Program specialist h1.location_city

General Job Information

When you become a member of Team DHCF (Department of Health Care Finance), the state Medicaid agency for the District of Columbia, you join our "Mission Possible!" We work every day, in concert with various District government agencies, to streamline access to comprehensive, affordable and quality healthcare services for District residents. Whatever your position within our agency, you will positively impact beneficiaries, their families and their future! We invite you to bring your skills, your experience and your passion to a job that makes a difference.

Job Summary
This position serves as a Program Specialist responsible for implementing day-to-day processes and programs supporting persons receiving health care services via Medicaid financed long-term services and supports (LTSS).

Duties and Responsibilities
Provides input and assists in the development and review of policies, procedures, and regulations for Medicaid LTSS and long-term care, crafting new plans as needed to comply with Federal and District laws or in response to Program Manager requests. Develops and updates standardized tools and data collection instruments to capture information from desk reviews, on-site visits to vendors/providers/health plans, and homes of beneficiaries receiving Medicaid LTSS. Conducts administrative audits and reviews, including provider/vendor/health plan administrative and personnel records, financial documents, and beneficiary files, as part of ongoing operations, quality oversight, and monitoring processes. Conducts reviews of the quality of services rendered by Medicaid providers and health plans and beneficiary outcomes using standardized survey tools. Drafts written reports summarizing results of reviews and visits, identify deficiencies, communicate findings to providers/vendors/health plans, and review corrective action plans submitted in response to deficiencies identified during reviews.

Participates in the development, implementation, and oversight of Medicaid-financed services and programs for LTSS beneficiaries. This includes developing and implementing operations, quality oversight, and monitoring instruments, then analyzing results and preparing written reports detailing findings for these LTSS programs. Works with providers to ensure timely, accurate, and complete processing and submission of documentation pertinent to the successful, ongoing operations, quality oversight, and monitoring of Medicaid LTSS, including but not limited to providers, health plans, or beneficiary-specific data. Engages in problem-solving to address policy and procedural challenges and collaborates with other LTCA sub-teams to improve the quality of service delivery. Performs basic research and analysis of the medical, demographic, legal, and financial components of long-term care programs and policies, and makes recommendations to the Program Manager or LTC Director based on research findings.

Qualifications and Education
Specialized experience is an experience that is directly related to the position and has equipped the individual with the knowledge, skills, and abilities to successfully perform the duties of the position. To be creditable, at least one (1) year of specialized experience must have been equivalent to at least the next lower grade level in the normal line of progression.

Licenses and Certifications
None

Working Conditions/ Environment
The work is sedentary and performed in a typical office setting.

Other Significant Facts

Tour of Duty: Monday – Friday; 8:15 – 4:45

Pay Plan, Series and Grade: CS-0301-12

Promotion Potential: No Known Promotion Potential

Collective Bargaining Unit (Union): This position is represented by a collective bargaining unit and is subject to union dues through payroll deduction.

Position Designation: This position has been designated as security sensitive therefore the incumbent of this position will be subject to enhanced suitability screening pursuant to Chapter 4 of DC Personnel Regulations, Suitability and as such, incumbents of this position shall be subject to criminal background checks, background investigations, and mandatory drug and alcohol testing, as applicable.

EEO Statement: The District of Columbia Government is an Equal Opportunity Employer. All qualified candidates will receive consideration without regard to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, physical handicap, or political affiliation.