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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00209971 |
Description Activated On: 12/15/2025 1:01:55 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 responsible for day-to-day operations and monitoring of the Office of Long-Term Living’s (OLTL) Community HealthChoices (CHC) Managed Care Organization(s) (MCO) for Agreement compliance. Responsible for completing correspondence, attending meetings and on-site visits as necessary. |
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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. The incumbent in this position is located in the Office of Long Term Living and is responsible for monitoring and compliance activities related to the Department’s CHC-MCO Agreements as well as handling the day-to-day operational issues resulting from these Agreements. A CHC-MCO is a prepaid, capitated health care program for eligible Medical Assistance consumers. The incumbent reports directly to the Contract Manager and is expected to demonstrate initiative and independence while ensuring that the MCOs meet established Department regulations, standards and Agreement requirements. RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO: Participate as a member of the CHC-MCO monitoring team. Assist in completing desk and on-site reviews of the CHC-MCO to ensure that policies and procedures, participant materials, provider materials, educational and training materials, provider networks and incentives are in compliance with the CHC-MCO Agreement. Coordinate with appropriate staff to develop, oversee and/or conduct surveys, inspections, reviews or other analyses to determine MCO compliance with contract, laws, regulations, policies and procedures within assigned timeframes Prepare for reviews by developing agendas, determining information needing to be reviewed, developing on-site questions, developing summaries and areas of follow up. Monitor assigned CHC-MCOs to ensure compliance with contract standards and assess MCO performance relative to the quarterly reports and the Performance Dashboard and other performance measures and quality improvement goals. Determine the effectiveness of CHC-MCO operational and contractual compliance by utilizing a standard set of assessment tools and analyzing all relevant data. Participate in identification of opportunities for improvement in CHC-MCO performance based upon consideration of performance data, stakeholder input, and Department priorities. Analyze data from operational reports and other sources to monitor compliance and performance. Inform the Contract Manager of significant CHC-MCO compliance and quality improvement issues and provide recommendations for action. Resolve contract performance and compliance issues by working collaboratively with CHC-MCO monitoring team, the Contract Manager, and the MCO to improve performance and contract compliance by participating in the development and monitoring of corrective action plans, as appropriate. Participate in the process to assess penalties or damages for failure of the MCO to meet Agreement performance requirements. Research individual participant or provider issues. Develop responses after gathering information and data from internal and external sources. Participate in functions related to special MCO projects and investigations, including but not limited to the development of and revision of Managed Care Operations contract management policies and procedures. Collaborate with CHC-MCOs to develop review materials, analyze and assess documents, data, and other relevant materials for special investigations, performance audits, readiness reviews, and other monitoring activities within assigned timeframes. Establish and maintain effective working relationships and communications with Department staff, CHC-MCO monitoring team, CHC-MCO staff, and staff from other agencies and organizations, appropriately interact with others, provide timely responses to requests and inquiries. Demonstrate commitment to the goals of the CHC-MCO program, including showing initiative to take on new projects; being team-oriented; being committed to outstanding customer services; and being willing to focus on promoting efficiencies and accountability. Communicate with supervisor on a timely and current basis with regard to problematic situations and apply proper judgment to assure action is appropriate. Analyze the CHC-MCO provider networks to ensure that they meet the guidelines in the Agreement to ensure adequate number of providers to ensure timely access to care. Assist in developing reports and presentations/trainings about the operations of the CHC-MCO program. Provide information as requested by other Commonwealth Offices, CMS, Legislature and stakeholders. Participate on workgroups (internal and external) to develop processes, operational and monitoring strategies related to CHC. Act as a liaison for the OLTL, as a designated expert in CHC. This includes attending meetings, doing research, preparing reports and doing presentations. Provide recommendations for changes to the CHC program as well as changes to the MCO Agreement. 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. Incumbent must be able to work both independently and as a member of the CHC-MCO monitoring Team. Make decisions based on established criteria and guidelines as MCO materials are reviewed and monitored. Advise and make recommendations to Supervisor as necessary. Identify any problem areas that will need input or decisions by upper management staff. |
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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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