Heritage Health Program Specialist - MLTC

The work we do matters!

Hiring Agency:

Health & Human Services - Agency 25

Location:

Statewide Job Posting

Hiring Rate:

$23.313

Classification Salary Range:

$23.31 - $34.37

Job Posting:

JR2024-00006669 Heritage Health Program Specialist - MLTC (Open)

Applications No Longer Accepted On (If no date is displayed, job is posted as open until closed):

06-17-2024

Job Description:

Join the dynamic team at the State of Nebraska's Department of Health and Human Services, Division of Medicaid and Long-Term Care – Plan Management as a full-time DHHS Program Specialist. We are seeking individuals who are organized, possess outstanding customer service skills, and are dedicated to supporting our team in providing excellent service.

We provide our teammates with a supportive work environment and a comprehensive benefits package that includes:

• State-matched retirement contribution of 156%!
• 13 paid holidays
• Generous leave accruals that begin immediately
• A culture that embraces work-life balance
• Tuition reimbursement program
• 79% employer-paid health insurance plans
• Dental and vision insurance plans
• Employer-paid $20,000 life insurance policy
• Opportunity to be part of meaningful work and make a difference through public service
• Training and development based on your career aspirations
• Job security and stability, even during times of economic hardship
• Employee Assistance Program
• Fun, inviting teammates


The Medicaid program provides medical coverage for low income or disabled individuals. To help fulfill the agency goal of Helping People Live Better Lives, this position is necessary to ensure the proper administration of the Medicaid program. Program Specialists are responsible for researching, reviewing, analyzing the Heritage Health contract, and both federal and state regulations, to assist providers and members with inquiries or issues, such as problems with claims or credentialing/contracting with an MCO. They are also responsible for analyzing how regulations could impact the Medicaid program.

Job Duties:
The DHHS Program Specialist will be part of the managed care unit. The successful candidate will be responsible for implementation of program plans, goals, and objectives for Medicaid managed care and will assist with the monitoring of the Managed Care Organization (MCO) vendor contracts.

This includes:
- Monitoring day-to day activities including all activities related to contract
performance and assuring compliance with State and Federal requirements.
- Review, analyze and monitor reporting requirements and quality improvement
activities of the managed care plan.
- Working with the managed care contractors to meet the requirement of 42
CFR 438 and State regulations.
- Will work with the Plan Management team and other MLTC departments to
evaluate the impact of quality assurance programs on the health care services
provide to Managed Care enrollees.
- Participate in the competitive procurement process and assist in completing
readiness reviews.
- Provides liaison between and confers with other MLTC departments and
divisional personnel.
- Explains, clarifies, and interprets operational practices, policies, procedures,
federal and state regulations, contract requirements and activities related to
assigned program(s) to agency staff, community organizations, members of
the general public and contractors/service providers.
- Other duties as assigned.

Must be willing to relocate to Lincoln

 

Requirements/ Qualifications:

Minimum 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.

Preferred Qualifications: Experience working in or knowledge of Medicaid programs or other Health Insurance programs. Experience in contract management, claims, and communications. Experience with data and/or quality analysis, spreadsheet software programs, and/or data software programs.

 

Knowledge of: managed healthcare delivery systems; principles and practices of management, business and Management principles, including planning, budgeting, resource allocation; techniques of research, planning and evaluation; work performance or other standards of development, program analysis/evaluation; policy development.

Skill in: communicating to convey information so others will understand; pe