Heritage Health Program Specialist

State of Nebraska•Lincoln, NE

9d•Onsite

About The Position

Join the dynamic team at the State of Nebraska's Department of Health and Human Services, Division of Medicaid and Long-Term Care – Plan Management as a full-time Heritage Health Program Specialist. We are seeking individuals who are organized, possess outstanding customer service skills, and are dedicated to supporting our team in providing excellent service. The Medicaid program provides medical coverage for low income or disabled individuals. To help fulfill the agency goal of Helping People Live Better Lives, this position is necessary to ensure the proper administration of the Medicaid program. Program Specialists are responsible for researching, reviewing, analyzing the Heritage Health contract, and both federal and state regulations, to assist providers and members with inquiries or issues, such as problems with claims or credentialing/contracting with an MCO. They are also responsible for analyzing how regulations could impact the Medicaid program. The Heritage Health Program Specialist will be part of the managed care unit. The successful candidate will be responsible for implementation of program plans, goals, and objectives for Medicaid managed care and will assist with the monitoring of the Managed Care Organization (MCO) vendor contracts. “You have the passion; we have the opportunities – let’s make a difference for Nebraskans!”

Requirements

Bachelor’s degree, OR equivalent coursework/training, in public administration, social/behavioral sciences, healthcare, human services or other program related field.
Professional experience working in a human/social service or health care agency with responsibility for planning or evaluation services, programs or operational policies and practices may substitute in lieu of the educational requirement.
Knowledge of: managed healthcare delivery systems; principles and practices of management, business and Management principles, including planning, budgeting, resource allocation; techniques of research, planning and evaluation; work performance or other standards of development, program analysis/evaluation; policy development.
Skill in: communicating to convey information so others will understand; performing quality assessment reviews and evaluating program effectiveness; identifying problems and developing options for solutions.
Excellent communication skills, organizational skills, and problem-solving ability as well as the ability to work on a team.
Ability to: work collaboratively in a team setting; establish and maintain positive relationships with agency staff and external partners; communicate effectively to promote, explain, discuss, and interact with interested groups on various program issues; prepare and review documents such as summaries of state and federal regulations and reports; understand, interpret and apply laws, rules, policies and procedures pertinent to the program; exercise independent thinking skills; maintain liaison with community representatives and other governmental agencies.

Nice To Haves

Experience working in or knowledge of Medicaid programs or other Health Insurance programs.
Experience in contract management, claims, and communications.
Experience with data and/or quality analysis, spreadsheet software programs, and/or data software programs.

Responsibilities

Monitor day-to-day activities including all activities related to contract performance and assuring compliance with State and Federal requirements.
Review, analyze and monitor reporting requirements and quality improvement activities of the managed care plan.
Work with the managed care contractors to meet the requirement of 42 CFR 438 and State regulations.
Work with the Plan Management team and other MLTC departments to evaluate the impact of quality assurance programs on the health care services provide to Managed Care enrollees.
Participate in the competitive procurement process and assist in completing readiness reviews.
Provide liaison between and confers with other MLTC departments and divisional personnel.
Explain, clarify, and interpret operational practices, policies, procedures, federal and state regulations, contract requirements and activities related to assigned program(s) to agency staff, community organizations, members of the general public and contractors/service providers.
Other duties as assigned.