Program Consultant - Medicaid School Policy

State of North Carolina•Wake County Wake, NC

3d•$57,983 - $101,470•Hybrid

About The Position

This position is responsible for providing expert education and technical assistance on the requirements of direct health care services covered in NC Medicaid Clinical Coverage Policy 10C, which are provided and billed by Local Education Agencies (LEAs). The role involves facilitating professional development and spearheading stakeholder engagement initiatives to drive continuous quality improvement across the state. The goal is to improve school health service utilization and mitigate audit risks. The incumbent will collaborate internally with NC Medicaid clinical and cross-functional teams on policy development, quality initiatives, and educational materials, in coordination with the NCDPI. This includes implementing changes, educating LEAs as healthcare providers, and ensuring understanding of federal and state regulations. The position will design and implement training and quality improvement initiatives regarding required LEA health care documentation, providing feedback and action plans to mitigate audit findings. The incumbent will monitor LEA action plan implementation, report findings to NC Medicaid management, and assist with analysis and planning to strengthen the program, aiming for increased service utilization and reduced audit risks. Additionally, the role involves assisting management with designing, implementing, evaluating, and monitoring procedures for quality initiatives, providing high-quality customer service, facilitating departmental communications, identifying and resolving customer issues, and developing/maintaining unit operational policies and procedures. State-wide travel is required.

Requirements

Master's degree in a discipline relative to the program from an appropriately accredited institution and four years of related experience; or Bachelor’s degree in a discipline relative to the program area from an appropriately accredited institution and six years of related experience; or an equivalent combination of education and experience.
Expertise in school operations and Medicaid services, specifically regarding health service documentation and billing for Local Education Agencies (LEAs).
Deep understanding of federal Medicaid requirements for beneficiaries under age 21.
Exceptional public speaking and interpersonal skills used to share expertise and cultivate strategic professional partnerships.
Excellence in translating complex medical and regulatory requirements into clear, actionable, and unambiguous policies.
Highly self-motivated with the ability to prioritize tasks and work independently with minimal supervision.
Strong critical thinking skills used to evaluate policies, perform quality assurance, and coordinate effective courses of action.

Nice To Haves

Clinical background as a NC licensed allied health (OT, PT or SLP), behavioral health or RN
Previous work within NC Medicaid clinical policy.
Previous work as a school health care provider.

Responsibilities

Act as the point person for all Medicaid school-based health service and unique CCP-10C related questions as the main representative voice for LEA school health service resources.
Host and organize regular meetings with DHB and NCDPI to discuss new and ongoing school health care issues, concerns, and opportunities for policy development and program improvement.
Work with DHB counterparts to ensure the accuracy of all Random Moment Time Study (RMTS) direct and indirect service pools to mitigate risk of audit findings.
Evaluate the current Random Moment Time Study pool set-up and study options for reconfiguration that might result in increased program effectiveness.
Provide clinical expertise in the state-wide effort to achieve a uniform documentation system and ensure that the statewide school Electronic Health Record (EHR) system has functionalities needed for Medicaid reimbursement and documentation.
Work with DHB clinical and cross-functional teams to clarify all Medicaid related questions and create technical assistance material with LEA facing language in coordination with NCDPI.
Act as the liaison for the specialized LEA billing vendors and refer questions to appropriate business units in DHB or to the MMIS vendor to assist with compliance understanding and mitigation of risk of audit findings.
Support all new LEAs and charter schools in understanding participation in the school-based health service program, and support Medicaid enrollment of LEAs through school-specific enrollment guidance.
Consistently evaluate the Medicaid school-based health service program for opportunities for growth and efficiencies as quality improvement initiatives to minimize audit risk.
Monitor national trends for growth opportunities for the Medicaid school-based health services program and changes in regulations, requirements, or additional guidance at the federal level and assess the impact.
Assess the need for new or revised clinical policy, procedures or communication.
Plan for sustainability of the Medicaid school-based health services program.
Collaborate with NCDPI counterparts to conduct monitoring of quality improvement initiatives, review of checklist items for LEA documentation to assess understanding of compliance with regulatory guidelines; identify areas of non-compliance and work with the LEA to develop action plans to improve program integrity and mitigate risk of federal audit findings.
Ensure all necessary documentation and monitoring tools are maintained within specified location.
Support program integrity oversight when clinical expertise and specific clinical policy knowledge is needed.
Provide annual and ongoing Medicaid school-based health program training in coordination with DHB and NCDPI.
Oversee research and preparation of information and materials to inform LEAs and school health providers of Medicaid school health program resources on a collaborative website with NCDPI.
Create and manage the Medicaid school health service program peer-to-peer sharing network for LEAs and school health providers.
Provide annual professional development for all LEA leaders, work in coordination with all LEA leaders participating in any of the Random Moment Time Study pools to ensure the pool accuracy, and provide outreach and support for districts not currently fully utilizing Medicaid.
Provide frequent in-person professional development and promote school-level and state-wide best practices for delivering health care services in schools and maintaining appropriate monitoring and billing practices.
Oversee the professional sharing network for each of the Random Moment Time Study direct and indirect service pools, and answer all questions on program implementation from school health providers.
Produce an annual Medicaid SBS program survey to look for and provide additional professional development opportunities.
Manage LEA Medicaid SBS program feedback sessions (to be made of a mix of each health care provider type, fiscal offices, and program coordinators) that meet monthly to review additional support needed.
Consult with representatives from other states and participate in national (Healthy Schools, Promising Futures - HSPF) and state (NC HSPF) meetings regarding emerging trends and best practices.
Perform other duties as assigned.