Eligibility Initiatives Manager; MA​/MCS

Overview

Eligibility Initiatives Manager (MA5/MCS) at State of Washington. This management analyst works on a strategic initiatives team to review and analyze evolving Apple Health (Medicaid) rules and policies being utilized to determine Apple Health eligibility in Washington state. The role is involved primarily in coordinating the transition of information from a legacy system (ACES) to a modernized system (Washington Healthplanfinder). They will contribute to unit initiatives, including facilitating work groups with state agencies, medical staff, and legal professionals.

The ideal candidate will be highly organized and bring familiarity with Apple Health to this detail-focused position.

Note: All HCA employees apply an equity lens to their work.

• Serve as the subject matter expert on Washington’s Streamlining Eligibility rules technical work streams.
• Lead and facilitate internal, external, and cross-system work groups as the subject matter expert in eligibility procedural, systems, and policy alignment as it relates to new eligibility and policy implementation.
• Research and analyze new and/or existing Apple Health eligibility procedures, policies, and regulations for state and federal compliance.
• Make recommendations for updates to impacted Apple Health eligibility systems based on analysis.
• Coordinate rule review from ACES to the Eligibility Service and Washington Healthplanfinder to ensure procedural, systematic, and policy alignment.
• Coordinate procedural updates with the EPICS outreach and training team for impacted staff, community assisters, and stakeholders.
• Establish and coordinate eligibility operational changes and standards to Apple Health eligibility delivery systems with staff, internal and external partners, and stakeholders.
• Manage multiple projects and assignments concurrently with a considerable degree of self-directed initiative.
• Facilitate process improvement projects, work groups, and meetings across the section and agency related to Apple Health eligibility policy, procedures, and workflows impacting Apple Health eligibility systems.
• Provide policy managers with data and analysis to support policy development and programmatic maintenance.
• Track eligibility data and coordinate requests through the data analysts within the section.
• Resolve issues, respond to inquiries, and review legislation to ensure consistency with strategic, long-range plans.

• Nine (9) years of experience as defined below.

• Associate degree with major study in health, social sciences, public administration, education, or closely related field, and
• Seven (7) years of experience as defined below.

• Bachelor’s degree with major study in health, social sciences, public administration, education, or closely related field, and
• Five (5) years of experience as defined below.

• Conducting research
• Analyzing policies, laws, rules, or regulations
• Policy development
• Conducting business analysis and developing requirements
• Leading business projects
• Using process improvement methodologies (i.e. Lean, organizational change management)

• Drafting Medicaid policy and procedures
• Researching Medicaid policy in other states
• Developing scenarios or strategies for long and short-term division planning
• Reviewing implementation of programs for compliance with legal requirements
• Conducting analyses of Medicaid system, facts, statistics, and other relevant materials to resolve questions concerning Medicaid and state medical programs eligibility policy, legislative changes, and budgetary constraints

• Working in or alongside state government with knowledge of Washington State governmental structure and Medicaid policies
• Experience leading diverse work groups on health plan administration
• Experience in project management, change management, and/or process improvement
• Demonstrated knowledge of management principles and organizational practice
• Certifications in project management, change management,…