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Manager Medicaid\Charitable Operations & Contract Administration Portland, OR

Accountable for building and strengthening the internal operational infrastructure for Medicaid programs while ensuring 100% compliance with state/federal/payer expectations. This leadership position within KPNW is accountable for implementing the organization's commitment to and adequate participation in Medicaid and Charitable Programs. Strives to achieve the goal of KPNW serving as a leading provider of health care to low income individuals and families.
Essential Functions:
- Facilitate strong operational processes within operational departments to ensure Medicaid contractual and financial considerations are efficient, cost effective and compliant
- Requires oversight of all operational, administrative and reporting issues related to the Medicaid and Charitable Programs
- Establish business metrics and ongoing reporting against the metrics; the development of Medicaid, finance and compliance infrastructure to support the Medicaid/Special Populations business lines
- Negotiate, implement and oversight all Medicaid and Charitable Program contracts/MOU's for KPNW ensuring compliance with all provisions contained within each agreement
- Requires developing and maintaining relationships with leaders in each State Department and those in Community Benefit-sponsored organizations. Proactively anticipate and respond to state and federal initiatives which impact Medicaid, Community Benefit and KPNW
- With KP Finance and Actuarial, build and maintain a strong forecasting and costing system with strong metrics to guide decision-making
- Working with the Director, Medicaid & Charitable Programs, manage costs savings initiatives, reporting regularly based on agreed upon metrics
Secondary Functions:
- Participate in the development of a rolling multi-year strategy and business plan for Medicaid/Special Populations offerings that achieve overall strategic direction while using and investing resources appropriately
- Work includes working closely with Senior Leadership across Operations, HPA and Medical delivery to ensure alignment with organizational strategy and goals
- Directly supervise Medicaid & Charitable Product Administrator and Product Administrator, ensuring compliance with contract requirements, review and submission deadlines and required reporting


Qualifications:

Basic Qualifications:
- A minimum of 5 years of management experience in health care/insurance industry
- A minimum of 3 years of experience in product line management, marketing management or project management
- Bachelor's degree in business administration, public policy, health care administration or related field or equivalent combination of education and experience
- Ability to interpret and communicate laws and regulations related to health care and HMO's
- Experience in working with regulatory agencies and managing a large organization's response to actions
- Excellent verbal/written communication skills, strong negotiation skills
- Strong analytical and strategic planning skills
- Excellent public presentation skills
- Strong persuasive and interpersonal skills
Preferred Qualifications:
- Broad knowledge of KPNW or other health care organization
- Broad knowledge of current trends in health care delivery systems or carriers
- Knowledge of Medicaid laws and regulations
- Knowledge of Oregon and Washington legislative processes
- Strong marketing and sales background working with special populations and external customers
Salary Range:
$79,500 - $108,900

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