Medicaid Program Manager – Medical Services

IA United States

Job Description

The Iowa Medicaid Enterprise (IME) division of the Department of Human Services (DHS) is seeking a knowledgeable and creative Medicaid Program Manager to join the team. Be part of an organization that is continually working to modernize and innovate solutions to improve the quality of life and health outcomes for the state’s Medicaid members.    The (IME) is an endeavor that unites State Staff and “Best of Breed” contractors into a performance-based model for the administration of the Iowa Medicaid program. Medicaid is a state-federal funded program that is administered by the Department of Human Services of the State of Iowa and is the second largest insurance program in the State of Iowa.  The IME establishes the state’s policy to oversee performance and compliance of the Medicaid Managed Care program.   This position requires strong knowledge of Medicaid policies and is responsible for the administration of the Medicaid programs.  Continual analysis of coverage and reimbursement policies are conducted to assess current and pending federal requirements.  Looking at future programmatic changes and options to meet federal and state program goals is a critical component of this job. Identifying, managing and capturing performance data to conduct performance analysis of Managed Care Organizations (MCO) and vendors is another important aspect of the job duties. Additional duites include:   * Write State Plan Amendments (SPA) for the Centers for Medicare and Medicaid Services (CMS)  * Draft Code language for Medicaid covered services incorporating service definitions, provider qualifications and reimbursement methodology in accordance with CMS regulations and state law * Consult with the Attorney General’s office and relevant constituency groups  * Collaborate with Iowa Medicaid Enterprise contract manager(s) to track, monitor and modify the process as needed  * Draft and publish administrative rules per guidelines * Develop and conduct training as needed or required for implementation guide * Monitor federal and state regulations and requirements on a routine basis. * Continually analyze, review and assess national trends, CMS initiatives, best practices and prepare benefit analysis or comparison analysis or proposed benefits and associated cost for Iowa IME/DHS; summarize with recommendations. * Provides program quality assurance and quality improvement reviews for  * Provides process improvement proposal and manages implementation   Employee must have an excellent knowledge of Medicaid services and supports and the medical background needed be able to understand and work with state and federal legislation relative to the areas of program responsibility.    Preference will be given to applicants who have any of the following experience or education:  * Licensed Masters Social Worker (LMSW) * Licensed Independent Social Worker (LISW) * Licensed Mental Health Counselor (LMCH) * Master’s degree in a human services field  * RN/BSN background * Demonstrated ability to strategically apply policy analysis and development inclusive of IT system structure supports  * Demonstrated experience drafting health care policy * Demonstrated experience interpreting health care data and national health care metrics The Iowa Department of Human serves almost a million Iowans through health coverage, mental health and disabilities services, long-term care and treatment, and adult, children, and family services. Our mission is to help Iowans achieve healthy, safe, stable, and self-sufficient lives through the programs and services we provide. We have a great total compensation package for all of our full-time employees, including: * Iowa Public Employees’ Retirement System (IPERS) * Retirement Investors Club (RIC) (Employer Sponsored Retirement Plan) * Health, Dental and Vision Insurance * Vacation Leave  * Sick Leave * Paid Holidays (9 days/year) * Flexible Spending Accounts * Life Insurance * Long-Term Disability Insurance To learn more about benefits available to State of Iowa employees visit the benefits web page.   DHS values those with “lived experience” and encourages adults who were fostered as youth, foster parents, and/or parents who were in the DHS system to apply.  Minorities, women, persons with disabilities and veterans are encouraged to apply (Hearing and Speech Impaired – Relay Iowa 1-800-735-2942 TDD).     Our agency uses E-Verify to confirm the employment eligibility of all newly hired employees. To learn more about E-Verify, including your rights and responsibilities, please visit  Applicants must meet at least one of the following minimum requirements to qualify for positions in this job classification: * Graduation from an accredited four-year college or university with a degree in business or public administration, management information systems, industrial management, or statistics, and experience equal to three years of full-time work in management analysis or project management. * Seven years of full-time work experience in management analysis or project management. * A combination of a total of seven years of education and full-time experience (as described in number one), where thirty semester hours of accredited college or university course work equals one year of full-time experience. * Current, continuous experience in the state executive branch that includes two years of full-time work as a Management Analyst 2 or two and a half years as a Management Analyst 1. For additional information, please click on this link to view the job description.


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