Description and Functions Open Until Filled GENERAL DESCRIPTION: Manages and oversees benefit and provider management for Wyoming's Medicaid Behavioral Health program, including oversight of all designated provider policy, reimbursement methodology, claims payment, provider services monitoring, expenditure management, and communication for a program that comprehensively pays over $60 million annually. Coordination will require ongoing collaboration between the Division of Healthcare Financing and the Centers for Medicare and Medicaid (CMS), and ensuring ongoing compliance. Human Resource Contact:[email protected] ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function that may be performed in the job level. * Independently directs and oversees agency rules and regulations governing the program administration and operations of the delegated provider oversight areas for: Community Mental Health Centers, Substance Abuse Treatment Centers, Psychiatrists, Clinical Psychologists, Neuropsychologists, Advanced Practice of a Registered Nurses (APRNs), Licensed Mental Health Providers (LMHPs), Provisional LMHPs, Certified Addictions Practitioner (CAPs), Certified Social Worker (CSWs), Registered Nurse (RNs), Licensed Practical Nurse (LPNs), Community Health Workers, Case Management, Peer Specialists, Board Certified Behavior Analyst- Doctoral (BCBA-Ds), Board Certified Behavior Analyst (BCBAs), Board Certified Assistant Behavior Analyst (BCBAs), Registered Behavior Technician (RBTs), Child Development Centers, Clubhouse services, Title 25 eligibility, and Psychiatric Residential Treatment Facilities (PRTFs). * Specific activities include: * Manages and monitors Behavioral Health, Title 25 eligibility, and PRTF programs. * Research current federal regulations and national trends to update policy as required and analyze impacts of federal and state legislation. * Establish and direct goals, objectives, policies, and procedures that govern the participation and reimbursement for the service providers. * Designs, develops, and manages policy, including identifying coverage and limitations for current and proposed services. * Manage billing methodology for program fee schedule establishment. * Create and evaluate draft rules for compliance, integrity, and reasonableness. * Establish provider guidance and expertise to various State agencies in matters pertaining to compliance with program policies and procedures. * Prepare State Plan Amendments (SPAs) and respond to federal agency inquiries regarding SPAs. * Develops, implements, and promulgation the process of final rules to reflect legislative changes or federal policy changes. * Follow legal requirements and procedures relating to agency rule promulgation and policy development. Qualifications PREFERENCES: Bachelor's Degree in a related field (multiple applicable). Background in mental health and substance use. KNOWLEDGE: * Skills in: * Intermediate level experience with Word and Excel. * Interpersonal relations, team building, and consensus building. * Goal setting, performance evaluation, and individual motivation. * Research and analysis of complex problems as well as identification of options and solutions; decision making and evaluation of results. * Public speaking, oral and written communication at a variety of levels and with multiple audiences. * General Medicaid waiver program opportunities - purpose, development and ongoing maintenance requirements to include in required federal reporting. * Ability to: * Coordinate and motivate individuals and teams to undertake complex projects and achieve specific goals. * Balance numerous demands on time and resources when assigning projects or delegating responsibilities to employees or team members. * Quickly identify problems, prioritize needs, research solutions, and make decisions. * Design and implement policies and processes in a timely, responsive, and cost-effective manner. * Comprehend complex budgets, federal fiscal match, and application to programs. * Coordinate complex integration of unique program and system interfaces. * Research, analyze, and resolve issues. * Understand technology as it relates to healthcare. * Make decisions in the absence of the Provider and Benefits Management Unit Manager. * Communicate state plan amendments and negotiate with regional and national representatives from the Centers of Medicare and Medicaid Services (CMS) regarding coverage, provider qualifications, and reimbursement methodologies. * Ability to work independently. * Maintain qualification for the federal definition of a "skilled professional medical personnel" per 42 CFR 432.50 by keeping clinical knowledge base up-to-date regarding the research base for efficacy criteria for indicated treatments and programming. MINIMUM QUALIFICATIONS: Education: Bachelor's Degree (typically in Healthcare) Experience: 1-2 years of progressive work experience (typically in Health Programs) with acquired knowledge at the level of a Health Program Specialist OR Education & ExperienceSubstitution: 4-6 years of progressive work experience (typically in Health Programs) with acquired knowledge at the level of a Health Program Specialist Certificates, Licenses, Registrations: None Necessary Special Requirements PHYSICAL WORKING CONDITIONS: * The employee may sit comfortably to perform the work; however, there may be some walking, standing, bending, carrying light items, driving an automobile, etc. NOTES: * FLSA: Exempt * The Wyoming Department of Health is an E-Verify employer. Supplemental Information 048-Wyoming Department of Health - Division of Healthcare Financing Clickhere to view the State of Wyoming Classification and Pay Structure. URL:http://agency.governmentjobs.com/wyoming/default.cfm The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities. Class Specifications are subject to change, please refer to the A & I HRD Website to ensure that you have the most recent version.