|
Commonwealth of Pennsylvania |
|
|
POSITION DESCRIPTION FOR JOB POSTING |
|
|
Position Number: 00134265 |
Description Activated On: 11/10/2025 2:48:16 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. The incumbent in this position is in the Division of Integrated Care Programs in the Office of Long-Term Living. The incumbent is responsible to be the Plan Lead overseeing the monitoring of the Living Independence for the Elderly (LIFE) Programs in their assigned region. The incumbent is responsible for performing staff work in the planning, development, implementation, evaluation and monitoring of the LIFE Program (nationally known as the PACE – Program of All-Inclusive Care for the Elderly). This position requires statewide travel and travel within the assigned region. |
|
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. Provide professional services to the Office of Long Term Living, including management of the LIFE Program, a managed care program for the frail elderly. This position requires a high degree of independence. Review, analyze and develop policies, procedures, regulations, monitoring tools and evaluation instruments for assigned program areas with special emphasis on the LIFE Program. This includes LIFE program agreements, defining operational requirements and assuring compliance with Medical Assistance program objectives and policies, and federal and state program requirements. Coordinate, schedule and facilitate the on-site monitoring review process for all LIFE programs in their assigned region to evaluate appropriateness, compliance, and effectiveness of requirements to ensure state and federal standards are met. Activities include collaboration with other state and federal review teams, the development of review materials and assignments and the development of final report of findings based on input of all review team members. Review of LIFE Provider plans of correction in response to report of findings to ensure appropriate response and correction to each item. Makes recommendations, approves or denies correction action plans and issues appropriate letters of acceptance. Establish and maintain cooperative and effective working relationships with CMS, other states, provider staff and co-workers in order to discuss operational issues as they relate to Pennsylvania programs. Provide supervisor with written and verbal reports making recommendations as appropriate. Provide consultative support and services to program staff, LIFE Provider’s and other state agencies involved with the LIFE program including Area Agencies on Aging and nursing facilities. Interact and provide consultation to Pennsylvania County Assistance offices and other state agencies determining financial eligibility and distribution of payments to LIFE Providers. Review and analyze provider risk reserve information to ensure provider is compliant with state and federal regulations. Analyze financial data and reports in conjunction with other internal and external staff and agencies. Work with appropriate Bureau, Office, Departmental and Interagency staff assuring collaboration and coordination between these offices/agencies to assure compliance with state and federal requirements, reviewing and modifying existing procedures/forms, and developing procedures regarding eligibility, enrollment and provider payment. Write and recommend Program Directives for LIFE to clarify the Department’s policies and procedures as needed. Develop requirements and format for reports to assist in management of LIFE. Ensure provider compliance with submission of required reports. Review and approve/disapprove proposed marketing materials, enrollee handbooks, grievance procedures and contracts. To ensure conformity and coordination with Department objectives and policies, consultation services are provided to LIFE marketing representatives. Consult with providers and CMS in the submission of PACE provider applications to enable them to obtain Medicare capitation. This includes the analysis of material prepared by providers, development of state documentation, forwarding to CMS, and acting as Departmental liaison from CMS team. Coordinate with staff from the state’s External Quality Review Organization (EQRO) contractor to ensure Department's compliance with federal external quality review requirements. This includes working with providers to ensure compliance with reporting requirements, forwarding review documentation, and coordinating and facilitating technical assistance to providers. Respond to inquiries about the LIFE Program from the public, providers and associations both verbally and in writing. Respond to and investigate complaints and incidents from the community, program participants/families and state government officials up to and including suspected abuse, serious injury and death of a program participant or staff. Review, analyze, interpret and provide comments on federal regulations and proposed regulations related to LIFE to determine impact on the Department and initiate action to assure compliance. Knowledgeable of federal and state regulations and Departmental policies and procedures for Prepaid Health Plans and Programs of All-inclusive Care for the Elderly. Draft correspondence related to the LIFE Program and other relevant long term care programs for signature by Division Director, Bureau Director, Deputy Secretary or Secretary. Develop and maintain comprehensive understanding of Medical Assistance Program regulations, third party payer information and Federal requirements concerning Home and Community Based Waivers. Provides consultative services, programmatic and fiscal monitoring of LIFE programs within an assigned geographic area and under the regulatory jurisdiction and oversight by the Department of Human Services and the Centers for Medicare and Medicaid Services. Work includes providing consultative services leading toward the improvement of operations and regulatory compliance; submitting written reports detailing areas of non-compliance and making recommendations to correct discrepancies; and providing advice to state, county, private and community-based program staff in a wide range of administrative and professional matters. Provides consultative services to Administrators, Executive Directors, CEOs and Board Members regarding program and fiscal administration, staff development, provision of services, and the implementation of new program initiatives. Provides consultation regarding contract compliance between the LIFE program and healthcare providers to include hospitals, nursing facilities, physicians and specialists. Advise LIFE Executive staff in the regulatory interpretation and administration of human services delivery for individuals. Consults with LIFE administrators, program representatives, county officials, community planning groups, advocacy groups, associations, and other interested groups to educate providers and promote and improve services. Perform other related duties as required. |
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. The incumbent is empowered to make decisions within established policies, procedures and regulations for the LIFE Program. The incumbent exercises autonomy in making administrative and “next step” decisions but will seek supervision as necessary. The incumbent must be able to represent the Office, Bureau and/or Division at meetings or reviews regarding LIFE programs and operations. |
||||||||||||||||||||
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. 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.
|