Care Management Program Specialist I
About The Position
The South Dakota Department of Social Services, Division of Medical Services also known as South Dakota Medicaid plays a vital role in the healthcare of South Dakotans. South Dakota Medicaid is one of the largest healthcare insurers in South Dakota, covering 146,542 individuals on average in state fiscal year 2025. Medicaid covers children and adults with low income, including parents and children in both working and nonworking families, individuals with diverse physical and mental conditions and disabilities, and seniors. South Dakota Medicaid is seeking a highly motivated individual to serve as part of our Care Management Program team. This position would: Interpret program methods to ensure compliance with department goals and all applicable regulations, both state and federal. Assist the Care Management team with implementing enhancements to our current care management programs including conducting research and making recommendations regarding potential enhancements. Develop and provide educational trainings for providers and clinics about care management programs as well as any enhancements or changes to the programs. Develop provider and recipient communications regarding the care management programs. Research and suggest edits to current policies and procedures and provider billing guidance for the care management programs. Provide statistical reports and analysis of data for the care management programs.-Provide enhanced support for Medicaid providers including developing and overseeing data supports such as provider report cards and developing learning resource supports for providers. Administering essential care management functions including reviewing and approving provider applications for the enhanced program and performing other key day-to-day operational tasks of the PCP, Health Home, and Baby Ready programs. Maintain logs, files, and other records of activities occurring within the care management programs. Field and coordinate responses to provider and recipient inquiries.
Requirements
- Prefer a bachelor's degree in health care administration, business, health information management, public health, or a similar degree
- 1 or more years in a similar field.
- motivation and passion for serving the public and displays a high level of effort and commitment toward completing assignments and goals
- experience successfully assisting with the planning and organizing large scale projects
- demonstrated success in establishing effective and collaborative working relationships with a broad variety of internal and external stakeholders
- demonstrated success in managing and organizing tasks and work effectively and efficiently
- dedication and a desire to represent the Department of Social Services with integrity and enthusiasm
- correctly interpret, analyze, and apply federal and state laws, regulations, and policies to provide technical advice, guidance, consultation, and policy interpretation in the assigned program area to other social services personnel, clients, public officials, and private citizens
- exercise good judgment in evaluating program performance, making decisions, and proposing corrective action
- develop methods and procedures and define standard actions for specific situations
- communicate information clearly and concisely
- conduct effective individual and group training and conferences
- effectively plan and organize work activities and prioritize task completion to meet schedules and deadlines
- establish and maintain effective working relationships with clients, their families, and other social service personnel, public officials, and private citizens
- experience being part of an implementation team for a large project
- ability to work with complex systems, environments, and understand business needs
- strong problem-solving skills and ability to move in fast paced environment
- skilled user of Microsoft Office suite
- demonstrated success exercising sound judgment
- To be considered, please attach your resume.
Responsibilities
- Interpret program methods to ensure compliance with department goals and all applicable regulations, both state and federal.
- Assist the Care Management team with implementing enhancements to our current care management programs including conducting research and making recommendations regarding potential enhancements.
- Develop and provide educational trainings for providers and clinics about care management programs as well as any enhancements or changes to the programs.
- Develop provider and recipient communications regarding the care management programs.
- Research and suggest edits to current policies and procedures and provider billing guidance for the care management programs.
- Provide statistical reports and analysis of data for the care management programs.
- Provide enhanced support for Medicaid providers including developing and overseeing data supports such as provider report cards and developing learning resource supports for providers.
- Administering essential care management functions including reviewing and approving provider applications for the enhanced program and performing other key day-to-day operational tasks of the PCP, Health Home, and Baby Ready programs.
- Maintain logs, files, and other records of activities occurring within the care management programs.
- Field and coordinate responses to provider and recipient inquiries.
Benefits
- $0 premium employee health insurance option plus eleven paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits.
- This position is a member of Class A retirement under SDRS.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Industry
Executive, Legislative, and Other General Government Support
Number of Employees
501-1,000 employees
