Position Description

Commonwealth of Pennsylvania
POSITION DESCRIPTION FOR JOB POSTING
Position Number: 00277457	Description Activated On: 9/21/2026 3:08:10 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 in the Office of Long-Term Living (OLTL) Bureau of Quality Assurance and Program Analytics (BQAPA) - Division of Quality Assurance. The incumbent reports to a Human Services Program Specialist Supervisor in the Quality Assurance and Appeals Section. The incumbent is responsible for supporting and evaluating the quality assurance activities of OLTL programs, including home and community-based services (HCBS) waivers, and supporting oversight requirements for CMS. The incumbent assists with identification of issues and improvement efforts for OLTL programs.

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.

Participates in the review and evaluation of Quality Assurance activities regarding home and community-based services (HCBS) and long-term services and support program, Community HealthChoices (CHC) to ensure CMS assurances are met, and eligible medical assistance recipients receive appropriate and quality long-term living services and medical care under state and federal regulations.

Work is performed collaboratively with the Division of Program Analytics and other team members within BQAPA to support other bureaus within OLTL. This includes all projects related to Waiver renewals, amendments, and Evidence Based Reviews (EBRs).

The incumbent serves as a Subject Matter Expert (SME) for several Quality Management/Utilization Management (QM/UM) reports. As SME the incumbent reviews information, analyzes data, and policy submissions from the MCOs. Additionally, as SME the incumbent works with the supervisor to provide feedback as deemed appropriate.

The incumbent collects data regarding the use of interpretation and translation services by OLTL employees. Incumbent uses this data to verify monthly invoices from OLTL’s interpretation and translation services vendor.

Incumbent attends Weekly and Monthly MCO Meetings. The incumbent is responsible for creating and distributing minutes from these meetings to the Bureau.

The incumbent is expected to review reports and work closely with the CHC-MCOs as needed for clarification, scheduling meetings, and providing guidance before validating the reports. The validated information will be used on CMS submissions.

The incumbent works on the states electronic monitoring system known as the Systemic Monitoring Access Retrieval Technology (SMART). The incumbent works with SMEs measuring MCO performance against the standards and assessing the MCOs overall compliance with CHC agreement requirements in the Medicaid Enterprise Monitoring Module (MEMM).

Incumbent participates in the Quarterly Quality Review Meetings (QQRM). Incumbent works with supervisor to create reports and presentations for QQRM.

Incumbent works with the supervisor to develop and analyze the Home and Community Based Services HCBS CAHPS Survey, and the Participant Review Tool.

Incumbent utilizes various systems, and they may include but is not limited to HCSIS and DocuShare to review CHC-MCO report submissions and provide recommendations for areas of improvements.

Projects are assigned, reviewed, and discussed during meetings with the supervisor. Work is done independently, while applying initiative, sound judgment and analytical abilities to successfully complete assignments. Work is performed with minimum daily supervision or review.

Develops and contributes to the development of spreadsheets and reports to collect and organize data to support quality management efforts.

Represents the bureau and participates, facilitates workgroups or team meeting, providing input and support as directed by the supervisor.

Assists in the gathering of information for the EBR, CHC Operations Reports and WAM, and 372 Reports to CMS.

Possess oral and written communication skills, problem solving, and decision-making ability.

Perform related work as required and other related duties as assigned by the Bureau Director, Division Director, Section Chief, or supervisor in line with the functions associated with this position.

The incumbent should maintain a current Pennsylvania driver’s license.

Performs related work 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.

Independent decisions are made by the incumbent relating to timeline adherence for the submission of data. Data requirements are outlined in report templates.

The incumbent reviews reports for adherence to DHS-OLTL requirements.

The incumbent will serve as the SME for operational reports and may include but not limited to LEP and other QM/UM Reports. As SME the incumbent will work with the supervisor to develop Corrective Action Plans (CAPs) when MCOs fail to be compliant with meeting the report’s requirement and as outlined in the CHC agreement.

The incumbent independently evaluates adherence to CMS requirements for waiver programs by determining if program policies and procedures are compliant and are implemented. Information is then forwarded to the Supervisor for further review and action.

Establish and maintain cooperative and effective relationships with CHC-MCOs and external parties in order to support OLTL.

Interact with other Bureaus to ensure the efficient and timely processing of DQA projects and activities.

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:

N/A

Licenses, registrations, or certifications:

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2.   N/A

3.   N/A

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

1.	Review federal and state policies relating to long term living.
2.	Review and analyze waiver related data from CHC-MCOs.
3.	Communicate effectively, orally and in writing.
4.	Use Microsoft Office Programs and other specific data programs.
5.	Prepare and deliver presentations and conduct meetings.
6.	Problem solving and decision-making ability.
7.	Use MEMM to analyze SMART Standards
8.	Use and navigate State and Federal Websites
9.	Use data collection and reporting systems i.e., eCIS, SAMS, HCSIS, MAPPER and PROMISe.
10.	Travel as Required.