Staff Manager / Medicaid Managed Care Contract Manager (HCA/MAD #9277)

$29.58 - $47.33 Hourly

$61,531 - $98,449 Annually

This position is a Pay Band 75

Posting Details

This posting will be used for ongoing recruitment and may close at any time. Applicant Lists may be screened more than once.

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 Staff Manager / Medicaid Managed Care Contract Manager will:

• Provide direct oversight, monitoring and compliance of the Medicaid Managed Care Organization (MCO) contracts.

How does it get done?

The Staff Manager / Medicaid Managed Care Contract Manager is responsible for:

• Leading and directing oversight and monitoring activities of the MCOs;
• Providing ongoing feedback and identifying trends as part of ongoing contract oversight activities;
• Participating in site visits, readiness reviews, and evaluations of the MCO as requested;
• Collaboratively working with coworkers within and outside the division on reviewing and problem-solving ongoing projects, issues and concerns regarding managed care;
• Cultivating productive, effective work relationships with the MCO clinical and administrative staff to achieve contract goals and objectives;
• Serving as a resource for healthcare assistance providing information to consumers, consumer advocates, providers, and the general public regarding the Medicaid managed care program;
• Collaborating with MCO clinical staff, which may include medical directors, to facilitate resolution of member issues as needed;
• Triaging consumer and provider calls based on judgment;
• Assisting the provider community in their interactions with the MCOs and the Medicaid managed care delivery system;
• Evaluating the urgency of health situation and directing the consumer or provider to the most appropriate healthcare resource for resolution;
• Participating in the enhancement or revision of contract amendments, policy manual, and the development of regulatory language as needed;
• Actively participating in the managed care procurement process, waiver renewal process, state plan amendment process, NMAC regulation revisions, and audits as needed and requested.

Who are the customers?

• Managed Care Organizations;
• Medicaid staff;
• Medicaid recipients;
• Other State and federal agencies.

Ideal Candidate

The Ideal Candidate has;

• Experience with Medicaid programs and contracts;
• Experience working high-level contract management and oversight;
• Experience implementing program policies and procedures;
• Experience providing technical assistance and training;
• Experience working with social service programs or community outreach organizations.

Minimum Qualification

A Bachelor's Degree in any field of study from an accredited college or university and five (5) years of professional level experience operating within parameters and guidelines directly related to the purpose of the position defined by the agency at the time of recruitment. Substitutions Apply. See Substitution Table below. A hiring agency will designate that a portion of the required experience to include supervisory and/or specialized experience. Any required licensure, certification or registration shall be defined at the time of recruitment and will be in addition to the above requirements.

Substitution Table

These combinations of education and experience qualify you for the position:
Education Experience 1 High School Diploma or Equivalent AND 9 years of experience 2 Associate's degree AND 7 years of experience 3 Bachelor's degree AND 5 years of experience 4 Master's degree AND 3 years of experience 5 PhD degree AND 1 year of experience
• Education and years of experience must be related to the purpose of the position.

• If Minimum Qualification requires a specific number of "semester hours" in a field (e.g. 6 semester hours in Accounting), applicants MUST have those semester hours in order to meet the minimum qualifications. No substitutions apply for semester hours.

Employment Requirements

Must possess and maintain valid driver's license.

Working Conditions

Work is performed in an office setting with exposure to Visual/Video Display Terminal (VDT) and extensive personal computer and phone usage.

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.