Position Description

Commonwealth of Pennsylvania
POSITION DESCRIPTION FOR JOB POSTING
Position Number: 00044139	Description Activated On: 1/23/2026 3:02:03 PM

Position Purpose: Describe the primary purpose of this position and how it contributes to the organization’s objectives. Example: Provides clerical and office support within the Division to ensure its operations are conducted efficiently and effectively.

This position is located in the Division of Fee for Service Operations, in the Bureau of Fee for Service Programs within the Office of Long-Term Living (OLTL). The incumbent is part of the Participant Services Review Unit team tasked (1) to provide effective assistance to participants, families, and local agencies in addressing participants’ concerns, grievances, service needs or preferences, specifically as they concern home and community-based programs; and (2) to ensure that quality, effective and efficient services are provided to participants in their communities. The functional areas within this team address these program components through service plan review and case management. The team is headquartered in Harrisburg, PA with teleworking options.

As a member of a team, the incumbent will primarily be responsible for the review of service plans and service provision data of participants receiving home and community-based services (HCBS) through OLTL’s Act 150 program, OBRA Waiver and Program Exception. The incumbent will also provide support and technical assistance on an array of HCBS available to older Pennsylvanians and persons with physical disabilities within OLTL's long-term services and supports system.

Description of Duties: Describe in detail the duties and responsibilities assigned to this position. Descriptions should include the major end result of the task. Example: Types correspondence, reports, and other various documents from handwritten drafts for review and signature of the supervisor.

1. Review electronically submitted individual service plans to ensure that plans are appropriate to participants’ needs and that services are delivered as defined in the plans. As necessary, seek additional information from the agency submitting the service plans to provide technical assistance and clarification in plan development in accordance with OLTL regulations, policies and waiver/program requirements. Timeliness of plan reviews is critical to the participant’s health and well-being and should be completed within established timeframes in accordance with OLTL regulations.

2. Plan reviews include thorough analysis of appropriateness of services for participants needs, back-up planning, risk management analysis, and cost-effective recommendations to ensure the health and safety of the participant remaining in the community.

3. Coordinate the closure and transition of individual service plans as it relates to provider disenrollments.

4. Collaborate with other areas of the office, department and stakeholders to manage complex caseloads.

5. Assist with the individual service plan management of Early and Periodic Screening, Diagnosis and Treatment (EPSDT) scenarios where the individual is aging out.

6. Track expenditure patterns for participants through use of data systems to effectively evaluate any trends in utilization of services that impact planning for the participant.

7. Respond orally and in writing to basic inquiries within a reasonable timeframe regarding HCBS programs. Prepare responses to legislative inquiries for review by supervisor. Investigate complaints received from participant, Service Coordinator or supervisor and provide resolution, seeking supervision when necessary. Assist with OLTL Fee for Service waiver/program Right-To-Know inquiries.

8. Use established precedent and policy to provide guidance, consultation, technical assistance, to providers; assist with billing issues due to plan development; advise supervisor of problems and/or unusual issues as appropriate.

9. Identify any operational issues which impede the provision of appropriate, cost-efficient services to individuals and recommend remedies/necessary changes to supervisor. As a member of a Team or Division group, participate in developing/revising OLTL home and community-based program policies and procedures.

10. Prepare detailed analysis and summary of current issues, service plan trends, or other statistical data both to support projects as well as on-going management of the program.

11. Participate in developing and presenting training to Division staff, other OLTL staff, key constituents, and providers.

12. Serve on workgroups comprised of staff from within OLTL or stakeholders from outside OLTL. Committee work may include preparing Medicaid waiver amendments and renewals, evaluating policy recommendations, reviewing directives and regulations; as well as assisting with the development of operational manuals, program directives, work plans, system changes and testing, regulations, policies and procedures. This is to ensure HCBS waiver/programs are administered accurately, effectively, efficiently and that services meet participant needs.

13. Draft responses to programmatic reviews of service provider agencies conducted by staff from other teams or bureaus, or reviews by federal oversight agencies such as Centers for Medicare and Medicaid Services (CMS). Work may include the development of written work plans to remediate particular findings in such reviews.

14. As needed, accompany team member(s) on field travel to provide on-site technical support, re-mediation, and problem-solving to participants, families, providers, and other key stakeholders.

15. Attend and participate in team meetings, division meetings, and bureau meetings as scheduled.

16. Participate in hearings as requested by the Department of Human Services Bureau of Hearings and Appeals.

17. Have knowledge of eligibility requirements for enrollment into waiver/programs including transfers from other programs and nursing home transitions.

18. Provide technical assistance to Service Coordinators to establish corrective actions or recommend appropriate service updates to ensure the health and safety of participants.

19. Perform other related duties as required.

20. The incumbent will utilize telework status during times when OLTL authorizes the incumbent to do so.

Decision Making: Describe the types of decisions made by the incumbent of this position and the types of decisions referred to others. Identify the problems or issues that can be resolved at the level of this position, versus those that must be referred to the supervisor. Example: In response to a customer inquiry, this work involves researching the status of an activity and preparing a formal response for the supervisor’s signature.

Within the parameters of established policy, regulations and procedures, this employee independently determines the appropriateness of the service plans and services provided. In more complex cases and inquiries regarding the availability of services, the employee makes recommendations to the supervisor on actions to be taken or seeks supervision.

The work involves investigating and developing appropriate responses to inquiries and complaints. The employee is expected to seek supervision when policies and procedures do not provide sufficient guidance in responding.

This employee determines the prioritization of service plan reviews when there is sufficient reason not to review in the order of submission within the goals established by the unit.

Requirements Profile: Identify any specific experience or requirements, such as a licensure, registration, or certification, which may be necessary to perform the functions of the position. Position-specific requirements should be consistent with a Special Requirement or other criteria identified in the classification specification covering this position. Example: Experience using Java; Professional Engineer License

Experience:

MINIMUM EXPERIENCE AND TRAINING: Successful completion of the
training program for the Human Services Program Trainee;

or

One year of professional experience developing, implementing or
evaluating human services, social services, health care services or
health care insurance programs.

Licenses, registrations, or certifications:

1.   N/A

2.   N/A

3.   N/A

4.   N/A

5.   N/A

6.   N/A

Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.

1.	Working knowledge of OLTL's Microsoft grouping of applications, HCSIS, eCIS, and Share-point.
2.	Functional understanding of OLTL Medicaid Waivers, Act 150 program, Program Exception, regulations, policies, and procedures.
3.	Prioritize tasks.
4.	Explain programmatic requirements to participants, providers, and other stakeholders.
5.	Communicate effectively, both orally and in writing.
6.	Availability to travel independently without public transportation with overnight stays.
7.	Understand and interpret Local, Federal and State laws as relevant.
8.
9.
10.