Medical Care Program Specialist Ii; Contractual

Pay: $27.30 - $43.87 / hour

Location:

Annapolis, Maryland

Employment type:

Full-Time

Req#:

Introduction

GRADE: 16

LOCATION OF POSITION: MDH - Division of Participant Enrollment and Service Review, 201 W. Preston Street, Baltimore, MD 21201

Main Purpose of Job: This full-time contractual position will develop, implement, and evaluate policies, procedures, and regulations 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. The Medical Care Program Specialist II is responsible for performing qualitative and quantitative analyses on programmatic data, including participant eligibility and enrollment, supports planning, utilization review, including plan of service (POS) review, and appeals to monitor service delivery and utilization, ensure compliance with program policies and regulations, and identify opportunities for continuous quality improvement.

The Medical Care Program Specialist II will also research, analyze, design, and direct the implementation of new workflows and project tasks related to participant eligibility and enrollment, supports planning, utilization review, including POS review, and appeals with the goal of increasing the efficiency, effectiveness, and quality of program services. Using data, the Medical Care Program Specialist II will develop and present recommendations concerning alternative approaches to the delivery, financing, and evaluation of Medicaid HCBS, specifically those provided to participants of the CPAS, CFC, HCBOW, and ICS programs.

As a subject matter expert, the Medical Care Program Specialist II will apply program policies by verifying medical, technical, and financial eligibility for the CPAS, CFC, HCBOW, and ICS programs and enrolling participants, engaging in utilization review, including authorizing services through the POS process, auditing supports planning agencies (SPA), developing educational materials and providing training and technical assistance to participants and SPA regarding program processes, identifying and implementing enhancements for LTSS Maryland, and collaborating with other Divisions regarding the Office of Long Term Services and Supports’ (OLTSS) overall quality program.

The Medical Care Program Specialist II will also consult on strategies for program policies, program operations, and program evaluation for the Department’s leadership. In support of this, the Medical Care Program Specialist II will prepare high-level documents on technical aspects of these strategies as they relate to existing State and federal regulations, service delivery and utilization, and overall fiscal impact.

Experience: Seven years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs.
Notes: 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.
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.
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.

The desired candidate should possess the following:
Experience working with Medicaid home and community-based services and supports. Experience creating spreadsheets, analyzing data, and developing or applying policies and regulations in medical assistance, health insurance,…