Program Coordinator II (DME Analyst) / 61079173

Are you the One? We are looking for a Program Coordinator II (DME Analyst) who will serve as serve as Policy Analyst for State Plan and Waiver durable medical equipment (DME) services, within the Office of State Plan Administration (OSPA) within the Bureau of Policy. The DME Services Policy Analyst evaluates existing policies and procedures and recommends improvements. Coordinates healthcare policy activities for State Plan or Waiver durable medical equipment (DME) services, including planning, developing, implementing and coordinating strategies for effective and efficient accomplishments of agency and program objectives in alignment with the agency's Strategic Plan. 

• Interpret healthcare policies and rules of programs jointly administered by federal (CMS) and state (SCDHHS) agencies, review, analyze, and make recommendations on developing proposals for State Plan services and Medicaid benefits. Through scientifically accepted methods, perform due diligence and research in order to recommend appropriate actions to take for new Medicaid benefits or revisions to existing Medicaid benefits related to State Plan or Waiver durable medical equipment (DME) services. 
• Evaluate existing policies for effectiveness and compliance with state and federal mandates. Research any unintended outcomes, either positive or negative. Develop cost analysis for existing policies based on utilization. 
• Apply industry and academically accepted research and evaluation methods to conduct research on critical, confidential, and highly sensitive matters that may require statutory or policy modifications. Identify any problems, either current or upcoming, and evaluate recommendations to address the issue(s) using tools such as surveys, cost-benefit analysis, focus groups, and others to forecast possible policy outcomes. Write policy briefs and memos of potential policy changes. 
• Ensure policy alignment with current agency policies and strategic plan. Assist in the state plan amendments process based on upcoming policy changes. 
• Ensure the agency's new or updated policies comply with new and current federal/state regulations. Create decision points for policy recommendations in a timely manner. Ensure state plan amendments are completed on time and communicated with executive leadership. Consistently evaluate current policies. Respond to executive leadership and external stakeholders' requests for policy changes/research in a timely manner. 
• Conduct provider manual and fee schedules reviews and updates as necessary to ensure the publications reflect accurate policy and rates. Conduct review and system updates during the quarterly CMS code updates or ad-hoc code updates as necessary. Participate and provide policy and medical coding expertise as necessary in agency projects related to Medicaid systems updates or operational projects. Ensure assigned policy manual is kept up to date with changes and changes are announce according to agency communication protocols.
• Serve as Policy Expert for assigned policy area. Maintain up to date knowledge of federal and state regulations related to assigned policy area. Ensure that the agency is in compliance with all regulations pertaining to the policy area. Collaborate with other areas within the agency to further assigned policy area. Participate in cross-functional teams to address key policy issues facing the assigned policy area. Represent the agency to external stakeholders including other state agencies, provider groups and professional boards as part of the policy team.
• Collaborate with other Policy team members and as assigned by management in research, development, implementation and evaluation activities related to other State Plan service categories, projects and agency initiatives. Participate and/or lead policy implementation projects, respond to provider, member or stakeholder inquiries received via State Plan mailbox. 
• Perform other duties as assigned. Attends and participates in relevant opportunities for professional development and training. Demonstrates utilization and application of new skills learned to improve effectiveness and efficiency within assigned responsibilities.
  
  

• Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
• 15 days annual (vacation) leave per year.
• 15 days sick leave per year.
• 13 paid holidays.
• State Retirement Plan and Deferred Compensation Programs.

A bachelor’s degree and three (3) years of relevant experience related to health care services such as home health, durable medical equipment (DME), or Medicaid waiver programs.

An equivalent combination of education and experience may be considered with prior State Human Resources approval.  

Preferred: Master's degree preferred in Public Health, Nursing, Healthcare Administration, or other relevant fields.

Additional Requirements:

• Sitting or standing for long periods of time.
• Lifting requirements: 20 lbs.

• Knowledge of healthcare needs and evidenced-based practices within durable medical equipment (DME). 
• Knowledge of medical terminology and its application in claims and clinical criteria. 
• Knowledge of laws, regulations, policies and procedures relevant to the area of employment. 
• Ability to interpret and apply laws, regulations, policies and procedures. 
• Ability to effectively communicate through written reports, bulletins and policy briefs and must demonstrate strong writing, verbal and presentation skills. 
• Ability to exercise judgment and discretion. 
• Ability to establish and maintain effective working relationships. 
• Ability to work in a complex, fast-paced, and cross-functional team environment.

Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.

Salary : $46,665 - $65,000