Medicaid Managed Care Accountability: How States Use Sanctions

National Health Law Program - Los Angeles, CA

Full-time - Mid Level

Los Angeles, CA

Professional, Scientific, and Technical Services

About the position

The position involves analyzing Medicaid managed care contracts to assess how states impose sanctions on managed care organizations (MCOs) for failing to meet contractual obligations. The role focuses on understanding the types of sanctions, the reasons for their imposition, and the overall impact on service delivery for Medicaid beneficiaries. The analysis includes reviewing contracts from various states and gathering data on sanctions imposed, with the goal of enhancing accountability and transparency in managed care services.

Responsibilities

• Conduct in-depth analysis of managed care contracts to identify categories of sanctions.
• Review and summarize sanctions imposed by states on MCOs for non-compliance.
• Gather publicly available information on sanctions and request data from states when necessary.
• Analyze the impact of imposed sanctions on service delivery and compliance by MCOs.
• Prepare reports detailing findings and recommendations for improving accountability in Medicaid managed care.

Requirements

• Strong analytical skills to assess complex contracts and data.
• Experience in healthcare policy, particularly in Medicaid or managed care.
• Ability to communicate findings clearly in written reports.
• Familiarity with state and federal regulations governing Medicaid managed care.
• Research skills to gather and synthesize information from various sources.

Nice-to-haves

• Knowledge of financial penalties and compliance measures in healthcare.
• Experience working with state Medicaid agencies or MCOs.
• Understanding of performance standards in healthcare delivery.

Benefits

• Health insurance coverage
• 401k retirement savings plan
• Paid holidays
• Flexible scheduling options
• Professional development opportunities