Program Integrity Specialist-Medicaid and Long-Term Care

State of Nebraska•Lincoln, NE

13d

About The Position

The Nebraska Department of Health and Human Services is seeking a human services professional to support Medicaid and Long-Term Care program integrity. The specialist supports the Nebraska Medicaid Program Integrity team by developing expertise in program regulations and setting expectations for Home and Community Based Services (HCBS) providers, particularly those required to use the electronic visit verification system. HCBS are available to people who qualify for Medicaid waivers, including older adults, people with disabilities, and infants and toddlers with special needs. The position helps manage the Program Integrity Team’s operational and technical functions through program planning, implementation, monitoring, and evaluation. It researches and interprets federal and state requirements and develops policies, procedures, and program regulations. The specialist also supports provider investigations, communicates requirements to providers and teammates, and coordinates resources and administrative support with other divisions and outside agencies.

Requirements

Bachelor’s degree, or equivalent coursework or training, in public administration, social or behavioral sciences, healthcare, human services, or another program-related field.
Professional experience in a human or social service or health care agency, with responsibility for planning or evaluating services, programs, or operational policies and practices, may substitute for the education requirement.
Valid driver’s license.

Nice To Haves

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

Responsibilities

Gather information from regulations, waivers, and Department staff to support development of internal policies and procedures.
Conduct data mining and develop intervention strategies for use in provider investigations.
Assist with investigations and correspondence with providers.
Ensure HCBS providers use the electronic visit verification system.
Plan, implement, monitor, and evaluate program activities to manage the Program Integrity Team’s day-to-day operational and technical functions.
Research, review, analyze, and interpret federal regulations, federal and state laws, and administrative requirements to develop policies, procedures, and interpretations.
Draft, develop, and implement policies, procedures, and program regulations for assigned programs, and coordinate and evaluate them to promote consistent guidelines for staff and service providers.
Analyze and report on regulations, laws, and administrative requirements that may affect assigned programs and formulate appropriate changes to state policies and procedures.
Write reports, position papers, impact statements, and other policy documents based on research and consultation with department staff, other agencies, and health or human service providers.
Explain and interpret operational practices, policies, procedures, regulations, contract requirements, and program activities to Program Integrity teammates and providers.
Coordinate with departmental divisions and outside agencies to develop resources and administrative support for the Nebraska Medicaid Program Integrity Team.