Program Specialist IV

Texas Health & Human Services Commission•Austin, TX

1d•$4,263 - $6,779•Onsite

About The Position

The HHSC Medicaid CHIP Services (MCS) division seeks a highly qualified candidate to fill the position of the Program Specialist IV in Managed Care Contracts and Oversight (MCCO). MCS is driven by its mission to deliver quality, cost-effective services to Texans. The Program Specialist IV makes a significant contribution to MCS’s mission by ensuring managed care organizations are compliant with all state and federal regulations, contractual requirements, established policies, rules and regulations. The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy. The Program Specialist IV is selected by and reports to the Deputy Director within MCCO. This position will be assigned to a team responsible for ensuring compliance with contracts between managed care organizations (MCO) and the agency. This position performs complex (journey-level) analysis and continuous review of the MCO to determine the appropriateness of operations and contract compliance. This position reviews MCO materials and evaluates compliance with contract requirements and manages corrective actions. This position participates in the development, implementation, analysis, and documentation of MCCO policies and processes and makes recommendations for changes as needed. This position works under general direction with some latitude for the use of initiative and independent judgment. This position performs other duties as may be assigned or required and attends work on a regular and predictable schedule.

Requirements

Knowledge of subsidized health insurance, including Medicaid, Medicaid Managed Care, and/or CHIP.
Knowledge of contract management and compliance principles.
Ability to work under limited direction and to use initiative and independent judgment.
Analytical and organizational skills and the ability to conduct investigations or audits; gather, assemble, correlate, and analyze facts and data; and devise solutions to problems.
Knowledge of state and federal laws, regulations and processes regarding Medicaid Managed Care and CHIP.
Skill in using personal computer applications software such as Microsoft Word, Excel, Power Point, or other similar programs.
Skill in written and oral communication, including the ability to make public presentations, write technical information in an understandable format, produce sophisticated research and analytical reports.
Ability to research and evaluate policies and procedures.
Two years of education at an accredited four-year college or university. The educational requirement may be substituted for relevant work experience on a year-for-year basis.
Strong written communication skills as demonstrated by submitted application materials.

Nice To Haves

Prior work experience in a field related to Medicare, Medicaid fee-for-service, Medicaid Managed Care, and/or CHIP preferred.
Certified Texas Contract Manager Certification (CTCM) or must obtain within 12 months upon hire.

Responsibilities

Ensures compliance with contract requirements and evaluates MCO compliance by reviewing the contract deliverables for compliance with state and federal regulations.
On a prompt and continuous basis accurately finalizes the review of MCO materials (deliverable) in accordance with required timeframes to determine appropriateness by utilizing contracts, manuals, issued guidance and notices, and state and federal rules and regulations.
Works collaboratively and follows up promptly with MCCO staff, Medicaid/CHIP program SMEs, and other internal/external stakeholders as needed to ensure the appropriateness of MCO materials (deliverable).
Promptly informs the Manager of significant or indication of MCO/DMO compliance issues and provides recommendations for action.
Works promptly and collaboratively to recommend remedies for noncompliance of contractual requirements.
Responds and provides accurate information to legislative, open records and audit requests within specified timeframes.
Collaborates actively in the planning, development, implementation, analysis, and documentation of functions related to training, onsites, desk reviews, implementations, readiness reviews, information sessions, special projects and other activities as required and within the specified timeframes.
Collaborates in determining trends and resolving technical problems.
Establishes and maintains effective working relationships and communications with the MCO, HHS staff, and other internal/external stakeholders and provides timely responses to requests and inquiries.
Receives no more than 1-2 justified complaints per annual review period from internal or external stakeholders regarding professional conduct, appropriate interactions with others, timely responses and follow up, and/or work and email etiquette.
Demonstrates commitment to the goals of the Medicaid/CHIP services, shows initiative to take on new projects.
Team-oriented and committed to outstanding customer service and focuses on promoting efficiencies and accountability.
Communicates with Manager in a timely manner regarding problematic situations and applies independent judgment to ensure action taken is appropriate.
Participates in the review of RFP and evaluation of RFP responses within assigned timeframes.
Participates in the review, analysis, and evaluation of rules, bills, and federal/state laws with implications to the Medicaid/CHIP programs as required.
Attends work on a regular predictable schedule in accordance with agency leave policy.
Performs Other duties as assigned, timely and accurately.