State of Wyoming BEQA10-08072-Eligibility Review Unit Manager-Cheyenne in Cheyenne, Wyoming

BEQA10-08072-Eligibility Review Unit Manager-Cheyenne

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BEQA10-08072-Eligibility Review Unit Manager-Cheyenne

Salary

$4,506.00 - $5,632.00 Monthly

Location

Cheyenne, WY

Job Type

Full Time

Department

048-Div. of Healthcare Financing - Eligibility & Operations

Job Number

08072

Closing

4/27/2018 11:59 PM Mountain

  • Description

  • Benefits

  • Questions

Description and Functions

Open Until Filled

GENERAL DESCRIPTION:

Make a difference in your community by stepping up to be the Eligibility Review Unit Manager in the Division of Healthcare Financing. The Wyoming Department of Health is looking for a motivated manager with the drive and talent to lead this unit. If you are skilled in Program Management and have what it takes to be a supervisor and a leader, then please apply!

ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function which may be performed in the job level.

  • Manages the MEQC program in adherence to guidance from the Centers for Medicare and Medicaid Services (CMS) and in accordance with Medicaid and CHIP programs regulations, rules, policies and procedures.

  • Uses knowledge of Medicaid and Kid Care CHIP programs to assure benefits are determined accurately, timely and consistently throughout the State.

  • Compiles and analyzes data from reviews and prepares statistical and narrative reports and presentations specific to the activities and findings.

  • Participates in administrative planning to advise and make recommendations to propose new tools to assist in review activities, system enhancements, outreach or other issues that impact Medicaid and Kid Care CHIP eligibility quality functions.

  • Participates in developing and monitoring Medicaid and Kid Care CHIP Eligibility Quality Control goals and performance.

  • Provides information to the Eligibility and Kid Care CHIP Units when an eligibility error is identified or fraudulent activity is suspected.

  • Confirms Medicaid Eligibility Quality Assurance Monitoring Activities are conducted timely to assure the accuracy and consistency of eligibility determinations made by the LTC Unit, the Customer Service Center and the Tribal Eligibility Workers.

  • Uses knowledge of Medicaid programs and system reports to monitor caseloads and identify errors, patterns, or trends.

  • Compiles and analyzes data from monitoring activities and prepares statistical and narrative reports and presentations specific to the activities and findings.

  • Participates in administrative planning to advise and make recommendations to propose new monitoring tools, system enhancements, outreach, or other issues that impact Medicaid eligibility quality functions.

  • Makes recommendations to the Eligibility and Operations Administrator, the Senior Eligibility Manager, the Vendor Contract Manager and the Benefit Coordination Manager as needed, to confirm Medicaid eligibility determinations are meeting the goals of the program.

  • Manages the PERM program in adherence to guidance from the Centers for Medicare and Medicaid Services (CMS) and in accordance with Medicaid and Kid Care CHIP programs regulations, rules, policies and procedures.

  • Uses knowledge of Medicaid and Kid Care CHIP programs to assure benefits are determined accurately, timely and consistently throughout the State.

Qualifications

PREFERENCES:

Preference may be given to the candidate with a bachelor's degree in Human Services or a related field.

KNOWLEDGE:

  • Knowledge of state and federal government functions and procedures; state and federal policies, rules and laws.

  • Knowledge of Medicaid functions and procedures; Medicaid policies, rules and laws.

  • Knowledge of healthcare systems, including policies, procedures, data and reference materials.

  • Knowledge of fraud and abuse detection methods and systems.

  • Knowledge of Wyoming personnel rules and skills in supervision.

  • Skills in research and analysis of complex problems; identification of options and solutions; decision making and evaluation of results.

  • Skills in public speaking, oral and written communication to varied audiences on complex and controversial issues.

  • Ability to establish and maintain positive working relationships with individuals and groups.

  • Ability to accept and be flexible with federal, state and agency changes.

  • Ability to balance multiple demands on time and resources.

  • Ability to self-educate both formally and informally to remain current in areas of responsibility.

MINIMUM QUALIFICATIONS:

Education:

Bachelor's Degree (typically in Human Services)

PLUS

Experience:

1-2 years of progressive work experience (typically in Benefits and Eligibility) with acquired knowledge at the level of a Senior Quality Assurance Specialist

OR

Education & Experience Substitution:

4-6 years of progressive work experience (typically in Benefits and Eligibility) with acquired knowledge at the level of a Senior Quality Assurance Specialist

Certificates, Licenses, Registrations:

None

Necessary Special Requirements

PHYSICAL WORKING CONDITIONS:

  • This job is performed in a normal office environment.

NOTES:

  • FLSA: Exempt

Supplemental Information

048-Wyoming Department of Health - Division of Healthcare Financing - HR Contact: 307-777-6057

Click here to view the State of Wyoming Classification and Pay Structure.

URL: http://agency.governmentjobs.com/wyoming/default.cfm

The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.

Class Specifications are subject to change, please refer to the A & I HRD Website to ensure that you have the most recent version.

There are many benefits to living and working in Wyoming. Beautiful country with wide open spaces and clean air, great recreational opportunities, and no State income tax to mention a few! In addition, the State of Wyoming offers State employees a very generous benefit package. Please click here for more information on the State of Wyoming employee benefits*.

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