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Check with seller Contract Monitor Boise

Published date: April 3, 2022
  • Location: Boise, Idaho, United States

Description

The Division of Medicaid, Bureau of Long Term Care (BLTC) has an exciting opportunity to join the team monitoring our nationally recognized managed care programs for Medicare-Medicaid beneficiaries. These programs serve over 23,000 of Idaho’s most vulnerable residents by integrating Medicare and Medicaid benefits into a single, easy to navigate system.

This position works directly with participating health insurance carriers to monitor performance and ensure compliance with contract provisions, state and federal regulations, and other requirements. This small team is embedded in a group that focuses on excellent quality of work while fostering a positive and supportive working environment. Our common goal across teams is to help people who are elderly or disabled remain safe and supported in their communities and support the network of service providers working with this population.

If you are a critical thinker with an interest in the many moving parts of a complex managed care program, this may be a great fit for you! The position offers an opportunity to gain a depth of expertise in many aspects of Medicare and Medicaid, while creating and maintaining relationships with key community partners and stakeholders.

Benefit Information:
In addition to providing rewarding and challenging work, this position may have the option to hybrid telework after a successful probationary period is completed and our generous benefits package increases the total compensation of a full-time (benefits eligible) Program Specialist DHW making $25.00/hour to an estimated $35.98/hour.

Our competitive benefits package offered to eligible employees includes:

excellent medical, dental and vision insurance-employee only coverage for PPO $65/month for medical and vision & $10.06/month for dental
generous vacation and sick leave accrual beginning as soon as you start
11 paid holidays a year
paid parental leave
participation in PERSI - one of the Nation's best state retirement systems (the state currently contributes 11.94% of gross wages to an employee’s PERSI account)
multiple savings plans, optional 401K, and optional 457
basic life insurance for employee and family
employee covered at one times annual salary
spouse covered at $10,000
child covered at $5,000
wellness programs
ongoing training opportunities
an opportunity for student loan forgiveness
and more!

If you have previously applied for Program Specialist - DHW and wish to be considered for this position, you must reapply under this announcement. Previous scores will not be used.

Example of Duties

Monitor participating health insurance carriers in their administration of the Medicare Medicaid Coordinated Plan and Idaho Medicaid Plus in alignment with the provisions outlined in the scope of work, Idaho Administrative Code (IDAPA), and applicable state and federal regulations.
Evaluate routine data reports supplied by participating health insurance carriers for compliance with scope of work provisions.
Monitor issues reported by internal and external stakeholders within the BLTC complaint database system; identify trends.
Issue Requests for Corrective Action when a participating health insurance carrier is operating out of compliance with scope of work provisions; evaluate and approve or deny Corrective Action Plans (CAPs); monitor the implementation of CAPs and successful remediation of identified issues; monitor for trends in CAPs over time.
Plan and execute periodic audits of participating health insurance carriers.
Support participant and provider outreach activities, including presentations to varying group sizes about the duals’ programs.
Possess a high attention to detail, exceptional documentation and writing abilities, and organizational skills. Proficiency with a minimum intermediate level experience in Microsoft Excel, Word and PowerPoint is expected.

Minimum Qualifications

You must possess all the minimum qualifications listed below to pass the exam for this position. Click on the Questions tab associated with this announcement for the details regarding minimum qualification requirements. The Supplemental Questions on the application are the exam questions. Please make sure your resume or work history supports your answers. Failure to do this may result in not passing the exam and disqualify you from being considered for this position.

Experience developing, recommending, and evaluating operating procedures and recommending changes.
Developing technical written materials such as policies, technical manuals or rules/regulations.
Providing technical program assistance to staff.

Supplemental Information

ADDITIONAL QUALIFICATIONS/EXTRA CREDIT:
Below are additional qualifications. They are not required, however, having the minimum qualifications and the education and/or experience below will increase your score. Please answer each item below with enough detail to determine you meet each requirement to receive extra credit.

Experience writing audit plans, preparing audit reports and monitoring implementation of corrective action plans. Gained by at least one year of related experience.
Experience in both individual and group communication techniques that involve various stakeholders, facilitation to include providing presentations, public speaking and fielding open question and answer sessions. Gained by at least one year of related experience.
Experience using programs such as SharePoint, Microsoft Word, PowerPoint, electronic document management systems, and Excel. Gained by at least six months of professional experience using these programs.

DEDICATED TO STRENGTHENING THE HEALTH, SAFETY, AND INDEPENDENCE OF IDAHOANS

People Making A Difference!

VISIT US ONLINE
Learn About a Career with DHW
https://healthandwelfare.idaho.gov/about-dhw/dhw-careers

For all Idaho state government jobs:
https://dhr.idaho.gov

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***PLEASE NOTE: application assistance is not available after the business hours listed below, on the weekends, or on holidays and you must apply before 11:59 pm on the closing date. When applying, use CHROME as your browser to avoid complications.

If you have questions, please contact us at:
TROUBLE APPLYING: 1-855-524-5627

(Monday through Friday, 6am - 5pm, Pacific Time)

EMAIL:
dhwjobs@dhw.idaho.gov
(answered Monday through Friday during business hours MST)

Email is the quickest way to get an answer to your questions.

PHONE:
(208) 334-0681
(answered Monday through Friday during business hours MST)

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EEO/AA/Veteran

Hiring is done without regard to race, color, religion, national origin, sex, age or disability. If you need special accommodations to satisfy testing requirements, please contact the Division of Human Resources at (208) 334-2263.

Preference may be given to veterans who qualify under state and federal laws and regulations.

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