Serves as the program consultant responsible for health care program administration and consultative services, including modifications to policies and procedures, program utilization review and analysis program materials and forms, policy and procedure change implementation, monitoring program contracts and/or providing technical assistance to clients, health care providers, community partners, agency staff and/or partner agencies.

Develops and makes recommendations for formal eligibility and authorization procedures for statewide administration and implementation of health care programs;

Coordinates implementation of policies with staff from other divisions to ensure cross-program compliance;

Recommends, interprets, and implements health care program policies and procedures; promulgates administrative and procedural regulations for program implementation;

Consults with federal, state, and agency staff in the development and implementation of program and procedural changes to assure compliance with federal/state eligibility requirements;

Leads in-depth analyses of complex health care issues and within program guidelines; prepares project plans, conducts or leads data-gathering operations, analyzes data, reports specific findings, develops recommendations, and prepares project reports for written and/or oral presentation;

Provides technical and consultative assistance to legislative staff, other state officials, providers, recipients, state and local groups, and legal aid professionals regarding the statewide health care programs;

Writes and maintains program materials and forms, including provider billing guides, resource guides, provider enrollment manuals, and other publications;

Works with providers and staff to ensure appropriate implementation and application of program policies; suggests policy modification to program manager;

Reviews and analyzes complex claims information to identify solutions to reduce claims errors; provides consultative services to providers and community partners on policy application and technical support for billing issues;

Analyzes and evaluates proposed legislation and program and policy changes to ascertain evaluate administrative feasibility; makes recommendations to program manager and agency leadership;

Assists with development and implementation of in-depth training on programs criteria, administration, and/or technical requirements to community partners, internal and external stakeholders, and staff; assists in the presentation of training;

Monitors program policies and procedures for adequacy and consistency and makes recommendations in order to improve effectiveness of program delivery;

Provides liaison and coordination with other bureaus and divisions on programs having cross-agency or cross-divisional impact;

Participates in the decision-making process and coordinates implementation of program policy changes from project recommendations;

Consults with division, agency, other state and federal administrative staff regarding implementation, monitoring, and follow-up on project recommendations;
Prepares correspondence to federal, state, provider, community, and other agencies regarding inquiries;

Performs other work as required.

Knowledge of: state and federal rules, policies, and regulations related to health care programs; principles and practices of program planning and evaluation; current trends and economic problems relating to health care providers and clients; health care organizations, and the health care industry; the legislative process; principles of individual and group behavior, social behavior, social and economic conditions, and their effects upon individuals; office procedures and practices; contract management and monitoring; the Health Information Portability and Accountability Act.

Ability to: develop programs and work with program evaluators; work effectively with program staff, providers, clients, members of the community, external organizations, and state and federal partners; manage projects; analyze and resolve complex problems related to health care programs; appropriately interpret and apply complex state and federal regulations; write and develop statewide policies; communicate clearly and effectively both orally and in writing ; make legally defensible independent decisions; analyze information and identify modification to improve program performance.

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.

Persons legally authorized to work in the U.S. under federal law, including Deferred Action for Childhood Arrivals recipients, are eligible for employment unless prohibited by other state or federal law.

A master's degree with major study in public health, behavioral health, public administration, business administration, social work, or closely related field.

Equivalent education/experience