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Metastar | Project Manager Medicaid Managed Care

January 12, 2022 3:45 PM | Mathias Lemos Castillo (Administrator)


Job Title: Project Manager Medicaid Managed Care

Division and/or Department: Managed Health and Long Term Care

Date Most Recently Reviewed, Updated, etc.:  12/27/2021

Pay Type:  Salaried 

Workforce Classification:  Full time (75-100%)

JOB SUMMARY 

  • Reports directly to: Vice President (VP) of External Quality Review

  • Direct reports to this position include:

    • Co-supervision of Quality Review team
  • Other individuals or MetaStar staff with whom the person works on a regular basis: 

    • State of Wisconsin Department of Health Services (DHS)
    • Managed Care Organization (MCO), Hospital, and Prepaid Inpatient Health Plans Compliance Officers, Quality Directors, and other designated staff 
    • County Waiver and Birth to 3 Agency staff
    • Long Term Care and Review Services Project Managers 
    • External Quality Review Project Coordinators
    • IT Department
    • Finance Department
    • Comagine Health
    • WISe Agencies
    • MetaStar Operations Group
  • Essential duties and responsibilities: 

To successfully perform this job, the individual must be able to perform each essential job function satisfactorily.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

    • Serves as a primary contact for DHS and organizations to develop and implement required and optional external quality review activities, as requested by DHS and in collaboration with DHS and program providers. 
    • External quality review is the analysis and evaluation of aggregated information on quality, timeliness, and access to services furnished by these programs. 
    • Collaborates and communicates with VP, PMs, and other team members to develop work plans and assign duties/tasks/responsibilities, such as review activities, to ensure contract deliverables meet timeliness, quality and budget expectations. 
    • In partnership with other internal managers, sets and revises priorities to maximize and leverage staff to create efficiencies and respond to DHS directives. 
    • Coordinates and participates in inter-rater reliability testing in order to achieve standards of accuracy and consistency in applying review guidelines for specific review activities. 
    • Promotes positive internal/external client relations. 
    • Leads, participates and supports department efforts to improve existing processes and develop new processes/standard operating procedures (SOPs) including identification of issues/barriers and methods for improvement. Promotes flexibility in process design, implementing PDSA cycles as needed. 
    • Coaches assigned staff, provides technical advice, and facilitates connections with other subject matter experts. 
    • Serves as a subject matter expert regarding external quality review (EQR) mandatory and optional review activities described in the External Quality Review contracts according to Federal and State requirements. 
    • Reviews written work products prepared by others. 
    • Communicates routinely and proactively regarding project progress, issues and needs, etc. 
    • In cooperation with other managers, develops contingency plans in response to staffing changes.
    • Develops and delivers presentations to internal and external groups, as needed. 
    • Actively participates in and develops team Internal Quality Control (IQC). 
    • Verifies time reporting and approves timesheets for assigned staff.
    • All other duties as assigned

QUALIFICATIONS, REQUIREMENTS, ETC. 

  • The requirements listed below are representative of the knowledge, skills, and/or abilities required to successfully perform this job at the minimum level.
  • Bachelor’s degree in health related or human service field. 
  • Minimum of five years of supervisory or leadership experience. 
  • Minimum of five years of project management experience managing complex projects.
  • Minimum of five years’ experience working with children with special healthcare needs
  • Minimum of five years’ experience working with adults with special healthcare needs
  • Experience with continuous quality improvement, process improvement and Lean principles. 
  • Experience and knowledge of regulatory reviews and compliance based surveys such as Federal managed care regulations, DHS health care regulations and licensing, health care organization accreditation standards. 
  • Knowledge of the conditions, current philosophies, nationally recognized approaches, and community alternatives for the adult and children’s populations being served under the DHS managed health, long-term care home and community based waiver programs 
  • Effective analytical and communication (oral and written) skills. 
  • Ability to work well independently and within a team structure. 
  • Self-motivated, critical thinker with a strong desire to learn and apply existing and new skills. 
  • Excellent communication (oral and written) and small and large group facilitation skills. 
  • Knowledge of Medicaid policies, data systems and processes. 
  • Knowledge and proficiency in using electronic medical and health records systems. 
  • Proficiency in Microsoft Office applications. 
  • As federal contractor, proof of COVID-19 vaccination is required for all employees.
  • Valid Driver’s License or ability and means to travel as required. 
  • Interest and availability for in-state and overnight travel (10 % of the time).
ORGANIZATIONAL CORE COMPETENCIES: 
  • Exemplifies MetaStar’s Mission, Vision, Values
  • Uses Quality Improvement Concepts in Daily Practice
  • Provides Excellent Customer Service
  • Shows Initiative
  • Applies MetaStar’s Management Philosophy

PHYSICAL EFFORT AND WORKING CONDITIONS

The requirements and conditions described below are representative of the general environment the individual is exposed to on a day-to-day basis while performing this job.

Manual Dexterity: Ability to operate computer and telephone

Physical Effort: Ability to sit or stand for five-to-eight hours per day (depending on scheduled FTE); occasionally lifting up to 15 pounds.

Equipment Used: Computer and telephone

Working Conditions:Traditional office environment; required to work on a computer five-to-eight hours per day (depending on scheduled FTE)


MetaStar is proud to be an equal opportunity employer. We do not discriminate based upon race, religion, color, national origin, sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other characteristics. We celebrate diversity and are committed to creating an inclusive environment for all employees.


Please send your resume to jobs@metastar.com.  Additional information on our benefits and culture can be found at Careers - MetaStar

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