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Medical Program Specialist

Idaho Department of Health and Welfare
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THE DEPARTMENT OF HEALTH AND WELFARE

DEDICATED TO STRENGTHENING THE HEALTH, SAFETY, AND INDEPENDENCE OF IDAHOANS

*THIS ANNOUNCEMENT WILL BE OPEN UNTIL FILLED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE TO BE CONSIDERED.*

The Division of Medicaid’s Bureau of Long Term Care is seeking a forward-thinking, self-motivated, and innovative professional to join our team as a Medical Program Specialist. This is an exciting opportunity to contribute to the integrity and effectiveness of services provided to Idaho’s Medicaid participants. This position is located in Twin Falls or Burley.

In this role, you will collaborate directly with service providers, participants, stakeholders, and agency leadership to ensure compliance with program requirements and the appropriate delivery of long-term care services. You will be responsible for scheduling and conducting both routine audits and targeted compliance reviews, assessing adherence to applicable laws, regulations, policies, and standards.

As a key member of the Quality Assurance team, you will work closely with the bureau’s Quality Assurance Manager, policy analysts, field staff, and Medicaid providers. Your work will support continuous improvement efforts and help maintain high standards of care across the Bureau’s programs.

We’re looking for a critical thinker who thrives in a collaborative, fast-paced environment and is passionate about conducting audits and monitoring activities, delivering training and educational support, evaluating compliance with state and federal regulations, identifying opportunities for process improvement, preparing clear, comprehensive reports, and engaging with diverse stakeholders to promote program excellence.

This position plays a vital role in partnering with Medicaid providers, professional associations, other Medicaid bureaus, and Health and Welfare divisions to ensure compliance with the Idaho Medicaid Provider Agreement, Idaho Administrative Code (IDAPA), and federal regulations. Together, we work to enhance the quality and consistency of services delivered under the Bureau of Long Term Care.

This position may be eligible for telework after successful completion of probation and necessary training. Approval to telecommute is not guaranteed and subject to termination at any time.

BENEFITS:

The State of Idaho offers a robust total compensation and benefits package, including but not limited to:

Additional information related to benefits and/or State programs can be found here: https://dhr.idaho.gov/StateEmployees/Benefits.html.* 

Example of Duties

  • Plan and execute provider audits to ensure compliance with IDAPA regulations and Idaho Medicaid Provider Agreements.
  • Develop detailed audit reports that include findings, supporting evidence, identified deficiencies, recommendations for improvement, requests for Corrective Action Plans, and suggestions for enforcement of provider agreements.
  • Communicate audit results and compliance assessments to management, offering guidance on adherence to established standards and requirements.
  • Collect, analyze, and synthesize data from assessments and monitoring activities to evaluate compliance with relevant state and federal regulations.
  • Assist the Quality Assurance Manager in creating instructional materials, reviewing program policies and procedures, and recommending system or policy enhancements.
  • Investigate and document complaints and critical incidents, including those involving abuse, neglect, or exploitation.
  • Deliver provider training sessions and offer technical assistance and subject matter expertise to providers, staff, and stakeholders. Respond to public records requests and other inquiries to ensure accurate, consistent, and professional program communication.
  • Demonstrate strong attention to detail, excellent documentation and writing skills, and effective organizational abilities. Proficiency in Microsoft Excel, Word, and PowerPoint at an intermediate level or higher is required.

MINIMUM QUALIFICATIONS:

You must possess all the minimum qualifications below to pass the exam for this position. Please make sure your resume or work history supports your meeting the minimum qualifications for this position. Failure to do this may disqualify you from being considered for this position. It is highly recommended to attach a one-page cover letter to your application to demonstrate how you meet the requirements below.

  • Good knowledge of medical service delivery systems. Typically gained by completion of at least two college courses in a medical/health services field, public health or health care administration or related field (including but not limited to psychology, special education, RN, LPN, medical office assistant, etc.) AND one year of experience applying the knowledge in a medical service delivery system OR at least two years of experience as described.
  • Some knowledge of current laws and regulations governing Title XIX Medicaid programs. Typically gained by one year of experience where knowledge and understanding of Title XIX Medicaid laws and regulations was a job responsibility.
  • Some knowledge of training methods. Typically gained by successful completion of coursework or workshops of 16 hours or more covering communication concepts, learning styles, course design, and presentation skills or experience in presenting formal training sessions to groups.
  • Experience developing instructional materials. Typically gained by one year of experience actually developing (not just presenting) instructional course content and materials.
  • Experience evaluating program policies and procedures and recommending changes. Typically gained by one year of job experience which included the opportunity to evaluate the employer’s policies and procedures and provide input and/or recommend changes. Experience comparing employer’s policies and procedures to Medicaid or other governmental regulatory requirements would qualify as experience.

Learn About a Career with DHW

***PLEASE NOTE: application assistance is not available after the business hours listed below, on the weekends, or on holidays and you must apply before 4:59 pm on the closing date. When applying, use CHROME as your browser to avoid complications.

If you have questions, please contact us at:

Email is the quickest way to get an answer to your questions.

(answered Monday through Friday during business hours MST)

EMAIL:dhwjobs@dhw.idaho.gov PHONE:(208) 334-0681

EEO/ADA/Veteran:

The State of Idaho is committed to providing equal employment opportunities and prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on their race, color, religion, political affiliation or belief, sex, national origin, genetics, or any other status protected under applicable federal, state, or local laws.

The State of Idaho is committed to access and reasonable accommodations for individuals with disabilities, auxiliary aids and services are available upon request. If you require an accommodation at any step in our recruitment process, you are encouraged to contact (208) 334-2263 (TTY/TTD: 711), or email ada.coordinator@dhr.idaho.gov.

Preference may be given to veterans who qualify under state and federal laws and regulations.