POSITION DESCRIPTION

Transcription

1 State of Michigan Civil Service Commission Capitol Commons Center, P.O. Box Lansing, MI Position Code 1. DEPTALTA711 POSITIO DESCRIPTIO This position description serves as the official classification document of record for this position. Please complete the information as accurately as you can as the position description is used to determine the proper classification of the position. 2. Employee's ame (Last, First, M.I.) 8. Department/Agency MDHHS-COM HEALTH CETRAL OFF 3. Employee Identification umber 9. Bureau (Institution, Board, or Commission) Medicaid Policy and Health System Innovation 4. Civil Service Position Code Description 10. Division Departmental Analyst-A Inegrated Care Division 5. Working Title (What the agency calls the position) 11. Section Contract Manager Integrated Programs Management 6. ame and Position Code Description of Direct Supervisor 12. Unit PERRY, ROXAE R; STATE ADMIISTRATIVE MAAGER-1 7. ame and Position Code Description of Second Level Supervisor 13. Work Location (City and Address)/Hours of Work GOURWITZ, PAMELA M; STATE DIVISIO ADMIISTRATOR S. Pine, Capitol Commons Bldg, Lansing / Monday - Frday 8 am - 5 pm 14. General Summary of Function/Purpose of Position As a senior level analyst, performs as a primary liaison between the Department of Health and Human Services (MDHHS), Medical Services Administration and Integrated Care Organizations (ICOs) that are contracted to provide integrated health care services and care coordination to people who are eligible for both Medicaid and Medicare in MI Health Link. This position performs as a communications liaison for DHHS, performing operational activities related to the ICOs. As a contract manager, this position must perform, at a minimum, the following duties: conduct on-site visits and site visit team responsibilities; serve as a contact person for providers, associations, county and local agencies, and inter- and intradepartmental entities; communicate with the ICOs via multiple means, including telephone, letter, , on-site visits, and/or meetings; facilitate and monitor contract compliance of the ICOs; serve as an advocate in resolving service problems that may occur; perform activities that enhance and sustain the operational capabilities of the ICO as a Medicaid/Medicare provider; and perform duties to maintain the integrity of the Medicaid/Medicare program, provider contractual agreements and the provision of health care to the persons eligible for both Medicaid and Medicare in MI Health Link..

2 15. Please describe the assigned duties, percent of time spent performing each duty, and what is done to complete each duty. List the duties from most important to least important. The total percentage of all duties performed must equal 100 percent. Duty 1 General Summary: Percentage: 60 As a senior level analyst, performs as contract manager of Integrated Care Organizations (ICOs). Clarifies and interprets contract language, Medicare policies and Medicaid policies in order to appropriately respond to questions, compliance and enrollment issues brought forth by the contracted ICOs; notifies program and department staff. Schedules and conducts monitoring calls to review the Contract Management Team (CMT) data findings, analyze the data and discuss any deficiencies, status reports, performance improvement plans, utilization reports, reconciliation reports, annual reports, data exchange and related issues and problems. Analyzes and resolves enrollment discrepancies; works with enrollment and systems staff as needed. Monitors ICOs for contract compliance on an on-going basis, in accordance with the three-way contract, Memorandum of Understanding (MOU) and federal regulations. Interprets and clarifies the the three-way contract, Michigan-specific Marketing Guidance for Medicare-Medicaid Plans, and Medicare-Medicaid Plan Enrollment and Disenrollment Guidance, as needed to ensure compliance. Facilitates meetings with internal staff and Centers for Medicare and Medicaid to discuss ICO noncompliance. Also initiates and coordinates meetings with ICOs to resolve compliance disputes. Analyzes current contract operations and recommends amendments to the contract to achieve greater efficiency and effectiveness of the program and better serve the MI Health Link population.

3 Duty 2 General Summary: Percentage: 15 Serves as a primary liaison between the Department of Health and Human Services, Medical Services Administation and the Integrated Care Organizations. Communicates with the contracted ICOs by telephone, letter, and and coordinates on-site visits and meetings. Regularly performs complex research and assessment of information relative to letters and bulletins on contract changes and clarifications to the ICOs. Compiles research into a format accessible to target audience and coordinates delivery. Serves as a contract expert for fellow staff. Revises department manuals such as the Bridges Adminstrative Manual (BAM) and Bridges Eligibility Manual (BEM) to ensure MI Health Link sections include up to date three-way contract requirements, when necessary. Functions as an intra- and inter-departmental expert on contract language. Analyzes, clarifies, and provides information on contractual language for Integrated Care Division staff, ICOs, the Department of Health and Human Services, and Medical Services Administration. Makes referrals to appropriate areas and, when needed, helps staff determine appropriate referrals. Designs and serves as lead facilitator for presentations, as needed, to the ICOs and/or community regarding Integrated Care. Responds to inquiries via telephone and written communication and serves as a primary back-up to staff when they are unable to resolve an issue. Serves as a primary consultant and expert on ICO contracts and facilitates the successful fulfillment of the ICO contracts with various State agencies, private and public organizations, and communities in assigned areas. Develops and conducts communication activities during program development, program implementation and on an ongoing basis. Duty 3 Serves as contact person for providers; associations; county and local agencies; and inter- and intra-departmental entities. Serves as communication liaison for the Department regarding various activities defined in the contract. Serves as a primary consultant and expert on ICO contracts and facilitates the successful fulfillment of the ICO contracts with various State agencies, private and public organizations, and communities in assigned areas. Develops and conducts communication activities during program development, program implementation and on an ongoing basis. Duty 4 Performs activities to enhance and support the operational capabilities of the ICO as a Medicaid/Medicare provider.

4 Performs as a technical expert for ICOs and Integrated Care Division staff, providing comprehensive technical guidance on compensation methodology, record layouts for billing and enrollment data exchanges, RA sample data, fee schedules, and other essential issues. Informs Provider Enrollment to issue ID#. Ensures that appropriate entities receive timely notice of the effective date for enrollment and when rates should be loaded. Designs and facilitates on-site training or re-training of ICO staff. Ensures activation of providers on CHAMPS is completed accurately and in a timely fashion. Ensure ICOs and PIHPs have access and maintain access for the MI Health Link SharePoint site. Duty 5 Performs activities to support the ongoing oversight and production of MI Health Link Mangament System (LMS) Develops content in a usable format for individual trainings. Participates in weekly meetings with contractor as needed. Reviews and edits on-line trainings that have been produced. Provides training to the ICOs on the use of the LMS system. Duty 6 Serves as a MI Health Link contract content expert in various internal and external workgroups. Participates in internal and external CareBridge/IT Workgroup. Assist in the development of new use cases for the C-CDA exchange. Assist in the planning and preparation for ongoing Quality Workgroups. Participate in the quality work group. Duty 7 Other duties as assigned. Other duties as assigned. 16. Describe the types of decisions made independently in this position and tell who or what is affected by those decisions. Work assignments, job priorities and work adjustments. 17. Describe the types of decisions that require the supervisor's review.

5 When issues or problems have program-wide implications or impacts areas other than the specific assigned area of responsibility. 18. What kind of physical effort is used to perform this job? What environmental conditions in this position physically exposed to on the job? Indicate the amount of time and intensity of each activity and condition. Refer to instructions. Majority of work is performed in an office setting with use of a personal computer. Travel is involved for site visits and meetings based on the ICOs and/or region assigned. Minimal transportation of documents for meetings is required. 19. List the names and position code descriptions of each classified employee whom this position immediately supervises or oversees on a fulltime, on-going basis. Additional Subordinates 20. This position's responsibilities for the above-listed employees includes the following (check as many as apply): Complete and sign service ratings. Assign work. Provide formal written counseling. Approve leave requests. Approve work. Review work. Approve time and attendance. Provide guidance on work methods. Orally reprimand. Train employees in the work. 22. Do you agree with the responses for items 1 through 20? If not, which items do you disagree with and why? Yes 23. What are the essential functions of this position? To serve as liaison and contract manager with Integrated Care Organizations. 24. Indicate specifically how the position's duties and responsibilities have changed since the position was last reviewed. The position has the full responsibilities of a contract manager handling the complex assignments dealing with the ICO s. At the senior level, the individual clarifies and interprets contract language, Medicare policies and Medicaid policies in order to appropriately respond to questions, compliance and enrollment issues brought forth by the contracted ICOs; notifies program and department staff. Schedules and conducts monitoring calls to review the Contract Management Team (CMT) data findings, analyze the data and discuss any deficiencies, status reports, performance improvement plans, utilization reports, reconciliation reports, annual reports, data exchange and related issues and problems. Monitors ICOs for contract compliance on an on-going basis, in accordance with the three-way contract, Memorandum of Understanding (MOU) and federal regulations. Interprets and clarifies the the three-way contract, Michigan-specific Marketing Guidance for Medicare-Medicaid Plans, and Medicare-Medicaid Plan Enrollment and Disenrollment Guidance, as needed to ensure compliance. This positikon will facilitate meetings with internal staff and Centers for Medicare and Medicaid to discuss ICO noncompliance. Also initiates and coordinates meetings with ICOs to resolve compliance disputes. Will also analyze current contract operations and recommends amendments to the contract to achieve greater efficiency and effectiveness of the program and better serve the MI Health Link population. 25. What is the function of the work area and how does this position fit into that function? The primary function of the work area is assisting management staff to ensure compliance with the contracts between the ICOs and the Department. 26. What are the minimum education and experience qualifications needed to perform the essential functions of this position. EDUCATIO: Possession of a bachelor s degree EXPERIECE: Departmental Analyst 12 Three years of professional experience, including one year of experience equivalent to the experienced (P11) level in state service. KOWLEDGE, SKILLS, AD ABILITIES: Possess the ability to communicate effectively, both verbally and in writing. Possess knowledge and/or experience in contract monitoring. Possess the ability to analyze documents, concepts and a program s viability; pay close attention to detail, and ability to function under pressure to make accurate independent decisions. Possess knowledge of the Medicaid Program.

6 CERTIFICATES, LICESES, REGISTRATIOS: /A OTE: Civil Service approval does not constitute agreement with or acceptance of the desired qualifications of this position. I certify that the information presented in this position description provides a complete and accurate depiction of the duties and responsibilities assigned to this position. Supervisor Date TO BE FILLED OUT BY APPOITIG AUTHORITY Indicate any exceptions or additions to the statements of employee or supervisors. /A I certify that the entries on these pages are accurate and complete. LORI LITTLE Appointing Authority 8/18/2017 Date I certify that the information presented in this position description provides a complete and accurate depiction of the duties and responsibilities assigned to this position. Employee Date