Senior Manager, Managed Care Oversight

Allegheny County’s Department of Human Services (DHS) is nationally recognized for making data-driven decisions and relentlessly testing new strategies to find what works. We care about people, and we show that by getting results. In Allegheny County, we hold the levers for a $500 million behavioral health Medicaid program, alongside another $200 million in additional, flexible funding to improve the behavioral health of the county’s most vulnerable children, youth, and adults. 

Allegheny County DHS is deploying cutting-edge solutions to modernize its system of care. In recent years, we have: 

• rebuilt our behavioral health crisis system, including implementing geographically focused teams to more quickly respond to people in crisis;  

• launched and expanded law enforcement assisted diversion, and deployed behavioral health teams from 911 in lieu of police;  

• launched a process and treatment to restore competency to participate in criminal proceedings in the community instead of jail or state hospitals;  

• bolstered the behavioral health workforce through a sizable fellowship that includes student-loan repayment as well as professional development; 

• invested millions in informal mental health supports -- non-clinical help from peers, friends and family, religious leaders, or other non-health professionals in communities that may mistrust government and/or traditional clinical services; 

• ensured that everyone coming into the jail can be assessed and provided full Medication Assisted Treatment for Opioid and Alcohol Use Disorders; 

• pioneered large-scale, gold-standard research on “contingency management” (i.e., using a behavioral therapy that uses “rewards” to help people stay on the path to recovery) and incentivizing the use of long-acting medications for people with serious mental illness;  

• transformed the mental health housing system by using data-driven approaches to serve the highest risk clients and reduce lengthy waitlists;  

• carefully considered the risks and benefits of including policy and practice options like adopting Assisted Outpatient Treatment in our continuum of care. 

Our next challenges lie in integrating care with physical health more seamlessly, reducing disparities by building a system that works better for people in greatest need, and deftly adjusting our Medicaid program to respond to policy changes at the state and federal levels while keeping our clients covered. 

These challenges and opportunities require a Senior Manager, Managed Care Oversight, to help us achieve a world-class Medicaid program. This position will work closely with the Director, Behavioral Health and report to the Director, Office of Analytics, Technology and Planning. The salary range for this position is $143,728-$158,100. The position is hybrid, with most work performed on-site in Allegheny County, where the Manager is required to reside.

We are seeking a leader who will set the roadmap for oversight and Medicaid client experience improvements, work closely with program leaders, analytics and technology staff, and managed care partners to develop the right solutions at the right time. They must be able to spot gaps and flaws in services and drive forward solutions that improve our clients’ experiences. They will lead a strategy with partners at DHS, Community Care Behavioral Health, the State and actuarial consultants to ensure that we run a Medicaid program with proper rate setting, optimized provider network, and full use of client and financial analytics to drive investments.

The role will lead a team of six staff focused on analytics, technology, policy, and quality improvement to: 

• Lead research and evaluation plans to establish and monitor the system's performance baseline across service access, service quality, health outcomes, and health equity. 

• Develop solution-oriented plans to address system deficiencies, invent new programs and services, and drive toward implementation. 

• Define strategy on the division of responsibilities between the managed care organization and DHS. 

• Manage reporting requirements from federal, state, and other entities. 

• Optimize Medicaid and other funding streams to serve more people or improve outcomes with fixed resources.

• Serve as a liaison to other departments, government agencies, research institutions, and the private sector. 

Qualifications and Experience: 

If hired for a position, candidates would work for Allegheny County, Department of Human Services and be employed by Community Family Advocates (CFA).

• Minimum 5 years in health care and/or behavioral health systems and programs, with at least 2 years of supervisory experience. 

• Exceptional process improvement, project management, and coordination skills with demonstrated ability to manage multiple workstreams and stakeholders. 

• Ability to lead both clearly defined and ambiguously scoped projects, anticipate problems and simplify solutions, and quickly learn the performance of a wide range of services and providers. 

• A skilled problem solver who can cut through bureaucracy, simplify complexity, and design practical solutions in a highly regulated environment. 

• A track record of designing and implementing data-driven policies or reforms and leading teams to deliver high-quality programs.

• Excellent written and verbal communication skills, with the ability to present complex issues and processes in a concise manner.

• Managed care and/or Medicaid background is a plus.

Our contract partner offers a generous total rewards package including: health, dental, vision, flexible spending accounts, health savings account, life insurance, long and short-term disability, employee assistance program, vacation and sick leave.

We invite interested, qualified candidates to explore and apply for this exciting opportunity.

                                                             AN EQUAL OPPORTUNITY EMPLOYER - M/F/V/D

Salary : $143,728 - $158,100