Program Specialist DHW - Medicaid Contract Monitor
The Department of Health and Welfare
DEDICATED TO STRENGTHENING THE HEALTH, SAFETY, AND INDEPENDENCE OF IDAHOANS
People Making a Difference!
***THIS ANNOUNCEMENT WILL BE OPEN UNTIL FILLED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE TO BE CONSIDERED.
The Division of Medicaid, Bureau of Care Management (BCM) has an exciting opportunity to join the team monitoring performance and customer care of a dynamic program that interacts with other IDHW programs, care providers, network service providers, and the plan's contractor.
The Bureau of Care Management is a supportive, dynamic team looking for applicants with a passion to support Idaho citizens, desire to improve systems, and excited to learn about federal and state healthcare systems. This position works directly with a participating service contractor to monitor performance and ensure compliance with contract provisions, state and federal regulations, and other requirements. A successful candidate will be a solution oriented critical thinker, tactful negotiator, and a skilled communicator both verbal and written. Experience with developing contracts and agreements, healthcare policy research and analysis, troubleshooting participant issues, and daily application of program rules are extremely beneficial.
The Bureau of Care Management oversees most of the division's managed care and service contracts and service delivery programs such as: duals, dental, vision and non-emergency medical transportation (NEMT). The overarching goal of this bureau is to ensure managed care and service organizations provide quality contracted services to participants and providers.
If you are a critical thinker with an interest in the many moving parts of a complex managed care program, this may be a great fit for you! The position offers an opportunity to gain a depth of expertise in many aspects of Medicaid, while creating and maintaining relationships with key community partners and stakeholders.
A hybrid schedule of in-office and telework can occur with approval of a telework agreement.
BENEFITS:
BEST RETIREMENT AVAILABLE IN THE NATION
We have one of the Nation's best state retirement systems (PERSI) that offers a lifetime benefit.
OTHER EXCELLENT BENEFITS
- Excellent medical, dental and vision insurance- (full-time/30+ hours per week) employee only coverage for PPO $65/month for medical and vision & $11.80/month for dental
- Generous vacation and sick leave accrual beginning as soon as you start
- 11 paid holidays a year
- Paid parental leave
- Multiple savings plans, optional 401K, and optional 457
- Basic life insurance for employee and family (employee covered at one times annual salary; spouse covered at $10,000; child covered at $5,000)
- Wellness programs
- Ongoing training opportunities
- An opportunity for student loan forgiveness
- And more!
EXAMPLE OF DUTIES:
- Monitor daily and long term contractor performance in alignment with the provisions outlined in the contract's scope of work, Idaho Administrative Code (IDAPA), and applicable state and federal regulations.
- Evaluate routine data reports supplied by the plan's contractor for compliance with scope of work provisions.
- Monitor issues reported to the program's team by internal and external stakeholders, dispatching for resolution and tracking trends for systemic issues.
- Produce regular and ad hoc monitoring reports as well as monitor the implementation of corrective action plans and successful remediation of identified issues.
- Provide program support and education in assisting members navigating the program's benefits.
- Support participant and stakeholder outreach activities, including presentations to varying group sizes about the program.
- Use a high attention to detail, exceptional documentation and writing abilities, and organizational skills.
- Track, document, and create with a minimum intermediate level experience in programs such as Microsoft Excel, Word, and PowerPoint.
- Utilize excellent verbal communication skills in presentations and on phone calls with participants.
MINIMUM QUALIFICATIONS:
You must possess all the minimum qualifications below to pass the exam for this position. Please make sure your resume or work history supports your meeting the minimum qualifications for this position. Failure to do this may disqualify you from being considered for this position. It is highly recommended to attach a one-page cover letter to your application to demonstrate how you meet the requirements below.
- Experience developing, recommending and/or evaluating policy and procedures and recommending changes. Typically gained by approximately one year of experience where this was a primary responsibility of the job. This experience may include participation in a regional or statewide quality assurance team, business change or project team or a similar assignment.
- Experience developing technical written materials such as policies, technical manuals or rules/regulations. Typically gained by at least one year experience working in a business setting developing training materials, reports, policy and/or procedure manuals, written interpretations of law, rules, or policies, or any related background which would be considered similar.
- Experience providing technical program assistance to staff. Typically gained by at least one year of experience providing technical program assistance to staff. Typically gained by at least one year of experience providing technical assistance to staff in a business setting which could include formal and informal assignments to assist, mentor or train new staff.
Below is preferred experience. It is not required for the position but applicants with this experience may receive consideration over other applicants.
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Experience writing audit plans, preparing audit reports and monitoring implementation of corrective action plans. Typically gained by at least one year of related experience.
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Experience in both individual and group communication techniques that involve various stakeholders, facilitation to include providing presentations, public speaking and fielding open question and answer sessions. Typically gained by at least one year of related experience.
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Experience monitoring contracts for compliance with contract requirements and federal or state regulations. Typically gained by at least one year of related experience.
- Experience in navigating eligibility systems for benefits or insurance plans to determine and communicate eligibility. Typically gained by at least one year of related experience.
***PLEASE NOTE: application assistance is not available after the business hours listed below, on the weekends, or on holidays and you must apply before 4:59 pm on the closing date. When applying, use CHROME as your browser to avoid complications.
If you have questions, please contact us at:
Email is the quickest way to get an answer to your questions.
(answered Monday through Friday during business hours MST)
EMAIL: dhwjobs@dhw.idaho.gov
PHONE: (208) 334-0681
EEO/ADA/Veteran:
The State of Idaho is committed to providing equal employment opportunities and prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on their race, color, religion, political affiliation or belief, sex, national origin, genetics, or any other status protected under applicable federal, state, or local laws.
The State of Idaho is committed to access and reasonable accommodations for individuals with disabilities, auxiliary aids and services are available upon request. If you require an accommodation at any step in our recruitment process, you are encouraged to contact (208) 334-2263 (TTY/TTD: 711), or email ada.coordinator@dhr.idaho.gov.
Preference may be given to veterans who qualify under state and federal laws and regulations.