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.*
Join our Idaho Medicaid team as a Program Specialist, where your work directly ensures thousands of Idahoans receive high-quality, reliable healthcare. In this role, you will provide compliance monitoring and operational oversight for Idaho Medicaid programs and contracted managed care plans. Your daily focus centers on steering critical contract amendments, coordinating federal CMS reporting deliverables, and leading routine operational and network audits. If you enjoy digging into operational details, collaborating with dedicated health plans, and making sure public programs deliver on their promises, this position offers a supportive team environment and a tangible way to make a lasting difference in our communities. This position is located in Boise.
This position may be eligible for limited telework after successful completion of probation and necessary training. Approval to telecommute is not guaranteed and subject to termination at any time.
BENEFITS:
BEST RETIREMENT AVAILABLE IN THE NATION
The State of Idaho offers a robust total compensation and benefits package, including but not limited to:
- We have one of the Nation's best state retirement systems (PERSI) that offers a lifetime benefit at retirement.
- 11 paid holidays
- Paid sick and vacation that begins accruing on your first day of employment; can be used immediately after accruing (no waiting time)
- Paid parental leave
- Medical, vision, and dental insurance benefits that become effective first of the month following your hire date. All contributions can be pre-tax (full-time/30+ hours per week)
- 2 voluntary supplemental retirement plans including both pre-tax and Roth options
- Deferred compensation plan
- Life insurance for self, spouse, and children
- Short and long-term disability insurance
- Flexible Spending Accounts (FSA)
- Wide variety of training opportunities
- Some positions offer flexible hours and/or telecommuting
- Additional perks and discounts available through medical provider
- Public Service Loan Forgiveness (PSLF) Eligibility
- Employee assistance program
Additional information related to benefits and/or State programs can be found here: https://dhr.idaho.gov/StateEmployees/Benefits.html.*
EXAMPLE OF DUTIES:
- Develop and manage contract amendments: Draft, update, and track formal contract amendments by identifying program needs, operational goals, timetables, and funding parameters in coordination with leadership, the DHW Contracts Unit, and the state purchasing division.
- Oversee CMS and regulatory compliance: Ensure all managed care contracts and program operations strictly align with Centers for Medicare & Medicaid Services (CMS) regulations, federal codes (e.g., 42 CFR Part 438), Idaho Code, and Medicaid State Plan authorities.
- Lead CMS reporting data collection and aggregation: Establish data collection schedules, gather required operational and program metrics from internal systems and contracted health plans, and reconcile incoming datasets to ensure data completeness and integrity.
- Coordinate and execute CMS report submissions: Prepare, format, and formally submit recurring federal reporting packages (including Managed Care Program Annual Reports (MCPAR), network adequacy assurances, and quality metrics) strictly adhering to CMS deadlines and portal technical specifications.
- Conduct managed care and operational audits: Plan and execute routine audits of contracted managed care plans and specialty vendors, evaluating operational performance, provider network adequacy, data accuracy, and contract deliverables and performance targets.
- Interpret complex healthcare policies: Analyze and apply state and federal statutory changes, Medicaid policy updates, and administrative rules to evaluate their impact on active contracts, reporting requirements, and program workflows.
- Provide technical assistance and stakeholder guidance: Serve as an operational liaison and subject matter resource for contracted health plans, internal DHW teams, and partner agencies regarding compliance standards, contractual requirements, and reporting expectations.
- Perform specialized compliance research and analysis: Evaluate operational challenges, analyze regulatory trends, and formulate data-driven recommendations to support continuous compliance and division leadership priorities.
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.
- Experience developing, recommending and evaluating operating procedures and recommending changes. Typically gained by approximately one year of experience where this was a primary responsibility of the job. This experience may include participation in a regional or statewide quality assurance team, business change or project team or a similar assignment.
- Experience developing technical written materials such as policies, technical manuals or rules/regulations. Typically gained by at least one year experience working in a business setting developing training materials, reports, policy and/or procedure manuals, written interpretations of law, rules, or policies, or any related background which would be considered similar.
- Experience providing technical program assistance to staff. Typically gained by at least one year of experience providing technical assistance to staff in a business setting which could include formal and informal assignments to assist, mentor or train new staff.
Below is preferred experience. It is not required for the position but applicants with this experience may receive consideration over other applicants.
- Federal or state contract compliance or amendment management experience. Typically gained by approximately one year of professional experience managing, drafting, or tracking contract amendments, scopes of work, and contract terms to meet evolving program needs and funding parameters.
- Experience with CMS federal reporting, data collection, and regulatory compliance. Typically gained by approximately one year of professional experience collecting, validating, or compiling operational datasets and submitting recurring federal or state compliance reports.
- Auditing and data validation experience. Typically gained by approximately one year of professional experience where auditing operational performance, provider networks, or validating large datasets against contract standards was a primary responsibility.
- Knowledge of Medicaid managed care operations and federal healthcare regulations (such as Title XIX and 42 CFR Part 438).
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 11:59 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.