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Contract Monitor - MED

Posting Begin Date: 2025/09/26

Posting End Date: 2025/10/26

Category: Business

Work Type: Full Time

Remote: Flexible Hybrid

Minimum Salary: 27.12

Maximum Salary: 27.70

Pay Rate Type: Hourly

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 Idaho Department of Health and Welfare; Division of Medicaid has an exciting opportunity for aContract Monitorto join the Bureau of Clinical and Quality Management. The Bureau of Clinical and Quality 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 and monitoring contracts and agreements, quality management practices, healthcare policy research and analysis, troubleshooting participant issues, and daily application of program rules are extremely beneficial.

While the preferred location for this position isBoise, it's possible it can be filled at any DHW locationstatewide.

This position may be eligible forlimitedtelework after successful completion of probation and necessary training. Approval to telecommute is not guaranteed and subject to termination at any time.

BENEFITS:

BEST RETIREMENT AVAILABLE IN THE NATION

The State of Idaho offers a robust total compensation and benefits package, including but not limited to:

+ We have one of the Nation's best state retirement systems (https://www.persi.idaho.gov/members-1/) (PERSI) that offers a lifetime benefit at retirement.

+ 11 paid holidays

+ Paid sick and vacation that begins accruing on your first day of employment; can be used immediately after accruing (no waiting time)

+ Paid parental leave (https://dhr.idaho.gov/information-for-state-employees/)

+ Medical, vision, and dental insurance benefits that become effective first of the month following your hire date. All contributions can be pre-tax (full-time/30+ hours per week)

+ 2 voluntary supplemental retirement plans including both pre-tax and Roth options

+ Deferred compensation plan

+ Life insurance for self, spouse, and children

+ Short and long-term disability insurance

+ Flexible Spending Accounts (FSA)

+ Wide variety of training opportunities

+ Some positions offer flexible hours and/or telecommuting

+ Additional perks and discounts (https://www.regence.com/producer/tools-for-members/advantages-discounts) available through medical provider

+ Public Service Loan Forgiveness (PSLF) Eligibility (https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service)

+ Employee assistance program

Additional information related to benefits and/or State programs can be found here: https://dhr.idaho.gov/StateEmployees/Benefits.html.*

EXAMPLE OF DUTIES:

+ Serve as a subject matter expert on provisions of Medicaid's Quality Improvement Organization contract.

+ 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.

+ Process, manage and serve as departmental representation at hearings for contract-related appeals

+ 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.

+ 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.

+ Provide program support and education in assisting members navigating the program's benefits.

+ Possess a high attention to detail, exceptional documentation and writing abilities, and organizational skills.

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 by at least one year of related experience.

+ Experience writing audit plans, preparing audit reports and monitoring implementation of corrective action plans. Typically gained by at least one year of related experience.

+ Experience in both individual and group communication techniques that involve various stakeholders, facilitation to include providing presentations, public speaking and fielding open question and answer sessions. Typically gained by at least one year of related experience.

+ 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 efficiently and effectively analyzing logistical needs for appointment scheduling. Typically gained by one year of related experience.

Learn About a Career with DHW (https://healthandwelfare.idaho.gov/about-dhw/dhw-careers)

***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: [email protected] 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[email protected].

Preference may be given to veterans who qualify under state and federal laws and regulations.