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MEDICAL CARE PROGRAM SPECIALIST II

Recruitment #22-000928-0008

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GRADE

15

LOCATION OF POSITION

MDH, Division of HealthChoice Quality Assurance, 201 W. Preston Street, Baltimore, MD

Main Purpose of Job

The main purpose of this position is to provide complex administrative support to the Division of HealthChoice Quality Assurance and the Division of HealthChoice Provider Network Management through monitoring, reporting, implementation, analysis, coordination, and procurement tasks related to the Maryland HealthChoice Program.

This position will assist with preparing, editing, and distributing procurement support documents and special reports related to vendor invoicing, MBE, and VSBE compliance; organizing and maintaining the shared drives for both divisions; drafting and editing correspondence; and performing other administrative functions as needed using the following systems: Microsoft Suite, Google Suite, the Maryland Medicaid Management Information System (MMIS), and customer relationship management (CRM) systems in general.  This position will also review and summarize information to prepare reports, charts, or other documents with word processing, database, spreadsheet, or desktop publishing computer software applications for supervisory review. This position tracks, categorizes, and stores historical Medicaid system change documents for both divisions. This position ensures any revisions that are made to division documents are stored historically, and all incoming correspondence (e.g., emails, hard mail, phone calls, etc.) are forwarded to the appropriate staff and stored accordingly. 

This position is the lead for scheduling, preparing documentation, taking meeting minutes, and performing any follow-up communications necessary for both the Quality Assurance Liaison Committee (QALC) Meetings and the Encounter Data Workgroup meetings. This position is responsible for keeping the HCQA Accounts Payable tracker, HCQA Project Calendar, and HCQA SOPs up to date and completed by all required timeframes. This position is the lead and main staff person to oversee the HCQA delegated email inbox to ensure that all HCQA correspondence has the appropriate staff addressed. This position will oversee and maintain the MCO Contact spreadsheet through quarterly and ad hoc updates to ensure that MDH staff has the most up to date contact personnel for different areas for each MCO that are utilized throughout MDH.   This position will also serve as the backup for the Medical Care Program Specialist II that oversees the MCO Marketing Material submission process. 

This position researches, investigates, and resolves complaints and inquiries for the corrective managed care (CMC) program that do not involve clinical intervention. This position refers CMC complaints requiring clinical intervention to the Division of HealthChoice Complaint Resolution as appropriate. This position documents all inquiry and complaint cases related to the CMC issues in the CRM database. Resolving these complaints and inquiries may involve educating members by reviewing and interpreting state and federal regulations, policies, and procedures. For the reconciliation of the CMC program data, this position reviews and updates the non-care related CMC cases and reports provided by MCOs via the Hilltop FTP website.

This position is eligible to telework 40% (2 days a week).

MINIMUM QUALIFICATIONS

Experience: Seven years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs.

Notes:

1. Candidates may substitute the possession of a Bachelor's degree from an accredited college or university and three years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs for the required experience.

2. Candidates may substitute the possession of a Master’s degree from an accredited college or university in the related field of work for the required experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Operational Analysis classifications or Health Services Management specialty codes in the health-related field of work on a year-for-year basis for the required experience.

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should have experience with data analysis and report writing/editing using Microsoft Office, especially Excel and Word, experience writing and editing correspondence and processes, be able to conduct administrative tasks and perform efficiently within timeframes as requested.

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties may be required to possess a motor vehicle operator's license valid in the State of Maryland.

SELECTION PROCESS

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview). 

Complete applications must be submitted by the closing date. Information submitted after this date will not be added. 

Incorrect application forms will not be accepted. Resumes will not be accepted in lieu of a completed application.

Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201. Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

If additional information is required, the preferred method is to upload.  If you are unable to upload, please fax the requested information to 410-333-5689. Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.

For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410-767-1251.

If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 or Application.Help@maryland.gov. 

Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258.

We thank our Veterans for their service to our country.

People with disabilities and bilingual candidates are encouraged to apply.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.




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