DSNP Program Specialist (HCPS/MPD)

State of Washington • Thurston County – Olympia, WA

5d • Hybrid

About The Position

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.

Requirements

• 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.
• Nine (9) years supervisory or consultative experience in health services, social service, Medicare programs, Medicaid programs or social security disability programs.
• One (1) year as a Medical Assistance Program Specialist 2.
• The ability to take action to learn and grow.
• The ability to take action to meet the needs of others.

Nice To Haves

• 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.
• 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.

Responsibilities

• 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.
• 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.

Benefits

• A clear agency mission that drives our work and is person-centered
• A healthy work/life balance, including alternative/flexible schedules and mobile work options.
• A great total compensation and benefit package
• WA State Government Benefits
• A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.
• And free parking!

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level