HMO Oversight Manager
Apply NowCompany: State of Wisconsin
Location: Madison, WI 53711
Description:
Introduction
The Department of Health Services (DHS) , Division of Medicaid Services (DMS) is recruiting for an Health Maintenance Organization (HMO) Oversight Manager in the Bureau of Quality and Oversight (BQO).
As an employee of the State of Wisconsin, you'll also have access to an amazing benefits package , including:
Position Summary
As the HMO Oversight Manager, you will be responsible for the oversight and management of staff that are responsible for contract services, including contract management of all programs including: BadgerCare Plus, Supplemental Security Income (SSI), managed care programs, and Medicare Advantage D-SNP plans. The scope of work in this section includes contract development, certification, provider network reviews, provider appeals, and monitors compliance with the contract and with state and federal requirements. This section also represents the acute managed care perspective in benefit policy projects and assesses managed care impacts of new Medicaid initiatives. The section collaborates with other Bureaus, Divisions, managed care organizations, the External Advocates, and other vendors and professional staff.
The HMO Oversight Manager is responsible for the evaluation and oversight of all HMO contracts providing services to approximately 800,000 Medicaid, SSI and BadgerCare recipients. This position will review HMO subcontracts and Memorandums of Understanding as required by contract, and is responsible for representing the HMO program to outside organizations while evaluating and developing program policies to ascertain MA/HMO program compliance with Federal and State regulations.
Salary Information
The starting pay is between $46.00 and $50.00 per hour (approximately between $95,700 and $104,000 per year), depending on qualifications, plus excellent benefits.
Pay for current or former state employees will be set based on the rules that apply to compensation for the applicable transaction. This position is classified as a Health Care Program Manager and is in pay schedule and range 81/02. A 24-month career executive trial period is required.
Job Details
All applicants who may be appointed to this position will be required to allow DHS to conduct a background check to determine whether the circumstances of any conviction may be related to the job being filled.
For positions that do allow remote working flexibility, working outside of Wisconsin or in bordering cities will not be allowed except in extremely limited circumstances due to the need to report to an office location in Wisconsin on short notice.
Employees must have access to both a private workspace and secure high-speed internet for remote work option. Mileage reimbursement to the employee's headquarter location is not provided. Remote work flexibility will be discussed in more detail during the interview process.
DHS does not sponsor work visas for this position, thus, in compliance with federal law, selected candidates will be required to verify eligibility to work in the United States by completing the required I-9 form upon hire.
Qualifications
Minimally qualified applicants will have all of the following:
How To Apply
Applying is easy! Click "Apply for Job" to start your application process. Sign in to your account or click "Register Now" to create an account before applying for the job. Follow the steps outlined in the application process and submit your application.
Helpful Information:
Veterans are encouraged to apply. For complete information on Veterans' hiring programs with the WI Department of Veteran's Affairs, click here .
Deadline to Apply
All applications must be finalized by 11:59 pm on October 3rd to be considered.
The Department of Health Services (DHS) , Division of Medicaid Services (DMS) is recruiting for an Health Maintenance Organization (HMO) Oversight Manager in the Bureau of Quality and Oversight (BQO).
As an employee of the State of Wisconsin, you'll also have access to an amazing benefits package , including:
- 3.5 weeks of vacation, 9 paid holidays and ample sick time.
- Top rated health plan options starting at $42/month for single plans and $104/month for family plans, after 2 months of state service.
- Premium pension plan with at least a 6.9% employer match in 2024. Plus, a tax advantaged supplemental retirement savings plan which allows you to save money directly from your paycheck for retirement. Use this Total Rewards Calculator to see the total value of our competitive benefits package!
- Several flex spending accounts: medical, dependent care, commuter, parking and High Deductible Health Savings.
- A casual office atmosphere, flexible work schedules, and telework options depending on the position's requirements.
- Well Wisconsin Wellness Program
- A free and confidential employee assistance program that offers employees and their immediate family dependents a variety of tools, resources, and professional consultation services to support their health, goals, and overall well-being.
- Public Service Loan Forgiveness Program employer.
Position Summary
As the HMO Oversight Manager, you will be responsible for the oversight and management of staff that are responsible for contract services, including contract management of all programs including: BadgerCare Plus, Supplemental Security Income (SSI), managed care programs, and Medicare Advantage D-SNP plans. The scope of work in this section includes contract development, certification, provider network reviews, provider appeals, and monitors compliance with the contract and with state and federal requirements. This section also represents the acute managed care perspective in benefit policy projects and assesses managed care impacts of new Medicaid initiatives. The section collaborates with other Bureaus, Divisions, managed care organizations, the External Advocates, and other vendors and professional staff.
The HMO Oversight Manager is responsible for the evaluation and oversight of all HMO contracts providing services to approximately 800,000 Medicaid, SSI and BadgerCare recipients. This position will review HMO subcontracts and Memorandums of Understanding as required by contract, and is responsible for representing the HMO program to outside organizations while evaluating and developing program policies to ascertain MA/HMO program compliance with Federal and State regulations.
Salary Information
The starting pay is between $46.00 and $50.00 per hour (approximately between $95,700 and $104,000 per year), depending on qualifications, plus excellent benefits.
Pay for current or former state employees will be set based on the rules that apply to compensation for the applicable transaction. This position is classified as a Health Care Program Manager and is in pay schedule and range 81/02. A 24-month career executive trial period is required.
Job Details
All applicants who may be appointed to this position will be required to allow DHS to conduct a background check to determine whether the circumstances of any conviction may be related to the job being filled.
For positions that do allow remote working flexibility, working outside of Wisconsin or in bordering cities will not be allowed except in extremely limited circumstances due to the need to report to an office location in Wisconsin on short notice.
Employees must have access to both a private workspace and secure high-speed internet for remote work option. Mileage reimbursement to the employee's headquarter location is not provided. Remote work flexibility will be discussed in more detail during the interview process.
DHS does not sponsor work visas for this position, thus, in compliance with federal law, selected candidates will be required to verify eligibility to work in the United States by completing the required I-9 form upon hire.
Qualifications
Minimally qualified applicants will have all of the following:
- Experience in a leadership role with duties such as providing guidance, coaching, overseeing workgroups, assigning work, etc.
- Experience with program and policy analysis, development, implementation, monitoring, or evaluation techniques.
- Experience with contract management (e.g. monitoring compliance, developing contract standards, measuring performance, etc.).
- Experience working in Medicaid long-term care or Medicaid managed care (e.g. Family Care, BadgerCare Plus, IRIS, etc.).
- Experience in a formal supervisory or management role (e.g. managing staff workload including use of workload tracking tools, delegating work responsibilities, hiring, disciplining, completing performance reviews, etc.).
- Experience working with health maintenance organizations (HMOs) in a professional or health care role.
How To Apply
Applying is easy! Click "Apply for Job" to start your application process. Sign in to your account or click "Register Now" to create an account before applying for the job. Follow the steps outlined in the application process and submit your application.
Helpful Information:
- Once your application is submitted, no changes are allowed. Click "Save" to allow changes to your application as needed before submitting by the deadline.
- You may want to save a copy of the job posting for referencing after the deadline.
- Submitted materials will be evaluated by a panel of job experts according to the qualifications above.
- Please monitor your email for communications related to this position.
- Current or former permanent, classified, state employees must complete the online application process to be considered.
- If viewing through an external site, please apply directly at Wisc.Jobs .
- For technical assistance and general information, please see Frequently Asked Questions . For questions about the position, to request a copy of the full position description, or for other employment inquiries, please contact Allyvia Vang in Human Resources at [redacted] .
Veterans are encouraged to apply. For complete information on Veterans' hiring programs with the WI Department of Veteran's Affairs, click here .
Deadline to Apply
All applications must be finalized by 11:59 pm on October 3rd to be considered.