Senior Manager, MCO Plan Performance, HCI & Dual Programs

Position overview

The Department of Healthcare and Family Services, Bureau of Managed Care is seeking to hire a skilled leader to serve as Senior Manager, MCO Plan Performance, HCI & Duals Programs. This role assists with overseeing account management operations for Illinois’ Managed Care Organization (MCO) programs, ensuring contract compliance with the HealthChoice Illinois program and programs related to dual eligible customers with Medicare and Medicaid, driving performance improvements, and supervising MCO Account Managers. The position represents HFS in high-level stakeholder meetings and leads initiatives to strengthen managed care operations and service delivery for Medicaid members statewide.

The ideal candidate for this position is a strategic, results-driven leader with deep expertise in managed care related to Medicaid and Medicare, exceptional communication skills, and a proven ability to drive performance, foster collaboration, and navigate complex challenges with professionalism and precision. While this position is posted for Cook County, applicants from Sangamon County are welcome and encouraged to apply

HFS values employees with different backgrounds, life experiences, and talents. If you are seeking a new opportunity, and this position appeals to you, please apply today!

Essential Functions

• Serves as Senior Manager, MCO Plan Performance - HCI & Dual Program for Managed Care Organizations (MCOs) participating in the HealthChoice Illinois (HCI) Program as well as Managed Care Organizations (MCOs) participating in programs related to dual eligible customers who have Medicare and Medicaid. This position is a part of the Bureau of Managed Care (BMC) within the Illinois Department of Healthcare and Family Services (HFS)
• Leads and drives stakeholder representation and executive communication by representing BMC in internal and external meetings, including routine and ad hoc discussions with MCOs and HFS executive leadership
• Oversees performance management processes for programs serving dual eligible customers who have Medicare, Medicaid, and HealthChoice Illinois
• Serves as a full line supervisor
• Drives research, benchmarking and policy development
• Leads reporting, analytics and governance processes
• Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above

Minimum qualifications

• Requires knowledge, skill, and mental development equivalent to completion of four (4) years of college with course work in health administration, public policy, public administration, business administration or related fields
• Requires prior experience equivalent to four (4) years of progressively responsible administrative experience in a public or private organization overseeing Medicare programs, including dual eligibility

Preferred qualifications

• Four (4) years of professional experience developing and implementing policies within a healthcare or medical organization
• Four (4) years of experience in a healthcare industry, including direct experience with Medicare and Medicaid programs
• Four (4) years of demonstrated experience establishing and maintaining effective working relationships with internal and external stakeholders, including executive leadership, and addressing sensitive or controversial issues with sound judgement, tact and professionalism
• Four (4) professional experience ensuring contract compliance for managed care health plans, including adherence to applicable federal, state, and organizational regulations
• Four (4) years of experience designing, implementing, and evaluating new or revised methods, procedures, and performance standards in a healthcare setting
• Four (4) years of experience supervising staff and managing team performance
• Four (4) years of experience involving knowledge of medical concepts and operations, preferably related to managed care health plans

Conditions of employment

• Requires completion of a background check and self-disclosure of criminal history
• Requires the ability to utilize and maintain state issued equipment such as laptop
• Requires the ability to travel in the performance of duties, with overnight stays as appropriate
• Overtime is a condition of employment, and you may be requested or required/mandated to work overtime including scheduled, unscheduled, or last-minute overtime. This may require the ability to work evenings and weekends
• This position has been found to meet the requirements in section 4A-101 of the Illinois Governmental Ethics Act requiring the occupant /employee to file a Statement of Economic Interest. The Illinois Governmental Ethics Act (5 ILCS 420/4A et seq.) requires certain state officials and employees to file annual Statements of Economic Interest with the Office of the Secretary of State that will be made available for examination and copying by the public. All employees required to file a Statement of Economic Interest are also required to file the Supplemental Statement of Economic Interest with the Executive Ethics Commission. (See Executive Order 15-09) Fines and penalties apply to untimely filings
• Certain provisions of the revolving door restrictions contained in 5 ILCS 430/5-45 apply to this position. As a result, the employee should be aware that if offered non-State employment during state employment or within one year immediately after ending State employment, the employee shall, prior to accepting any such non-State employment offer, notify the Office of the Executive Inspector General for the Agencies of the Illinois Governor (OEIG) or may be subject to a fine
  • The conditions of employment listed here are incorporated and related to any of the job duties as listed in the job description

About the agency

At the Illinois Department of Healthcare and Family Services (HFS), we value staff as our greatest asset. We work in a spirit of teamwork to help millions of Illinoisans access high quality healthcare and fulfill child support obligations to advance their physical, mental, and financial well-being. We provide healthcare coverage for children and adults through Medicaid and other medical programs, and we help ensure that children receive financial resources from both their parents through Child Support Services. The HFS Office of the Inspector General investigates, audits and reviews program activity to ensure the integrity of our programs is maintained.

HFS is committed to promoting and preserving a workplace culture that embraces diversity, equity, and inclusion. We welcome and value employees with different backgrounds, life experiences, and talents. It is the collective sum of our individual differences that provides a broad perspective, leading to greater innovation and achievement. In recruiting for our team, we recognize the unique contributions of each applicant regardless of culture, ethnicity, race, national origin, sex, gender identity and expression, age, religion, disability, and sexual orientation. HFS is an equal opportunity employer.

Benefits statement

Employees receive a robust benefit package including:

• Monday-Friday work schedule
• Flexible work schedules are available in many program areas. (Remote work may be an option for certain positions.)
• Health, Life, Vision, and Dental Insurance
• Pension Plan
• Paid Parental Leave
• Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
• Employees earn (12) paid Sick Days annually.
• New Employees earn (10) paid Vacation Days their first year of service and can earn up to (25) paid Vacation Days annually.
• Employees earn (3) paid Personal Days annually.
• (13-14) paid holidays annually (based on start date)