Program Director – SMPIR
The Program Director –SMPIR supports the Centers for Medicare & Medicaid Service’s State Medicaid Program Integrity Review (SMPIR) project. This position is responsible for the design, development, and implementation of a program integrity structure to meet all objectives of program.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Essential duties and responsibilities include the following. Other duties may be assigned.
Responsible for the integration of CNI Core Competencies into daily functions, including: commitment to integrity, knowledge / quality of work, supporting financial goals of the company, initiative / motivation, cooperation / relationships, problem analysis / discretion, accomplishing goals through organization, positive oral / written communication skills, leadership abilities, commitment to Affirmative Action, reliability / dependability, flexibility and ownership / accountability of actions taken.
Maintains positive working relationships with the customer and stakeholders. Ensures customer satisfaction with the successful execution of each assignment.
Ensures quality assurance program and processes are in place and strictly adhered to for all tasks.
Creates monthly cost reports and ensures they are submitted timely and accurately, including a plan to correct any cost variances or projected rate adjustments.
Responsible for the management and direction of all program integrity solutions including staffing, budgeting, service efforts and accomplishments, work plans, employee performance appraisals and quality assurance.
Plans and directs external review functions for all SMPIR tasks.
Designs and performs all review protocols, review programs, review procedures, and review reports necessary to fulfill all SMPIR tasks. Tasks include but are not limited to Personal Care Review Protocol, Comprehensive Program Integrity Review Protocols for four U.S. Territories, Provider Termination Reviews, Accuracy of Beneficiary and Consumer Eligibility Determination Reviews, PI Focus Reviews and Ad hoc reports and papers as requested.
Maintains timely communications and develops collaborative rapports with solutions-oriented approaches.
Communicates key performance indicators (KPIs), plans, objectives, timelines, schedules, designated responsibilities and reporting relationships.
Sets, manages and communicates project expectations to project managers and project team members and stakeholders.
Ensures project staffing levels and skill mix is appropriate for the overarching scope and delivery for a project.
Identifies potential threats to success, crises and risk management to create contingency plans and paths for Project Teams.
Responsible for aiding in own self-development by being available and receptive to all training made available by the company.
Plans daily activities within the guidelines of company policy, job description and supervisor’s instruction in such a way as to maximize personal output.
Responsible for keeping own immediate work area in a neat and orderly condition to ensure safety of self and coworkers. Will report any unsafe conditions and/or practices to the appropriate supervisor and human resources. Will immediately correct any unsafe conditions to the best of own ability.
EDUCATION / EXPERIENCE
Bachelors’ degree and ten (10) years of related experience; or equivalent combination of education and experience. Five years of Medicaid program and policy experience at the state or federal level, and a minimum of seven years in a management capacity with responsibility for managing complex systems and workflows. Extensive Medicaid program integrity subject-matter and analytics expertise, including managed care program integrity or oversight experience.
CERTIFICATES, LICENSES, REGISTRATION
JOB SPECIFIC KNOWLEDGE / SKILLS / ABILITIES
Demonstrated ability to develop and apply comprehensive solutions to client requirements / issues
Skilled proficiency in the use of Microsoft Office Suite (i.e., Word, Excel Outlook, Project, etc.) and Microsoft SharePoint web application
Exceptional organization skills with ability to effectively manage multiple projects and priorities
Skilled in facilitating teamwork and coordinating efforts for the successful achievement of goals
Excellent supervisory and management skills with ability to resolve conflicts, grievances, confrontations or disagreements in a constructive manner
Ability to extract meaning from complex information
Excellent verbal and written communications skills with solid presentation skills
Ability to schedule, plan and lead meetings
Exceptional customer service and relationship-building skills
Adept analytical, critical thinking and financial management skills
Ability to implement a proactive approach to problem-solving
Ability to interact professionally with team members, corporate management, and clients of all levels
Demonstrated ability to work under pressure and to meet tight deadlines
Demonstrated ability to effectively work both independently and in a highly collaborative, team environment
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference and volume. Ability to apply concepts of basic algebra and geometry.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
SPECIAL 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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this job. Work is primarily performed in an office environment. Regularly required to sit. Regularly required use hands to finger, handle, or feel, reach with hands and arms to handle objects and operate tools, computer, and/or controls. Required to speak and hear. Occasionally required to stand, walk and stoop, kneel, crouch, or crawl. Must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus. Exposed to general office noise with computers printers and light traffic.