Healthcare Standards Administrator (SPSA, Opt. 8N)

State of Illinois • Springfield, MO

2d • Hybrid

About The Position

The Department of Healthcare and Family Services, Office of Inspector General, is seeking a highly capable and experienced professional to serve as the supervisor for the Health Care Standards section. The ideal candidate for this challenging and rewarding role will have management and supervisory experience in nursing and healthcare oversight. They will understand Medicaid and managed care and the state and federal regulatory landscape for healthcare providers. The ideal candidate will demonstrate the ability to exercise sound judgment in the identification of priorities, to work collaboratively with internal and external partners, to proactively address issues, and to ensure timely completion of all work. The ideal candidate will exhibit strong leadership skills to achieve goals while demonstrating independent initiative. HFS values employees with different backgrounds, life experiences, and talents. Employees receive a robust benefit package including: Monday-Friday work schedule Flexible work schedules are available in many program areas. (Remote work may be an option for certain positions.) Health, Life, Vision, and Dental Insurance Pension Plan Paid Parental Leave Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare) Employees earn (12) paid Sick Days annually. New Employees earn (10) paid Vacation Days their first year of service and can earn up to (25) paid Vacation Days annually. Employees earn (3) paid Personal Days annually. (13-14) paid holidays annually (based on start date) If you are seeking a new opportunity, and this position appeals to you, please apply today! At the Illinois Department of Healthcare and Family Services (HFS), we value staff as our greatest asset. We work in a spirit of teamwork to help millions of Illinoisans access high quality healthcare and fulfill child support obligations to advance their physical, mental, and financial well-being. We provide healthcare coverage for children and adults through Medicaid and other medical programs, and we help ensure that children receive financial resources from both their parents through Child Support Services. The HFS Office of the Inspector General investigates, audits and reviews program activity to ensure the integrity of our programs is maintained. HFS is committed to promoting and preserving a workplace culture that embraces diversity, equity, and inclusion. We welcome and value employees with different backgrounds, life experiences, and talents. It is the collective sum of our individual differences that provides a broad perspective, leading to greater innovation and achievement. In recruiting for our team, we recognize the unique contributions of each applicant regardless of culture, ethnicity, race, national origin, sex, gender identity and expression, age, religion, disability, and sexual orientation. HFS is an equal opportunity employer.

Requirements

• Requires licensure as a Registered Nurse in the State of Illinois
• Requires knowledge, skill and mental development equivalent to the completion of four (4) years of college with coursework in nursing
• Requires prior experience equivalent to four (4) years of progressively responsible professional nursing experience in a public or business organization
• Requires ability to travel in the performance of duties, with overnight stays as appropriate.
• Requires appropriate, valid driver’s license

Nice To Haves

• Three (3) years of professional supervisory experience related to health care oversight
• Three (3) years of professional experience reviewing medical records for quality of care
• Three (3) years of professional experience reviewing medical records clinical criteria for decision making for utilization review
• Three (3) years of professional experience assessing medical services to validate appropriateness using established criteria and guidelines and ensuring the medical necessity of treatments
• Three (3) years of professional experience developing and monitoring plans of corrective action
• Three (3) years of professional experience in managing multiple projects and priorities to adhere to deadlines and time frames
• Three (3) years of professional experience ensuring compliance with healthcare standards
• Four (4) years of professional experience working with government health insurance rules and regulations
• Certified Professional Coder for Medical billing or three (3) years of extensive medical coding experience
• Three (3) years of experience utilizing professional written and verbal communications skills for external and internal stakeholders

Responsibilities

• Serves as Heath Care Standards Administrator for the Office of the Inspector General (OIG) by planning, executing, controlling, and directing the statewide Health Care Standards Section
• Serves as a full line supervisor
• Receives and reviews case referrals from OIG bureaus, managed care organizations, external auditors, federal, state, and local law enforcement, community organizations, or individuals
• Directs and reviews the assignment of professional nursing staff and other contractual medical professionals to conduct investigations
• Plans, schedules, and attends Medical Quality Review Committee meetings to review case evidence gathered and documented to determine /recommend sanctions
• Interviews, hires, and enters into contractual agreements with medical professionals
• Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above

Benefits

• Health, Life, Vision, and Dental Insurance
• Pension Plan
• Paid Parental Leave
• Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
• 12 paid Sick Days annually
• 10 paid Vacation Days their first year of service and can earn up to 25 paid Vacation Days annually
• 3 paid Personal Days annually
• (13-14) paid holidays annually (based on start date)

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree