Medical Policy Specialist jobs in Twin Falls, ID

Description

DEDICATED TO STRENGTHENING THE HEALTH, SAFETY, AND INDEPENDENCE OF IDAHOANS

Applications will be accepted through 4:59 PM MST on the posting end date.

The Division of Medicaid, Bureau of Long Term Care has an exciting opportunity for a forward-thinking, self-directed, innovative team member to join us as a Quality Assurance Specialist.

This position will work directly with service providers, participants, stakeholders, and administration to ensure program compliance and the appropriate delivery of services administered by the Bureau of Long Term Care. This position schedules and conducts routine audits and targeted reviews of provider compliance to evaluate compliance with laws, regulations, policies and standards. This position will directly support and work closely with the bureau’s Quality Assurance Manager, program policy staff, field staff and Idaho Medicaid providers.

The Idaho Department of Health & Welfare is a drug-free workplace. Any applicant offered employment in this position at the Idaho Department of Health and Welfare will be required to pass a pre-employment drug test. In addition, successful candidates will be required to complete a criminal history background investigation. Employment is dependent upon satisfactory results of the investigation.

BENEFITS:

BEST RETIREMENT AVAILABLE IN THE NATION

We have one of the Nation's best state retirement systems (PERSI) that offers a lifetime benefit.

OTHER EXCELLENT BENEFITS

• 11 paid holidays
• Generous vacation and sick leave accrual beginning as soon as you start
• Paid parental leave
• Medical, dental, vision insurance - incredible rates!(full-time/30 hours per week)
• PERSI Choice 401(k)
• Deferred compensation plan
• Life insurance
• Short and long-term disability insurance
• Student Loan Forgiveness
• Wellness programs
• Employee Assistance Program (EAP)
• Flexible Spending Accounts (FSA)
• Wide variety of training opportunities
• Some positions offer flexible hours and/or telecommuting

• Schedule and conduct audits for provider compliance in accordance with IDAPA and Idaho Medicaid provider Agreement(s).
  
• Prepare comprehensive written reports of completed audits and provide supporting conclusions, possible deficiencies, recommendations for improvement, Corrective Action Plan requests, and recommendations for provider agreement enforcement.
  
• Present findings and results to management and advise on compliance with established requirements and standards.
  
• Collect, analyze, and aggregate data from all assessment and monitoring activities, assess for compliance with applicable state and federal regulations.
  
• Support the Quality Assurance Manager in developing instructional materials.
• Evaluate program policies, procedures, or system modifications and recommend changes.
  
• Investigate and document incoming complaints and critical incidents, including abuse, neglect, and exploitation complaints.
  
• Conduct provider training(s) and provide expertise and technical assistance to providers, staff, and other stakeholders, including responding to public record requests and other inquiries, to ensure professional, accurate, consistent program administration and communication.
  
• Possess a high attention to detail, exceptional documentation and writing abilities, and organizational skills. Proficiency with a minimum intermediate level experience in Microsoft Excel, Word and PowerPoint is expected.

MINIMUM QUALIFICATIONS:

You must possess all the minimum qualifications below to pass the exam for this position. Please make sure your resume or work history supports your meeting the minimum qualifications for this position. Failure to do this may disqualify you from being considered for this position. It is highly recommended to attach a one-page cover letter to your application to demonstrate how you meet the requirements below.

• Good knowledge of medical service delivery systems. Typically gained by completion of at least two college courses in a medical/health services field, public health or health care administration or related field (including but not limited to psychology, special education, RN, LPN, medical office assistant, etc.) AND one year of experience applying the knowledge in a medical service delivery system OR at least two years of experience as described.
• Some knowledge of current laws and regulations governing Title XIX Medicaid programs. Typically gained by one year of experience where knowledge and understanding of Title XIX Medicaid laws and regulations was a job responsibility.
• Some knowledge of training methods. Typically gained by successful completion of coursework or workshops of 16 hours or more covering communication concepts, learning styles, course design, and presentation skills or experience in presenting formal training sessions to groups.
• Experience developing instructional materials. Typically gained by one year of experience actually developing (not just presenting) instructional course content and materials.
• Experience evaluating program policies and procedures and recommending changes. Typically gained by one year of job experience which included the opportunity to evaluate the employer’s policies and procedures and provide input and/or recommend changes. Experience comparing employer’s policies and procedures to Medicaid or other governmental regulatory requirements would qualify as experience.

Below is preferred experience. It is not required for the position but applicants with this experience may receive consideration over other applicants.

• Experience writing audit plans, preparing audit reports and monitoring implementation of corrective action plans. Typically gained by at least one year of related experience.
  
• Experience in both individual and group communication techniques that involve various stakeholders, facilitation to include providing presentations, public speaking and fielding open question and answer sessions. Typically gained by at least one year of related experience.
  
• Experience using programs such as SharePoint, Microsoft Word, PowerPoint, electronic document management systems, and Excel. Typically gained by at least six months of professional experience using these programs.

Learn About a Career with DHW

***PLEASE NOTE: application assistance is not available after the business hours listed below, on the weekends, or on holidays and you must apply before 4:59 pm on the closing date. When applying, use CHROME as your browser to avoid complications.

If you have questions, please contact us at:

Email is the quickest way to get an answer to your questions.

(answered Monday through Friday during business hours MST)

EMAIL: dhwjobs@dhw.idaho.gov
PHONE: (208) 334-0681

EEO/ADA/Veteran:

The State of Idaho is committed to providing equal employment opportunities and prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on their race, color, religion, political affiliation or belief, sex, national origin, genetics, or any other status protected under applicable federal, state, or local laws.

The State of Idaho is committed to access and reasonable accommodations for individuals with disabilities, auxiliary aids and services are available upon request. If you require an accommodation at any step in our recruitment process, you are encouraged to contact (208) 334-2263 (TTY/TTD: 711), or email ada.coordinator@dhr.idaho.gov.

Preference may be given to veterans who qualify under state and federal laws and regulations.