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Job Summary

This position is responsible for providing operational services, assistance, and program implementation and coordination for one or more of the day-to-day Medicaid operational functions, including Utilization Management (UM), Care Management (CM), reporting, compliance, billing, claims, enrollment, and customer service.

This resource is responsible for resolving complex and/or escalated internal or external operational questions. Additionally, this position works with other areas of the organization on the development, testing, and implementation of program policies, business processes, reporting solutions, and system changes to ensure the state requirements of the plan are met. The role will have a particular focus on Texas Medicaid managed care operations, including interpreting and supporting requirements outlined in the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and applicable managed care contracts, while using data and reporting to monitor operational performance, identify gaps, and support compliance.

Required Job Qualifications:

Bachelor Degree in Business with 4 years’ experience OR 8 years of experience working in health insurance operations
Experience in project development, implementation and execution skills
Experience interfacing with internal clients, operations personnel
Verbal and written communication skills and ability to represent Medicaid department at committee meetings
Experience with interacting effectively with all levels of internal and external customers
Experience managing multiple projects effectively
Interpersonal, organizational and analytical skills
Organizational and leadership skills

Preferred Job Requirements:

Experience with managing contract provisions
Experience in Project Management
Direct experience supporting Texas Medicaid managed care operations, preferably within a Medicaid Managed Care Organization (MCO), healthcare services organization, delegated entity, or vendor supporting a Texas Medicaid population.
Working knowledge of the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and the Uniform Managed Care Contract (UMCC) requirements to ensure that and the and experience interpreting or applying UMCM requirements to operational processes, reporting, deliverables and , or compliance activities are compliant.
Hands-on experience with Texas Medicaid Utilization Management (UM) and/or Care Management (CM) operations.
Experience working with or interpreting Texas Medicaid managed care contract requirements, including the relationship between contract requirements, UMCM guidance, and operational execution.
Experience monitoring operational performance or compliance, identifying gaps, validating deliverables/data, and coordinating corrective actions or operational improvements.
Strong reporting and data-analysis skills, including advanced Microsoft Excel; Power BI/dashboard development or reporting experience strongly preferred.
Experience with managing contract provisions
Experience in Project Management
Ability to analyze complex Medicaid operational requirements and translate them into clear business requirements, processes, reporting, and actionable recommendations.
Location: Richardson, TX Headquarters
Schedule: This is a Flex (Hybrid) role: 3 days in office; 2 days remote.
Sponsorship: Sponsorship is not available

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$55,900.00 - $123,500.00

Exact compensation may vary based on skills, experience, and location.

Health Care Service Corporation

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