Posting Type: Open to All Applicants
Category: Healthcare Support
Agency: Health & Human Services Comm
Job Title: Project Manager II
Full Time/Part Time : Full Time
Job Location: 701 W 51ST ST
Contact: AccessHR Service Center
Salary Range: $5,670.54 - $7,039.91
Shift: Days (First)
Closing Date: 05/02/2022
Job Description:
Project Manager II, Medical and Dental Benefits Policy The Project Manager II reports to the Manager of Medical and Dental Benefits Policy. The Project Manager II performs project management work related to the development and maintenance of Medicaid medical and dental benefits in the Medicaid/CHIP Policy Development Unit. This position requires excellent project management skills, writing skills and strong research skills. This position leads and/or participates in major special Medicaid policy projects, works across HHS areas, and provides guidance to staff in the development and integration of new benefits by reviewing documents and analyzing provider questions or concerns. This position is expected to understand state and federal Medicaid and CHIP laws and regulations. This position may lead on medical and dental benefit policy reviews and projects. This position works under limited direction of the Manager with extensive latitude for the use of initiative and independent judgment.
Essential Job Functions:
(35 %) Performs project management work across HHS areas related to the development, planning, and implementation of complex new or current medical and dental benefit policies. Prepares technical project summaries and reports and keeps Executive Leadership updated on projects in a prompt manner. Gives presentations to groups and facilitates and participates in policy meetings for internal, intra-agency, vendors, stakeholders, public, or legislature. Works with internal and external entities to identify the need for policy changes through the analysis of claims appeals and denials, provider complaints, and prior authorization requests. Performs the analysis, collection, organization, and preparation of medical and dental policy materials in response to internal/external requests for information and reports in a professional and timely manner. Acts as the liaison with HHSC staff and other HHS agencies by providing complex technical assistance and guidance on medical and dental benefit changes during workgroups and meetings. (35 %) May lead in the development, planning, and implementation of new or current medical and dental benefit policies. Researches, analyzes, and synthesizes Medicaid policies, complicated federal and state regulations, client information, and claims system processing information for each policy review. Identifies the applicable Code of Federal Regulations (CFR), Medicaid State Plan, and Texas Administrative Code (TAC) citations for policy reviews by performing technical research using online resources. Researches, analyzes, and synthesizes very technical information such as standards of care, evidence-based practices, and peer reviewed literature using a variety of resources and websites and applies findings to policies, as appropriate. Conducts complex research on managed care organization (MCO) benefit coverage, private payer benefit coverage, and other state Medicaid benefit coverage during the policy development process. May lead medical policy meetings and participate in policy discussion by providing comments and recommendations orally or in writing. Performs quality review of policy language and claims processing system changes to ensure all changes are appropriate and have been captured accurately. Develops, submits, and coordinates policy changes to TAC Rules, the Medicaid State Plan, and/or Medicaid waivers. Participates in Post Implementation Utilization Report (PIUR) meetings for medical and dental policies to identify if additional benefit changes are necessary and provides guidance and advice on how to implement these changes. (20 %) Collaborates with HHSC staff and other HHS agencies to ensure that medical and dental benefits information in the Texas Medicaid Provider Procedures Manual (TMPPM) and other Medicaid materials is accurate and in accordance with policies and procedures. Serves as a subject matter expert on current Medicaid benefits for Medicaid medical and dental policy for HHSC internal staff, HHS agencies, stakeholders, providers, and the public. Serves as a resource for new employees and internal/external staff by providing training, direction, and guidance on the development of medical and dental policies. Maintains and organizes electronic files of activities and shares with staff and stakeholders as necessary. (10%) Develops complex memos, briefs, and other documents for HHSC Executive Leadership regarding medical and dental benefit changes. Develops and provides recommendations for benefit coverage to HHSC Executive Leadership. Supports team members in the development of medical and dental benefit policy. Other duties, as assigned, include but are not limited to actively participating in or serving in a supporting role to meet the agency’s obligations. Attends work on a regular and predictable schedule in accordance with agency leave policy.
Knowledge Skills Abilities:
Knowledge of health and human services agencies and programs, and state and federal Medicaid and CHIP laws and regulations. Strong project management skills and ability to establish project goals and objectives, lead project teams, work with multiple stakeholders Highly organized and the ability to manage several projects concurrently in a fast-paced environment and juggle competing priorities. Ability to effectively facilitate meetings and maintain working relationships with staff or program stakeholders. Strong skills in analyzing and evaluating complex federal and state legislation. Skill in researching, analyzing, and synthesizing medical policy, claims processing systems, and program issues. Knowledge of the legislative process including analyzing legislation. Strong skill in developing and evaluating policies and procedures, assessing risks, developing contingency plans, and making recommendations. Strong skills in written and oral communication, including the ability to make public presentations, write technical information in an understandable format, and produce sophisticated reports. Ability to exercise creative problem-solving techniques in a highly complex environment. Ability to work cooperatively as a team member in a fast-paced, deadline-orientated environment. Ability to work independently and perform work with a high degree of attention to detail. Skill in using personal computer application software such as Visio, MS Word, PowerPoint, Excel, MS Project or similar programs.
Initial Selection Criteria:
Graduation from an accredited four-year college or university. A minimum of four years of experience with policy analysis, health care policy and/or Medicaid/CHIP policy, or work in a related area.
Additional Information:
Requisition# 516537. Applicants selected for an interview may be required to submit a resume, a professional or academic writing sample, and may be asked to complete an in-basket exercise. Salary Note: The salary offered will follow HHS HR Policy and Procedures. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual. For internal applicants, there can be limitations in consideration of an applicant’s current classification and salary. Only complete applications will be considered.
MOS Code:
There are no direct military occupation(s) that relate to the responsibilities, and registration or licensure requirements for this position. All active duty, reservists, guardsmen, and veterans are encouraged to apply if they meet the qualifications for this position.
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work. In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.