MCUR Operations Director

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Director II - Managed Care Utilization Review (MCUR) Operations Job Description

Under the direction of the Director for Managed Care Utilization Review, the MCUR Operations Director is responsible for supporting the effective and efficient operation of the Managed Care Utilization Review (MCUR) department.  Core functions of the MCUR Operations unit include provision of project management support;; coordination of management reports; coordination of legislative bill analysis and implementation; supporting and performing complex data analysis; tracking and monitoring program data, expenses, and processes, including policy and contract revisions and contract remedies; conducting research on state and federal requirements; maintaining administrative infrastructure, including records management; and maintaining current internal policies and procedures. The MCUR Operations Director establishes goals and objectives for the MCUR Operations unit that are aligned with the MCUR business plan.  Plans, assigns, and supervises the work of the MCUR Operations unit. Works under minimal supervision, with extensive latitude for the use of initiative and independent judgment.

Essential functions

25% Directs the activities of the MCUR Operations unit.  Makes recommendations and develops plans to improve operations.  Directs, hires, plans, assigns, and supervises the MCUR Operations management team.  Develops team members to support professional growth and addresses performance issues in accordance with Human Resources policy.

20% Directs and oversees development of management and compliance reports and dashboards.  Develops standard templates.  Identifies scope and works with various areas of MCUR, Medicaid and CHIP Services, and report recipients to receive input on report content.  Ensures reports are timely, and include all required content, and agency style requirements. 

20% Directs and oversees project management function, to include implementation of legislation.  Actively manages assigned special and routine projects, using standard project management techniques, to ensure projects are completed within scope and on time.  Oversees the development of timelines for tracking major MCUR projects, noting internal and external relationships and dependencies, Oversee the completion of project portfolios and project closure reporting. 

20% Direct and guide MCUR Operations staff related to complex data analysis and policy research related to MCUR.  Policy research includes federal and state regulations and state contracts with Managed Care Organizations (MCOs).  Products from this activity will inform reports, project planning, and recommendations to executive leadership.

10% Oversees development and maintenance of administrative and programmatic infrastructure.  Ensures referrals to policy, legal, and contract oversight areas are tracked and identifies items requiring action.  Develops and oversees process for tracking MCO remedies recommended by MCUR and provides data from this tracking process to inform follow activities.  Ensures internal policies and procedures are comprehensive and complete; internal shared files are organized and easy to navigate; and records are maintained according to agency record management standards.  Supports expense tracking for MCUR and develops other centralized processes to streamline and support administrative functions.

5% Represents the MCUR department at meetings, including presenting to internal and external stakeholders on MCUR program and functions.  Direct, lead and create presentations made to HHSC leadership and other internal and external stakeholders on the status of MCUR projects and activities. May perform oversight visits for learning experiences. 

Knowledge, Skills, and Abilities

Knowledge of: Management principles; managed care laws, rules, standards and regulations; quality management; utilization management and review principles and practices; data analytics techniques and processes; knowledge of health care needs and services for individuals who are aged or disabled; project management principles, tools, and techniquest; legislative process; policies surrounding assessment of remedies; and Medicaid managed care.

Skill in: written and verbal communication; directing, managing and motivating staff through guidance and coaching;  development and maintenance of MCUR policies, rules, and guidelines; using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions,or approaches to problems; consulting, teaching, and providing clear and concise direction; and developing reports resulting from complex data analyses; application of risk management strategies including the ability to routinely identify, manage and effectively mitigate risks.

Ability to: direct and manage department activities and staff; to establish goals and objectives; to devise solutions to administrative problems; to communicate effectively; prepare and present reports; explain and interpret applicable managed care regulations and contract standards; recognize patterns of medical necessity fraud and abuse; work collaborative in cross functional groups and teams; interpret results of data analytics and to guide staff conducting data analysis; gather, assemble, correlate, and analyze facts; devise solutions to problems; oversee comprehensive training function; develop and evaluate policies and procedures; manage multiple complex projects simultaneously; and plan, assign, and supervise the work of others. build and maintain effective working relationships, negotiate with individuals and groups internally and externally, develop professional networks with other organizations, and to identify the internal and external dynamics that impact the work of the organization; develop and manage department budgets and resources; use a personal computer, fax machine, copier, telephone conferencing functions, and components of Microsoft Office Suite and Outlook e-mail.   Ability to travel independently throughout the state as necessary.  

Licensure, registrations and certifications required: None

Initial selection criteria

Graduation from an accredited four-year college or university with a bachelor’s degree.  Experience leading complex business operations. Experience working in or with the Texas Medicaid program.  Utilization management experience.

Prefer an advanced degree in public affairs, public administration, business administration, health care administration, or related field.  Prefer experience with Medicaid managed care programs.

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework.  Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.