Senior Healthcare Program Specialist – Managed Care Surveillance in Albany, NY

Item 1063

Duties Description:

This position is needed for the OHIP’s Division of Health Plan Contracting and Oversight, Bureau of Managed Care Certification and Surveillance. The responsibilities include but are not limited to the daily activities related to ensuring Managed Care Organizations in New York State are compliant in accordance with regulations, statutes, and the Medicaid Managed Care Model Contract. This incumbent will be a subject matter expert and will be developing and implementing tools necessary to oversee the implementation and integration of the NYS Perinatal Standards and maternal initiatives aimed at expanding and improving perinatal care offered to Medicaid managed care members.

Minimum Qualifications

• Bachelor’s degree 
• Five (5) years’ experience

The incumbent will:

• Collaborate with various policy, program and survey partners to develop and facilitate a Managed Care survey tool to assess MCOs have established and in place, policies and procedures necessary to deliver or monitor delivery of perinatal services in accordance with current standards of care.
• Perform Quality Assurance review and issuance of survey related results and correspondence.
• Participate in monthly survey team meetings
• Issue External Quality Review Organization (EQRO) Focus Surveys designed to test and confirm access to care.
• Review Fair Hearing decisions and ensure timely compliance of the Managed Care Organizations.
• Participate in ongoing educational needs, training, and guidance for staff.
• Assist in interpreting and clarifying policy guidelines.
• Communicate with Managed Care Organization staff and management regarding DOH policy changes, guidance, or other applicable correspondence.
• Communicate with other DOH bureaus or State partners where applicable.
• Provide daily supervision of professional staff and ensure efficiency and accuracy of work assignments
• Complete Special Projects and other related duties as assigned, including Team Lead for Operational Surveys if required.
• Travel throughout New York State is required.

Preferred Qualifications:

• Experience in managed care, care coordination, Medicaid, compliance, and/or delivery of perinatal services in accordance with current standards of care, evidence-based practice, and practice guideline recommendations of professional clinical organizations including (but not limited to) the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), the American Academy of Family Physicians, the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF).
• Master’s Degree in health care related field or 5 years healthcare or social service experience or 5 years subject matter expertise in field of Nursing, Nutrition, Social Work, Counseling, Community Health, Maternal Health or Education.

*Employees must follow established work schedules. The usual work schedule is 40 hours per week, Monday through Friday. Normal work hours are 8:00 a.m. to 4:30 p.m. unless otherwise specified by the supervisor or, this includes a half hour unpaid lunch break. Total work hours must equal 40 hours per week.

Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides the following reasonable range of compensation for this role: $49,400-65,000. In addition, SSO provides a range of benefits for this role.

Public Consulting Group is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, protected veteran status, or status as a qualified individual with a disability.  VEVRAA Federal Contractor.