- State-matched retirement contribution of 156%
- 13 paid holidays
- Generous leave accruals that begin immediately
- A culture that embraces work-life balance
- Tuition reimbursement program
- 79% employer-paid health insurance plans
- Dental and vision insurance plans
- Employer-paid $20,000 life insurance policy
- Opportunity to be part of meaningful work and make a difference through public service
- Training and development based on your career aspirations
- Job security and stability, even during times of economic hardship
- Employee Assistance Program
- Fun, inviting teammatesThe Medicaid program provides medical coverage for low income or disabled individuals. To help fulfill the agency goal of Helping People Live Better Lives, this position is necessary to ensure the proper administration of the Medicaid program. Program Specialists are responsible for researching, reviewing, analyzing the Heritage Health contract, and both federal and state regulations, to assist providers and members with inquiries or issues, such as problems with claims or credentialing/contracting with an MCO. They are also responsible for analyzing how regulations could impact the Medicaid program.
- Monitoring dayto day activities including all activities related to contract performance and assuring compliance with State and Federal requirements.
- Review, analyze and monitor reporting requirements and quality improvement activities of the managed care plan.
- Working with the managed care contractors to meet the requirement of 42 CFR 438 and State regulations.
- Will work with the Plan Management team and other MLTC departments to evaluate the impact of quality assurance programs on the health care services provide to Managed Care enrollees.
- Participate in the competitive procurement process and assist in completing readiness reviews.
- Provides liaison between and confers with other MLTC departments and divisional personnel.
- Explains, clarifies, and interprets operational practices, policies, procedures, federal and state regulations, contract requirements and activities related to assigned program(s) to agency staff, community organizations, members of the general public and contractors/service providers.
- Other duties as assigned.
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Heritage Health Program Specialist - Lincoln, United States - State of Nebraska
Description
The work we do mattersHiring Agency:
Health & Human Services - Agency 25Location: Statewide Job Posting
Hiring Rate:
$23.313
Classification Salary Range:
$ $34.37
Job Posting:
JR Heritage Health Program Specialist - MLTC (Open)
Applications No Longer Accepted On (If no date is displayed, job is posted as open until closed):
Job Description:This is an in-office position located in Lincoln, you must be willing to relocate.
Join the dynamic team at the State of Nebraska's Department of Health and Human Services, Division of Medicaid and Long-Term Care - Plan Management as a full-time DHHS Program Specialist.
We are seeking individuals who are organized, possess outstanding customer service skills, and are dedicated to supporting our team in providing excellent service.
We provide our teammates with a supportive work environment and a comprehensive benefits package that includes:Job Duties:
The DHHS Program Specialist will be part of the managed care unit.
The successful candidate will be responsible for implementation of program plans, goals, and objectives for Medicaid managed care and will assist with the monitoring of the Managed Care Organization (MCO) vendor contracts.
This includes:
Must be willing to relocate to LincolnRequirements/ Qualifications:
Minimum Requirements:
Bachelor's degree, OR equivalent coursework/training, in public administration, social/behavioral sciences, healthcare, human services or other program related field.
Professional experience working in a human/social service or health care agency with responsibility for planning or evaluation services, programs or operational policies and practices may substitute in lieu of the educational requirement.
Preferred Qualifications:
Experience working in or knowledge of Medicaid programs or other Health Insurance programs. Experience in contract management, claims, and communications. Experience with data and/or quality analysis, spreadsheet software programs, and/or data software programs.
Knowledge of:
managed healthcare delivery systems; principles and practices of management, business and Management principles, including planning, budgeting, resource allocation; techniques of research, planning and evaluation; work performance or other standards of development, program analysis/evaluation; policy development
Skill in:
communicating to convey information so others will understand; performing quality assessment reviews and evaluating program effectiveness; identifying problems and developing options for solutions.
The successful candidate will possess excellent communication skills, organizational skills, and problem-solving ability as well as the ability to work on a team.
Ability to:
work collaboratively in a team setting; establish and maintain positive relationships with agency staff and external partners; communicate effectively to promote, explain, discuss, and interact with interested groups on various program issues; prepare and review documents such as summaries of state and federal regulations and reports; understand, interpret and apply laws, rules, policies and procedures pertinent to the program; exercise independent thinking skills; maintain liaison with community representatives and other governmental agencies.
BenefitsWe offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life.
Your paycheck is just part of your total compensation.Check out all that the State of Nebraska has to offer For more information on benefits currently offered to permanent teammates, please visit:
Opportunity StatementThe State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex. age, national origin, disability, marital status or genetics.
Current employees of the State of Nebraska should NOT apply on this external career. Instead go to Workday and access the Jobs Hub - Internal Apply app from your home landing page.
