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Care Coordination Quality Assurance Administrator

Oregon Health Authority Human Resources
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Do you have experience developing, implementing, and providing oversight of contracts, policies and programs at the community, state, and/or national level that promote equity and inclusion and reduce disparities? Are you passionate about designing quality assurance mechanisms that translate to effective and streamlined care coordination, supportive care experience and improved health outcomes? We look forward to hearing from you!

 

OHA values service excellence, leadership, integrity, health equity and partnership and has a strategic goal to end all health inequities by 2030.

 

Work Location: Salem/Marion or Portland/Multnomah; hybrid position

 

What you will do!

Medicaid Fee-for-Service (FFS) care coordination contracts will be administered to a third-party administrator (TPA), which will provide comprehensive, person-centered care for Medicaid members, including behavioral health, physical health, oral health, and Medicaid 1115 Waiver Health Related Social Needs (HRSN) services. The TPA will also include care coordination for an expanded group of members such as individuals in incarcerated settings and Substance Use Disorder 1115 Waiver beneficiaries. 

 

MEDICAID: Clinical Care Coordination Quality Assurance Administrator. The purpose of this OPA3 position is to center Medicaid Fee-for-Service (FFS) members in the development of statewide FFS clinical standards and FFS care coordination contract quality assurance processes.  The development of these statewide FFS care coordination clinical standards will include research into current federal trends and statewide Coordinated Care Organization (CCO) clinical practices, the development of clinically based FFS care coordination Oregon Administrative Rules (OARs), the development of a comprehensive complaint resolution process in partnership with the agency External Relations Division (ERD), and the development of clinical quality improvement processes through which the state can continuously improve the federally mandated standard of healthcare service for Oregonians.

 

This position will provide technical assistance in physical health and behavioral health claims and develop and oversee a comprehensive complaint resolution process in conjunction with partners in Client Services, Ombuds, Innovator Agents, Community Partner Outreach Program (CPOP), contractors and the Director’s Office. To do so, this position will build on and establish new cross-division relationships, facilitate round table meetings, listening sessions and dialogue, on both a regular and as-needed basis. The internal and external complaint resolution process work led through this position will help drive care coordination administrative rulemaking and care coordination contract quality assurance process development to improve care for all Medicaid members.

 

 

MEDICAID: Fee For Service Contracts Quality Assurance Administrator. The purpose of this OPA3 position is to center Medicaid Fee-for-Service (FFS) members in the development of FFS care coordination contract administration policy and quality improvement processes designed to establish statewide FFS care coordination contract administration standards.  The development of these statewide FFS contract administration standards will include research into current federal trends and statewide Coordinated Care Organization (CCO) contract administration practices, the development of FFS care coordination Oregon Administrative Rules (OARs), the creation of criteria for measuring the effectiveness of FFS care coordination contract administration, and the development of administrative quality improvement processes through which the state can continuously improve the federally mandated standard of healthcare service for Oregonians.  

 

To establish criteria for measuring the effectiveness of statewide FFS contract administration, this position will help facilitate and gather data and analyzes collected to monitor and manage FFS program compliance. This work is done in collaboration with various entities and partners, including but not limited to behavioral, oral, and physical health providers, the Federal Centers for Medicare and Medicaid Services (CMS), the Oregon Legislature, the Health System Division, OHA’s Office of Actuarial and Fiscal Analysis, Budget Unit, Health Policy and Analytics, and the Public Health Division.

 

What's in it for you?
We offer exceptional medical, vision and dental benefits.

  • Paid Leave Days:
    • 11 paid holidays each year
    • 3 additional paid "Personal Business Days" each year
    • 8 hours of paid sick leave accumulated every month
    • Progressive vacation leave accrual with increases every 5 years
  • Pension and retirement programs 
  • Optional benefits: short and long-term disability, deferred compensation savings program, and flexible spending accounts.


WHAT WE ARE LOOKING FOR:

Minimum Qualifications

Any combination of experience and education equivalent to seven years of professional-level evaluative, analytical and planning work experience.

 

Example: A Bachelor's Degree in Business or Public Administration, Behavioral or Social Sciences, Finance, Political Science or any degree demonstrating the capacity for the knowledge and skills; and four years professional-level evaluative, analytical and planning work.

 

Desired Attributes

  • Preference may be given for the ability to read, write, speak and interpret English and one of the 5 most common languages in Oregon other than English (Spanish, Vietnamese, Chinese, Russian, and Korean) with full proficiency in a culturally humble manner. 
  • Experience working in clinical health care setting; advanced degree preferred. [for Clinical Care Coordination Quality Assurance Administrator] 
  • Knowledge of health services delivery systems, particularly the Oregon Health Plan/ Medicaid Administration in Oregon, and experience in working with Community Mental Health Programs, Behavioral Health Service Providers, Coordinated Care Organizations or other managed care entities and their leadership to guide operations and policies. 
  • Knowledge about contracts/interagency agreement administration, procurement, and project management within the context of Oregon state government (e.g. OHA/ODHS) or other complex health services delivery organizations.
  • Ability to demonstrate advanced Microsoft Excel, Word, PowerPoint, Outlook, skillset; and skilled use of collaboration tools such as Microsoft Teams, SharePoint, and Smartsheet; experience with  SPSS, ArcGIS, R, python and/or other analyses is preferred. 
  • Ability to provide organizational leadership to support inter-and cross-agency collaboration and systems-wide changes that facilitate advocacy, equity, and client-centered policies and solutions.
  • Specific knowledge of business and management principles involved in strategic planning, resource allocation, leadership technique, iterative design, and improvement science.
  • Strong communication skills across a variety of forms that demonstrate the ability to facilitate appreciative inquiry, foster trust and transparency, and promote human-centered change management.
  • Demonstrates skills in the following areas: 
    • Contract Administration
    • Data Synthesis, Analysis and Reporting
    • Performance / Process / Quality Improvement
    • Policy Advisement
    • Program Design, Implementation, and Evaluation
    • Project Management
    • Strong Oral and Written Communication 
    • Systems and Organizational Improvement
    • Expert level Technical Assistance
  • Community and Partner Engagement