HEALTH POLICY ANALYST II

Introduction

GRADE

18

LOCATION OF POSITION

MDH - Office of Medical Benefits Management 201 W. Preston Street Baltimore, MD 21201

Main Purpose of Job

This position will be the project lead in the Division of HealthChoice Quality Assurance and will be responsible for monitoring and evaluating MDH HealthChoice quality assurance activities, specifically in the area of the federally required External Quality Review (EQR). HealthChoice is the State of Maryland’s managed health care system for Medicaid. This position reviews and analyzes all EQR manuals, presentations, executive summaries, and reports to ensure they are accurate and complete. This position analyzes and evaluates all reports, data, and correspondence related to HealthChoice’s EQR initiatives and makes recommendations for improvement and approval. These quality initiatives assess the performance and health care services provided by managed care organizations (MCOs), including Systems Performance Reviews; Performance Improvement Projects; Value-Based Purchasing Initiative; Early and Periodic Screening, Diagnosis, and Treatment, (EPSDT)/Healthy Kids Review; HealthChoice Consumer Report Card; HealthChoice Network Adequacy Validation; Quarterly and Annual Analysis of Pre-Service Requests, Appeals, and Grievances; and HealthChoice Annual Technical Report. This position serves as the project lead of the EQRO PIP validation projects including topic recommendations, MCO report reviews for quarterly and annual submissions, and technical support and guidance to the vendor. The project includes managing key timelines and deliverables, disseminating sustainability surveys, and analyzing MCO results and HEDIS data. This position will serve as the project lead for developing and updating the HealthChoice Quality Strategy report, which sets programmatic goals for HealthChoice based on EQR results, other quality assurance initiatives, and MDH priorities. This project includes managing key timelines and deliverables, analyzing and researching information to include in the report, coordinating with key staff throughout the Maryland Medicaid Administration, interacting with the Centers for Medicare and Medicaid Services (CMS) for technical assistance and coordinating the stakeholder review activities associated with the report. This position analyzes federal and state policies, laws, and regulations that affect the HealthChoice program and EQR, and develops health policy recommendations related to MDH and MCO compliance activities. These policy recommendations may lead to revising quality assurance methodologies, state regulations, state policies, model notices, and guidelines for oversight of the MCOs. This position analyzes EQR findings and prepares summaries of EQR activity processes and results in easy-to-understand formats for internal and external stakeholders to support HealthChoice policies, programs, and service development, including compiling quality assurance updates for CMS reporting on a quarterly and annual basis. This position evaluates the impact of HealthChoice MCO and program performance on health care access, quality, timeliness, and cost, in addition to reporting and tracking MCO noncompliance with HealthChoice program requirements. This position also analyzes the quality assurance methodologies used in each EQR activity and develops recommendations for improvement, including performing research into Medicaid quality assurance activities, marketing materials, and reporting in other states. This position will lead the updates for future requests for proposals for EQR services. Additionally, this position will serve as the project lead for the creation of the HCQA divisional dashboard, along with the creation of the quality dashboard that will be public facing. This position will be responsible for learning, developing, creating, training, maintaining and ensuring that policies and regulations align with the development of the dashboard to convey the quality data obtained through our three vendors can be displayed to the appropriate audiences for their viewing and knowledge purposes. This position will independently meet with the Medical Program Specialist who oversees the MCO marketing materials to help track, store, and ensure policies are placed into the MCOs marketing materials that are submitted for review. This position will also lead the training development for the backup to the Medical Program Specialist who serves in this position.

MINIMUM QUALIFICATIONS

Education: A Bachelor's degree from an accredited college or university. Experience: Two years of experience evaluating, analyzing, researching and developing health care services, policies and programs. Notes: 1. Candidates may substitute the possession of a Master's degree in Health Sciences, Health Care Administration, Public Health, Public Policy or closely related field for one year of the required experience. 2. Candidates may substitute the possession of a Doctorate degree in Health Sciences, Health Care Administration, Public Health, Public Policy or closely related field for the required experience.

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should possess the following: Experience with data analysis Experience with Medicaid Managed Care programs Experience with Project Management Experience with Microsoft Office, specifically Word and Excel

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator’s license valid in the State of Maryland.

SELECTION PROCESS

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview). Complete applications must be submitted by the closing date. Information submitted after this date will not be added. Incorrect application forms will not be accepted. Resumes will not be accepted in lieu of a completed application. Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

STATE OF MARYLAND BENEFITS

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201. Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted. If additional information is required, the preferred method is to upload. If you are unable to upload, please fax the requested information to 410-333-5689. Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time. For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410-767-1251. If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 or Application.Help@maryland.gov. Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258. We thank our Veterans for their service to our country. People with disabilities and bilingual candidates are encouraged to apply. As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity. MDHMedCare