Medicaid Program Advisor
About The Position
The Bureau of Specialized Services for Children (BSSC) within the Division of Program Development and Management (DPDM) is seeking a Medicaid Program Advisor 1 to support critical programs serving children and youth with behavioral health needs, developmental disabilities, medical complexities, and foster care involvement. This role combines program administration, eligibility assessment, care coordination, policy development, stakeholder engagement, and process improvement. The ideal candidate is passionate about improving access to care and services for children and families while working collaboratively with providers, community organizations, and government partners.
Requirements
- Eight (8) years of professional experience
Nice To Haves
- Medicaid programs and healthcare policy
- Home and Community Based Services (HCBS)
- Children's Waiver programs
- Children's Health Home services
- Care coordination or case management
- Pediatric healthcare, behavioral health, or developmental disabilities
- Foster care and child welfare systems
- Program eligibility determination and enrollment processes
- Policy analysis, training development, and stakeholder engagement
- Strong interpersonal and relationship-building skills
- Excellent communication and presentation abilities
- Critical thinking and problem-solving skills
- Sound decision-making and organizational abilities
- Ability to manage multiple priorities and deadlines
- Experience analyzing reports, data, and operational processes
- Proficiency with Microsoft Office and other business applications
- Ability to work independently and collaboratively in a hybrid environment
Responsibilities
- Conduct Home and Community Based Services (HCBS) eligibility determination assessments for Children's Waiver applicants.
- Manage referrals and guide applicants and families through the eligibility and enrollment process.
- Gather and evaluate assessment information from applicants, providers, and other stakeholders.
- Determine eligibility and enroll qualified participants into the Children's Waiver program.
- Facilitate participant transfers to their selected Children's Health Home or provide HCBS care coordination services as appropriate.
- Develop expertise in Children's Health Home, Children's Waiver, Children and Family Treatment and Support Services (CFTSS), and Foster Care/29-I services.
- Assist with program planning, implementation, evaluation, reporting, and continuous improvement initiatives.
- Provide education, technical assistance, and guidance to providers, participants, families, and community stakeholders.
- Research Medicaid regulations, policies, and program requirements.
- Develop and revise policies, procedures, provider guidance documents, and operational materials.
- Draft program communications, announcements, training materials, and presentations.
- Deliver webinars and training sessions to support successful program implementation.
- Monitor eligibility, enrollment, and operational reports.
- Analyze trends, performance metrics, and stakeholder feedback.
- Prepare status updates and recommendations for leadership.
- Support data-driven decision-making and program enhancements.
- Utilize management information systems to support daily program operations.
- Identify opportunities to improve workflows, efficiency, and participant experience.
- Provide recommendations for system enhancements and streamlined business processes.
- Participate in special projects and initiatives as needed to support the evolving priorities of the Office of Health Insurance Programs (OHIP).
Benefits
- Medical, Dental, and Vision Insurance
- 401(k) with Discretionary Employer Match
- Generous Paid Time Off and Paid Holidays
- Flexible Spending Accounts (FSA)
- Employee Assistance Program (EAP)
- Employee Discounts and Wellness Perks
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
