Managed Care Solutions Administrator

Position Summary
Under the general authority of the County Commissioners and leadership of the Department of Health and Human Services (HHS), the Administrator for the Office of Managed Care Solutions oversees the Behavioral HealthChoices (BHC) Program, a Medicaid-funded initiative supporting individuals in need of behavioral health services. This position is responsible for the strategic, operational, financial, and programmatic direction of the Office of Managed Care Solutions, ensuring full compliance with the Pennsylvania Department of Human Services (DHS) contract and regulations.
As a member of the HHS Cabinet and leadership team within the Office of Strategy Management (OSM), the Administrator collaborates across all HHS divisions to support integrated, high-quality behavioral health services across Montgomery County.

Key Responsibilities

• Lead the administration of the Behavioral HealthChoices and Community HealthChoices programs.
• Oversee financial operations, including capitation rate negotiations, risk-based contracting, cash management, and audits.
• Ensure compliance with all federal and state regulations, including DHS Program Standards Requirements.
• Manage the contract and performance of the County's Managed Care Organization (MCO).
• Collaborate with leaders in Mental Health and Drug & Alcohol Services to manage the County's Behavioral Health System of Care.
• Supervise the provider network and ensure alignment with MCO and County goals.
• Drive integration efforts to support whole-person wellness and address social determinants of health.
• Oversee information systems for compliance, data integrity, Medicaid eligibility, claims, and performance reporting.
• Ensure timely and accurate reporting to DHS and other oversight bodies.
• Lead quality assurance initiatives to meet internal and external standards.
• Develop and track performance metrics to assess program effectiveness.
• Represent the Office on the HHS Cabinet and contribute to strategic planning across the department.

• Monitor utilization and financial performance of contracted services and identify growth opportunities.
• Serve as the primary liaison with DHS, the County's MCO (currently Magellan), and contracted providers.
• Lead regulatory compliance efforts, policy implementation, and contract negotiations with DHS.
• Manage legal, financial, audit, and actuarial elements of the HealthChoices program.
• Play a key role in MCO procurement and potential sanctions processes.
• Assist the HHS Director in building partnerships with health systems and insurers.
• Provide leadership for integrated physical and behavioral health service delivery.

Qualifications

• Bachelor's degree in behavioral health or a related field required.
• At least 5 years of experience in a leadership role, preferably in Managed Care, OR
• At least 10 years of progressive administrative/management experience in the Managed Care field, OR
• Any equivalent combination of experience and training that includes 10 years of administrative/management level experience in the Managed Care Field.
• Must pass Child Abuse, Criminal History, and FBI background clearances.

• Strong financial and budget management.
• Project management experience.
• Excellent communication, negotiation, and conflict resolution skills.
• Effective time management and problem-solving abilities.
• Strategic planning and organizational development expertise.
• Proven leadership and supervisory abilities.
• Proficiency in Microsoft Office (Word, Excel, Outlook).