NETWORK ADEQUACY SPECIALIST 13 - BPHASA - Hybrid - State of Michigan
Lansing, MI
About the Job
The Michigan Department of Health and Human Services mission is to provide opportunities, services, and programs that promote a healthy, safe, and stable environment for residents to be self-sufficient. We are committed to ensuring a diverse workforce and a work environment whereby all employees are treated with dignity, respect and fairness. For more information, please visit MDHHS Diversity Equity and Inclusion.
This position functions as the sole statewide specialist for the design, implementation, and oversight of Specialty Behavioral Health Services Provider Network Adequacy. The position is responsible for monitoring and oversight of contractor performance on standards designed to ensure beneficiary access to covered specialty behavioral health services. The Pre-Paid Inpatient Health Plans and Community Mental Health Service Programs (PIHP/CMHSPs) grants and contracts exceed $3 billion annually. Provider Network Adequacy is the vehicle used by the State to ensure a full array of Medicaid community-based mental health and substance use disorder services are being provided to the public. This position is necessary to coordinate Provider Network Adequacy policy, program service issues, and monitoring for the PIHPs in the State. In this role, the specialist serves as the advisor to MDHHS staff and PIHPs on the implementation of Provider Network Adequacy processes. This position is responsible for developing and monitoring procedures, guidelines, and policies that are the foundation of this specialty area. Position is also necessary to coordinate the development and implementation of policies and partnerships to identify and ensure the ongoing compliance of PIHPs as it relates to Provider Network Adequacy according to federal and state policy and contractual requirements. The position functions as the recognized authority to ensure the appropriate development of tools and processes, and to coordinate with other units within MDHHS and the PIHPs to reduce duplication and improve data collection. Additionally, this position functions in the lead role for the design and development of policy and training recommendations and tools for monitoring Provider Network Adequacy requirements. This position will design, develop, and conduct Network Adequacy improvement activities in coordination with other MDHHS staff and the PIHPs. This position will represent and act as lead for MDHHS in network adequacy related meetings and workgroup discussions.
This position is also responsible for contract completion and for analyzing, monitoring, and reporting on PIHPs/CMHSPs for performance throughout the state. The position will monitor compliance and risk management with an unstable network and complete the Managed Care Program Annual Report (MCPAR) reporting to CMS. The position will be responsible for managing assigned contractors, including monitoring performance with Network Adequacy, and providing on-going technical assistance.
Position Description
Job Specification
To be considered for this position you must:
This position functions as the sole statewide specialist for the design, implementation, and oversight of Specialty Behavioral Health Services Provider Network Adequacy. The position is responsible for monitoring and oversight of contractor performance on standards designed to ensure beneficiary access to covered specialty behavioral health services. The Pre-Paid Inpatient Health Plans and Community Mental Health Service Programs (PIHP/CMHSPs) grants and contracts exceed $3 billion annually. Provider Network Adequacy is the vehicle used by the State to ensure a full array of Medicaid community-based mental health and substance use disorder services are being provided to the public. This position is necessary to coordinate Provider Network Adequacy policy, program service issues, and monitoring for the PIHPs in the State. In this role, the specialist serves as the advisor to MDHHS staff and PIHPs on the implementation of Provider Network Adequacy processes. This position is responsible for developing and monitoring procedures, guidelines, and policies that are the foundation of this specialty area. Position is also necessary to coordinate the development and implementation of policies and partnerships to identify and ensure the ongoing compliance of PIHPs as it relates to Provider Network Adequacy according to federal and state policy and contractual requirements. The position functions as the recognized authority to ensure the appropriate development of tools and processes, and to coordinate with other units within MDHHS and the PIHPs to reduce duplication and improve data collection. Additionally, this position functions in the lead role for the design and development of policy and training recommendations and tools for monitoring Provider Network Adequacy requirements. This position will design, develop, and conduct Network Adequacy improvement activities in coordination with other MDHHS staff and the PIHPs. This position will represent and act as lead for MDHHS in network adequacy related meetings and workgroup discussions.
This position is also responsible for contract completion and for analyzing, monitoring, and reporting on PIHPs/CMHSPs for performance throughout the state. The position will monitor compliance and risk management with an unstable network and complete the Managed Care Program Annual Report (MCPAR) reporting to CMS. The position will be responsible for managing assigned contractors, including monitoring performance with Network Adequacy, and providing on-going technical assistance.
Position Description
Job Specification
To be considered for this position you must:
- apply for this position online via NEOGOV; click on "Apply" in the job posting for instructions on submitting your electronic application. Hard copy applications are not accepted.
- relevant experience and/or education referred to in supplemental questions must be documented in resume, transcript and/or application to allow for accurate screening.
- attach a resume identifying specific experience and dates of employment. Dates of employment should include month and year and hours per week.
- attach a cover letter.
- if applicable, attach a copy of an official transcript(s). We accept scanned copies of official transcripts. We do not accept web-based, internet, or copies of unofficial transcripts. Official transcripts provide the name of the institution, confirmation that a degree was awarded and on what date, and the registrar's signature.
Job Type: Permanent Full Time
Location: Lansing, Michigan
Agency: Health and Human Services - Central Office
Source : State of Michigan