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Job description
Position Summary:
The FHK Contract Manager is CCP's primary contact for the Florida Healthy Kids contract. This role leads client communications and governance, interprets and operationalizes contract and amendment requirements, orchestrates cross-functional deliverables across CCP departments and subcontractors, and ensures audit readiness and timely regulatory submissions. Success in this role is measured by on-time, accurate reporting; proactive risk escalation; disciplined closure of audit and corrective actions; and positive client relationship outcomes
Qualifications:
Bachelor of Science/Arts in Business or other degree in a related medical or business field or equivalent years of experience is required Business Administration (MBA) or Management is preferred
Three to five (3 to 5) years in a Managed Care Organization; or other healthcare related field is preferred
Essential Duties and Responsibilities:
Establish and maintain collaborative working relationship with assigned client(s) and other key industry stakeholders; serve as primary liaison per contract requirements; provide accurate, timely and concise replies to requested data or reports, etc.
Primary liaison to provide interpretation and guidance to the organization regarding contract requirements, reporting and administration.
Owns interpretation of FHK contract requirements; decides intake triage, due-date commitments, and deliverable acceptance prior to submission to the client.
Analyze, summarize, and guide the implementation of the annual and interim contract amendments in conjunction with appropriate business owners.
Ensure effective implementation of new and renewing contracts through communication and coordination with other functional areas.
Coordinate and compose time-sensitive responses to incoming regulatory requests and inquiries/issues reflective of compliance with contract requirements.
Coordinate ,lead and participate in desktop audits, regulatory responses and site visits by client(s), as per contract.
Triage provider inquiries on claims, authorizations, and network status; ensure handoffs and closure.
Develop and maintain relationships with key internal and external stakeholders to ensure successful collaboration.
Identify and recommend performance improvement opportunities.
Report potential risks, non-compliance, or alleged contract violations.
Engage in Quality Management Initiatives including, but not limited to, material approval, complaints, and grievances, etc. (when applicable)
Lead weekly meeting with the Client(s).
Participate in the monthly Joint Operations Committee (JOC) meetings to address performance and FHK contract-related items with CCP's Subcontractors.
Lead and monitor CCP Subcontractors Corrective Action Plans for FHK contract-related non-compliance issues.
Develop and present Quarterly Performance Measures report to client(s) (when applicable).
Liaison between client(s), providers, and Community Care Plan corporate office.
Assist providers regarding claims inquiries, authorization status, network status etc.
Serve as the liaison for resolving issues with Community Care Plan's internal depts, e.g., Medical Economics, Claims, Provider Operations, IT, UM, etc.
Travel for FHK Board Meetings, presentations, account satisfaction functions, etc., when required
This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.
Skills and Abilities: Proficient in Microsoft Word, Excel and PowerPoint
Knowledge of regulatory environment
Experience in a high-growth business environment
Working knowledge of health plan policies and procedures
Strong analytical and statistical skills
Ability to work in a fast-paced environment and reprioritize
Effective problem-solving skills with attention to detail
Ability to develop, prioritize and accomplish goals
Strong communication skills (both written and verbal)
Strong interpersonal skills and high level of professionalism
Ability to work independently and within a team environment
Effective active listening and critical thinking skills
Display a customer service, member-focused orientation
Work Schedule:
Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. A reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee may occasionally be required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic travel. A reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.
Background Screening Notice:
In compliance with Florida law, candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.
The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants.
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Who can apply
Review the original listing for work authorization, qualifications and employer requirements.