What are the responsibilities and job description for the Program Specialist 2 position at TulaRay?
Minimum Qualifications :
One (1) year of professional experience in developing, implementing or evaluation human services, sociology, public health, health care services, or health care insurance programs; and a bachelor's degree in human services or education Field; or
Any equivalent combination of experience and training that includes at least one (1) year of professional experience in developing, implementing or evaluation human services, sociology, public health, health care services, or health care insurance programs.
Intermediate Computer skills to include but not limited to Microsoft Office Products.
Additional Desired Qualifications :
- Applied analytical skills.
- Strong written and verbal communication skills.
- A working knowledge of Medicaid / Medical Assistance is a plus, but not required
Principal Duties and Responsibilities
This position is located in the Enhanced Member Support Unit of the Division of Quality and Special Needs Coordination (DQSNC) in the Bureau of Managed Care Operations (BMCO), Office of Medical Assistance Programs (OMAP). This position reports to the Supervisor of the Enhanced Member Support Unit (EMSU) in DQSNC. The incumbent is responsible to provide professional level services that include facilitating and coordinating services and the resolution of issues regarding HealthChoices (HC) members with special healthcare and / or health related social needs (HRSN's).
Responsible for monitoring compliance of the Physical Health MCO's Enhanced Member Support Units (EMSU's) for assigned MCO / s.
Monitor issues regarding children in substitute care, monthly age-out lists for each PH-MCO as assigned, and other member issues related to case management that may arise.
Addresses reported member issues referred by legislative offices, other DHS offices, various stakeholders, hospital systems, doctor's offices, etc. with the MCO's and follows the cases until resolved.
The incumbent is expected to resolve problems and / or issues consistent with the HC agreement, have knowledge of Department goals and work independently. Issues that have a major impact on other program offices or involve a major barrier to care for a member must be discussed with the Supervisor, Manager, and / or the Division Director.
Duties may include, but are not limited to planning, implementing and evaluation of disability and placement issues, system support, and liaison relationships with appropriate internal and external program offices, agencies, consumer organizations and advocacy groups.
Review Managed Care Organization (MCO) initiatives that address the reduction / elimination of disparities.
Responsible for coordination of EPSDT Age Out transitions as assigned and participate in the Resource Facilitation Meetings that are utilized to plan for these members. This position independently researches systems, develops updates, interfaces with other office within DHS, and provides verbal updates of their findings during meetings.
Responsible for appropriate data sharing and collaboration with DHS program offices including the office of Developmental Programs (ODP), the Office of Long-Term Living (OLTL), Office of Mental Health and Substance Abuse Services (OMHSAS), the Office of Children Youth & Families (OCYF), Adult Protective Services (APS), and Bureau of Fee for Services (FFS) to ensure necessary and mandated services are received in a timely and seamless manner.
Interpret Medical Assistance policies, regulations and procedures.
Participate in Contract Management Team activities, quarterly meetings with the MCO's EMSU's, quarterly meetings conducted with each MCO (360 meetings), various stakeholder meetings, and related activities as assigned.
Review and analyze assigned reports to identify trends and program needs. This includes the review of quarterly reports submitted by the MCO's to report discharge efforts for children residing in pediatric facilities, to ensure the MCO is meeting established standards set forth in the HC Agreement.
Responsible to serve as back up for Resource Facilitation Team (RFT) and general age out issues as needed.
Staff will be responsible for coordinating efforts with the staff of BMCO's Division of Monitoring and Compliance. This would include conducting meetings to address cases that require a review of the MCO's case management of the member, difficult to staff shift care cases, and other cases identified as having multiple complexities. Staff will be responsible for documenting these calls. This documentation will be used to track and measure the efforts made to address the barriers as discussed on the calls.
Prepare reports, correspondence, file notes and other responses as approved by the Manager.
Participate in assigned workgroups, committees, webinars, and trainings and provide necessary follow up with supervisor, manager and / or director, including providing a file note.
Coordinate and schedule meetings via Teams.
The incumbent also performs other assigned duties and special projects as assigned by the Supervisor, manager and / or Division Director.
Travel to alternate work locations as necessary and requested.
Performance considerations :
Verbal or written assignments for on-going processes, standing work groups and projects will include specific and detailed descriptions of deliverables including nature of the work product, expected timeframes, available resources, and desired outcomes. Progress towards interim goals and deliverables will be assessed during regular status meetings.
About Us :
TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.
TulaRay is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at tularay.com
