Program Specialist for Home Health, Hospice, Continuous Skilled Nursing, and Therapy Program

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The MassHealth Office of Long Term (Care) Services and Supports (OLTSS) is responsible for managing a robust system of supports for members of all ages who need services to enable them to live with independence and dignity in their daily lives, participate in their communities, and increase their overall quality of life. These services and supports may be provided in the home; in residential, day, and other community-based settings; or in certain facility-based settings, such as nursing homes and chronic disease rehab hospitals. Additionally, OLTSS manages fully capitated integrated care plans primarily for dually eligible individuals (i.e. Medicare and Medicaid): Senior Care Options (SCO), the One Care Program, and the Program of All-Inclusive Care for the Elderly (PACE). OLTSS also oversees 10 home and community based (HCBS) Medicaid waiver programs that provide specialized services and supports to especially vulnerable OLTSS populations. OLTSS is responsible for ensuring that services provided in any setting and all delivery systems are member-focused, accessible, of the highest quality, and delivered in a cost-effective manner.

Duties and Responsibilities (these duties are a general summary and not all inclusive):

The Program Specialist will support the day-to-day management of OLTSS' home health, hospice, therapy, and Continuous Skilled Nursing (CSN) programs. MassHealth members who use home health, hospice, CSN and therapy services are often vulnerable individuals who without such services may require more intensive care. The Program Specialist will work to ensure these members receive high quality care and also assist those providers that serve them remain complaint with federal and state regulations. Responsibilities will include provider, member, and advocate stakeholder engagement; provider education; provider enrollment and provider network management; meeting planning; operationalization of program integrity efforts; and data collection and analysis.

The Program Specialist will assist the Home Health, Hospice, Therapy Program Manager, the CSN Program Manager, and the Acting Director with additional tasks including program and rate development, policy planning, and regulatory management and development.

Day-to-Day Operational Duties:

• Day-to-day monitoring of the OLTSS Third Party Administrator (TPA) contractual functions relating to provider enrollment and credentialing, overseeing the Electronic Visit Verification (EVV) compliance, claims operations, prior authorization, appeals, program integrity and reporting related to the relevant programs, and ability to triage and/or escalate issues to the appropriate OLTSS internal staff.
• Work with both Program Managers to resolve MassHealth member issues that relate to relevant provider networks and respond to requests for information regarding payment and policy questions.
• Provide assistance to both Program Managers during program regulation and rate regulation development and implementation, including working with IT team and Claims operation team.
• Assist both Program Managers to ensure provider compliance with all applicable program rules, regulations and sub regulatory guidance including provider education, engagement and issue escalation.
• Under the guidance of both Program Managers, lead provider and constituent affairs services to resolve program policy and service delivery issues.
• Assist with reviewing, filing, and following up on critical incident reports.
• Manage, track and monitor multiple projects and initiatives relative to the programs, and work with both Program Managers to recommend changes in policy, communication strategies and/or program structure to the Acting Director and other members of the OLTSS leadership team.
• In coordination with both Program Managers, effectively communicate priority project statuses, risks and outstanding decisions to OLTSS and MassHealth leadership both verbally and in written form under quick timelines.
• Monitor TPA Board of Hearing (BOH) cases and collaborate with appropriate OLTSS internal staff.
• Assist both Program Manager to provide program-related assistance to other units within the MassHealth, the Executive Office of Aging and Independence, and other agencies in the state government.
• Review and analyze data concerning assigned agency programs to determine progress and effectiveness, to make recommendations for changes in procedures, guidelines, and regulations, and to devise methods of accomplishing program objectives.
• Assist both Program Manager to provide technical assistance and advice to agency personnel, contractors, and others concerning assigned programs to exchange information, resolve problems, and to ensure compliance with established policies, procedures, standards, and regulations.
• Performs related duties such as attending meetings and conferences, maintaining records, and preparing reports.
• Assist both Program Manager to develop and implement procedures, guidelines, and regulations to accomplish assigned agency program objectives and goals.
• Review draft reports, memoranda, and regulations etc. for completeness, accuracy, and content.
• Assist the CSN Program Manager in the oversight of Community Case Management as needed.

Program Integrity Duties:

• Conduct onsite visits with providers including but not limited to program audits, site reviews and provider education visits which may include educational sessions within conferences (limited travel required).
• Maintain databases and spreadsheets to provide current and accurate program and audit activities and follow-up on recommended corrective action or compliance issues raised in audits.
• Collaborate on TPA program integrity (PI) responsibilities and serve as program integrity specialist in the relevant program area.

Additional Duties:

• Assist both Program Manager in working with provider stakeholder groups to solicit feedback or provide training, as needed.
• Collaborate with the Strategic Initiatives team in the management of all relevant TPA functions.
• Collaborate with MassHealth Finance and Strategy Teams on budget, cost reports, rate setting, modeling and implementation of a value-based payment methodology.
• Collaborate with the OLTSS External Affairs team on drafting talking points, policies, memoranda, and meeting materials.

Required Qualifications:

• Ability to prepare charts, tables, and graphs.
• Knowledge of the methods of general report writing.
• Ability to understand, explain, and apply the laws, rules, regulations, policies, procedures, etc. governing assigned unit activities.
• Ability to analyze and determine the applicability of data, to draw conclusions and make appropriate recommendations.
• Ability to gather information by examining records and documents and questioning individuals.
• Ability to determine proper format and procedure for assembling items of information.
• Ability to prepare general reports, draft memos, bulletins, and other internal or external guidance/regulations
• Ability to write concisely, to express thoughts clearly, and to develop ideas in logical sequence.
• Ability to give written and oral instructions in a precise, understandable manner.
• Ability to establish rapport and harmonious working relationships with others.
• Ability to adjust to varying or changing situations to meet emergency or changing program requirements.
• Proficiency in Microsoft Excel, Word, and PowerPoint; knowledge of Microsoft Project and Visio is a plus.

Preferred Qualifications:

• Experience working with complex medical populations and knowledge of their general medical needs. Knowledge of in-home nursing, home health, hospice, and/or CSN services preferred.
• Excellent analytical and problem-solving skills.
• Excellent writing, presentation, facilitation, and communication skills.
• Excellent organization skills, including ability to manage time, to set priorities and to work under time constraints.
• Knowledge and experience in LTSS program policy development, analysis and evaluation.
• Possess an understanding of the role of data and analysis in driving system change.
• Ability to develop and maintain effective working relationships with a range of LTSS stakeholders and partners.
• Knowledge of the Massachusetts health care industry and market dynamics related to LTSS.
• Knowledge of payment reform and care delivery reform strategies, including an understanding of the relationship between payment reforms, delivery system change, quality improvement and member satisfaction in LTSS.
• Ability to understand, apply and explain pertinent laws, rules, regulations, policies and procedures.
• Knowledge of the methods used in the preparation of charts, graphs and tables, and of the methods of general report writing.
• Ability to analyze and determine the applicability of data, to draw conclusions and to make appropriate recommendations.
• Ability to gather and assemble information in accordance with established procedures to compile statistical data and to communicate clearly, concisely, logically, accurately and persuasively in written, verbal and visual formats in internal, external and public settings.
• Ability to work independently and collaboratively.
• Ability to lead meetings and manage projects.
• Proficiency in Microsoft Excel, Word, and PowerPoint; knowledge of Microsoft Project and Visio is a plus.
• Strong interpersonal skills.
• Commitment to health equity.

To Apply:

Please upload both Resume and Cover Letter for this position when applying. First consideration will be given to those applicants that apply within the first 14 days.

About MassHealth:

The mission of MassHealth is to improve the health outcomes of our diverse members, their families, and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence, and quality of life.

For more information about our agency and programs please visit: www.mass.gov/masshealth

Pre-Offer Process:

A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori.

Education, licensure, and certifications will be verified in accordance with the Human Resources Division's Hiring Guidelines.

Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth's website.

ADA Reasonable Accommodation:

If you require a reasonable accommodation with the application/interview process, please contact us at: EOHHS Candidate ADA Requests.

For questions regarding this requisition, please contact the Executive Office of Health and Human Services Human Resources at 1-800-510-4122, option 4.

For questions regarding MassCareers access and navigation please contact MassHR at 617-979-8500.

'',''!*!

The MassHealth Office of Long Term (Care) Services and Supports (OLTSS) is responsible for managing a robust system of supports for members of all ages who need services to enable them to live with independence and dignity in their daily lives, participate in their communities, and increase their overall quality of life. These services and supports may be provided in the home; in residential, day, and other community-based settings; or in certain facility-based settings, such as nursing homes and chronic disease rehab hospitals. Additionally, OLTSS manages fully capitated integrated care plans primarily for dually eligible individuals (i.e. Medicare and Medicaid): Senior Care Options (SCO), the One Care Program, and the Program of All-Inclusive Care for the Elderly (PACE). OLTSS also oversees 10 home and community based (HCBS) Medicaid waiver programs that provide specialized services and supports to especially vulnerable OLTSS populations. OLTSS is responsible for ensuring that services provided in any setting and all delivery systems are member-focused, accessible, of the highest quality, and delivered in a cost-effective manner.

Duties and Responsibilities (these duties are a general summary and not all inclusive):

The Program Specialist will support the day-to-day management of OLTSS' home health, hospice, therapy, and Continuous Skilled Nursing (CSN) programs. MassHealth members who use home health, hospice, CSN and therapy services are often vulnerable individuals who without such services may require more intensive care. The Program Specialist will work to ensure these members receive high quality care and also assist those providers that serve them remain complaint with federal and state regulations. Responsibilities will include provider, member, and advocate stakeholder engagement; provider education; provider enrollment and provider network management; meeting planning; operationalization of program integrity efforts; and data collection and analysis.

The Program Specialist will assist the Home Health, Hospice, Therapy Program Manager, the CSN Program Manager, and the Acting Director with additional tasks including program and rate development, policy planning, and regulatory management and development.

Day-to-Day Operational Duties:

• Day-to-day monitoring of the OLTSS Third Party Administrator (TPA) contractual functions relating to provider enrollment and credentialing, overseeing the Electronic Visit Verification (EVV) compliance, claims operations, prior authorization, appeals, program integrity and reporting related to the relevant programs, and ability to triage and/or escalate issues to the appropriate OLTSS internal staff.
• Work with both Program Managers to resolve MassHealth member issues that relate to relevant provider networks and respond to requests for information regarding payment and policy questions.
• Provide assistance to both Program Managers during program regulation and rate regulation development and implementation, including working with IT team and Claims operation team.
• Assist both Program Managers to ensure provider compliance with all applicable program rules, regulations and sub regulatory guidance including provider education, engagement and issue escalation.
• Under the guidance of both Program Managers, lead provider and constituent affairs services to resolve program policy and service delivery issues.
• Assist with reviewing, filing, and following up on critical incident reports.
• Manage, track and monitor multiple projects and initiatives relative to the programs, and work with both Program Managers to recommend changes in policy, communication strategies and/or program structure to the Acting Director and other members of the OLTSS leadership team.
• In coordination with both Program Managers, effectively communicate priority project statuses, risks and outstanding decisions to OLTSS and MassHealth leadership both verbally and in written form under quick timelines.
• Monitor TPA Board of Hearing (BOH) cases and collaborate with appropriate OLTSS internal staff.
• Assist both Program Manager to provide program-related assistance to other units within the MassHealth, the Executive Office of Aging and Independence, and other agencies in the state government.
• Review and analyze data concerning assigned agency programs to determine progress and effectiveness, to make recommendations for changes in procedures, guidelines, and regulations, and to devise methods of accomplishing program objectives.
• Assist both Program Manager to provide technical assistance and advice to agency personnel, contractors, and others concerning assigned programs to exchange information, resolve problems, and to ensure compliance with established policies, procedures, standards, and regulations.
• Performs related duties such as attending meetings and conferences, maintaining records, and preparing reports.
• Assist both Program Manager to develop and implement procedures, guidelines, and regulations to accomplish assigned agency program objectives and goals.
• Review draft reports, memoranda, and regulations etc. for completeness, accuracy, and content.
• Assist the CSN Program Manager in the oversight of Community Case Management as needed.

Program Integrity Duties:

• Conduct onsite visits with providers including but not limited to program audits, site reviews and provider education visits which may include educational sessions within conferences (limited travel required).
• Maintain databases and spreadsheets to provide current and accurate program and audit activities and follow-up on recommended corrective action or compliance issues raised in audits.
• Collaborate on TPA program integrity (PI) responsibilities and serve as program integrity specialist in the relevant program area.

Additional Duties:

• Assist both Program Manager in working with provider stakeholder groups to solicit feedback or provide training, as needed.
• Collaborate with the Strategic Initiatives team in the management of all relevant TPA functions.
• Collaborate with MassHealth Finance and Strategy Teams on budget, cost reports, rate setting, modeling and implementation of a value-based payment methodology.
• Collaborate with the OLTSS External Affairs team on drafting talking points, policies, memoranda, and meeting materials.

Required Qualifications:

• Ability to prepare charts, tables, and graphs.
• Knowledge of the methods of general report writing.
• Ability to understand, explain, and apply the laws, rules, regulations, policies, procedures, etc. governing assigned unit activities.
• Ability to analyze and determine the applicability of data, to draw conclusions and make appropriate recommendations.
• Ability to gather information by examining records and documents and questioning individuals.
• Ability to determine proper format and procedure for assembling items of information.
• Ability to prepare general reports, draft memos, bulletins, and other internal or external guidance/regulations
• Ability to write concisely, to express thoughts clearly, and to develop ideas in logical sequence.
• Ability to give written and oral instructions in a precise, understandable manner.
• Ability to establish rapport and harmonious working relationships with others.
• Ability to adjust to varying or changing situations to meet emergency or changing program requirements.
• Proficiency in Microsoft Excel, Word, and PowerPoint; knowledge of Microsoft Project and Visio is a plus.

Preferred Qualifications:

• Experience working with complex medical populations and knowledge of their general medical needs. Knowledge of in-home nursing, home health, hospice, and/or CSN services preferred.
• Excellent analytical and problem-solving skills.
• Excellent writing, presentation, facilitation, and communication skills.
• Excellent organization skills, including ability to manage time, to set priorities and to work under time constraints.
• Knowledge and experience in LTSS program policy development, analysis and evaluation.
• Possess an understanding of the role of data and analysis in driving system change.
• Ability to develop and maintain effective working relationships with a range of LTSS stakeholders and partners.
• Knowledge of the Massachusetts health care industry and market dynamics related to LTSS.
• Knowledge of payment reform and care delivery reform strategies, including an understanding of the relationship between payment reforms, delivery system change, quality improvement and member satisfaction in LTSS.
• Ability to understand, apply and explain pertinent laws, rules, regulations, policies and procedures.
• Knowledge of the methods used in the preparation of charts, graphs and tables, and of the methods of general report writing.
• Ability to analyze and determine the applicability of data, to draw conclusions and to make appropriate recommendations.
• Ability to gather and assemble information in accordance with established procedures to compile statistical data and to communicate clearly, concisely, logically, accurately and persuasively in written, verbal and visual formats in internal, external and public settings.
• Ability to work independently and collaboratively.
• Ability to lead meetings and manage projects.
• Proficiency in Microsoft Excel, Word, and PowerPoint; knowledge of Microsoft Project and Visio is a plus.
• Strong interpersonal skills.
• Commitment to health equity.

To Apply:

Please upload both Resume and Cover Letter for this position when applying. First consideration will be given to those applicants that apply within the first 14 days.

About MassHealth:

The mission of MassHealth is to improve the health outcomes of our diverse members, their families, and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence, and quality of life.

For more information about our agency and programs please visit: www.mass.gov/masshealth

Pre-Offer Process:

A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori.

Education, licensure, and certifications will be verified in accordance with the Human Resources Division's Hiring Guidelines.

Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth's website.

ADA Reasonable Accommodation:

If you require a reasonable accommodation with the application/interview process, please contact us at: EOHHS Candidate ADA Requests.

For questions regarding this requisition, please contact the Executive Office of Health and Human Services Human Resources at 1-800-510-4122, option 4.

For questions regarding MassCareers access and navigation please contact MassHR at 617-979-8500.

'',''!*!

First consideration will be given to those applicants that apply within the first 14 days.

MINIMUM ENTRANCE REQUIREMENTS: Applicants must have at least (A) four years of full-time, or equivalent part-time, professional, administrative or managerial experience in business administration, business management or public administration the major duties of which involved program management, program administration, program coordination, program planning and/or program analysis, and (B) of which at least one year must have been in a supervisory capacity, or (C) any equivalent combination of the required experience and the substitutions below.

Substitutions:

I. A Bachelor''s degree with a major in business administration, business management or public administration may be substituted for a maximum of two years of the required (A) experience.*

II. A Graduate degree with a major in business administration, business management or public administration may be substituted for a maximum of three years of the required (A) experience.*

III. A Bachelor''s or higher degree with a major other than in business administration, business management or public administration may be substituted for a maximum of one year of the required (A) experience.*

• Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed.

NOTE: No substitutions will be permitted for the required (B) experience.

Salary placement is determined by a combination of factors, including the candidate's years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division's Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range.

Comprehensive Benefits

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

Want the specifics? Explore our Employee Benefits and Rewards!

An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don''t meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.

'',''!*!

First consideration will be given to those applicants that apply within the first 14 days.

MINIMUM ENTRANCE REQUIREMENTS: Applicants must have at least (A) four years of full-time, or equivalent part-time, professional, administrative or managerial experience in business administration, business management or public administration the major duties of which involved program management, program administration, program coordination, program planning and/or program analysis, and (B) of which at least one year must have been in a supervisory capacity, or (C) any equivalent combination of the required experience and the substitutions below.

Substitutions:

I. A Bachelor''s degree with a major in business administration, business management or public administration may be substituted for a maximum of two years of the required (A) experience.*

II. A Graduate degree with a major in business administration, business management or public administration may be substituted for a maximum of three years of the required (A) experience.*

III. A Bachelor''s or higher degree with a major other than in business administration, business management or public administration may be substituted for a maximum of one year of the required (A) experience.*

• Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed.

NOTE: No substitutions will be permitted for the required (B) experience.

Salary placement is determined by a combination of factors, including the candidate's years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division's Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range.

Comprehensive Benefits

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

Want the specifics? Explore our Employee Benefits and Rewards!

An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don''t meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.

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