Job Description:
The program specialist is selected by and reports to the Manager for Program Policy in the Medicaid & CHIP services department (MCS). This position is responsible for coordinating and monitoring the implementation of Medicaid activities related to the Frew, et al. v Young, et al. Civil Action No. 3:93:CV65 (Frew) lawsuit. The position is also responsible for other activities related to Medicaid programs including Texas Health Steps.
The Program Specialist VI provides highly advanced consultative, analytical, and monitoring services to promote performance improvement of managed care organizations (MCOs) and dental maintenance organizations (DMOs as well as traditional Medicaid). The Program Specialist VI identifies problems or areas for improvement, analyzes issues, and proposes solutions; and provides consultation and technical assistance to relevant Medicaid/CHIP areas on contract requirements necessary to meet court orders, assist with monitoring compliance with lawsuit requirements; and identify and escalate areas of concern. Works under limited direction with extensive latitude for the use of initiative and independent judgment. Develops and implements complex work plans and timelines. Leads groups and committees of internal and external stakeholders. Independently prepares reports of findings and recommendations. Prepares briefings for senior level staff to provide project status updates and to identify issues and recommendations.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy.
(20%) Works closely with the HHS Frew Coordinator, the HHS Legal department, and Data, Analytics and Performance team and vendors on behalf of the MCS Office of Policy. Provides written and oral communication regarding status of court orders, identifying potential risks /potential conflicts associated with compliance with those orders, and federal statutes. Participates in development and implementation of solutions to mitigate risks. Works with the MCS Managed Care Compliance and Operations staff to ensure and enforce MCO/DMO compliance with reporting required by the lawsuit. Explains and educates internal and external MCS staff about Frew requirements. Participates in implementation of new laws and regulations to ensure compliance Frew. Develops and recommends new and effective Texas Medicaid policies for children and youth under age 21 as the lawsuit rulings change.
(20%) Leads projects related to performance improvement and quality monitoring for Texas Medicaid services for children and youth under age 21, including both managed care and traditional Medicaid. These include validation of Texas Health Steps reports, analyzing trends and making recommendations for improvement projects. Serves as functional lead on assigned managed care improvement projects such as review and analysis of annual migrant plans for migrant families. Manages complex processes to identify quality gaps to improve reporting processes, track quality improvements, and enhance current system. Develops and implements complex work plans and timeline for critical initiatives like improving utilization of Texas Health Steps checkups.
(20%) Develops internal policies and procedures; works with other program staff in determining trends and resolving technical problems; coordinates with staff across areas and agencies and with contractors; provides consultative services and technical recommendations to MCOs/DMOs on applicable topics and works with MCO/DMO staff to resolve technical and operational issues. Works with staff and external stakeholders to identify risks/issues and develop mitigation strategies and solutions. Provides consultative and technical assistance for health plan operational issues, program and policy changes that affect quality and performance of MCOs and DMOs, issues identified by MCOs/DMOs, HHSC leadership, or other external stakeholders. Conducts detailed research and analyses of quality assurance and performance improvement operational issues including examination of rules, policies, laws and regulations.
(20%) Prepares a variety of high quality reports, studies, policies, and other deliverables containing analyses of Medicaid performance for children and youth under age 21, including the identification of issues and recommendations for HHSC leadership. Provides oral presentations related to these written materials and reports. Analyzes Texas Medicaid services and quality indicators as well as the impact of state and federal laws and regulations for children and youth under age 21 enrolled in Texas Medicaid. Identifies the need of new requirements for programs to mitigate risk. Oversees the collection, analysis, organization, and preparation of materials in response to leadership and legislative requests for Frew-related formation and reports. Serves as the subject matter expert on Frew-required activities
(10%) Provides consultative services and technical assistance related to the development, evaluation and implementation of Frew court orders and special projects related to Medicaid/CHIP programs including review of existing policies and uniform managed care contract and manual requirements, making subsequent revisions and responding to stakeholder comments; convening and leading workgroups of agency staff, external stakeholders (e.g., health plans, dental plans), and consumers to identify and resolve issues related to Frew court orders and assigned projects.
(10%) Develops and maintains provider relations SharePoint site to promote good communication between HHSC and the Department of State Health Services provider relations staff. Special projects as assigned, which could include legislative analysis; reports on issues related to children and youth under age 21 unrelated to the lawsuit; and using writing, analysis, and presentation skills to help the broader MCS Policy team. Keeps supervisor informed of pertinent issues in a timely manner and refers budgetary decisions to supervisor.
Knowledge Skills Abilities:
Knowledge of Medicaid and CHIP, including managed care programs. Knowledge of federal laws, regulations, and processes regarding Medicaid managed care. Skill in research, data analysis, and policy development. Skill in leading teams and working with multiple stakeholders. Skill in written and oral communication, including the ability to make public presentations, write technical information in an understandable format, and produce sophisticated reports. Skill in using personal computer application software such as MS Word, PowerPoint, Excel, or similar programs. Ability to work cooperatively as a team member in a fast-paced, deadline-orientated environment. Ability to plan and organize work. Ability to perform work with a high degree of attention to detail. Ability to lead others. Ability to use initiative and independent judgment.
Registration or Licensure Requirements:
N/A
Initial Selection Criteria:
Initial Screening Criteria:
Candidates must meet one of the following:
1) Bachelor's degree from an accredited four-year college or university and at least two years' full-time work experience in health and human services;
2) Master's degree in public affairs, social work, public health, or related field and at least one year of full-time work experience in health and human services; or
3) Combined six or more years of college and full-time work experience in health and human services.
Additional Information:
Requisition ID: 620833
MOS Code:
N/A
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I-9 Form - Click here to download the I-9 form.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at [redacted]. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
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