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Medical Program Specialist
2 months ago
We are seeking a highly skilled Medical Program Specialist to join our team at the Idaho Department of Health and Welfare. As a Medical Program Specialist, you will play a critical role in ensuring the quality and compliance of our medical programs.
Key Responsibilities:- Schedule and conduct audits for provider compliance in accordance with IDAPA and Idaho Medicaid provider Agreement(s).
- Prepare comprehensive written reports of completed audits and provide supporting conclusions, possible deficiencies, recommendations for improvement, Corrective Action Plan requests, and recommendations for provider agreement enforcement.
- Present findings and results to management and advise on compliance with established requirements and standards.
- Collect, analyze and aggregate data from all assessment and monitoring activities, assess for compliance with applicable state and federal regulations.
- Support the Quality Assurance Manager in developing instructional materials; evaluating program policies, procedures or system modifications and recommending changes.
- Investigate and document incoming complaints and critical incidents, including abuse, neglect and exploitation complaints.
- Conduct provider training(s) and provide expertise and technical assistance to providers, staff, and other stakeholders, including responding to public record requests and other inquiries, to ensure professional, accurate, consistent program administration and communication.
- Good knowledge of medical service delivery systems. Typically gained by completion of at least two college classes in a medical/health service field, public health or health care administration or related field (including but not limited to psychology, special education, social work, certified nursing assistant course, RN, LPN, medical office assistant, etc.) AND one year of experience applying that knowledge in a medical service delivery system (including but not limited to medical institution, clinic, medical office, Medicaid service provider, etc.).
- Some knowledge of current laws and regulations governing Title XIX Medicaid programs. Typically gained through at least 1 year of experience where knowledge and understanding of Title XIX Medicaid laws and regulations was a job responsibility. Some job responsibilities include (but are not limited to): Direct service provision in a program that is reimbursed by Title XIX; quality assurance activities directed toward compliance with Title XIX regulations; billing for services to a State Medicaid program; answering questions/making referrals on Title XIX programs; and staffing activities directed towards compliance with Title XIX.
- Some knowledge of training methods. Typically gained by successful completion of coursework or workshops of 16 hours or more covering communication concepts, learning styles, course design, and presentation skills. It may also be demonstrated through experience presenting formal training sessions to groups.
- Experience developing instructional materials. Typically met through at least one year experience actually developing (not just presenting) instructional course content and materials.
- Experience evaluating program policies and procedures and recommending changes. Typically gained through at least 1-year of job experience which included the opportunity to evaluate the employer's policies and procedures and provide input and/or recommend changes. Experience comparing employer's policies and procedures to Medicaid or other governmental regulatory requirements would qualify as experience to meet this qualification.
- Experience writing audit plans, preparing audit reports and monitoring implementation of corrective action plans. Typically gained by at least one year of related experience.
- 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.
- Experience using programs such as SharePoint, Microsoft Word, PowerPoint, electronic document management systems, and Excel. Typically gained by at least six months of professional experience using these programs.
We offer a comprehensive benefits package, including:
- Best retirement available in the nation
- 11 paid holidays
- Generous vacation and sick leave accrual
- Paid parental leave
- Medical, dental, vision insurance
- PERSI Choice 401(k)
- Deferred compensation plan
- Life insurance
- Short and long-term disability insurance
- Student Loan Forgiveness
- Wellness programs
- Employee Assistance Program (EAP)
- Flexible Spending Accounts (FSA)
- Wide variety of training opportunities
We are an equal opportunity employer and welcome applications from diverse candidates. If you are a motivated and detail-oriented individual with a passion for healthcare and compliance, we encourage you to apply for this exciting opportunity.