Program Coodinator II (Provider Network Analyst) / 61047841

**Job Responsibilities** ------------------------ **The Agency's mission is to be boldly innovative in improving the health and quality of life for South Carolinians.** This is position is located in the **Bureau of Managed Care****, Richland County.** This is an in\-office role and not a telecommute or remote position. **Are you the One?** We are looking for a **Program Coordinator II (Provider Network Analyst)**who will serve as the Medicaid Provider Network Analyst for the South Carolina Department of Health and Human Services in the Bureau of Managed Care. Acts as the lead analyst and performs independent, complex work providing coordination of managed care plan provider network activities within the Bureau of Managed Care. This work consists of reviewing administrative policies, procedures, guidelines, and related directives impacting managed care plan contract compliance issues and problems; interpreting network analysis results and identifying areas of opportunity; and recommending appropriate action.* Develops and implements solutions and improvements related to provider networks as part of an interdisciplinary team. Consults with team members to ensure solutions are compliant with federal regulations, statutes, administrative rules, South Carolina State Medicaid State Plan, contract requirements, and Medicaid policies and procedures. Investigates, assesses, analyzes compliance, and makes recommendations to resolve issues and problems identified in managed care plan provider network activities. Provides direction to SCDHHS contract monitors for assigned managed care plans, Plan Management leadership, and their staff to address non\-compliance issues related to provider network activities. * Coordinates and participates in meetings within the Agency, managed care organizations, and other stakeholders. Prepares and delivers presentations to managed care organizations and other stakeholders. Represents SCDHHS on health care related committees, task forces, and special projects as assigned. Participates in meetings, conferences, and workshops on federal and state health care related programs and managed care programs. Participates in strategic planning activities to improve access and quality of care, and increase the efficiency and cost\-effectiveness of the Medicaid programs. + Conducts program training and provides technical assistance related to Medicaid managed care programs, compliance with contract provisions, including provider network requirements, to ensure consistency in program operation and conformity with goals and objectives of the Agency, state and federal laws, rules, regulations and guidelines. Works MCOs to identify and resolve network challenges impacting individual members with unique circumstances. * Performs program monitoring and network analysis activities to determine managed care plan compliance, including: analyzing provider network reports for managed care plans, coordinating and conducting "sec