• Job Description

  Req#: 23-002419-0018

  GRADE

  18

  LOCATION OF POSITION

  MDH - Division of Provider Integrity, Claims and Compliance 201 W. Preston Street Baltimore, MD 21201

  Main Purpose of Job

  This position will be responsible for conducting audits of the program providers and analyzing data and policies to improve provider quality and compliance. Monitoring of Federal Community Settings Rule for all providers enrolled in Medicaid, including implementation of a division-wide work plan, managing workload to accomplish the required tasks and site visits. Engage the provider community in policy and implementation plan. Initiate education and training activities related to the Final Rule and responsible for demonstration of full compliance. This position will develop, implement, and evaluate policies, procedures, and regulations for Medicaid home and community-based services (HCBS), including the Community Personal Assistance Services (CPAS), Community First Choice (CFC), Home and Community-Based Options Waiver (HCBOW), and Increased Community Services (ICS) programs. This position is responsible for performing qualitative and quantitative analyses on programmatic data, provider network adequacy and availability, service claims and payments, and overall program expenditures, to monitor service delivery and utilization, ensure compliance with policies and regulations, and identify opportunities for continuous quality improvement. This position will also research, analyze, design, and direct the implementation of new workflows and project tasks related to provider service claims and payments, and the routine evaluation of provider performance with the goal of increasing the efficiency, effectiveness, and quality of services provided. Using data, this position will develop and present recommendations concerning alternative approaches to the delivery, financing, and evaluation of Medicaid HCBS, specifically those provided to participants of the CPAS, CFC, HCBOW, and ICS programs. As a subject matter expert, this position will apply program policies by verifying program-specific eligibility for providers of the CPAS, CFC, HCBOW, and ICS programs, initiating payment adjustments based on claims data analyses, auditing providers, including conducting on-site visits, developing educational materials and providing training and technical assistance to providers regarding program processes, identifying and implementing enhancements for LTSS Maryland, and collaborating with other Divisions regarding the Office of Long-Term Services and Supports’ (OLTSS) overall quality program. This position will also consult on strategies for program policies, program operations, including eligibility and enrollment, and program evaluation for the Department’s leadership, in support of this, the position will prepare high-level documents on technical aspects of these strategies as they relate to existing State and federal regulations, service delivery and utilization, and overall fiscal impact. This position operates in a hybrid manner, meaning job duties will be performed both remotely and on-site unless otherwise directed by the appointing authority.

  MINIMUM QUALIFICATIONS

  Education: A Bachelor's degree from an accredited college or university. Experience: Two years of experience evaluating, analyzing, researching and developing health care services, policies and programs. Notes: 1. Candidates may substitute the possession of a Master's degree in Health Sciences, Health Care Administration, Public Health, Public Policy or closely related fieldfor one year of the required experience. 2. Candidates may substitute the possession of a Doctorate degree in Health Sciences, Health Care Administration, Public Health, Public Policy or closely related fieldfor the required experience.

  LICENSES, REGISTRATIONS AND CERTIFICATIONS

  Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator’s license valid in the State of Maryland.

  SELECTION PROCESS

  Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position.Therefore, it is essential that you provide complete and accurate information on your application.Please report all related education, experience, dates and hours of work.Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview). Complete applications must be submitted by the closing date.Information submitted after this date will not be added. Incorrect application forms will not be accepted.Resumes will not be accepted in lieu of a completed application. Candidates may remain on thecertified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

  BENEFITS

  Contractual employees who work for an agency covered under the State Employee and Retiree Health and Welfare Benefits Program, have a current employment contract and work 30 or more hours a week (or on average 130 hours per month) may be eligible for subsidized health benefits coverage for themselves and their dependents. As a contractual employee, you will be responsible for paying 25% of the premiums for your medical and prescription coverage, including any eligible dependents you have enrolled. The State of Maryland will subsidize the remaining 75% of the cost for these benefits. You can also elect to enroll in dental coverage, accidental death and dismemberment insurance, and life insurance, but will be responsible to pay the full premium for these benefits. Leave may be granted to a contractual employee who has worked 120 days in a 12 month period. This leave accrues at a rate of one hour for every 30 hours worked, not to exceed 40 hours per calendar year.

  FURTHER INSTRUCTIONS

  Online applications are highly recommended. However, if you are unable to apply online,the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201.Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted. If additional information is required, the preferred method is to upload. If you are unable to upload, please fax the requested informationto 410-333-5689.Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time. For questions regarding this recruitment, please contact theMDH Recruitment and Selection Division at 410-767-1251. If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 orApplication.Help@maryland.gov. Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258. We thank our Veterans for their service to our country. People with disabilities and bilingual candidates are encouraged to apply. As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.

• About the company

  Maryland is on the path to becoming the best state in the nation. Referred to as “America in Miniature”, Maryland embodies the very spirit of the United States. Maryland is home to ethnic groups of every origin, just about every natural feature, and much like our country, opportunity!

Notice