Program Specialist

Program Specialist (Open)

Join the dynamic team at the State of Nebraska's Department of Health and Human Services, Division of Medicaid and Long-Term Care Claims as a full-time DHHS Program Specialist. We are seeking individuals who are organized, possess outstanding customer service skills, and are dedicated to supporting our team in providing excellent service. The Medicaid program provides medical coverage for low income or disabled individuals. To help fulfill the agency goal of Helping People Live Better Lives, this position is necessary to ensure the proper administration of the Medicaid program. Program Specialists are responsible for researching, reviewing, analyzing, and interpreting both federal and state regulations to develop agency regulations, procedures, and interpretations and are responsible for analyzing how regulations could impact the Medicaid program.

The DHHS Program Specialist will be part of the managed care unit. The successful candidate will be responsible for implementation of program plans, goals, and objectives for Medicaid managed care; assist with the monitoring of the Managed Care Organization (MCO) vendor contracts.

This includes :

• Serves as a liaison between Nebraska Medicaid providers and members and the managed care organizations regarding various program issues.
• Maintains an accurate log and applicable records of provider and member issues, follows up on outstanding items, works issues through to resolution.
• Provides quality service to internal and external entities.
• Manages daily downloading and uploading of managed care deliverables into SharePoint.
• Reviews and analyzes managed care deliverables and reports to determine regulatory and contract compliance.
• Identifies and monitors trends in issues, performance, and compliance.
• Explains and clarifies federal and state regulations, MCO contract requirements to Nebraska Medicaid providers and members (when necessary.)
• Contributes to special projects and leadership requests for Plan Management individually or with other team members.
• Other duties as assigned.

Minimum Qualifications : Bachelor's degree, or equivalent coursework / training, in public administration, social / behavioral sciences, healthcare, human services or other program related field. Professional experience working in a human / social service or health care agency with responsibility for planning or evaluation services, programs or operational policies and practices may substitute in lieu of the educational requirement.

Preferred Qualifications : Experience working in or knowledge of Medicaid programs or other Health Insurance programs. Experience in contract management, claims, and communications. Experience with data and / or quality analysis, MS Suite, NFOCUS, C1, and / or data software programs.

Other : Position is located on-site at the Nebraska State Office Building in Lincoln.

Knowledge of : managed healthcare delivery systems; principles and practices of management, business, and Management principles, including planning, budgeting, resource allocation; techniques of research, planning and evaluation; work performance or other standards of development, program analysis / evaluation; policy development.

Skill in : communicating to convey information so others will understand; performing quality assessment reviews and evaluating program effectiveness; identifying problems and developing options for solutions.

The successful candidate will possess excellent communication skills, organizational skills, and problem-solving ability as well as the ability to work on a team.

Ability to : work collaboratively in a team setting; establish and maintain positive relationships with agency staff and external partners; communicate effectively to promote, explain, discuss, and interact with interested groups on various program issues; prepare and review documents such as summaries of state and federal regulations and reports; understand, interpret and apply laws, rules, policies and procedures pertinent to the program; exercise independent thinking skills; maintain liaison with community representatives and other governmental agencies.