Adult Care Home Quality Program Manager

We are seeking a highly skilled and experienced professional to join our team as an Adult Care Home Quality Program Manager. This role will be responsible for working with prospective Nursing Facility providers on enrollment into the Medicaid reimbursement program, changes of ownership, and monitoring the NF Enforcement Civil Monetary Penalties and Denial of Payments.

• Provide technical assistance to Nursing Facility providers on enrollment into the Medicaid reimbursement program, changes of ownership, and monitoring the NF Enforcement Civil Monetary Penalties and Denial of Payments.
• Collaborate with the Survey, Certification and Credentialing Commission (SCCC), the fiscal agent & KMAP, the owners involved, current rate setting contractor, and current PEAK contractor to facilitate changes of ownership.
• Research and evaluate past NF records to identify the source of any possible conflicting information, determine necessary changes, complete, and submit KDADS MS-1 Form to the State Medicaid Fiscal Agent to initiate change to MMIS and KMMS records.
• Compile and forward information from KDHE reports using appropriate forms and formats to the fiscal agent, the Division Director, KDADS' Auditing Services Manager, the Managed Care Organizations (MCOs) and the state's NF rate-setting contractor to ensure that all who need updated information receive it.
• Receive requests, process, and track and monitor listing of request, prepare appropriate forms and letters.
• Sends enrollment packets to potential providers for enrollment, tracks, and processes business portion of change of ownership requests including initial rate setting, and cost report schedule.
• Review, route for audit, director, and final approval on change of ownership requests.
• Conduct Medicaid enrollment background checks for new providers and changes of ownership prior to enrollment in Medicaid program.
• Work with SCCC and providers to resolve questions, issues regarding change of ownership process and/or requirements.
• Works with state staff on tracking and reports, current program tasks, and policies and procedures.
• Analyze, review, and recommend technological and procedural changes to ensure compliance with policy and improve work process.
• Interprets statutes, regulations, policies, and procedures and assists owners and employees of nursing facilities, independent accountants, and the general public seeking information about nursing facility reimbursement.
• Responds to provider complaints of a routine and non-routine nature.
• Quarterly Care Assessment/Data Management.
• Establish, maintain, and update files and database records on each NF provider (approximately 360 homes).
• Identify and retrieve data from KMMS, KOTA NF files and database records as necessary.
• Serves as a subject matter expert for the Nursing Facility Quality Care Assessment program.
• Track Quality Care Assessment payments and format, type, and send Quality Care Assessment notices and delinquency letters to Nursing Facilities when appropriate.
• Develops, and maintains an electronic tracking system for the Quality Care Assessment payments, which includes the collections and assessments penalties for non-payments, payment plans, and non-timely payments.
• Maintains database and provides periodic status and fiscal report on Quality Care Assessment payments.
• Works with KDHE, Medicaid Fiscal Agent, MCOs, and rate-setting contractors regarding any changes required to Licensed bed count and Quality Care Assessment.
• Quality Initiatives/NF Enforcement/PEAK Program.
• Take the lead in re-establishing an annual quality of life survey for nursing home residents.
• Agency lead for the Promoting Excellent Alternatives in Kansas Program.
• Manage, schedule, and participate in PEAK site visits to nursing facilities across Kansas to measure compliance with person-centered care.
• Provide feedback on process improvement and attend trainings related to person-centered care.
• Attend Association and other related conferences, typically in the Fall, to promote and provide education around agency initiatives.
• Manage contract compliance with contractor that administers the program.
• Oversee notification, processing, and collection of civil monetary penalties for NF Enforcement.
• Works with SCCC, providers, and CMS to resolve issues regarding civil monetary penalty or denial of payment.
• Be proficient in working with the ASPEN database.
• Notifies MCOs of resulting rate changes due to imposition or disposition of penalties and denials of payment.
• Format, type, and send enforcement letters to nursing facilities and other state agency staff in notification of denials of payment.
• Create MS-1 forms to notify fiscal intermediary of denial of payment status and initiate data changes in MMIS and KMMS.
• File completed MS-1 forms until confirmation that the change has been entered into the MMIS and KMMS system to ensure that changes are made.
• Track payment status of nursing facilities from which payment is being denied and initiate removal of payment denials upon notification that nursing facilities are back in compliance with state and federal requirements.
• Identify sources, obtain, compile, and evaluate data and information relative to special projects and initiatives as assigned.
• Determine possible results and impact on agency programs by incorporation of possible changes and submit written recommendation for application to Program & Policy Commission; program managers, Division Director for further consideration and final determination of action to be taken.
• Back-up for VENT program to include: Track and process applications for clinical review to ensure compliance with regulations, and work with provider regarding issues; advocate for the growth of this program; collaborate with clinical team; notify MCOs, policy team and fiscal agent of approvals and removals.
• Division/Commission/Agency Support and Assistance.
• Support team with contract amendments, updates and requests for proposals as requested.
• Serve on committees as appointed to provide input and assistance on agency issues such as intra-agency communication and central filing systems or as the agency's representative on external committees.
• Liaison on agency executive's behalf by planning, coordinating and/or participating in KMMS transition.
• Resource Maintenance.
• Maintain the KDADS Policy Manual for Division staff reference incorporating updates in a timely manner to ensure that the manual offers the most recent information available on agency policy and procedures.
• Completes special projects and performs other duties as assigned including but not limited to ensuring the agency is adequately staffed during and immediately following natural and/or manmade disasters, infectious disease outbreaks, and/or acts of terrorism.
• Assists other employees in the work unit in accomplishing assignments as necessary.

• One year of experience in providing direction necessary to implement the objectives of an agency, program, or organizational unit.
• One year of experience in collecting, evaluating, studying, or reporting on statistical, economic, fiscal/budget, legislative or administrative data.
• Proficient with MS Outlook, Word, and Excel.
• Travel.
• Preferred:
• Bachelor's Degree in Public Administration, Health Care Policy/Education, or related/relevant area of study.
• Experience working in the Adult Care Home field-may be substituted for formal education as determined relevant by the agency.
• Familiarity with use of KOTA, ASPEN, KMMS and KMAP.
• Reporting; analysis and evaluation of raw data and rendering of conclusions.
• Two years of experience reading and interpreting policies and/or State and Federal, statutes or regulations.
• Ability to effectively meet timelines and deadlines.
• One year of experience with contracts and financial agreements and payment processing.
• Ability to exercise sound decision-making and work with limited supervision.
• Ability to communicate effectively orally and in writing.
• Great customer service and work ethic.
• Knowledge of HIPAA.

Please note that the State of Kansas is an Equal Opportunity Employer and values diversity, equity, and inclusion as essential elements that create and foster a welcoming workplace.