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State of Massachusetts Program Specialist for Home Health, Hospice, and Therapy Program in Boston, Massachusetts

The MassHealth Office of Long Term (Care) Services and Supports (OLTSS) is responsible for managing a robust system of supports for members of all ages who need services to enable them to live with independence and dignity in their daily lives, participate in their communities, and increase their overall quality of life. These services and supports may be provided in the home; in residential, day, and other community-based settings; or in certain facility-based settings, such as nursing homes and chronic disease rehab hospitals. Additionally, OLTSS manages fully capitated integrated care plans primarily for dually eligible individuals (i.e. Medicare and Medicaid): Senior Care Options (SCO), the One Care Program, and the Program of All-Inclusive Care for the Elderly (PACE). OLTSS also oversees 10 home and community based (HCBS) Medicaid waiver programs that provide specialized services and supports to especially vulnerable OLTSS populations. OLTSS is responsible for ensuring that services provided in any setting and all delivery systems are member-focused, accessible, of the highest quality, and delivered in a cost-effective manner. Program Specialist Duties: * The Program Specialist will take lead under the guidance of the Program Manager on the day-to-day management of OLTSS’ home health, hospice, and therapy programs. MassHealth members who use home health, hospice, and therapy services are often vulnerable individuals who without such services may require more intensive care. The Program Specialist will work to ensure these members receive high quality care and assist those providers that serve them remain complaint with federal and state regulations. Responsibilities will include provider, member, and advocate stakeholder engagement; provider education; provider enrollment and provider network management; meeting planning; operationalization of program integrity efforts; and data collection and analysis. In addition, the Program Specialist will assist the Home Health, Hospice, Therapy Program Manager and the Senior Policy Manager with additional tasks including program and rate development, policy planning, and regulatory management and development /Day-to-Day Operational Duties:/ * Day-to-day monitoring of the OLTSS Third Party Administrator (TPA) contractual functions relating to provider enrollment and credentialing, claims operations, prior authorization, appeals, program integrity and reporting related to the relevant programs, and ability to triage and/or escalate issues to the appropriate OLTSS internal staff. * Work with Program Manager to resolve MassHealth member issues that relate to relevant provider networks and respond to requests for information regarding payment and policy questions. * Provide assistance to the Program Manager and Senior Policy Manager during program regulation and rate regulation development and implementation, including working with IT team and Claims operation team. * Assist Program Manager to ensure provider compliance with all applicable program rules, regulations and sub regulatory guidance including provider education, engagement and issue escalation. * Under the guidance of the Program Manager and Senior Policy Manager, lead provider and constituent affairs services to resolve program policy and service delivery issues. * Assist with reviewing, filing, and following up on critical incident reports. * Manage, track and monitor multiple projects and initiatives relative to the programs, and work with the Program Manager to recommend changes in policy, communication strategies and/or program structure to the Senior Director of Fee for Service (FFS) Home Based Programs and other members of the OLTSS leadership team. * In coordination with the Program Manager, effectively communicate priority project statuses, risks and outstanding decisions to OLTSS and MassHealth leadership both verbally and in written form under quick timelines. * Monitor TPA Board of Hearing (BOH) cases and collaborate with appropriate OLTSS internal staff. * Assist the Program Manager toprovide program-related assistance to other units within the MassHealth, the Executive Office of Elder Affairs, and other agencies in the state government. * Review and analyze data concerning assigned agency programs to determine progress and effectiveness, to make recommendations for changes in procedures, guidelines, and regulations, and to devise methods of accomplishing program objectives. * Assist the Program Manager to provide technical assistance and advice to agency personnel, contractors, and others concerning assigned programs to exchange information, resolve problems, and to ensure compliance with established policies, procedures, standards, and regulations. * Performs related duties such as attending meetings and conferences, maintaining records, and preparing reports. * Assist the Program Manager to develop and implement procedures, guidelines, and regulations to accomplish assigned agency program objectives and goals. * Review draft reports, memoranda, and regulations etc. for completeness, accuracy, and content. /Program Integrity Duties:/ * Conduct onsite visits with providers including but not limited to program audits, site reviews and provider education visits (limited travel required). * Maintain databases and spreadsheets to provide current and accurate program and audit activities and follow-up on recommended corrective action or compliance issues raised in audits. * Collaborate on TPA program integrity (PI) responsibilities and serve as program integrity specialist in the relevant program area. /Additional Duties:/ * Assist Program Manager in working with provider stakeholder groups to solicit feedback or provide training, as needed. * Collaborate with the Strategic Initiatives team in the management of all relevant TPA functions. * Collaborate with MassHealth Finance and Strategy Teams to assist the program manager on budget, cost reports, rate setting, modeling and implementation of a value-based payment methodology, implementation of risk adjusted rates for coordinated care. * Collaborate with the OLTSS External Affairs team on drafting talking points, policies, memoranda, and meeting materials. *Preferred Qualifications MassHealth is seeking candidates who possess the following qualifications: * Experience working with a complex medical populations and knowledge of their general medical needs. * Bachelor’s degree inpublic policy/administration, health administration, social services, business, law, orSocial Work; Master’s degree preferred. * Excellent analytical and problem-solving skills * Excellent writing, presentation, facilitation, and communication skills. * Excellent organization skills, including ability to manage time, to set priorities and to work under time constraints. * Knowledge and experience in LTSS program policy development, analysis and evaluation. * Possess an understanding of the role of data and analysis in driving system change. * Ability to develop and maintain effective working relationships with a range of LTSS stakeholders and partners. * Knowledge of the Massachusetts health care industry and market dynamics related to LTSS. * Knowledge of payment reform and care delivery reform strategies, including an understanding of the relationship between payment reforms, delivery system change, quality improvement and member satisfaction in LTSS. * Ability to understand, apply and explain pertinent laws, rules, regulations, policies and procedures. * Knowledge of the methods used in the preparation of charts, graphs and tables, and of the methods of general report writing. * Ability to analyze and determine the applicability of data, to draw conclusions and to make appropriate recommendations. * Ability to gather and assemble information in accordance with established procedures to compile statistical data and to communicate clearly, concisely, logically, accurately and persuasively in written, verbal and visual formats in internal, external and public settings. * Ability to work independently and collaboratively. * Ability to lead meetings and manage projects. * Proficiency in Microsoft Excel, Word, and PowerPoint; knowledge of Microsoft Project and Visio is a plus. * Strong interpersonal skills. * Commitment to health equity. _TO APPLY:_ Please upload both Resume and Cover Letter for this position when applying. First consideration will be given to those applicants that apply within the first 14 days. _About MASSHEALTH:_ To improve the health outcomes of our diverse members and their families by providing access to integrated health care services that promote sustainable & equitable health, well-being, independence and quality of life. For more information about our agency and programs please visit:_ _Pre-Offer Process:_ A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit Education, licensure and certifications will be verified in accordance with the Human Resources Division’s Hiring Guidelines. Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website. If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete the Reasonable Accommodation Online Request Form. For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #2. First consideration will be given to those applicants that apply within the first 14 days. MINIMUM ENTRANCE REQUIREMENTS: Applicants must have at least (A) four years of full-time, or equivalent part-time, professional, administrative or managerial experience in business administration, business management or public administration the major duties of which involved program management, program administration, program coordination, program planning and/or program analysis, and (B) of which at least one year must have been in a supervisory capacity, or (C) any equivalent combination of the required experience and the substitutions below. Substitutions: I. A Bachelor's degree with a major in business administration, business management or public administration may be substituted for a maximum of two years of the required (A) experience.* II. A Graduate degree with a major in business administration, business management or public administration may be substituted for a maximum of three years of the required (A) experience.* III. A Bachelor's or higher degree with a major other than in business administration, business management or public administration may be substituted for a maximum of one year of the required (A) experience. Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed. NOTE: No substitutions will be permitted for the required (B) experience. _Comprehensive Benefits_ When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future. Want the specifics? Explore our Employee Benefits and Rewards! *Executive Order #595:As a condition of employment, successful applicants will be required to have received COVID-19 vaccination or an approved exemption as of their start date. Details relating to demonstrating compliance with this requirement will be provided to applicants selected for employment. Applicants who receive an offer of employment who can provide documentation that the vaccine is medically contraindicated or who object to vaccination due to a sincerely held religious belief may make a request for exemption. An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply. The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role. Job: Administrative Services* *Organization: Exec Office Of Health and Human Services *Title: *Program Specialist for Home Health, Hospice, and Therapy Program Location: Massachusetts-Boston-1 Ashburton Place Requisition ID: 230003QN