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Program Specialist II

Health Innovations Business Ops Managers | Harrisburg, PA | Contract

Job Description
Program Specialist II
Work Location: Harrisburg, PA

Job Summary/Description
• The incumbent will be assigned to the Case Management Unit. The Case Management Unit is tasked with managing functions related to the Office of Long Term Living’s Participant Helpline, providing effective assistance to participants, families and local agencies in addressing participant’s concerns, grievances, service needs or preferences, management of cases with complex issues that may rise to the level of Protective Services identified within the Fee for Service (FFS) Home and Community Based Service Programs and the Long-Term Services and Supports Managed Care Program, known as Community Health Choices (CHC) and data collection and report management in relationship to performance of CHC Managed Care Organizations (MCO).
• The Case Management Team is tasked with management and oversight of the Long-Term Living Transition activity project, triaging FFS and CHC complaint calls, management of cases involving continuity of care and responsible for review and analyzing monthly operational reports submitted by the CHC Managed Care Organizations.
• As a member of the Case Management Unit, the incumbent will be primarily responsible for management of complex cases for the unit, making recommendations to service coordinators and providers to maximize waiver benefits, responsible to facilitate a biweekly interdisciplinary meeting that involves both Adult Protective Service staff and Department of Aging staff, responsible for meeting agendas and minutes for this meeting. The incumbent will provide recommendations according to OLTL regulations, policies and waiver requirements. Provide technical assistance and case management to Service Coordinators to ensure coordination of care is followed. Work directly with OLTL’s medical director to consult on cases not resolved at interdisciplinary team meeting.

Job Duties/Responsibilities/Functions (including but not limited to)
• Responsible for reviewing and analyze monthly operational reports submitted by the CHC Managed Care Organizations assigned to CMU. Prepare detailed analysis of data in order to develop program objectives, policies, procedures, and standards for CMU or other statistical data both to support projects as well as on-going management of the program.
• Responsible to collect and documents reports to measure the effectiveness of providers to meet OLTL guidelines and expectations around case management and care coordination.
• Respond orally and in writing to enrollment and eligibility inquiries received from the Office of Legislative Affairs, and other Offices.
• Be knowledgeable of home and community-based waiver requirements and CHC MCO agreement. Review electronically submitted service plans for HCBS FFS waivers and Act 150 Program to provide technical assistance to team and service coordination entities.
• Participate in hearings for appeals related to CMU appeals.
• Use specialized databases such as, but not limited to, Client Information System (CIS), PROMISe, Home and Community Services Information System (HCSIS), Social Administration Management System (SAMS), OLTL Participant Helpline data base, EIM (OLTL’s enterprise incident management system) and PIA.
• Use established regulations, policy and requirements to provide guidance, consultation, technical assistance, policy/procedural and regulatory interpretation to providers; advise supervisor of problems and unusual issues as appropriate.
• Serve on workgroups, comprised of staff from within OLTL or stakeholders from outside OLTL. Committee work may include evaluating policy recommendations, directives and regulations; and assisting with the development of operational manuals, program directives, work plans, system changes, regulations, policies and procedures regarding the case management process.
• Attend and participate in team meetings, division meetings and bureau meetings as scheduled.
• Performs other duties as assigned

Minimum Qualifications
• Bachelor's Degree in Education, Human Services, social work or related field preferred from an accredited college or university and at least two years’ experience providing working knowledge of Medicaid home and community-based services, long-term care services, or support service agencies including policies, procedures, performance measure and data collection.
• Intermediate Computer Skills – Required with experience and proficiency in use of Microsoft office with an emphasis on Microsoft Excel and Access
• Strong interpersonal skills for working with contract vendor, agency and other professional personnel
• Ability to learn and apply Commonwealth procedures and regulations and standard business practices related to the operations of the contract.
• Demonstrated ability for written and oral communication, and program development responsibilities.
• Strong organizational skills with attention to details and a demonstrated ability to work independently under general supervision.
• Public speaking experience is desirable.

About InGenesis
InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.

EEOC Statement
We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.