Primary Function

The EBCI Tribal Option (“TO”) Contract Liaison will report to the Tribal Option Director of the Cherokee Indian Hospital Authority (CIHA).   The Tribal Option Contract Liaison, under the direction of the Tribal Option Director, serves as the lead within the Tribal Option for the planning, development, implementation and monitoring of the contracts with the North Carolina Department of Health and Human Services (“DHHS” or “the Department”) including but not limited to the Indian Managed Care Entity Contract #30-2020-014-DHB and its subsequent revisions, any changes in Medicaid authorities for managed care to include Medicaid waivers and state plan options such as 1915i or fee for service delegation agreements, and other contracts with TO third party vendors and subcontractors..

Primary functions are in the areas of: 

• Communication: This position must be able to communicate ideas effectively to the other parties involved in the contracts and to stakeholders to keep everyone apprised of contract-related matters.
• Negotiation: This position will serve as the lead contract negotiator and responsible for achieving the greatest benefit to CIHA from any contract considered.
• Confidence: The position must demonstrate confidence as the individual must demonstrate a strong attitude to successfully negotiate and execute contracts, as well as an understanding of when to walk away and when to stand one’s ground.
• Finance Skills: In order to evaluate whether or not a contract is good for CIHA, the position must have the necessary financial skills to determine exactly how the company would benefit or suffer if compliance issues are noted.

Job Description

The position serves as the primary point of contact between the EBCI Tribal Option and the NCDHHS and TO third party vendors and subcontractors.  The position is responsible for ensuring that all CIHA and Tribal Option departments are aware of NC DHHS contractual requirements pertaining to the operations of the TO and other applicable agreements associated with NC Medicaid Waivers such as but not limited to the Home and Community Based Waivers (HCBS). The position ensures all procedures, manuals, practices, reporting  and processes meet contractual requirements.

• Work with CIHA and Tribal Option employees, NC DHHS Division and Offices, EBCI Divisions and Offices, members of the CIHA Provider Network, and other key community stakeholders to coordinate Medicaid Waivers and Programs and HCBS waivers activities in accordance with Waiver (s) requirements as defined in DHHS contracts;
• Interpret contract language into CIHA and Tribal Option operational terms in order to determine duties and functions of individual departments, units and employees to assure compliance with all areas of Tribal Option and other applicable contracts;
• Provide technical assistance with staff to ensure understanding of contractual requirements, the development of implementation and operational plans, coordination of activities, and managing deliverables;
• Coordinate the submission of materials requested by the Department for state plan or waiver renewals; contracts and related activities; Materials and outreach should represent the values of the Cherokee people and the mission and vision of the CIHA.
• Regularly monitor performance indicator reports, research problems and recommend/ implement corrective actions as required for maintaining compliance with contractual requirements;
• Work with Quality Management staff, Information Technology staff and other
  CIHA or Tribal Option employees to develop reports needed for effective oversight of the Tribal Option and Programs under contract with DHHS;
• Provide key information in dashboard format on TO performance to Tribal Option and CIHA staff, identified Operational Teams and other groups and individuals at the direction of the Tribal Option Director;
• Conduct general research, fact finding and review written documents to ensure understanding of the TO contracts for dissemination to applicable stakeholders;
• Serve as lead Tribal Option staff related to the coordination of the contract(s) and other contractual Programs, including internal/external activities necessary for the smooth operations;
• Work with external consultants/contractor when external assistance is needed to carry out specific tasks related to the TO Contractual requirements and other relevant Program expectations. Provide coordination and consultation in negotiating TO/Standard Plans (SP), Tailored Plans (TP), Child and Family Specialty Plan (CFSP)contracts, capitation rates with DHHS and other areas related to TO contract and other relevant programs;
• Evaluate and make recommendations regarding contractual requirements and modifications.
• Identify and negotiate amendments to contracts as needed.
• Ensure the development, assist in the interpretation of and the timely submission of all required contract reports; This position works with the subject matter experts or owners of the reports for the content and monitors for contractual requirement compliance.
• Provide input and ensure Medicaid contractual requirements (TO, SPs, TPs, CFSPs) are considered as part of the budget Tribal Option and CIHA process;
• Work closely with CIHA and Tribal Option staff to ensure the development of necessary internal policies/procedures to accomplish contractual requirements.Policies and procedures should not only be developed in compliance with DHHS requirements but also reflect the mission, values and principles of the Right Way.
• Identify key indicators for Tribal Option “alerts” when data show that CIHA and Tribal Option are out of compliance with the contractual requirements and benchmarks.
• Serve as the Tribal Option’s lead for coordinating, organizing and facilitating DHHS Intra-Departmental Monitoring Team (IMT) or subsequent equivalent DHHS group meetings.
• Serve as Tribal Options liaison with other Medicaid SPs/TPs/CFSP for initial/ongoing planning and development of State-wide systems and for uniformity of Medicaid managed care operations;
• Bring to the attention of the Tribal Option Director and/or DHHS tribal issues, ideas, and problems in an effort to problem solve all facets of the TO/CIHA operations;
• Serve as the point person for reviews by outside sources (i.e. evaluation contracts, DHB employees, applicable EQRO or other 3^rd party reviews, and others as requested by DHB);

Job Knowledge

• Demonstration of abilities to craft, evaluate, negotiate and execute a wide variety of different Medicaid contracts and other TO contracts covering a range of managed care and programmatic functions.
• Demonstration of abilities to create and maintain relationships with DHHS staff and serve as the singular point of contact for matters concerning contracts.
• Demonstration of abilities to maintain detailed records for correspondence and documentation in relation to established contracts and those in progress and retrieve records and tracking immediately.
• Demonstration of abilities to communicate and present information to stakeholders about all contract-related matters.
• Demonstration of techniques to monitor contracts and move forward with renewals, amendments, and compliance monitoring.Must have knowledge of service level agreements and compliance planning.
• Demonstration of abilities to solve any contract-related problems that may arise with external entities as well as internally with existing CIHA operations.
• Demonstration of managed care contracting requirements and program integrity for contractual compliance issues.
• Demonstration of contract negotiations skills and techniques.
• Ability to design and generate dashboards for contractual requirements and compliance status.

   

  Education/Experience

• A bachelor’s degree and a minimum of 7 years of management experience, or a JD degree with a minimum of 2 years legal experience in the field of contracting.
• Preferred experience in healthcare. Knowledge of Medicaid managed care and previous work with tribal health care and contracts is preferred.