medical care program specialist ii

Introduction

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GRADE

16\r

LOCATION OF POSITION

MDH - Division of Participant Enrollment and Service Review\r
201 W. Preston Street\r
Baltimore, MD 21201\r

Main Purpose of Job

This full time contractual Medical Care Program Specialist II will develop, implement, and evaluate policies,\r
procedures, and regulations for Medicaid home and community-based services (HCBS),\r
including the Community Personal Assistance Services (CPAS), Community First Choice\r
(CFC), Home and Community-Based Options Waiver (HCBOW), and Increased\r
Community Services (ICS) programs. The Medical Care Program Specialist II is\r
responsible for performing qualitative and quantitative analyses on programmatic data,\r
including program activities such as participant eligibility and enrollment, supports\r
planning, utilization review, including plan of service (POS) review, and appeals to\r
monitor service delivery and utilization, ensure compliance with program policies and\r
regulations, and identify opportunities for continuous quality improvement.\r
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The Medical Care Program Specialist II will also research, analyze, design, and direct\r
the implementation of new workflows and project tasks related to participant eligibility\r
and enrollment, support planning, utilization review, including POS review, and\r
appeals with the goal of increasing the efficiency, effectiveness, and quality of program\r
services. Using data, the Medical Care Program Specialist II will develop and present\r
recommendations concerning alternative approaches to the delivery, financing, and\r
evaluation of Medicaid HCBS, specifically those provided to participants of the CPAS,\r
CFC, HCBOW, and ICS programs.�\r
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As a subject matter expert, the Medical Care Program Specialist II will apply program\r
policies by verifying medical, technical, and financial eligibility for the CPAS, CFC,\r
HCBOW, and ICS programs and enrolling participants, engaging in utilization review,\r
including authorizing services through the POS process, auditing supports planning\r
agencies (SPA), developing educational materials and providing training and technical\r
assistance to participants and SPA regarding program processes, identifying and\r
implementing enhancements for LTSSMaryland, and collaborating with other Divisions\r
regarding the Office of Long Term Services and Supports' (OLTSS) overall quality\r
program.�\r
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The Medical Care Program Specialist II will also consult on strategies for program\r
policies, program operations, and program evaluation for the Department's leadership. In\r
support of this, the Medical Care Program Specialist II will prepare high-level\r
documents on technical aspects of these strategies as they relate to existing State and\r
federal regulations, service delivery and utilization, and overall fiscal impact.\r

MINIMUM QUALIFICATIONS

Experience:�Seven years of administrative or professional experience�developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs.\r
Notes:\r
1. Candidates may substitute the possession of a Bachelor's degree from an accredited college or university and three years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs for the�required experience.\r
2. Candidates may substitute the possession of a Master's degree from an accredited college or university in the related�field of work for the required experience.\r
3.�Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Operational�Analysis classifications or Health Services Management specialty codes in the health-related field of work on a year-for-year basis for the required experience.\r

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.\r

SELECTION PROCESS

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position.�Therefore, it is essential that you provide complete and accurate information on your application.�Please report all related education, experience, dates and hours of work.�Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview).�\r
Complete applications must be submitted by the closing date.�Information submitted after this date will not be added.�\r
Incorrect application forms will not be accepted.�Resumes will not be accepted in lieu of a completed application.\r
Candidates may remain on the�certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.\r

BENEFITS

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Contractual employees who work for an agency covered under the State Employee and Retiree Health and Welfare Benefits Program, have a current employment contract and work 30 or more hours a week (or on average 130 hours per month) may be eligible for subsidized health benefits coverage for themselves and their dependents. As a contractual employee, you will be responsible for paying 25% of the premiums for your medical and prescription coverage, including any eligible dependents you have enrolled. The State of Maryland will subsidize the remaining 75% of the cost for these benefits. You can also elect to enroll in dental coverage, accidental death and dismemberment insurance, and life insurance, but will be responsible to pay the full premium for these benefits.\r
Leave may be granted to a contractual employee who has worked 120 days in a 12 month period. This leave accrues at a rate of one hour for every 30 hours worked, not to exceed 40 hours per calendar year.\r
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FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online,�the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201.�Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.\r
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.\r
For questions regarding this recruitment, please contact the�MDH Recruitment and Selection Division at \r
If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at or��\r
Appropriate accommodations for individuals with disabilities are available upon request by calling: or MD TTY Relay Service \r
We thank our Veterans for their service to our country.\r
People with disabilities and bilingual candidates are encouraged to apply.\r
As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.\r