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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00095756 |
Description Activated On: 2/4/2026 11:22:16 AM |
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 is a professional management position located in the Division of Operations and Communications, Bureau of Policy, Analysis and Planning, Department of Human Services. This position is eligible for a part-time telework option. The incumbent is responsible for reviewing, interpreting, and analyzing statewide Medical Assistance (MA) policies related to MA General Provisions, MA Managed Care, and MA Payment Policy to ensure compatibility and compliance with state and federal Medicaid requirements. This includes reviewing, interpreting, and analyzing PA Medicaid reforms and related policy initiatives, including development and submission of the Department's federally-approved 1915(b) MA Managed Care waiver and amendments to the waiver. The incumbent also serves on the MA Advisory Committee/Consumer Subcommittee management and operations team and as a liaison for meetings that require bureau representation. The incumbent must function and make decisions independently in discharging these duties. |
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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. Review, analyze and evaluate statewide MA policies and programs and direct program operations; develop and write procedures, standards, policies, and programs pertinent to the delivery and/or payment of MA Program Services, including existing programs within the Office of Medical Assistance Programs as well as new programs that the Department intends to implement; administratively coordinate operational activities for the general payment of MA providers. Review, interpret and analyze proposed and implemented Federal and State laws and regulations and court decisions that may impact the MA Program to determine the necessity for revising Departmental policies for compliance. Review, interpret, analyze, develop, and write policies, procedures, handbooks, and related materials pertinent to the delivery and/or payment of MA Program services Analyze, evaluate, and monitor objectives of the MA Program to coordinate operational activities. Advise and provide direction to Departmental staff on methods of resolving program issues. Research, collect, and evaluate information used as a basis for writing policy and procedures internally, as well as for documents prepared by other agencies; obtain documents, conduct research, answer interrogatories, and give testimony at both administrative and judicial hearings relative to MA Program issues. Review documents prepared by other agencies for accuracy and conformance with MA Program policies, managed care organization (MCO) policies, and PA Medicaid reform efforts. Develop draft documents and program materials necessary for internal review and certification as to legality and form in preparation for public review and comment, including briefing materials for the Governor, the Secretary of Human Services, and other executive staff, and other documents as needed. Respond directly to, or prepare responses for, the Secretary of Human Services, Deputy Secretary, Bureau Director, Division Director, and/or Section Chief; respond to inquires regarding issues of program policy or interpretation; respond to complaints or inquiries received from providers, legislators, and legal service organizations. Prepare or assist in the preparation of reports, background papers, budget narratives, policy clarification documents, and survey responses regarding the MA Program and comment on the impact of program and legislative initiatives on the MA Program. Participate in program implementation committees; participate in both Departmental and extra-Departmental meetings where MA representation is required; prepare and delivery presentations in order to establish and maintain a professional working relationship with these entities; plan and conduct meetings with Department staff and collateral staff to coordinate the resolution of various issues and program problems and ensure the efficiency and effectiveness of provider billing regulations. Design and direct special studies by identifying issues; coordinate the collection of data with various sources and prepare written reports summarizing findings while recommending problem resolution to effectively plan provider training sessions. Maintain the necessary updates and renewal of PA 67 managed care waiver. Perform other related duties and special projects as assigned. |
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. This position requires a great deal of independence and judgement to perform tasks and on the projects that the individual in this position is assigned, which includes the review, research, analysis, and interpretation of MA Program policy and initiatives, Federal and State laws, regulations and guidelines, applications, amendments, and renewals to 1915(b) waivers, and responses to correspondence. The individual is responsible for making decisions to ensure efficient and effective day-to-day operations and works independently, obtaining supervisory guidance on the most complex, sensitive or precedent setting issues. The individual in this position consults with the supervisor on any issue dealing with policy decisions that deviate from the normal processes/procedures, works independently within assigned program areas and manages priorities and workload to meet established goals. Although performance of duties and responsibilities is governed by established policies, procedures and regulations, the individual in this position exercises considerable independence, initiative, and judgment in their application. The individual in this position discusses technical and problem areas will be discussed with the supervisor; however, day-to-day operations are the individual's responsibility. The individual in this position is required to independently prioritize work on a daily basis to ensure deadlines are met. Work may be unpredictable at times, requiring the individual to change priorities as needed. When problems with meeting deadlines or conflicting priorities occur, the individual in this position seeks advice from the supervisor. The individual in this position is expected to use independent judgement to solve day-to-day problems and issues that arise and to meet the established responsibilities of this position. Because this individual’s work impacts, reinforces or sets the Department's Office of Medical Assistance Programs policy or regulations, draft documents/recommendations are completed and forwarded to the supervisor, Section Chief, Division Director and Bureau Director for review and approval. In response to assigned work, the individual works independently to analyze the assignment, research the issue, and prepare response for the supervisor's approval. Responses are based upon history, findings, and future directions of the Office of Medical Assistance Programs in accordance with agency policy, procedures, goals and objectives. |
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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: Licenses, registrations, or certifications: 1. N/A 2. N/A 3. N/A 4. 5. 6. |
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Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.
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