Medical Care Program Specialist Ii - Baltimore, United States - State of Maryland

State of Maryland

Verified Company

Baltimore, United States

2 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Introduction:

GRADE:

16

LOCATION OF POSITION:

MDH - Long Term Services and Supports-Community Settings

201 W. Preston Street

Baltimore, MD 21201

Main Purpose of Job:

This position will monitor the Federal Community Settings Final Rule for all providers enrolled in Medicaid, including implementation of the community settings work plan, manage the workload to accomplish required tasks, including but not limited to, site visits and desk audits.

Engage the provider community in the policy and implementation plan for community settings.

Analyze data and policies to improve provider quality and compliance for Medicaid home and community-based services (HCBS), including the Community Personal Assistance Services (CPAS), Community First Choice (CFC), Home and Community-Based Options Waiver (HCBOW), and Increased Community Services (ICS) programs.

This position is responsible for performing qualitative and quantitative analyses on programmatic data, provider network adequacy and availability, service claims and payments, and overall program expenditures, to monitor service delivery and utilization, ensure compliance with policies and regulations, and identify opportunities for continuous quality improvement.

This position will assist in the development of educational materials, conduct outreach and educational visits to provider sites, conduct compliance audits of provider sites and files.

Draft correspondence and communicate the results of audits, analyze aggregate provider data to identify trends and quality improvement initiatives, coordinate meetings with other internal units and external partners to implement quality improvement initiatives, monitor ongoing provider compliance.

Develop data systems and tracking processes to automate and improve the efficiency of provider compliance activities, engage with stakeholders including providers, advocates, program participants and other high-level leadership as needed.

This position will also research, analyze, design, and direct implementation of new work flows and project tasks related to routine evaluation of provider performance with the goal of increasing the efficiency, effectiveness, and quality of services provided.

Using data, this position will develop, present and analyze data and policies related to provider compliance for Medicaid HCBS programs.

This position will research, plan, implement and evaluate special projects resulting from federal and state legislation and guidance, to include integrity monitoring, communicating with internal programs and the Centers for Medicare and Medicaid Service (CMS), using databases, and preparing reports for internal program monitoring.

The position also develops data tracking tools to design and evaluate data metrics to gauge successful strategies for project implementation.

This position develops internal and external communication materials and facilitates data-driven analysis and coordination; responds to program providers, recipients, legislators and other program customers; represents Medicaid and aids at internal and external meetings.

As well as, all other duties as assigned.

This position operates in a hybrid manner, meaning job duties will be performed both remotely and on-site unless otherwise directed by the appointing authority.

MINIMUM QUALIFICATIONS:

Notes:

DESIRED OR PREFERRED QUALIFICATIONS:

Experience with computers
Experience with automated accounting systems and spreadsheet software

LICENSES, REGISTRATIONS AND CERTIFICATIONS:

Employees in this classification may be assigned duties which require the operation of a motor vehicle.

Employees assigned such duties may be required to possess a motor vehicle operator's license valid in the State of Maryland.

SELECTION PROCESS:

BENEFITS:

STATE OF MARYLAND BENEFITS

FURTHER INSTRUCTIONS:

If additional information is required, the preferred method is to upload.

If you are unable to upload, please fax the requested information to Only additional materials that are required will be accepted for this recruitment.

All additional information must be received by the closing date and time.

For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at

Appropriate accommodations for individuals with disabilities are available upon request by calling: or MD TTY Relay Service

We thank our Veterans for their service to our country.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.