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Job Description:
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The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) Department seeks a highly qualified candidate to fill the position of the Program Specialist V. This position will focus on a variety of areas including critical incident management systems (CIMS), behavioral health issues and coordination of benefits processes in Texas Medicaid and CHIP programs. MCS is driven by its mission to deliver quality, cost-effective services to Texans. The Program Specialist V will be selected by and directly report to a Manager in the Program policy unit in the Medicaid and CHIP Services Department (MCS). The Program Specialist performs advanced consultative and technical work related to the planning, development, implementation, maintenance and oversight of Medicaid and CHIP managed care program policy, including policy development, program management and oversight, and service delivery. Specifically, the Program Specialist could be assigned to focus on Medicaid and CHIP managed care or services within managed care.
The Program specialist is expected to provide subject matter expertise on Medicaid and CHIP managed care issues to agency staff, governmental agencies, community organizations, provider organizations, and the general public; coordinate and collaborate with internal and external stakeholders to develop policy; oversee the development of operational policy, including contract, administrative rule, manual and procedural requirements; assist in ensuring compliance and resolution of program policy-related issues; participate in and help to facilitate meetings with stakeholders, including managed care organizations, managed transportation organizations, provider associations, clients, advisory committee members; ensure policy and guidance documents are up-to-date; prepare high quality written reports, correspondence, and other documents; draft and complete legislative reports; and analyze program regulations, policies and legislation. The Program Specialist works under the general direction of the program Policy Manager with latitude for the use of initiative and independent judgement. Experience with and knowledge of Medicaid and CHIP managed care along with behavioral health, critical incident management systems and coordination of benefits is preferred.
Why do you want to work here?
This unit offers an exciting and demanding work environment where staff constantly learn and take initiative on projects that lead to upward mobility and future career success. It is a fast-paced work environment that requires flexibility and adaptability, and a willingness to participate as a member of a collaborative and supportive team.
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Essential Job Functions:
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Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
(25%) Plans for and oversees the analysis, development. Implementation and documentation of federal and state legislation and regulations related to Medicaid and CHIP managed care services in managed care. Provides oversight in the development of legislative analyses, research papers, reports and legislative information.
(25%) Develops and/or oversees the development and implementation of Medicaid and CHIP managed care program policy options for related initiatives impacting HHSC agencies, including policy analysis, option development, timelines, project structures, financial analyses and detailed work plans.
(20%) Establishes, facilitates and participates in multiple workgroups and committees, including inter-agency workgroups and committees that support program management and oversight of Medicaid and CHIP managed care or services in managed care.
(20%) Prepares and approves high quality written documents, including project updates, memos, summaries, legislative reports, rules, waivers, state plan amendments and other documents.
(10%) Works with an presents to community and professional groups to coordinate and improve Medicaid and CHIP managed care initiatives. Consults with public and private agencies to resolve problems, identify training needs and discuss effectiveness.
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Registrations, Licensure Requirements or Certifications:
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N/A
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Knowledge Skills Abilities:
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Knowledge of:
Federal and state Medicaid and CHIP laws and regulations, including those related to managed care or services in managed care.
Skill in:
- Researching, analyzing and evaluating complex federal and state regulations, legislation, program policy and operational issues;.
- Project management; and
- Interpersonal relationships, including the ability to work with people under pressure, negotiate amongst multiple parties, resolve conflicts and establish and maintain effective working relationships.
Ability to:
- Perform work with a high degree of attention to detail;
- Develop workable solutions to complex problems and policy issues;
- Interpret legal documents such as contracts and manuals;
- Exercise judgement and work independently with minimum supervision;
- Work cooperatively as a team member in a fast-paced, deadline-oriented environment;
- Balance multiple assignments, projects and responsibilities; and
- Lead workgroups and meetings.
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Initial Screening Criteria:
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1. Graduation from an accredited four-year college or university (each year of related experience may count toward the education requirement); Master’s degree preferred.
2. At least one year of full-time work experience with policy research and analysis, project management and/or program management.
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Additional Information:
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• Additional information about the programs these positions support can be found on the 2024 edition of the Texas Medicaid Pink Book.
• Teleworking opportunities are available, contingent on performance.
• State of Texas employees participate in outstanding benefits:
o Excellent health benefits,
o Lifetime monthly retirement annuity,
o Generous time off benefits.
• Additional benefits of joining the MCS Office of Policy include:
• Leadership commitment to invest in and foster your professional growth or knowledge of the Texas Medicaid program and your career advancement.
• Having a profound impact to the lives of thousands of Medicaid clients that depend on Medicaid services throughout Texas.
• Being on the ground level of healthcare policy implementation, including the opportunity to work closely with stakeholders such as federal partners, providers, advocates, managed care organizations, and other healthcare contractors.
• Engagement with the Texas legislative process, including the opportunity to analyze and inform legislators of potential impact of proposed bills.
• Being part of a team at the forefront of interpreting, implementing, and developing policy that has statewide impact.
• The opportunity to learn and engage with multiple domains of the healthcare delivery system, including managed care, fee-for-service, federal/state Medicaid partnerships and other activities related to the administration of the Medicaid program;
• Note: Factors including but not limited to HR Policies, budgetary limitations, qualifications, experience and tenure will determine the final salary offer.
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MOS Code:
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• There are no direct military occupation(s) that relate to the responsibilities, and registration or licensure requirements for this position. All active duty, reservists, guardsmen, and veterans are encouraged to apply if they meet qualifications for this position.
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