Program Integrity Liaison (Wms2/Daio)

Program Integrity Liaison (WMS2/DAIO)

71071935

The Legislature has also approved a 3% general wage increase for all state employees, effective July 1, 2024.

As the state's Medicaid agency, the Health Care Authority (HCA) has administrative oversight over all Medicaid expenditures in the state of Washington. This position's task is to establish and maintain program integrity practices including reporting, performance metrics, and enforcement internally and externally. This individual represents HCA with external agencies and organizations, so the ideal candidate will have demonstrated an ability to navigate similar relationships and an understanding of associated regulatory environments, including federal and state laws and regulations.

All HCA employees will apply an equity lens to their work, which may include but is not limited to all analyses of core business and processes.

About the division:

The Office of Regulatory Compliance & Oversight (ORCO) is part of the Division of Audit, Integrity, and Oversight (DAIO) of HCA. ORCO provides technical assistance, resources, and oversight functions to federal and state grants, subawards, and state Medicaid expenditures. ORCO provides leadership, education, and support to all divisions of the agency at all employee levels to mitigate risks, comply with changing laws, and assist the agency in accomplishing its goals.

The Program Integrity Liaison reports to the Compliance & Oversight Manager and leads, directs, and supervises a team devoted to ensuring proper expenditure of Medicaid dollars by our sister state agencies and Managed Care Organizations (MCOs). This team is designed to provide corrective action and technical assistance to external entities that are tasked with administering Medicaid funds.

About the position:

The Program Integrity Liaison serves as the single point of contact for our sister state agencies and MCOs who have program integrity related questions. The Program Integrity Liaison is responsible for program integrity appendixes and contract language in our Integrated Managed Care (IMC) contracts and facilitates meetings between the MCOs and the Medicaid Fraud Control Unit (MFCU) of the Attorney General's Office.

This position is responsible for managing the workload of the unit and is responsible for facilitating coordination between HCA, MCOs, the Department of Social and Health Services (DSHS), the Department of Children, Youth, and Families (DCYF), the Department of Health (DOH), and the Medicaid Fraud Control Uni     t (MFCU) of the Attorney General's Office to bring accountability and transparency of external expenditures of Medicaid funds. This position is further responsible for assisting in developing and maintaining all agency policies and procedures relating to oversight and compliance of external agency expenditures of state Medicaid funds.

This position is eligible to telework and is typically not required to report on-site. The default assigned work location of all Health Care Authority (HCA) positions - both on-site and telework eligible positions - is within the State of Washington. Frequency of onsite work will vary based on business and operational needs. HCA may choose, but is not required, to support out-of-state telework on a case-by-case basis.

Some of what you will do:

• Supervises a unit of professional staff responsible for establishing and implementing effective internal controls over state agencies that receive and administer Medicaid funds in compliance with federal regulations.

• Develops processes that accurately meet conditions prescribed by state and federal law and regulation regarding program integrity.

• Develops a strategic plan and performance measures for program integrity, which will include goals, agreed-upon objectives, performance measures, and a system to monitor progress and hold responsible parties accountable.

• Advises and consults with the HCA executive management team regarding specific issues or the consistent application of state and federal law, policy, and procedures regarding statewide surveillance of Medicaid expenditures or specific provisions of 42 CFR Part 456.

• Develops, implements, and administers policies, procedures, and processes for monitoring the statewide utilization control program, which includes overseeing and monitoring the activities of other state agencies who administer Medicaid funds.

• Facilitates coordination meetings with external partners to include sibling state agencies, MCOs, and MFCU.

• Analyzes bills and legislation as they pertain to program integrity matters.

• Provides coaching and mentoring to section and agency staff on best practices, methods, and procedures.

• Develops partnerships and works collaboratively with other managers, executives, senior leaders, and line staff, external stakeholders, other agencies and assistant attorneys general.

• Represents HCA on intergovernmental program integrity issues.

• Collaborates with agency senior leadership on process improvement initiatives, risk management, special assignments, as required; and with DAIO Management Team to resolve organizational issues, and other duties as assigned.

Required qualifications:

Qualifying candidates will satisfy one of the following criteria options:

Option 1:

• 9 years of advanced/senior/expert level experience in the administration of Medicaid funds and expenditures to include strategic implementation of programs or processes.

Option 2:

• 7 years of experience identified above and

• Associate's degree

Option 3:

• 5 years of experience identified above and

• Bachelor's degree in business administration, public administration, contracting, business law, commerce, mathematics, statistics, economics or closely allied field.

Option 4:

• 3 years of experience identified above and
• A law degree from an accredited college or university approved by the Washington State Bar Association.

Preferred qualifications:

• Experience working with Medicaid or the behavioral health industry.

• A law degree from an accredited college or university approved by the Washington State Bar Association.

• Demonstrated ability to problem-solve, prioritize workloads, meet deadlines, and provide independent strategic direction/decision making.

• Handles customer service questions and complaints in a pleasant and professional manner.

• Meets commitments, works independently, accepts accountability, and stays focused under pressure.

• Deals with others in a straightforward and honest manner, is accountable for actions, maintains confidentiality, and supports agency values.

• Gives the appropriate attention to detail and accuracy, has a commitment to excellence, strives for continuous quality improvement.

• Supervisory experience including conducting employee performance reviews.

• Ability to clearly communicate complex information, verbally and in writing to a non-technical audience.

• Excellent interpersonal skills.

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 position

• Current resume

To take advantage of veteran preference, please do the following:

• Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter.

• Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov.

About HCA:

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

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 & Values

• A healthy work/life balance, including alternative/flexible schedules and mobile work options.

• A great total compensation and benefit package WA State Government Benefits

• A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby.

• Tuition reimbursement

• And free parking!

Notes:

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.

HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA's mission. Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Studies have shown women, racial and ethnic minorities, and persons of disability are less likely to apply for jobs unless they feel they meet every qualification as described in a job description. Persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are also encouraged to apply. If you have any questions about the required qualifications or how your experience relates to them, please contact us at HCAjobs@hca.wa.gov. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Jake Nelko at jake.nelko@hca.wa.gov or 360.725.0945.

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.

E-Verify is a registered trademark of the U.S. Department of Homeland Security.

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