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Medicaid Program Specialist - MED

Posting Begin Date: 2025/10/30

Posting End Date: 2025/11/13

Category: Records Management

Work Type: Full Time

Remote: Flexible Hybrid

Minimum Salary: 27.12

Maximum Salary: 28.93

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 Division of Medicaid, Bureau of Care Management (BCM) has an exciting opportunity to join the team 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 as aMedicaid Program Specialistsupporting various contracts overseen by BCM, but primary focus will be for supporting the Non-Emergency Medical Transportation and Vision programs, as well as for other monitoring, participant assistance, and related projects in BCM as needed.

NEMT provides support and oversight of services carried out by a contracted broker to provide transportation to participants with medically necessary appointments. Vision program provides contractual support and oversight to a vendor that fulfills medically necessary vision equipment, working with internal teams, licensed providers, and participants to connect medicaid optical providers with glasses and contacts supplier.. 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 is a statewide position and will report to their nearest DHW location.

This position may be eligible for limited telework 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:

+ Leads in daily relationship and assistance to the Medicaid vision products contractor, ensuring products are compatible with contract and IDAPA restrictions.

+ Provides prompt assistance, review, quality assurance, and compliance monitoring for urgent, non-typical, complex, and long distance transportation requests in NEMT.

+ Monitor daily and long term contractor performance in alignment with the provisions outlined in the contract's scope of work, Idaho Administrative Procedures (IDAPA) and applicable state and federal regulations.

+ Evaluate routine and as-needed data reports supplied by the plans' contractors for compliance with scope of work provisions.

+ Monitor issues reported to the programs' teams by internal and external stakeholders, dispatching for resolution and tracking trends for systemic issues.

+ Ensure timely responsiveness to email and phone boxes for NEMT and vision teams, and supporting other BCM teams and colleagues as needed; provide prompt and thorough review and referral of urgent requests.

+ Support quality insight research in multiple BCM programs.

+ Ensure eligibility issues with members or providers are investigated and referred for resolution timely and as appropriate.

+ Ensure prompted thorough review of fair hearings requests and public records requests assigned to vision and NEMT programs as assigned, including collection of responses and coordination with hearings staff.

+ Produce regular and ad hoc monitoring reports as well as monitor the implementation of corrective action plans and successful remediation of identified issues.

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 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.

+ Experience in daily coordination of order needs and support within the context of Medicaid NEMT and/or Vision programs.Typically gained by one year of related experience.

+ Experience with coordination of Idaho Medicaid benefits with vendors, members, and providers.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.