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This position is located in the NJ FamilyCare, DMAHS Offices, Hamilton Township, NJ 08619

SUMMARY:

The Medicaid Eligibility Policy Subject Matter Expert will work within the Office of Eligibility Policy and Operations (OEP) leadership at the Division of Medical Assistance and Health Services (DMAHS), New Jersey Department of Human Services located in Hamilton NJ. This individual will provide support and recommendations in analyzing, developing, and providing expert guidance on Medicaid policies at the State and Federal levels. The role requires someone who can apply NJ eligibility rules and systemic processes to navigate and advise on improvements within the NJ Medicaid system.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

+ Researches, analyzes and interprets NJ Medicaid State and Federal rules and regulations.

+ Recommends program policy changes and clarifications to better serve members and leadership.

+ Works with DMAHS System Workgroups to build eligibility functionality in the Worker Portal.

+ Recommends and participates in testing processes, data analysis and may work on manual processes that result from systemic rejections.

+ Works across Office of Eligibility Policy and Operation’s office units on researching policy and operational processes to provide guidance on complex cases.

+ Provides written and oral guidance to all Eligibility Determining Agencies (EDAs) including but not limited to writing Medicaid communications, creating training materials, fact sheets and progress reports.

+ Recommends training content and leads training workshops as appropriate to EDAs, stakeholders and DMAHS staff. Trains additional trainers as needed.

+ Visits County Social Services Agency (CSSA) / eligibility determining agencies to assist in establishing best practices and troubleshooting issues.

+ Assists with Special Projects as assigned.

+ May interact with the public and stakeholders as needed to fulfill the essential duties of the position.

+ May supervise eligibility policy or county operations staff as needed.

+ Proficient with electronic and/or manual recording and information system used by the agency, office, or related units.

+ Stay current with changes in Medicaid policies and regulations and conduct research and analysis to support policy development and implementation.

+ Excellent oral and written communication skills. Ability to prioritize, exercise sound judgment and discretion, meet deadlines and work under pressure in a fast-paced environment with multiple stakeholders. Demonstrated knowledge of how to accomplish superior performance in a unionized environment is necessary.

+ Other related duties for the Office of Eligibility Policy as needed.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION:

+ Bachelor’s degree in public policy, Healthcare Administration, Political Science, or a related field required.

EXPERIENCE:

+ At least 5 years of experience working with Medicaid programs with strong preference working in an eligibility determining agency with staff oversight.

+ Strong understanding of Medicaid policies, regulations, and preference for someone experienced with NJ Medicaid operations and eligibility systems.

+ Excellent research, analytical, and problem-solving skills.

+ Proficient in using Microsoft office systems, especially Excel.

+ Strong communication and interpersonal skills, with the ability to clearly explain complex Medicaid issues to non-experts.

+ Ability to work independently and as part of a team, managing multiple projects with competing deadlines.

+ Knowledge of Medicaid systems that include Integrated Eligibility System (IES), Medicaid Eligibility System (MES), Medicaid Management Information System (MMIS), Asset Verification System, Personal Responsibility System and Document Imaging Management System preferred.

+ Experience in training staff/stakeholders on Medicaid information.

+ Knowledge of Medicaid waivers, managed care enrollment, and state-specific Medicaid program requirements.

NOTES:

+ Only completed, online applications submitted on or before the deadline will be considered.

+ Candidates must be legally authorized to work in the US, and the university will not sponsor an applicant for a work visa for this position.