Insurance Contract Manager Jobs in Florida (NOW HIRING)

Location: Tallahassee, FL

Salary Range: $50,000 to $55,000 annually (commensurate with education and/or experience).

How to Apply: OPEN UNTIL FILLED. Applicant should apply on this site to be fully considered for the position.

About FHKC:

The Florida Healthy Kids Corporation (FHKC) is a private, nonprofit organization created in 1990 by the Florida Legislature to expand access to affordable, high-quality health and dental insurance for Florida children ages 5 to 18. FHKC’s primary responsibilities are to: 1) manage health and dental plan contracts, 2) receive and process KidCare applications and collect premium, and 3) market and promote all four Florida KidCare programs – Medicaid, Florida Healthy Kids, MediKids, and Children’s Medical Services. The Corporation is funded primarily by federal and state dollars. FHKC offers employee benefits that are comparable, if not better than, state of Florida employee benefits.

To learn more about who we are, visit https://www.healthykids.org/.

About this Job:

We are seeking a full-time Contract Manager professional to join our team! The role of the Contract Manager is to Manage Florida Healthy Kids Corporation (FHKC) health and dental plan contracts; ensure compliance with contract performance requirements; analyze plan performance and enrollee utilization trends to improve delivery of healthcare services and satisfaction; and ultimately improve child health outcomes. The successful candidate is a life-long learner who demonstrates humility, is determined to get things done and will contribute to the success of the Corporation and knows how to have a positive outcome on others.

This position is administrative in nature and does not typically work directly with patients.

Essential Job Functions:

Manage dental plan contracts and assist with managing health plan contracts as needed:

• Maintain contract monitoring plan, tool, and file
• Monitor and document receipt of deliverables.
• Review and analyze deliverables to ensure compliance with federal and state laws, policies and procedures, and contractual performance requirements.
• Ensure corrective action plans are in place to address noncompliance issues.
• Complete, organize, and maintain contract monitoring documentation in accordance with FHKC standards and record retention requirements.
• Assist with review of member materials, marketing materials and plan and FHKC website content.
• Conduct reviews and special studies of health and dental plan deliverables and performance requirements, compile documentation and data, and prepare comparative or summary reports and correspondence that meets FHKC standards for content, style, and grammatical accuracy.
• Support implementation of quality improvement projects including documentation of deliverables and task lists, progress monitoring, and reporting.
• Serve as liaison for FHKC staff, customers, third party administrator (TPA), state agency partners and other stakeholders in researching and resolving plan-related issues.
• Track plan issues/complaints and facilitate accurate and timely resolution and closeout with originator.
• Analyze plan and provider issues/complaints, identify trends, and collaborate with plans to identify root causes and develop and implement solutions to mitigate future issues, improve utilization and quality of care, and enhance customer service.
• Serve as primary point of contact for dental plan communication, facilitate training, schedule, and facilitate meetings, record minutes, and track action items.

Participate in the procurement process including solicitation development, negotiation, and implementation of new contracts and amendments and draft preliminary amendments for any changes to the contracts.

Develop, implement, and maintain standard operating procedures and develop and maintain desktop instructional guides to facilitate cross training and compliance.

Serve as back-up for TPA customer service team and front desk reception.

Think strategically, innovatively, and proactively collaborate with all staff to advance organizational goals, perform other duties as assigned.

Comply with FHKC, state, and federal privacy policies, rules, and regulations.

Maintain industry currency, including trends and best practices related to health care quality assurance.

Supervisory Responsibility:

This position has no direct reports.

Travel:

• Occasional same day travel for work or corporate events
• Occasional out-of-town travel with overnight stay for work or corporate events
• Must have a valid driver’s license with acceptable driving record and ability to operate a motor vehicle

Benefits Package:

The corporation offers a competitive benefits package which includes:

· Health and life insurance

· Medical reimbursement

· 403(b) retirement plan

· Paid holiday, vacation and sick leave

· Disability insurance

· Training and career development

Remote work and relocation assistance are not offered for this position.

This role is not eligible for company sponsored immigration visas.

AAP/EEO Statement:

Florida Healthy Kids Corp. does not discriminate against any applicant for employment on the basis of gender, marital status, pregnancy, race, color, ethnicity, national origin, age, disability, religion, sexual orientation, gender identity or expression, veteran status, or other legally protected characteristic with respect to recruitment, hiring, job assignment, compensation or other terms and conditions of employment. All decisions regarding employment are solely based upon an individual’s qualifications relative to the requirements of the position.

Minimum Qualification Requirements:

• Four (4) years of related experience in a professional office environment. An equivalent combination of education or experience which equals four (4) years can substitute for the above requirements.

Preferred Qualifications:

• Contract/grant management experience and/or contract management certification.
• Experience in the health insurance industry or related fields.
• Experience with Children's Health Insurance Program (CHIP) or Medicaid.
• Experience complying with state and/or federal rules and regulation

Desired Knowledge, Skills, Abilities:

• Ability to manage multiple responsibilities.
• Ability to think critically to evaluate information; think creatively to solve problems; analyze a large volume of data, find trends and patterns, and report findings succinctly orally and in writing.
• Ability to organize data into logical format for presentation in reports, documents, and other written materials.
• Ability to conduct fact finding and problem-solving techniques.
• Excellent written and oral communication skills with professional command of the English language.
• Highly organized, with great attention to detail.
• Ability to apply federal and state health care policy, rules, regulations, and Title XXI requirements.
• Excellent contract management, compliance monitoring, and reporting skills.
• Ability and professional judgment to maintain confidential or sensitive information exercise appropriate discretion.