DSNP Program Specialist (HCPS/MPD)

DSNP Program Specialist (HCPS/MPD)

Someone would want this job if they are passionate about healthcare policy, Medicare-Medicaid integration, and making a tangible impact on vulnerable populations. You would directly shape and improve healthcare access for "dually eligible" individuals (those who qualify for both Medicare and Medicaid) in Washington state. Providing consultative expertise to top-level managers, state agencies, and Managed Care Organizations (MCOs), directly supporting the Washington State Health Care Authority's mission. Help develop Agency policy, monitor compliance with federal guidelines (like the Affordable Care Act and mental health parity), and bridge the gap between physical and behavioral health services.

All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.

The mission of the Medicaid Programs Division (MPD) within the Health Care Authority (HCA) is to provide high quality administrative services to assist in the purchase and delivery of medical assistance program services to clients and members. MPD works across the agency and in partnership with the health care community and community stakeholders to develop and manage high-quality, evidence-based health care programs and purchase services that enhance Medicaid clients' ability to access appropriate, quality health care. This supports the mission of providing quality services that enhance our clients' ability to obtain and access health care.

This position reports to the SDPO Unit Supervisor in the Strategic Design and Program Oversight section and will provide contract management assistance for our Dual Eligible Special Needs plans and work toward Advancing Medicaid and Medicare Integration. This position provides consultative expertise on this program to top level managers within the Health Care Authority and to other state agency staff, Managed Care Organizations, Contracted Leads, and community providers. This position supports HCA's mission by leading a program that is innovative in its array of services and in the authorizing environment, by utilizing existing approvals and integration of Highly Integrated Special Needs plans and coordination with Medicaid Managed Care Organizations.

This position is eligible to telework and is typically not required to report on-site. The default assigned work location of all Health Care Authority (HCA) positions both on-site and telework eligible positions is within the State of Washington. This position reports to Olympia, WA. Frequency of onsite work will vary based on business and operational needs. All agency employees are required to report on-site in Olympia on their first and last days of employment to pick up and return state-issued equipment, regardless of telework status or location.

Duties

Some of what you will do:

• Collaborates with the Agency subject matter expert of one or more SMACs to ensure high quality and coordinated health care services.
• Collaborates with Agency subject matter expert for the development of Medicare Policy, oversight, and federal compliance of Medicare Advantage Plans contracted for the Dual Special Needs Program (DSNP).
• Assists SMEs in analyzing and evaluating Medicare policy and monitoring protocols established by the Centers for Medicare and Medicaid Services and State Guidelines and State Contract Terms, and provides oversight and monitoring of MA Health Plan and;
• Assists in developing Agency Policy for Medicare clients using drafts the annual SMAC in accordance with Agency policy and recommends changes consistent with Federal guidance and Agency Directive.
• Collaborates with SMEs in reviewing State and Federal guidance, legislation, and Health Care Advisory Commissions and recommends options for Leadership then promulgates, and implements policy changes to improve access to health care services for dual eligible enrollees advancing Medicare and Medicaid integration;
• Collaborate with DSHS on policies and initiatives regarding Dual Eligible population to advance the integration Medicare and Medicaid
• Works with subject matter experts to ensure Apple Health managed care plans and MA Health Plans are in compliance with Affordable Care Act provisions related to mental health parity for Medicaid enrollees.
• Assists in preparing comprehensive, long-range plans relating to health care program objectives of coordinating Behavioral health between MA Plans and BHSOs.

Qualifications

Required qualifications:

Qualifying candidates will meet one of the following criteria options:

• A bachelor's degree from an accredited college with a major study in public health, public administration, business administration, social work or closely related field.
• Five (5) years supervisory or consultative experience in health services, social service, Medicare programs, Medicaid programs or social security disability programs.

Option 2:

• Nine (9) years supervisory or consultative experience in health services, social service, Medicare programs, Medicaid programs or social security disability programs.

Option 3:

• One (1) year as a Medical Assistance Program Specialist 2.

Required competencies:

• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.

Preferred qualifications:

• 4 years' experience working with managed care operations, delivery systems, customer service activities and policy issues to ensure provision of high-quality care to Medical Assistance enrollees.
• Two (2) years' experience in program development, implementation and evaluation of Medicare.
• Project management, including team facilitation and process improvement methods.
• Four (4) years of experience working with diverse client populations with chronic illness, especially clients with behavioral health issues; including cultural competency in working with an ethnically diverse population.
• Knowledge of the structure and function of the various sub-divisions of the Health Care Authority and the Department of Social and Health Services, including experience in cross system collaboration, team building and aligning internal and external resources in support of program development to ensure the delivery of quality healthcare services to high-risk clients.
• Two (2) years' experience in participating in and facilitating meetings and task forces involving internal.
• One (1) year of experience in operating the ProviderOne MMIS system and related data and information systems.
• Experience in data analysis and clear communication of complex data analysis results for multiple audiences.
• Ability to analyze data related to contract performance and other issues relating to managed care contracts.

Competencies:

• State and federal managed care and related laws (e.g., HIPAA) laws, policies, regulations and procedures on Medicaid and healthcare both within and outside HCA.
• Medicare rules and regulations on eligibility, enrollment, Part C, Part D, Grievance and Appeals, and Quality Performance.
• Familiarity with Care Coordination contract terms and processes.
• Communication skills, including written and oral presentations for a wide variety of audiences, community members, provider groups, clients and client advocates.
• Ability to facilitate timely communication and interchange between diverse groups of internal and external departments, agencies and the public.
• Experience in technical and non-technical report writing for both low-literacy audiences and others, such as executive leadership, internal staff, contractors and interested stakeholders.
• Critical systems thinking skills.

How to apply

Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile which includes three professional references and attach in separate files:

• A cover letter that specifically addresses how you meet the qualifications for this position
• Current resume

To take advantage of veteran preference, please do the following:

• Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter.
• Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov.

About HCA

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents. What we have to offer:

• Meaningful work with friendly co-workers who care about those