MaineCare Policy Planner

State of Maine • Augusta, ME

1d • Hybrid

About The Position

The Policy Planner will develop policies that describe the health care services covered by MaineCare and how MaineCare reimburses for those services. The Policy Planner works with internal and external partners to develop these policies in accordance with federal and state requirements and with the goal of meeting the needs of MaineCare members and providers. This includes researching Medicaid policies in other states, staying up to date on Medicaid regulations that relate to the policy writer’s areas of focus, and reviewing best practices, data analyses, and collecting interested party feedback The position requires effective communication, including strong analytical, writing, and presentation skills. This role also involves working collaboratively with diverse groups and agencies, including holding public hearings. The position will help OMS adopt policies needed for comprehensive rate system reform, which aims to improve MaineCare’s reimbursement system to ensure rates are equitable and sufficient to provide all MaineCare members with access to needed, high value healthcare services. The MaineCare Policy Planner will work collaboratively with other agencies, members, and providers to understand how these policies best work in practice. This position may work with and actively collaborate on all sections of the MaineCare Benefits Manual (MBM) – the state rules governing the MaineCare program - but may have a primary focus in either: outpatient, clinic, and hospital services including medical and preventative services and programs; or children’s and behavioral health services including home and community-based, residential, and inpatient behavioral health services, case management services, and health home services for children and adults with behavioral health conditions.

Requirements

• A Bachelor’s Degree in Public/Community Health, Health Administration, Health Sciences or Health Education; Public Administration, Public Policy, Law/Legal Studies, Government, Social Work, or a closely related field and three (3) years professional experience in the planning, development, coordination and/or evaluation of health programs, or services, -OR- an equivalent seven (7) year combination of education, training, and experience.
• Applicants must include a resume, cover letter, and writing sample with their application.

Nice To Haves

• Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low-income populations.
• Lived experience with Medicaid and/or other health-related social needs common to individuals and families receiving Medicaid coverage.
• Knowledge of Alternative Payment Models and value-based purchasing.
• Experience with the analysis, development, interpretation and/or implementation of policy and programs.
• Knowledge of health care benefit programs (e.g. MaineCare, other state Medicaid, or private insurance coverage) and relevant issues facing the health care field and health care consumers.
• Strong analytic and problem-solving skills.
• Knowledge of Medicaid policy, including but not limited to, coverage, reimbursement, eligibility, and/or systems.
• Demonstrated writing, editing and proofreading skills, including the ability to simplify and summarize technical language and complex subject matter in a concise manner and in alignment with plain language principles.
• The ability and motivation to effectively manage multiple long- and short-term projects with diverse stakeholder groups.

Responsibilities

• Develop expertise in their assigned MaineCare covered services, including qualified providers, best practices, how payments are made, reimbursement methodology, and compliance with applicable state and federal laws.
• Initiate formal MaineCare policy rulemaking through the MAPA process, including but not limited to:
• Draft new rules and/or changes to existing rules, working with various internal and external partners.
• Facilitate public hearings and respond to public comments on proposed rules.
• Work collaboratively with internal teams and other state offices and with a wide variety of third parties including members, providers, and advocates.
• Think critically and strategically to address complex health policy issues and manage multiple priorities at once.
• Effectively research healthcare best practice, state statute, and federal regulations to inform policy development.

Benefits

• Work-Life Fit – Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave.
• Health Insurance Coverage – The State of Maine pays 85%-100% of employee-only premiums ($12,845.82 - $15,112.76 annual value), depending on salary.
• Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%.
• Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($395.72 annual value).
• Retirement Plan – The State contributes the equivalent of 14.11% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS).
• Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child—including non-birthing and adoptive parents—receive six weeks of fully paid parental leave.
• State employees are eligible for an extensive and highly competitive benefits package, covering many aspects of wellness.

What This Job Offers

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