Medical Program Specialist (Quality Assurance Specialist)

The Idaho Department of Health and Welfare’s Division of Medicaid, Bureau of Long Term Care has an exciting opportunity for a forward-thinking, self-directed, innovative team member to join us as a Quality Assurance Specialist for the West Hub (Regions 3 and 4). This position may be based in either Boise or Caldwell, but will frequently travel between the two regions.

This position will work directly with providers, participants, stakeholders, and administration to ensure program compliance and the appropriate delivery of services. This position will serve as Quality Assurance Specialist for the Bureau of Long Term Care covering Regions 3 and 4 for the West Hub operations team. This position schedules and conducts audits and targeted reviews for Provider compliance to measure accuracy, consistency and compliance with laws, regulations, policies and standards. This position will directly support and work closely with the bureau’s Quality Assurance Manager, program policy staff, field staff and Idaho Medicaid providers.

We are seeking applicants with experience conducting healthcare audits and monitoring; provider training and education; assessment of compliance with policies, procedures, and federal and state regulations and guidelines; identification and recommendation of strategies for process improvements; and preparation of written reports and findings. The ability to deliver excellent customer service and work in a fast-paced, evolving, dynamic work environment is also required.

This individual will join a team of clinical and non-clinical staff who partner with Medicaid providers and associations, as well as other Medicaid bureaus and Health and Welfare divisions, to ensure waiver providers are complying with the requirements set forth in the Idaho Medicaid Provider Agreement and IDAPA regulations, and to ensure consistent audits and evaluations are completed and support the service delivery outlined for Medicaid participants.

This announcement will be used to fill the current vacancy in Boise/Caldwell only. If you have previously applied for Medical Program Specialist and wish to be considered for this position, you must reapply under this announcement. Previous scores will not be used.

The Idaho Department of Health and Welfare is a drug-free workplace. Any applicant offered employment in this position at the Idaho Department of Health and Welfare will be required to pass a pre-employment drug test.

Responsibilities:
Schedule and conduct audits for provider compliance in accordance with IDAPA and Idaho Medicaid provider Agreement(s)

Perform quality assurance/improvement activities related to service delivery

Collect, analyze and aggregate data from all assessment and monitoring activities, assess for compliance with state regulations

Review provider operations for efficiency, effectiveness, and compliance with program requirements

Identify operational deficiencies and remediation strategies

Prepare comprehensive written reports of completed audits and provide supporting conclusions, possible deficiencies, recommendations for improvement, Corrective Action Plan requests, and recommendations for provider agreement enforcement, provider sanctions, up to disenrollment or

monetary withholds

Present findings and results to management and advise on compliance with established requirements and standards

Perform both desk reviews and on-site assessments compliance with regulations. Use a collaborative approach to support providers in correcting deficiencies

Support the Quality Assurance Manager in developing instructional materials; evaluating program policies, procedures or system modifications and recommending changes

Investigate and document abuse, neglect and exploitation complaints

Conduct quality assurance activities and conduct professional level interviews

Conduct HCBS provider training(s) and provide expertise and technical assistance to staff and stakeholders, including responding to public record requests and other inquiries, to ensure professional, accurate, consistent program administration and communication

Possess a high attention to detail, exceptional documentation and writing abilities, and organizational skills, including proficiency with a minimum intermediate level experience in Microsoft Excel, Word and PowerPoint. Statistics experience a plus.

Minimum Qualifications:
Experience performing healthcare audits and/or healthcare quality reviews

Good knowledge of medical service delivery systems

Some knowledge of current laws and regulations governing Title XIX Medicaid programs

Some knowledge of training methods

Experience developing instructional materials

Experience evaluating program policies and procedures and recommending changes

Additional Qualifications: Are not required, however, having the minimum qualifications and the education and/or experience below will increase your score.

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 Q&A sessions. Typically gained by at least one year of related experience.

Experience using programs such as SharePoint, Microsoft Word, PowerPoint, electronic document management system, and Excel. Typically gained by at least three months of professional experience using these programs.

Exam:
There is an exam for this position to determine an applicant’s eligibility. Click the “Preview Exam” button below to review the exam. You must receive a score of 63 to pass this exam. If at any time during the screening/testing process your responses or resume do not support the answers you provided, your name will be removed from the register.