Program Integrity Specialist-Medicaid and Long-Term Care

State of Nebraska•Lincoln, NE

11d•Onsite

About The Position

The Program Integrity Specialist supports the work of the Nebraska Medicaid Program Integrity team by becoming the subject matter expert on program regulations and setting expectations for Home and Community Based Services (HCBS) providers, especially those required to use the electronic visit verification system. Home and community-based services are available to those who qualify for Medicaid waivers, such as the elderly, adults and children with disabilities, and infants and toddlers with special needs. This is just one of the ways DHHS helps Nebraskans Live Better Lives.

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.
Valid Driver’s License

Nice To Haves

Experience with Nebraska Medicaid providers, Medicaid Waiver Services, and the electronic visit verification system.
Knowledge of Medicaid federal regulation.

Responsibilities

Gather information from regulations, waivers, and Department staff to assist with development of internal policy and procedures.
Conduct data mining, and intervention strategies to use during provider investigations.
Assist with investigations and correspondence with providers.
Ensure HCBS providers are using the electronic visit verification system.
Perform program planning, implementation, monitoring and evaluation of program activities to manage the day-to-day operational and technical functions of the Program Integrity Team.
Research, review, analyze, and interpret federal regulations, federal laws, state laws and their administrative requirements to formulate appropriate policies, procedures and interpretations for the Program Integrity Team.
Draft, develop, and implement policy, procedure and program regulations related to assigned program(s) and ensure staff and service provider are working with uniform guidelines by evaluating and coordinating program policies and regulations.
Research, review, analyze, and report on federal regulations, state laws and administrative requirements that may affect an assigned program for intent and meaning and to formulate appropriate changes in State policies and procedures.
Write reports, position papers, impact statements and other documents to formulate policy material to cover specific areas of health and human services programs by conducting research and meeting with other department staff, representatives of other agencies and health and/or human service providers.
Explain, clarify and interpret operational practices, policies, procedures, federal and state regulations, contract requirements and activities related to assigned programs to Program integrity teammates and providers.
Develop the necessary resources and administrative support to ensure the Nebraska Medicaid Program Integrity Team operates effectively and efficiently by coordinating with other departmental divisions or outside agencies.