Salary
$32.15 - $48.23 Hourly
$66,880 - $100,320 Annually
This position is a Pay Band C9
Posting Details
Interviews are anticipated to be conducted within two weeks of closing date.
This job posting may be used to fill multiple vacancies.
Our Vision
- Every New Mexican has access to affordable health care coverage through a coordinated and seamless health care system.
Our Mission
- We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.
Our Goals
- Leverage purchasing power and partnerships to create innovative policies and models of comprehensive health care coverage that improve the health and well-being of New Mexicans and the workforce.
- Achieve health equity by addressing poverty, discrimination, and lack of resources, building a New Mexico where everyone thrives.
- Implement innovative technology and data-driven decision-making to provide unparalleled, convenient access to services and information.
- Build the best team in state government by supporting employees continuous growth and wellness.
Why does the job exist?
The Senior Program Manager - Behavioral Health (BH) Managed Care Organization (MCO) Contracts will:
- Provide contract oversight and management for behavioral health functions, services and requirements of the (Medicaid) Turquoise Care Managed Care Organizations (MCO) that are contracted to provide Turquoise Care;
- Perform as the primary point of contact for the MCO behavioral health contract related communications with the MCO operations teams;
- Collaborate with Medical Assistance Division (MAD) staff and teams on behavioral health Turquoise Care contractual language, activities related to procurement, readiness reviews, contractual updates, revisions, audits, technical assistance to MCO's and any other MCO contractual tasks and related projects as needed;
- Perform as the subject matter expert with a focus on behavioral health Medicaid related contract requirements;
- Provide direct support to the Behavioral Health Services Division (BHSD) leadership and program staff, Health Care Authority (HCA), Medical Assistance Division (MAD), Office of Inspector General (OIG), Children Youth and Families Division (CYFD) and Department of Health as needed to collaborate contractual management and oversight;
- Provide excellent writing and verbal communication skill, flexibility, understanding of competing deadlines, strong multitasking skills, ability to prioritize and resolve complex issues timely, understanding of Federal and State regulation, ability to work with a variety of stakeholders, state agencies and understand state goals and priorities.
How does it get done?
The Senior Program Manager - Behavioral Health (BH) MCO Contracts is responsible for:
- Providing leadership and Technical Assistance to MCO's regarding behavioral health Medicaid Turquoise Care contract;
- Oversight of Two to Four (2-4) Managed Care Organizations (MCO) Turquoise Care contractual agreements as it pertains to BHSD;
- Providing technical assistance to Managed Care Organizations, providers, and stake holders as it pertains to understanding and the operationalization of Turquoise Care Contract, New Mexico Administrative Code (NMAC), Turquoise Care Policy Manual, and Behavioral Health Policy and Billing Manual to work toward resolutions of provider credentialing, billing, claims, and member issues;
- Collaborating with BHSD, MAD, CYFD and Department of Health (DOH) staff on inquiries related to member and provider concerns, grievances and responses to Constituent Concerns to the Office of the Secretary and Governor's offices;
- Ensuring timely and appropriate follow-up to all behavioral health deliverables required by the Managed Care Organizations;
- Managing and tracking contract issues and outcomes with MCOs in the areas such as billing, deliverable requests, and letters of direction for the contract;
- Participating in MCO meetings at/with BHSD and/or Medical Assistance Division (MAD) and/or Children Youth and Families Division (CYFD);
- Aiding BHSD staff with inquiries and informational requests from stakeholders about behavioral health Medicaid related services, Medicaid rules, and Medicaid billing, and becoming a Medicaid and MCO provider;
- Participating in audits, readiness activities and other Medicaid functions, workgroups, and projects as related to behavioral health Turquoise Care contract oversight and BH services;
- Participating in 1115 Wavier renewal, monitoring and implementation activities and processes with MAD as needed;
- Providing expertise for MCO's and providers needing support navigating policies, procedures, and guidelines to administer contracted behavioral health services under Medicaid.
Who are the customers?
- Medicaid clients, providers, staff and managers throughout the division and department.
Ideal Candidate
The Ideal Candidate has experience:
- Providing expert guidance to customers, staff, managers and other divisions and departments;
- Collaborating and communicating with internal and external entities;
- Conducting research to obtain information and resolve issues;
- Providing excellent communication, writing and verbal skills;
- With document review and editing skills;
- Understanding of competing deadlines, strong multitasking skills, ability to prioritize and resolve complex issues timely;
- Understanding of Federal and State regulation;
- Working with a variety of stakeholders;
- Demonstrating a passion for serving the citizens of New Mexico.
Minimum Qualification
Bachelor's Degree in a relevant field of study from an accredited college or university and four (4) years of professional level experience with a tactical impact directly related to the purpose of the position defined by the agency at the time of recruitment. Any combination of education from an accredited college or university in a related field and/or direct experience in this occupation totaling eight (8) years may substitute for the required education and experience.
Employment Requirements
Must possess and maintain a valid driver's license.
Must obtain a Defensive driving certification.
Working Conditions
Work is performed in an office setting with exposure to Visual/Video Display Terminal (VDT), extensive personal computer and phone usage with extended periods of sitting. Must be able to lift 25lbs.
Supplemental Information
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Agency Contact Information: Jolene Jaffa, (505) 690-9920. Email
For information on Statutory Requirements for this position, click the Classification Description link on the job advertisement.
Bargaining Unit Position
This position is not covered by a collective bargaining agreement.
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