Job description

JOB
Medical Assistance Program Specialist 2 (MAPS2/CQCT) 71094791 This is a non-permanent position funded for 12 months.Per Governor Inslee’s Directive 22-13.1, state employees must be fully vaccinated. Your vaccine status will be verified upon acceptance of a contingent job offer. Please note, medical or religious accommodation may be available once an offer of employment is made. About the division: The Health Care Authority (HCA) is Washington’s largest health care purchaser responsible for providing comprehensive health coverage to more than 2 million residents through the Public Employees Benefits and Medicaid programs. HCA’s mission is to provide high quality health care through innovative health policies and purchasing strategies. The Clinical Quality and Care Transformation (CQCT) division makes clinical policy decisions that guide medical coverage, maintain quality standards, and ensure evidence-based practices for those on whose behalf HCA purchases medical care. The mission of the Pharmacy Policy Section is to assure the highest quality of care for low-income state medical assistance recipients by guiding appropriate and cost-effective use of pharmaceuticals. About the position: This Medical Assistance Program Specialist 2 position is the Medicaid Pharmacy Second Opinion Program Coordinator. This position is responsible for management and coordination of the Medicaid Second Opinion Program. This includes coordinating, tracking, and resolving the second opinion requests submitted by the managed care organization and fee-for-service pharmacy programs. This position is eligible to telework, occasional travel to local off-site meetings is required.

EXAMPLE OF DUTIES
Some of what you will do: Coordinate and manage the issues and resolution of authorization cases for children exceeding quality review thresholds established by the Children’s Mental Health Stakeholder Workgroup, including management of case referrals from Apple Health Fee for Service, case tracking with the Second Opinion Network, interpreting and implementing decisions of agency clinical staff.Responsible for date tracking and analysis for the administration of the Children’s Psychotropic Medication program, to include development and maintenance IT systems for client case management, clinical review, and measurements of program effectiveness.Responsible for the managing of Children’s Psychotropic MC Tracker utilization reports from Managed Care Organizations in order to independently identify cases through manual processes which exceed agency established review thresholds for referral to the Second Opinion Network (SON), through random sampling reviews.Analyzes clinical intent of changes or additions to Children’s Psychotropic medication requirements and review thresholds and responsible for their implementation, identifying opportunities for automation, developing prescriber questionnaires, and operationalizing workflow changes with the Managed Care Organizations and Second Opinion Networks.Monitors changes in agency policy and preferred drug list selection in order to develop work plans for the implementation of said changes. Provides written report of analysis for review by the Medicaid Pharmacy Unit Manager, and upon approval, be responsible for implementation requirements.Triage, troubleshoot, and resolve issues escalated to Pharmacy Policy, or escalate for policy review and resolution by the Medicaid Pharmacy Unit Manager.Support other MAPS2s staff to develop written processes and procedures such as publications in all media formats, form development, and application of administrative policies.

MINIMUM QUALIFICATIONS
Required qualifications: A Bachelor’s degree with major study in public health, public administration, or closely related field and three (3) years of supervisory or consultative experience in health services, or Medicaid programsORA Bachelor’s degree and two (2) years of experience as a Financial Services Specialist 5 or as a Work First SupervisorOR A Master’s degree with major study in public health, public administration, social work, or closely related field and two (2) years of supervisory or consultative experience in health services, social services, or Medicaid programsORA minimum of two (2) years qualifying experience. Additional qualifying experience may substitute year for year, for required education or supervisory experience. For the purposes of this position, “qualifying experience” includes any of the following: 1. Claims processing, billing, authorization, or analysis in an NCPDP compliant Pharmacy Point of Service claims processing system2. Claims processing, billing, authorization, or analysis in HCA’s ProviderOne MMIS system, or comparable medical claim management system. Preferred qualifications: Licensed Pharmacy TechnicianKnowledge of pharmacy industry and prescription drug terminology.Knowledge of medical claim processing and edits within the ProviderOne system.Knowledge of and experience with Excel, Word, and Decision Support applications.Knowledge of Federal and state laws and regulations, related to Medicaid and health care, with particular emphasis in the optional provision of pharmacy benefits within Medicaid according to section 1927 of the SSA.Knowledge of continuous quality improvement practices.Knowledge of methods of practice of research, analysis, and report writing at an independent level.

SUPPLEMENTAL INFORMATION
How to apply: Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile which includes three professional references and attach: A cover letter that specifically addresses how you meet the qualifications for this positionCurrent resume About HCA: The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents. HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and the School Employees Benefits Board (SEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost. What we have to offer: Meaningful work with friendly co-workers who care about those we serve Voices of HCA A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & ValuesA healthy work/life balance, including alternative/flexible schedules and mobile work options.A great total compensation and benefit package WA State Government BenefitsA safe, pleasant workplace in a convenient location with restaurants, and shopping nearby. Tuition reimbursementAnd free parking! Notes: At HCA, we understand the importance of having a diverse workforce. It’s imperative we reflect the image of America in all our programs throughout our workforce which includes our supervisory, management, and executive leadership positions. Therefore, we’re actively involved in promoting a diverse work environment. At HCA, we assist our recruitment team with their DEI staffing objectives. Additionally, we promote diversity, equity, and inclusion through internal discussions, meetings, and written instructions. Furthermore, we must be extremely vigilant to recognize shortfalls and recommend solutions to those challenges. Lastly, we know that the most successful organizations in America are ones that promote diversity throughout their workforce, and our goal is to ensure HCA does the same. The Washington State Health Care Authority is an equal opportunity employer. We strive to create a working environment that provides equal access and opportunity to anyone who qualifies, regardless of sex, race, age, color, religion, mental or physical disability, national origin, sexual orientation, gender identity and expression and/or military status. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Julie Laney at Julie.Laney@hca.wa.gov Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment.The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.

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