and external customers, as well as vendor relationships, and model behavior accordingly. The Deputy COO shall manage an efficient and cost-effective organization that demonstrates viable financial practices according to the OIM annual budget, contracts administration requirements, and state procurement standards. The Deputy COO shall participate in strategic planning and advise agency executives on technology and operations decisions and their business and budget impacts. The Deputy COO shall be a key stakeholder in the OIM transformation governance process, ensuring that project oversight and OIM steering committee decisions about infrastructure, network, and security investments are fully informed and represent the best value to SCDHHS and the taxpayers of South Carolina. The Deputy COO shall stay current with new and emerging technologies, operations practices, analytics and reporting, and policy and procedural changes. The Deputy COO will recommend and oversee implementation of program improvement initiatives as they relates to MO service categories. The Deputy COO shall maintain current knowledge of government health program and payor program issues and develop and maintain effective relationships with CMS to ensure success of the transformation initiative. The Deputy COO shall also maintain effective relationships with the Deputy Directors, Program Managers, Business Owners, Operations Managers of vendor organizations, and subject matter experts (SMEs) who represent user groups for OIM services throughout the agency.
Minimum and Additional Requirements: The candidate must have earned at least a Bachelor's degree (master's preferred). SCDHHS prefers candidates with degrees such as business administration or public administration, however this is not mandatory. All degrees must be from a higher education institution recognized by the US Department of Education and Council for Higher Education Accreditation (CHEA). The candidate must have at least 10 years' experience in Medicaid operations, with at least five years' experience in a management or director role. SCDHHS may accept an equivalent combination of education and relevant direct experience to meet the minimum requirement.
Some in-state and out-of-state travel required. Must be able to work beyond scheduled work hours.
Must have and maintain a valid driver's license.
Occasional overnight travel.
Overtime and/or weekend work with Deputy approval.
Preferred Qualifications: The candidate should have experience leading teams and/or organizations through significant process design and improvement. This includes the ability to improve operational efficiency, service delivery, and information management across an organization. The candidate should have exceptional project management skills including the ability to manage multiple projects in a cross-functional environment. The candidate should have expertise in budget planning, financial management, and resource management (including the ability to develop cost-effective approaches to organizational needs). The candidate should have the ability to communicate effectively, in both written and oral forms, and to articulate complex technology and operations solutions in business terms.
The candidate should have experience with commercial and/or public health payor systems, Medicaid Management Information Systems (MMIS), medical claims processing, provider network management and engagement, and the federal and South Carolina rules and regulations governing public health policy and service delivery. The candidate should have experience managing operations service units in environments with highly sensitive data such as financial, insurance, and health care. The candidate should demonstrate experience with designing, managing, and incrementally improving service units to optimize performance. Experience in health insurance or health service delivery environments, especially public sector health-Medicaid, Medicare, Tricare-is a plus.
The candidate should demonstrate an extreme focus on translating strategy into action and achieving measurable results in a dynamic environment. This position will entail rapid implementation of strategy and tactics to meet the goals of the transformation initiative, demonstration of progress toward goals at key milestones, and the ability to quickly modify or change strategies/tactics if milestones are not met. The candidate should be prepared to offer examples of the above during the application and interview process.
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 on line. All correspondence from the Office of Human Resources will be through electronic mail.
This position is located in Medicaid Operations, Richland County.