Case Management Performance Specialist
Case Management Performance Specialist
$5,537.00 - $6,821.00 Monthly
Denver Metro, CO
Department of Health Care Policy and Financing
UHA 04637 07.05.2022
7/28/2022 11:59 PM Mountain
STATE OF COLORADO RESIDENCY REQUIRED
NOTE: This announcement may be used to fill multiple openings.
The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.
We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.
We are looking for a Case Management Performance Specialist to join our Quality Performance Team in the Case Management & Quality Performance Division in the Office of Community Living !
As part of the State of Colorado, HCPF offers a competitive benefits package :
PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans
Medical (https://stateofcoloradobenefits.com/index.php/portfolio-item/overview/) , Dental (https://stateofcoloradobenefits.com/index.php/portfolio-item/dental/) , and Vision (https://stateofcoloradobenefits.com/index.php/portfolio-item/vision/) insurance coverage
Automatic Short-Term and Optional Long-Term Disability Coverage (https://stateofcoloradobenefits.com/index.php/portfolio-item/disabilityinsurance/)
Life and AD&D Insurance
Flexible Spending Accounts (https://stateofcoloradobenefits.com/index.php/portfolio-item/flexible-spending-account/) (FSAs)
Family Medical Leave Act (FMLA) (https://dhr.colorado.gov/state-employees/time-off-leave/family-medical-leave-act-fmla) job protection and State of Colorado Paid Family Medical Leave (PFML)
11 Paid Holidays Annually and Accrued Annual and Sick Leave (https://dhr.colorado.gov/state-employees/time-off-leave)
Accrued Sick Leave for State of Colorado Temporary Employees
Flexplace and Flextime work arrangements
Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program
Discounted RTD EcoPass (https://www.rtd-denver.com/fares-passes/ecopass)
Reduced college tuition through CSU Global (https://csuglobal.edu/cost/tuition-discounts/employer-partners/state-colorado)
Credit Union of Colorado Membership Eligibility
The Case Management and Quality Performance Division provides the lead role in policy decisions and technical assistance for intake, eligibility, quality, and case management functions, The Division works to insure quality compliance and performance excellence by monitoring, trending, training, and providing technical assistance to our Case Management Agencies (CMAs) and stakeholders. The Division is responsible for case management delivery and quality performance monitoring to assure a cohesive, efficient process and structure needed to optimize the experience of the individuals we serve.
The ongoing COVID-19 pandemic has impacted how and where we do our work. During this pandemic, we are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements. Depending on the business need and description of the position, we have options that range from fully remote, hybrid, to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage.
Description of Job
As the Case Management Performance Specialist, what will you do?
Position serves as the Departments staff authority for complex data analysis of case management performance metrics. This includes performing complex data analysis of CMA compliance with administrative, regulatory, and federal waiver requirements.
Conducts data analysis and a thorough examination of documentation provided by the CMAs to determine compliance of their responsibilities as defined in contract, regulations and statute for each of the financial and programmatic reviews.
Develops written defensible reports for publication that details all findings and recommendations for each performance, financial, and programmatic review of the CMAs. Written reports outline requirements for remediation for improved program operations, case management and administrative functions.
Serves as the staff authority in continuous quality improvement and corrective action plan management for the CMAs. Position determines whether a CMA is place on a continuous quality improvement plan or a corrective action plan.
Determines and develops comprehensive corrective action plan work plans and tracking for each CMA as well as an overall state-wide corrective action status plan.
Determines action steps to be completed by the CMA when concerns for CMA performance have been identified and are impacting member health, safety, or welfare; potential fraud, waste or abuse; case manager performance; etc.
Provides technical assistance to CMAs specific to corrective action plans, remediating deficiencies, and supporting documenation. Technical assistance includes a variety of training opportunities for CMA staff.
Collects, analyzes and reports data consistent with administrative performance submitted to CMS for the Departments Quality Improvement Strategies.
Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights
Education and Experience:
Bachelor's degree from an accredited institution in a health-related field, management, business, public administration or a similar field of study related to the work assignment AND three years experience performing compliance analysis.
A combination of work experience in the occupational field or specialized subject area of the work assigned to the job, which provided the same kind, amount, and level of knowledge acquired in the required education, may be substituted on a year-for-year basis for the bachelor's degree.
A master's or doctorate degree from an accredited college or university in a field of study related to the work assignment may be substituted for the bachelor's degree and at the agency's discretion, one or two years of general experience respectively.
Experience writing reports that outline audit and/or review findings and recommendations.
Experience developing or maintaining review and/or audit tools, procedures, and/or risk assessments.
Experience performing financial reviews and/or programmatic auditing of agencies performing Government contracted work.
Data Analysis experience
Case Management experience
DEFINITION OF PROFESSIONAL EXPERIENCE: Work that involves exercising discretion, analytical skill, judgment, personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods.
CONDITIONS OF EMPLOYMENT
All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.
Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.
Effective September 20, 2021, employees will be required to attest to and verify whether or not they are fully vaccinated for COVID-19. Employees who have not been fully vaccinated may be required to submit to serial testing in the future. Upon hire, new employees will have three (3) business days to provide attestation to their status with proof of vaccination. Vaccinated employees must provide proof of vaccination.
Note: Fully Vaccinated means two (2) weeks after a second dose in a two-dose series of the COVID-19 vaccine, such as the Pfizer or Moderna vaccine, or two (2) weeks after the single-dose vaccine, such as Johnson & Johnsons Janssen vaccine, as defined by the most recent State of Colorados Public Health Order and current guidance issued by the Colorado Department of Public Health & Environment.
If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.
An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email [Click Here to Email Your Resumé]), postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed (303.866.5038) within ten (10) calendar days from your receipt of notice or acknowledgement of the departments action.
For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov; contact the State Personnel Board for assistance at (303) 866-3300; or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.
How to Apply (https://careers.colorado.gov/how-to-apply) (PLEASE READ CAREFULLY)
Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.
Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.
Comparative Analysis Process
The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email.
Failure to submit properly completed documents by the closing date will result in your application being rejected.
ADAAA Accommodations : The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.
The Department of Health Care Policy & Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Virginia Miller, at [Click Here to Email Your Resumé] [Click Here to Email Your Resumé]) .
The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.