Program Consultant - Medicaid School Policy

Agency

Division

Job Classification Title

Human Services Program Consultant III (NS)

Position Number

Grade

NC16

About Us

North Carolina State Government is one of the state’s largest employers, with over 76,000 employees all working toward a common goal: a safer and stronger North Carolina. We are a large organization comprised of various agencies, offices, and universities, each providing important public services.

Eligible state employees are entitled to comprehensive benefits, including a variety of leave options, professional development opportunities, insurance, and more. To learn more about the benefits of being a North Carolina state employee, visit the N.C. Office of State Human Resources' website.

Permanent, temporary, and time-limited state government jobs can be found from the mountains to the coast. Find your next opportunity today!

Description of Work

Primary responsibilities include providing expert education and technical assistance on requirements of direct health care services covered in NC Medicaid Clinical Coverage Policy 10C that are provided and billed by LEAs, facilitating professional development, and spearheading stakeholder engagement initiatives to drive continuous quality improvement across the state to improve school health service utilization and mitigate audit risks. The incumbent will work internally with NC Medicaid clinical and cross-functional team leads on initiatives to develop policy, quality initiatives and education materials coordinated with NCDPI, to implement changes and education and support LEAs as health care providers in understanding federal and state regulations in providing these services. With a health care perspective, the incumbent will design and implement training and quality improvement initiatives regarding required LEA health care documentation and provide feedback through discussion and action plans designed to mitigate risk of audit findings.

The incumbent will continue to monitor LEAs for implementation of action plans, report findings to NC Medicaid clinical management and lead/assist management with analysis and planning to strengthen the program with expected increased utilization of services according to clinical policy, while supporting mitigation of risk of adverse audit findings.

The incumbent will assist management with designing and implementing evaluating and monitoring procedures and processes for quality initiatives; provide high quality customer services internally/externally; facilitate Departmental communications in coordination with NCDPI and school health/LEA provider relations functions; identify, evaluate and resolve customer issues and collaborate closely with management and others to develop and implement solutions; assist in developing/maintaining Unit operational policies and procedures; actively participate in Unit and other discussions/meetings; perform other duties as assigned. State-wide travel is required for this position.

Description of Work

Liaison for LEA-Medicaid Program Implementation:

• Act as the point person for all Medicaid school-based health service and unique CCP-10C related questions as the main representative voice for LEA school health service resources
• Host and organize regular meetings with DHB and NCDPI to discuss new and ongoing school health care issues, concerns, and opportunities for policy development and program improvement
• Work with DHB counterparts to ensure the accuracy of all Random Moment Time Study (RMTS) direct and indirect service pools to mitigate risk of audit findings
• Within the first year, evaluate the current Random Moment Time Study pool set-up and study options for reconfiguration that might result in increased program effectiveness
• Provide clinical expertise in the state-wide effort to achieve a uniform documentation system and ensure that the statewide school Electronic Health Record (EHR) system has functionalities needed for Medicaid reimbursement and documentation.
• Work with DHB clinical and cross-functional teams to clarify all Medicaid related questions and create technical assistance material with LEA facing language in coordination with NCDPI
• Act as the liaison for the specialized LEA billing vendors and refer questions to appropriate business units in DHB or to the MMIS vendor to assist with compliance understanding and mitigation of risk of audit findings.
• Support all new LEAs and charter schools in understanding participation in the school-Liaison for LEA-Medicaid Program Implementation
• Act as the point person for all Medicaid school-based health service and unique CCP-10C related questions as the main representative voice for LEA school health service resources
• Host and organize regular meetings with DHB and NCDPI to discuss new and ongoing school health care issues, concerns, and opportunities for policy development and program improvement
• Work with DHB counterparts to ensure the accuracy of all Random Moment Time Study (RMTS) direct and indirect service pools to mitigate risk of audit findings
• Within the first year, evaluate the current Random Moment Time Study pool set-up and study options for reconfiguration that might result in increased program effectiveness
• Provide clinical expertise in the state-wide effort to achieve a uniform documentation system and ensure that the statewide school Electronic Health Record (EHR) system has functionalities needed for Medicaid reimbursement and documentation.
• Work with DHB clinical and cross-functional teams to clarify all Medicaid related questions and create technical assistance material with LEA facing language in coordination with NCDPI
• Act as the liaison for the specialized LEA billing vendors and refer questions to appropriate business units in DHB or to the MMIS vendor to assist with compliance understanding and mitigation of risk of audit findings.
• Support all new LEAs and charter schools in understanding participation in the school-based health service program, and support Medicaid enrollment of

LEAs through school-specific enrollment guidance.

• Consistently evaluate the Medicaid school-based health service program for opportunities for growth and efficiencies as quality improvement initiatives to minimize audit risk.
• Monitor national trends for growth opportunities for the Medicaid school-based health services program and changes in regulations, requirements, or additional guidance at the federal level and assess the impact.
• Assess the need for new or revised clinical policy, procedures or communication.
• Plan for sustainability of the Medicaid school-based health services program
• Collaborate with NCDPI counterparts to conduct monitoring of quality improvement initiatives, review of checklist items for LEA documentation to assess understanding of compliance with regulatory guidelines; identify areas of non-compliance and work with the LEA to develop action plans to improve program integrity and mitigate risk of federal audit findings.
• Ensure all necessary documentation and monitoring tools are maintained within specified location
• Support program integrity oversight when clinical expertise and specific clinical policy knowledge is needed

Professional Development and Support:

• Provide annual and ongoing Medicaid school-based health program training in coordination with DHB and NCDPI
• Oversee research and preparation of information and materials to inform LEAs and school health providers of Medicaid school health program resources on a collaborative website with NCDPI
• Create and manage the Medicaid school health service program peer-to-peer sharing network for LEAs and school health providers
• To LEA Leaders: Provide annual professional development for all LEA leaders, work in coordination with all LEA leaders participating in any of the Random Moment Time Study pools to ensure the pool accuracy, and provide outreach and support for districts not currently fully utilizing Medicaid
• To School Leaders: provide frequent in-person professional development and promote school-level and state-wide best practices for delivering health care services in schools and maintaining appropriate monitoring and billing practices.
• To School health care providers: Oversee the professional sharing network for each of the Random Moment Time Study direct and indirect service pools, and answer all questions on program implementation from school health providers
• Produce an annual Medicaid SBS program survey to look for and provide additional professional development opportunities
• Manage LEA Medicaid SBS program feedback sessions (to be made of a mix of each health care provider type, fiscal offices, and program coordinators) that meet monthly to review additional support needed
• Consult with representatives from other states and participate in national (Healthy Schools, Promising Futures - HSPF) and state (NC HSPF) meetings regarding emerging trends and best practices

Knowledge Skills and Abilities/Management Preferences

Salary Range: $57,983 -$101,470

Recruitment Range: $57,983 -$90,176

Candidates now meet the minimum qualifications of a position if they have the minimum education and experience listed on the vacancy announcement.

The following Management Preferences are not required, but applicants that possess these skills are preferred.

• School Medicaid Expertise: Extensive knowledge of school operations and Medicaid services, specifically regarding health service documentation and billing for Local Education Agencies (LEAs).
• Regulatory Knowledge: Deep understanding of federal Medicaid requirements for beneficiaries under age 21.
• Strategic Communication: Exceptional public speaking and interpersonal skills used to share expertise and cultivate strategic professional partnerships.
• Policy Translation: Excellence in translating complex medical and regulatory requirements into clear, actionable, and unambiguous policies.
• Self-Management: Highly self-motivated with the ability to prioritize tasks and work independently with minimal supervision.
• Analytical Problem-Solving: Strong critical thinking skills used to evaluate policies, perform quality assurance, and coordinate effective courses of action.

Management Preference:
• Clinical background as a NC licensed allied health (OT, PT or SLP), behavioral health or RN
• Previous work within NC Medicaid clinical policy.
• Previous work as a school health care provider.

The Position Is Time-Limited, Concluding on June 30, 2027

Position is 100% funded through federal funds.

Position is eligible for a hybrid-teleworking schedule to include weekly onsite work hours.

Posting closes at 11:59 p.m. the night before the end date

 

About the NC Division of Health Benefits: 
The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget of over $27 billion in state and federal funds per fiscal year, DHB ensures that more than 108,000 enrolled providers are reimbursed for delivering covered services to 3.1 million beneficiaries. 

Compensation and Benefits:

The State of North Carolina offers excellent comprehensive benefits. Employees can participate in health insurance options, standard and supplemental retirement plans, and the NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis). Employees also receive paid vacation, sick, and community service leave. In addition, paid parental leave is available to eligible employees.

Supplemental Contact Information:

The North Carolina Department of Health and Human Services (DHHS) is an Equal Opportunity Employer that embraces an Employment First philosophy, which consists of complying with all federal laws, state laws, and Executive Orders.  We are committed to reviewing requests for reasonable accommodation at any time during the hiring process or while on the job.  For more information about DHHS: https://www.ncdhhs.gov/.

DHHS uses the Merit-Based Recruitment and Selection Plan to fill positions subject to the State Human Resources Act with the most qualified individuals.  Hiring salary will be based on relevant qualifications, internal equity, and budgetary considerations pertinent to the advertised position.

In accordance with the Governor’s Executive Order 303, our agency supports second-chance employment for individuals who were previously incarcerated or justice-involved.  We invite all potential applicants to apply for positions for which they may be qualified.

    

Application Process
Be sure to complete the application in its entirety.   Resumes will not be accepted in lieu of completing this application.

• Information should be provided in the appropriate areas, to include the following: Education, including high school and all degrees obtained, Work Experience, and Certificates & Licenses. It is critical to our screening and salary determination process that applications contain comprehensive candidate information.

• Answers to Supplemental Questions are not a substitute for providing all relevant information within the body of your application. To receive credit for the supplemental questions, you must provide supporting information within the "Work Experience" section of the application to support your answers.

• If multiple applications are submitted to an individual posting, only the most recent application received prior to the closing date will be accepted. Applications must be submitted by 5:00 PM on the closing date.

• Applicants may be subject to a criminal background check. All candidates selected for positions considered "Positions of Trust" will be subject to a criminal background check.

• Due to the volume of applications received, we are unable to provide information regarding the status of your application over the phone. To check the status of your application, please log in to your account.  Upon the closing date, applications are "Under Review" and will be screened by Human Resources for qualified applicants. The hiring process may take several weeks.

• Degrees must be received from appropriately accredited institutions.  Transcripts and degree evaluations may be uploaded with your application. The State of North Carolina/Office of State Human Resources uses the National Association of Credential Evaluation Services (NACES) as a referral resource for applicants who need to have their credentials certified as equivalent.

• For a list of organizations that perform this specialized service, please visit the NACES membership website at https://www.naces.org/members.

Degree/College Credit Verification

Degrees must be received from appropriately accredited institutions.  Transcripts, degree evaluations and cover letters may be uploaded with your application.

Veterans’ and National Guard Preference

• Applicants seeking Veteran's Preference must attach a DD-214 Member-4 Form (Certificate of Release or Discharge from Active Duty) to their applications.

• Applicants seeking National Guard Preference must attach an NGB 23A (RPAS), along with the state application, if they are a current member of the NC National Guard in good standing. 

• Applicants who are former members of either the NC Army National Guard or the NC Air National Guard, with honorable discharge and six years of creditable service, must attach a copy of their DD 256 or NGB 22, along with the state application.

ADA Accommodations

Consistent with the Americans with Disabilities Act (ADA) and the Pregnant Workers Fairness Act (PWFA), DHHS is committed to the full inclusion of all qualified individuals. As part of this commitment, DHHS will ensure that people with disabilities, or known limitations covered by the PWFA, are provided with reasonable accommodation.  If reasonable accommodation is needed to participate in the job application or interview process, please contact the person indicated below.

CONTACT INFORMATION: 

If there are any questions about this posting, please contact Talent Acquisition at [email protected]. Resumes will not be accepted in lieu of completing this application.

Minimum Education and Experience

Some state job postings say you can qualify by an “equivalent combination of education and experience.” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See the Education and Experience Equivalency Guide for details.

Master's degree in a discipline relative to the program from an appropriately accredited institution and four years of related experience; or Bachelor’s degree in a discipline relative to the program area from an appropriately accredited institution and six years of related experience; or an equivalent combination of education and experience.

EEO Statement

The State of North Carolina is an Equal Employment Opportunity Employer and dedicated to providing employees with a work environment free from all forms of unlawful employment discrimination, harassment, or retaliation. The state provides reasonable accommodation to employees and applicants with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for religious beliefs, observances, and practices.

Recruiter:

Charlene Michele Moore

Recruiter Email:

[email protected]