Senior Project Manager - Managed Care & Compliance
Texas Medical Center-Houston, Texas
UTHealth School of Public Health
Requisition #: 2000002F
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Plans, organizes and coordinates project management activities ensuring that
the project is successfully implemented within budget and on-schedule.
Department: School of Public Health
Location: Texas Medical Center, Houston, TX
Position Type: Full Time/ Exempt
Coordination and management of project planning,project development, and strategic planning among various staff and determinesproper project delivery methods.
Oversees and performs cost estimating, design,project scheduling and budgeting, quality assurance, communication, procurement,project closeout, and direct billing of purchase orders for multiple projectsites and customers across all project platforms.
Identify, develop, and gather resources to completethe project. This may include preparing designs and work specifications;developing project schedules, budgets and forecasts; and selecting materials,equipment, and project staff. May liaise with other operational areas in theorganization to secure specialized resources and contributions for the project.
Designs and implements strategicprocedures to maintain managed carecompliance standards and prepare for external reviews and reporting.
Serves as knowledge expert of regulations and performancestandards required by Centers for Medicare and Medicaid Services (CMS) and the State for Managed Medicaid Plans
May manage ongoing procurements and vendorrelationships for state initiatives. Researches new customer prospects andwrites formal proposals for business bids. Oversees the submission and renewalsof formal proposals with administration, UT Health’s legal department andoutreach site administrators to generate new income and retention of projectsites
Coordinatesthe communication of performance evaluation results and compliancerecommendations to key stakeholders.
Subject matter expert forHealthcare Effectiveness Data and Information Set ( HEDIS )and other Quality improvementinterventions including member satisfaction
Identifies and evaluates Qualityinterventions that meet state and federal intervention rules and are alignedwith effective practices as identified in the healthcare quality improvementliterature
Communicates new state, federal and third party regulations andrequirements to the staff and 3 rd parties that include Health &Human Service Commission (HHSC).
Ensures project controls, tracking and performancemeasurement, reporting and project delivery objectives are met. Monitorprogress and performance against the project plan; take action to resolveoperational problems and minimize delays.
Oversees communications, internally and externally,including community engagement activities.
Responsible for assisting with the management,implementation, and launch of new products and services. Supports uppermanagement with long-term planning, external relationship development, andstaff development.
May conduct onsite visits, meetings, observationsand on the job training. Also directs and creates professional development,staff training, and mentoring for all project staff.
May manage Human Resources activities for directreports in regards to: recruiting and selection, hiring and termination,training, professional development, mentoring, counseling, performanceevaluations, and salary planning.
Performs other duties asassigned.
Six (6) years of Quality Improvement or Quality Management experience in Managed Care Organization environment,including three (3) years of supervisory and/or management experience.
Knowledge ofUtilization Review Accreditation Commission(URAC), andNational Committee for Quality Assurance(NCQA) accreditation standards
Strong customer service, organizational, communication, analytical, writing and interpersonal skills.
Microsoft Office suite :
Knowledge of health plan performance andHealthcare Effectiveness Data and Information Set (HEDIS)
Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance
Certified Professional in Health Quality (CPHQ)
Certified HEDIS Compliance Auditor (CHCA)
Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.
This job class may contain positions that are security sensitive and thereby subject to the provisions of Texas Education Code § 51.215
If you are looking for a great healthcare career in Houston, visithttp://go.uth.edu/careers!
University of Texas Health Science Center at Houston (UTHealth)
Established in 1972 by The University of Texas System Board of Regents, The University of Texas Health Science Center at Houston (UTHealth) is Houston’s Health University and Texas’ resource for health care education, innovation, scientific discovery and excellence in patient care. The most comprehensive academic health center in the UT System and the U.S. Gulf Coast region, UTHealth is home to schools of biomedical informatics, biomedical sciences, dentistry, nursing and public health and the John P. and Kathrine G. McGovern Medical School. UTHealth includes The University of Texas Harris County Psychiatric Center, as well as the growing clinical practices UT Physicians, UT Dentists and UT Health Services. The university’s primary teaching hospitals are Memorial Hermann-Texas Medical Center, Children’s Memorial Hermann Hospital and Harris Health Lyndon B. Johnson Hospital.
UTHealth offers a comprehensive and competitive benefits package. For more information on our benefits programs please refer to the UTHealth Office of Benefits Website.
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