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Director, Medicaid Administration


Posted: 10/2/2019
Job Reference #: 5000537534106

Job Description

Employment Type


Exempt or Non-Exempt


Job Summary

Direct and manages HMSA's Medicaid QUEST program for members who do not receive Long Term Services and Support (LTSS) in compliance with HMSA policies, contractual standards, Federal/ State requirements, and applicable accreditation standards. Responsible for the general administration and day-to-day business activities of the program(s).
Requires frequent travel offsite to attend meetings, presentations and collaborating with key business partners, vendors and various resource agencies.

Minimum Qualifications

  1. Bachelors degree in business administration, public health or related field, and seven (7) years progressively responsible positions in managed care or governmental health plans, including leading and managing programs and people, budgeting, planning, and project management or equivalent combination of education and experience. Work experience must demonstrate knowledge of health care systems and include external communication experience.
  2. Five (5) years of previous management/supervisory experience.
  3. Effective verbal and written communication skills.
  4. Budget development/management experience.
  5. Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and Power Point.
  6. Valid U.S. driver's license, access to an automobile with current license, registration and no fault insurance.

Duties and Responsibilities

  1. Provide strategic leadership and direction to HMSA and HMSA's partners in activities ensuring that all contractual, regulatory, governmental, and accreditation requirements and objectives of HMSA's Medicaid QUEST program for members requiring LTSS services are met, with direct responsibility to oversee:
    • Strategy, planning, design, development, integration, and management of HMSA's programs and services offered to the Medicaid QUEST LTSS population.
    • Communication and coordination with HMSA departments, subsidiaries, and business associates to ensure compliance with Medicaid QUEST program requirements and high quality LTSS are being provided to QUEST members who require such services.
    • Planning, goal setting, monitoring, and oversight activities related to HMSA's Medicaid QUEST LTSS program requirements and objectives.
    • Projects related to enhancing current capabilities and developing new capabilities.
    • Partnering with Providers Services and Provider Operations to develop and maintain an adequate LTSS and HCBS (home and community based services) provider network.
    • Collection and analysis of business information with an emphasis on the identification, development, and use of appropriate data and analytical methods to answer specific business questions and report to contractual, regulatory, governmental, and accreditation audiences.
    • Identifies and implements opportunities to improve HMSA's Medicaid QUEST program and collaborates within HMSA and with HMSA partners and providers to ensure effective communication, operations, and customer experience. Responsible for maintaining awareness of industry developments, policy or regulatory changes, and other factors that affect HMSA and collaborating to develop effective long and short term strategies and tactics in response.
  2. Serve as primary HMSA representative liaison with the State of Hawaii, Department of Human Services (DHS) for all HMSA activities related to the Medicaid QUEST LTSS contract to include financial, contractual, administrative, operational, and compliance. Responsible for collaborating internally with other HMSA departments that implement LTSS services to assure adequate internal monitoring, interpreting of DHS guidance, and assures understanding of changes in Medicaid QUEST requirements within HMSA and with HMSA partners and providers.
  3. Represent HMSA by participating in Medicaid QUEST and community committees as requested by DHS.
  4. Represent HMSA in regard to Medicaid QUEST LTSS with various publics, including the legislature and advocates.
  5. Develop and implement all communication and marketing activities for the Medicaid QUEST LTSS program in strict compliance with all regulatory requirements.
  6. Develop and monitor plans and budgets.
  7. Performs all other miscellaneous responsibilities and duties as assigned or directed.