Managed Care Regulatory Specialist

STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATION

Note: This announcement may be used to fill multiple openings.

Envision Yourself Working at HCPF

The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness. The State is resolute in non-discriminatory practices in everything we do, including hiring, employment, and advancement opportunities.

The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado. 

We are looking for a Managed Care Regulatory Specialist for the Accountable Care Collaborative (ACC) Delivery System Division of the Cost Control and Quality Improvement Office (CCQI)!

The ACC Delivery System Division of CCQI is responsible for the design, administration, and oversight of the Medicaid managed care delivery system. The Program Management Section within the ACC/Delivery Systems Division was created to more efficiently manage the Regional Accountable Entity (RAE) and Managed Care (MCO) contracts for the ACC. The Program Management Section contributes to the Division goals through managing and driving performance in the RAE and MCO contracts and overseeing the implementation of programs and initiatives that improve member access, limit duplication and gaps in service and improve quality and cost effectiveness of services. The Managed Care Unit in the section oversees the MCOs and the Dual Special Needs Program (DSNP) contracts.

We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.

As part of the State of Colorado, HCPF offers a competitive benefits package:

• PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans

• Medical, Dental, and Vision insurance coverage

• Automatic Short-Term and Optional Long-Term Disability Coverage

• Life and AD&D Insurance

• Flexible Spending Accounts (FSAs)

• Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)

• 11 Paid Holidays Annually and Accrued Annual and Sick Leave

• Accrued Sick Leave for State of Colorado Temporary Employees

• Flexplace and Flextime work arrangements

• Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program

• Free RTD EcoPass to all eligible State Employees

• Reduced college tuition through CSU Global

• Credit Union of Colorado Membership Eligibility

• Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, go to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs.https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs

We are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements. Depending on the business need and description of the position, we have options that range from hybrid to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage. 

**Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment.**

What You’ll Be Doing as Managed Care Regulatory Specialist:

• Serves as the Staff Authority for interpretation and application of federal and state laws, regulations, and rules governing Medicaid managed care across the ACC Division and CCQI Office. HCPF management and program teams rely on this position's authoritative regulatory guidance when determining broad managed care policy and program direction.

• Provides regulatory oversight and federal compliance for the Medicaid managed care contracts.

• Staff authority on federal and state managed care requirements and provides essential advice and counsel to management on policy direction, implementation of policy decisions, responses to federal and state government, and the Department's positions with internal and external stakeholders.

• Provides authoritative interpretation when managed care policy and regulatory requirements must be applied to operational circumstances, establishing the compliance framework Department teams and contractors use to proceed.

• Serves as a resource for physical and behavioral health managed care contract activities.

• Drafts, negotiates, processes, and implements contracts, amendments, policy guidance, and waivers.

• Drafts and implements rule changes, requests for proposals (RFPs) and other contract related documents.

• Manages member, external stakeholder, or other governmental body concerns and questions.

• Responds to internal and external information requests and assists with identifying and resolving information system issues that impact program operations.

• Reviews and monitors contractor compliance with program requirements and state and federal regulations.

• Evaluates contractor performance and develops corrective action plans if a contractor needs to improve performance.

• Analyzes proposed and existing legislation, regulations, and rules for impact on the program, the stakeholders, and the contractors.

• Serves as liaison between the Department and Centers for Medicare and Medicaid Services (CMS) and policy groups.

• Represents the assigned program through regular participation in the Quality Strategy Team or other Departmental teams.

• Guides ACC Delivery Systems Division program and policy development by determining applicable regulatory requirements, compliance constraints, and the mechanisms needed to implement Department direction.

• Provides authoritative regulatory and compliance direction to contractors, stakeholders, and agency staff on managed care policy and program issues within the position's assigned authority.

Residency Requirement:

Class Code & Classification Description:

H1R4XX Policy Advisor IV

Minimum Qualifications:

There are two ways to qualify for this position:

Option 1:

Experience Only:

Seven (7)  total years of professional experience in health care policy, publicly funded health care programs, public policy, or regulatory analysis.

Option 2:

Education and Experience:

Bachelor's degree from an accredited institution in Public Health, Legal Studies, Paralegal Studies, Health Policy, Public Policy, Health Economics, Public Administration, or a field of study related to the work assignment 

AND

Three (3) total years of professional experience in health care policy, publicly funded health care programs, public policy, or regulatory analysis.

Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following:

• An associates will count as two years of experience

• A bachelors will count as four years of experience

• A masters degree will count for six years of experience

• A doctorate or juris doctorate degree will count for seven years of experience

Note: Per the Job Application Fairness Act, you may redact information that identifies your age, date of birth, or dates of attendance at or graduation from an educational institution on your transcripts.

Preferred Qualifications

• Previous relevant professional state experience

• Master’s level or professional degree in a relevant field.

• Previous professional experience in:

  • Managed Care, Public Health, and/or Medicaid policy

  • Legislative and rule development process for Colorado and HHS.

  • Writing contractual language or applications for federal programs.

  • Researching and interpreting state and federal laws.

  • Communicating with federal regulatory agencies, particularly CMS.

Definition of Professional Experience: Work that involves exercising discretion, analytical skill, judgment, personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods. 

Conditions of Employment

• All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.

• Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.

Appeal Rights:

An applicant who has been removed from an employment list or removed from consideration during the selection process may request a review by the State Personnel Director.

As an applicant directly affected by the results of the selection or comparative analysis process, you may file a written appeal with the State Personnel Director.

Review of the completed, signed, and submitted appeal will be timely on the basis of written material submitted by you, using the official appeal form signed by you or your representative. This form must be completed and delivered to the State Personnel Board by email at [email protected] within ten (10) calendar days from your receipt of notice or acknowledgment of the Department’s action.

For further information on the Board Rules, you can refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov/board-rules.

How to Apply (Please Read Carefully)

Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.

Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.

Comparative Analysis Process

The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email.

Failure to submit properly completed documents by the closing date will result in your application being rejected.

ADAAA Accommodations

The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.

The Department of Health Care Policy & Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Anupreet Kaur, at [email protected].

The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.