NE DHHS is seeking a Program Accuracy Specialist to work in its Omaha office. Under limited supervision, this position is responsible for conducting quality assurance reviews of case management activities; coordinates with management and staff to develop and implement various strategies and initiatives to achieve the highest possible accuracy rate for Medicaid programs. Conducts secondary or second party case reviews. Utilize various quality assurance tools to measure and improve case management performance. Consolidates and analyzes data from various case reviews to determine general category of error and suspected root cause of error. Confers with supervisors and/or quality control teams to discuss findings, errors, causes of errors, and recommended corrective actions to address current and future program errors. Provides training with workers to discuss identified errors, causes of errors, and to develop effective work habits and/or knowledge of program regulations to improve on level of work performance. Collaborate with policy and field teams to discuss identified problem areas, new regulations, and/or changes in procedures. Coordinates with other Program Accuracy Specialists to develop program “training tips”, develop and present formal training, or coordinate with Human Resources and Development training Staff to develop and present formal training. May require overnight travel.
REQUIREMENTS: Two years experience in a health and/or human services field or public service organization with responsibility for determining eligibility, assessing public assistance needs, or case management using program rules and regulations OR 24 semester hours of post high school education in behavioral sciences, social sciences, public/business administration, adult education or closely related field and experience in eligibility determination or assessing needs for public assistance and/or social services programs.
Knowledge of: federal and state Medicaid program regulations, laws, and case processing; quality assurance and monitoring tools and methods; case management practices including assessment, analyzing critical information, plan development and implementation, adult training theories, principles and practices; statistical data and collection methods. Skill in: teaching others; monitoring and assessing work performance of others. Ability to: learn and apply agency policies and procedures; interpret, explain, and apply State and federal laws and regulations; conduct data analysis, quality assurance reviews, and identify trends; communicate with others to receive and relay information; analyze situations and develop an appropriate course of action; effectively interrelate with a wide variety of individuals; formulate conclusions; persuade others; develop, implement and present training programs; conduct root cause analysis and recommend appropriate actions. Requires excellent effective communication skills and ability to establish/maintain effective working relationships. Knowledge of computer programs such as NFOCUS, NEARS 2.0, Word, Excel, and Power Point helpful.
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