Grants Administrator ; MCO Contract Monitor

The Agency's mission is to be boldly innovative in improving the health and quality of life for South Carolinians.

This position is located in the Bureau of Managed Care, Richland County.

This is an in-office role and not a telecommute or remote position.

Are you the One? We are looking for a MCO Contract Monitor who will support the oversight and accountability of Medicaid and Medicare Managed Care Plans operating in South Carolina. This position plays a vital role in safeguarding quality care and program integrity for members by ensuring contractual and regulatory compliance by Managed Care Organizations (MCOs). This is a regulatory oversight position that involves reviewing, analyzing, and monitoring health plan performance, ensuring adherence to federal and state requirements, and collaborating across internal and external stakeholder groups to improve outcomes for Medicaid/Medicare members.

• Serves as subject matter expert on all aspects of MCO contract by providing knowledge and expertise to internal partners, vendors, and external stakeholders. Provides guidance and direction to internal staff, vendors and external stakeholders on interpreting and operationalizing contract requirements. Clarifies contractual obligations to ensure all impacted stakeholders understand their roles in implementing deliverables as written in the contract. Assists with planning, coordination, administration and execution of new contracts, contracts amendments, change notices and bulletin updates as needed.
  
  Archives and maintains supportive documentation, communications, and reports to ensure accountability and accessibility of historical contract activities and decisions. Provides input, serves as liaison, and prepares communications for publication to vendors, internal departments, stakeholders, and/or administration, as well as facilitates internal and external meetings with partners to assist with the execution of the contract as written. Serves as the primary point of contact for escalations, assisting internal/external partners in resolving issues that impact contract execution.
• Monitors and evaluates MCO performance against contract deliverables as outlined in the contract and report companion guide, including the collection and storage of data required to monitor, analyze, and report compliance. Measures, tracks, and reports regularly on contract activity, contract compliance, contractor performance and agency satisfaction as defined in internal policies and procedures. Assists in the development and maintenance of procedural documentation, tools, reports, FAQs, monitoring protocols and operational tools necessary for consistent and accurate evaluation of contract and vendor deliverables.
  
  Collaborates with cross functional teams (policy, finance, quality, provider management and legal) to support managed care policy enforcement and continuous improvement. Conducts detailed reviews and validation of contractual reports, documentation, corrective action plans (CAPs), and performance metrics as defined in the report companion guide and internal policies and procedures. Prepares written analyses, issue summaries, and formal presentation for agency leadership and stakeholders to communicate managed care plans compliance status, identified risks and trends, and recommended actions for improvement.
• Provides day-to-day oversight, follow-up, and maintenance of assigned contract/vendor related escalations, and collaborates with appropriate parties to render resolution. Measures, tracks, and reports regularly on contract/vendor related escalations for assigned contracts and archives documentation as defined in internal policies. Develops and submits after action review documents to management to address…