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Colorado State Eligibility Programs and Contracts Manager in Denver Metro, Colorado

Eligibility Programs and Contracts Manager

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Eligibility Programs and Contracts Manager

Salary

$63,864.00 - $67,056.00 Annually

Location

Denver Metro, CO

Job Type

Full Time

Department

Department of Health Care Policy and Financing

Job Number

UHA4566 - 04/2021

Closing

4/18/2021 11:59 PM Mountain

  • Description

  • Benefits

  • Questions

Department Information

STATE OF COLORADO RESIDENCY REQUIRED

Make a difference-Join HCPF by improving health care access and outcomes for the people we serve while demonstrating stewardship of financial resources. Information about the Department:

The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.

We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.

As part of the State of Colorado, HCPF offers a competitive benefits package:

  • PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans

  • Medical (https://stateofcoloradobenefits.com/index.php/portfolio-item/overview/) , Dental (https://stateofcoloradobenefits.com/index.php/portfolio-item/dental/) , and Vision (https://stateofcoloradobenefits.com/index.php/portfolio-item/vision/) insurance coverage

  • Automatic Short-Term and Optional Long-Term Disability Coverage (https://stateofcoloradobenefits.com/index.php/portfolio-item/disabilityinsurance/)

  • Life and AD&D Insurance

  • Flexible Spending Accounts (https://stateofcoloradobenefits.com/index.php/portfolio-item/flexible-spending-account/) (FSAs)

  • Family Medical Leave Act (FMLA) (https://dhr.colorado.gov/state-employees/time-off-leave/family-medical-leave-act-fmla) job protection and State of Colorado Paid Family Medical Leave (PFML)

  • 10 Paid Holidays Annually and Accrued Annual and Sick Leave (https://dhr.colorado.gov/state-employees/time-off-leave)

  • Accrued Sick Leave for State of Colorado Temporary Employees

  • Flexplace and Flextime work arrangements

  • Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program

  • Discounted RTD EcoPass (https://www.rtd-denver.com/fares-passes/ecopass)

  • Reduced college tuition through CSU Global (https://csuglobal.edu/cost/tuition-discounts/employer-partners/state-colorado)

The Medicaid Operations Office oversees health plan operations administered by the Department. This office is responsible for the overall operations of Medicaid, including Child Health Plan Plus (CHP+). This office manages the daily operations of Medicaid to ensure compliance with Federal and State laws, rules and regulations. In addition, this office is responsible for establishing and monitoring the operational performance standards (e.g., call center performance standards, claims payment standards, enrollment processing standard, etc.) for contractors working for the Department. This office establishes systems for robust monitoring of health plan operations, oversees the collection of information necessary for performance monitoring and directs staff reviews to identify and mitigate compliance risks. This office has oversight of claims payment operations, the member and provider call centers; the member identification card contractor; and eligibility determinations made by eligibility sites and monitoring of county partners.

Description of Job

The position exists as a staff authority for the Eligibility Overflow Processing Center (OPC). The OPC is a new program to assist counties in managing backlog and exceptional circumstances. This position is responsible for developing the program, determining and implementing policies and procedures, establishing performance standards and holding the vendor to meeting those standards. Position conducts research, analyzes data, and prepares written reports and makes determinations regarding contractors’ performance. The position also provides professional and technical expertise regarding the management and oversight of eligibility processes and vendors. Position is responsible for monitoring the contract and operations of the vendor(s) to ensure compliance with state requirements and federal regulations, rules, policies, contract deliverables, milestones, and service level requirements. Position provides analysis of data for fiscal reports and reviews the contracts for potential impact on financial forecasting. Position monitors, and as necessary, coordinates compliance activities with other sections and eligibility site partners to identify trends, ensure efficiencies, improved member experience and improved performance of vendor(s).

Position drafts assigned contract(s) and reviews assigned contract(s), develops amendments and other contract-related documents as needed. Position responds to feedback collected from program staff and community partners, determining and developing changes in processes and procedures as needed. Position ensures contract(s) are drafted within state and federal guidelines and include appropriately developed service level agreements required for effective monitoring, sanctions and assessment of damages. Position works with appropriate staff for the development of budgets and contract negotiations. Position is the staff authority on performance requirements and contract reporting. Position ensures all financial and contract issues are properly completed at the close out of contracts. This position also maintains formal contract administration files.

The position assists in the administration of contractor’s external project reviews and project audits, responds to queries and informs management on appropriate steps to take to achieve compliance and meet agreed upon standards. Position conducts site visits to evaluate contractor’s business processes and operations for the identification of potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues and provides general guidance on how to avoid or deal with similar situations in the future. Position supervises resolutions to procedural, operational and other work-related problems as it relates to the contract. Position prepares and presents to management, detailed and complex written reports based on quality initiatives and changes to contractual performance measures required to improve efficiency and effectiveness of contractor’s processes. Position implements remedial actions, sanctions and assessment of damages, as applicable, based on monitoring of the contractor’s performance.

The position provides direction to vendor regarding medical assistance programs. Position researches quality and contractual issues; complaints; creates and implements resolutions; and drafts complaint response letters. This position provides expertise in medical assistance eligibility and enrollment processes and the Colorado Benefits Management System (CBMS). Position develops, implements and manages project plans. Position is responsible for communicating changes, drafting written guidance and participating in conferences and workgroups. Position actively participates in all relevant meetings that pertain to the planning and implementation of changes to vendors’ processes and procedures. Position will require occasional travel to the vendor’s location, county offices and community partner locations for the purposes of meetings and oversight.

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

MINIMUM QUALIFICATIONS:

Education and Experience:

Bachelor's degree from an accredited institution in a field of study related to the work assignment. Three years of professional experience in an occupational field related to the work assigned to the position. Minimum 2 years’ experience working with Medicaid and CHP+ Eligibility.

Substitutions:

Additional appropriate experience will substitute for the degree requirement on a year-for-year basis.

PREFERRED QUALIFICATIONS:

  • Knowledge of how to gather and analyze data and produce report of findings;

  • Experience with program development involving complex problem resolution;

  • Prior experience working with diverse stakeholders or managing stakeholder relations;

  • Strong interview skill used to obtain system requirements from policy staff and other stakeholders;

  • Creativity and innovation including the ability to come up with unusual or clever ideas about a given topic or situation, or to develop creative ways to present materials;

  • Ability to set and prioritize workload, develop a work plan with tasks, time frames, milestones, resources, and dependencies;

  • Strong communication skills, verbal and written

  • Ability to be self-motivated and self-directed, while possessing the ability to work in a team environment.

DEFINITION OF PROFESSIONAL EXPERIENCE:

Work that involves exercising discretion, analytical skill, judgment, and personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods.

Conditions of Employment

  • All positions at HCPF are security sensitive positions and require individuals undergo a criminal record background check as a condition of employment.

  • Employees who have been disciplinarily terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.

Appeal Rights

If you receive notice that you have been eliminated from consideration for the position, you may protest the action by filing an appeal with the State Personnel Board/State Personnel Director within 10 days from the date you receive notice of the elimination.

Also, if you wish to challenge the selection and comparative analysis process, you may file an appeal with the State Personnel Board/State Personnel Director within 10 days from the receipt of notice or knowledge of the action you are challenging.

Refer to Chapters 4 and 8 of the State Personnel Board Rules and Personnel Director's Administrative Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel Director's Administrative Procedures are available at www.colorado.gov/spb.

A standard appeal form is available at: www.colorado.gov/spb. If you appeal, your appeal must be submitted in writing on the official appeal form, signed by you or your representative, and received at the following address within 10 days of your receipt of notice or knowledge of the action: Colorado State Personnel Board/State Personnel Director, Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver, CO 80203. Fax: 303-866-5038. Phone: 303-866-3300. The ten-day deadline and these appeal procedures also apply to all charges of discrimination.

Supplemental Information

How to Apply (PLEASE READ CAREFULLY)

Check out this video. (https://www.youtube.com/watch?v=vUwZiY6G24U&feature=youtu.be)

Applicants are encouraged to submit a resume and cover letter with their application. Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all of your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.

Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.

Comparative Analysis Process

The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email.

Failure to submit properly completed documents by the closing date or when the required number of applications have been received, as specified in this announcement, will result in your application being rejected.

Due to COVID-19, we anticipate interviews for this position will be done via Google Hangouts or ZOOM.

ADAAA Accommodations: Any person with a disability as defined by the ADA Amendments Act of 2008 (ADAAA) may be provided a reasonable accommodation upon request to enable the person to complete an employment assessment. To request an accommodation, please contact the person listed on this announcement by phone or email at least five business days before the assessment date to allow us to evaluate your request and prepare for the accommodation. You may be asked to provide additional information, including medical documentation, regarding functional limitations and type of accommodation needed. Please ensure that you have this information available well in advance of the assessment date.

The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.

The Department of Healthcare Policy and Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Debra Becerra at debra.becerra@state.co.us or call 303-866-3887.

We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.

THE STATE OF COLORADO IS AN EQUAL OPPORTUNITY EMPLOYER

Technical Assistance

If you experience difficulty in uploading or attaching documents to your online application, or for any other technical difficulties, call NEOGOV technical support at 855-524-5627 anytime between 6:00 a.m.-6:00 p.m. (Pacific Time).

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