medical care program specialist ii

Introduction

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GRADE

16\r

LOCATION OF POSITION

MDH - Long Term Services and Supports-Community Settings\r
201 W. Preston Street\r
Baltimore, MD 21201\r

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.\r
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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.�\r
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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.�\r
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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.�\r
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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.\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

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should possess the following:\r
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Experience with computers��\r
Experience with automated accounting systems and spreadsheet software\r
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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

STATE OF MARYLAND BENEFITS\r

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