Contract Monitor - MED - State of Idaho

Description

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

*THIS ANNOUNCEMENT WILL BE OPEN UNTIL FILLED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE TO BE CONSIDERED.*

The Division of Medicaid, Bureau of Care Management (BCM) has an exciting opportunity to join the team as a Contract Monitor. This position will be  monitoring performance and customer care of a dynamic program that interacts with other IDHW programs, care providers, network service providers, and Idaho Medicaid's contractors. This opening is for one full time position supporting various contracts overseen by BCM, but primary focus will be for supporting the Non-emergency Medical Transportation and Dental programs, as well as for other monitoring, participant assistance, and related projects in BCM as needed. This is a statewide position and will report to the nearest DHW location.

NEMT provides support and oversight of services carried out by a contracted broker to provide transportation to participants with medically necessary appointments. Dental program provides contractual support and oversight to a managed care organization that contracts with providers to provide necessary dental services. Both programs are statewide, single contractor, respectively. DHW Program Specialists in BCM review performance issues and gaps in service, review reporting, provide stakeholder education, review documents necessary to implement services or contracts in the programs, and similar activities on a routine and ongoing basis.

The Bureau of Care Management is a supportive, dynamic team looking for applicants with a passion to support Idaho citizens, desire to improve systems, and excited to learn about federal and state healthcare systems. This position works directly with a participating service contractor to monitor performance and ensure compliance with contract provisions, state and federal regulations, and other requirements. A successful candidate will be a solution oriented critical thinker, tactful negotiator, and a skilled communicator both verbal and written. Experience with developing contracts and agreements, healthcare policy research and analysis, troubleshooting participant issues, and daily application of program rules are extremely beneficial.

 If you are a critical thinker with an interest in the many moving parts of a complex managed care program, this may be a great fit for you! The position offers an opportunity to gain a depth of expertise in many aspects of Medicaid, while creating and maintaining relationships with key community partners and stakeholders. This position can be hybrid (after probationary period) or fully in the office but the candidate must be willing to travel to the main office as necessary.

This position may be eligible for telework after successful completion of probation and necessary training.

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

EXAMPLE OF DUTIES:

• Monitor daily and long term contractor performance in alignment with the provisions outlined in the contract's scope of work, Idaho Administrative Code (IDAPA), and applicable state and federal regulations. 
• Evaluate routine data reports supplied by the plan's contractor for compliance with scope of work provisions. 
• Monitor issues reported to the program's team by internal and external stakeholders, dispatching for resolution and tracking trends for systemic issues.
• Produce regular and ad hoc monitoring reports as well as monitor the implementation of corrective action plans and successful remediation of identified issues. 
• Provide program support and education in assisting members navigating the program's benefits. 
• Support participant and stakeholder outreach activities, including presentations to varying group sizes about the program. 
• 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. 
• Excellent verbal communication skills in presentation and on phone calls with participants is required. 

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.

• Experience developing; recommending and evaluating operating procedures and recommending changes. Typically gained by 

  approximately one year of experience where this was a primary responsibility of the job. This experience may include participation in a regional or statewide quality assurance team, business change or project team or a similar assignment.
• Experience developing technical written materials such as policies, technical manuals or rules/regulations. Typically gained by at least one year experience working in a business setting developing training materials, reports, policy and/or procedure manuals, written interpretations of law, rules, or policies, or any related background which would be considered similar. 
• Experience providing technical program assistance to staff. Typically gained by at least one year of experience providing technical assistance to staff in a business setting which could include formal and informal assignments to assist, mentor or train new staff. 

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

• Experience multi-tasking projects of varying urgency and due dates. Typically gained through one year of experience requiring the completion, attention, and coordination of multiple projects with varying urgency and timelines.
• Experience providing consistent, high-quality, customer assistance in verbal and written form. Typically gained through two years of combined education or experience where communication with customers involved consistent use of verbal and written communications to inform, investigate, or educate customers in a professional manner.
• Experience applying rules, policies, and procedures to particular circumstances on a regular basis. Typically gained by at least one year of related experience. 
• Experience in navigating eligibility systems for benefits or insurance plans to determine and communicate eligibility. Typically gained by at least one year of related experience. 
• Experience in efficiently and effectively analyzing logistical needs for appointment scheduling. Typically gained by one year of related experience.

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.