Program Consultant - Medicaid School Policy

Agency

Division

Job Classification Title

Human Services Program Consultant III (NS)

Position Number

Grade

NC16

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Description of Work

Primary responsibilities include providing expert education and technical assistance on requirements of direct health care services covered in NC Medicaid Clinical Coverage Policy 10C that are provided and billed by LEAs, facilitating professional development, and spearheading stakeholder engagement initiatives to drive continuous quality improvement across the state to improve school health service utilization and mitigate audit risks. The incumbent will work internally with NC Medicaid clinical and cross-functional team leads on initiatives to develop policy, quality initiatives and education materials coordinated with NCDPI, to implement changes and education and support LEAs as health care providers in understanding federal and state regulations in providing these services. With a health care perspective, the incumbent will design and implement training and quality improvement initiatives regarding required LEA health care documentation and provide feedback through discussion and action plans designed to mitigate risk of audit findings.

The incumbent will continue to monitor LEAs for implementation of action plans, report findings to NC Medicaid clinical management and lead/assist management with analysis and planning to strengthen the program with expected increased utilization of services according to clinical policy, while supporting mitigation of risk of adverse audit findings.

The incumbent will assist management with designing and implementing evaluating and monitoring procedures and processes for quality initiatives; provide high quality customer services internally/externally; facilitate Departmental communications in coordination with NCDPI and school health/LEA provider relations functions; identify, evaluate and resolve customer issues and collaborate closely with management and others to develop and implement solutions; assist in developing/maintaining Unit operational policies and procedures; actively participate in Unit and other discussions/meetings; perform other duties as assigned. State-wide travel is required for this position.

Description of Work

Liaison for LEA-Medicaid Program Implementation:

• Act as the point person for all Medicaid school-based health service and unique CCP-10C related questions as the main representative voice for LEA school health service resources
• Host and organize regular meetings with DHB and NCDPI to discuss new and ongoing school health care issues, concerns, and opportunities for policy development and program improvement
• Work with DHB counterparts to ensure the accuracy of all Random Moment Time Study (RMTS) direct and indirect service pools to mitigate risk of audit findings
• Within the first year, evaluate the current Random Moment Time Study pool set-up and study options for reconfiguration that might result in increased program effectiveness
• Provide clinical expertise in the state-wide effort to achieve a uniform documentation system and ensure that the statewide school Electronic Health Record (EHR) system has functionalities needed for Medicaid reimbursement and documentation.
• Work with DHB clinical and cross-functional teams to clarify all Medicaid related questi