Position Description

Commonwealth of Pennsylvania
POSITION DESCRIPTION FOR JOB POSTING
Position Number: 50703283	Description Activated On: 3/9/2026 8:42:17 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 position is responsible to conduct program analysis and evaluation of Statewide Medical Assistance (MA) Programs related to Long-term Services and Supports (LTSS) delivery (such as home and community-based waiver and nursing facility services for MA recipients) and Community Health Choices Nursing Facility Ineligible (CHC-NFI) dually eligible participants, using both Medicare and Medicaid data. The result of the work directly impacts budgetary, legislative, policy, legal and public issues related to these multi-billion dollar Medicaid programs. The work requires in depth knowledge of research, statistical, and program evaluation methodologies as well as extensive knowledge of the MA programs and data systems. All work results, including methodology and analysis, must be capable of litigation defense. Develops reports and conclusions that support the goals and needs of the Bureau.

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.

This position is responsible for collecting, compiling, analyzing, reviewing, reporting and managing data. Position focuses on the integration of Medicare and Medicaid data to determine the effectiveness of care coordination and to identify opportunities for quality improvement for Pennsylvania's dual eligible individuals. Uses advanced statistical and program evaluation techniques to provide management staff with accurate information to be used in decision making, planning, monitoring and funding allocation for MA programs. Responsibilities include the following activities:
1. Develops and implements appropriate statistical and program evaluation methodologies for analysis of program data.
2. Interprets data and effectively communicates results through written and verbal format, including presentation to management and executive level staff.
3. Develops and maintains an in-depth knowledge of Pennsylvania's LTSS and CHC-NFI program goals, trends and statistics.
4. Provides consultation and support to both internal and external management and staff in understanding the LTSS and NFI program data.
5. Creates, evaluates and analyzes market penetration studies and the healthcare needs of the current and future long-term care Medicaid population and the influence of the changing demography of the State’s aging and disability population.
6. Identifies needs and necessary LTSS and NFI services by geographical areas and provides strategies and recommendations to address these needs.
7. Uses complex outcome-oriented methodology to determine if significant or meaningful results are being achieved from the Medicaid program being offered.
8. Performs research and evaluation studies to develop and conduct programmatic evaluation of the needs of the State’s LTSS and NFI programs.
9. Prepares program reports, graphs, tables and maps that supports recommendations and are used for program planning and development.
10. Evaluates and measures effectiveness of new program alternatives for the dual eligible population by using Medicare and Medicaid data. Works with various Bureaus within the OLTL and Department to identify and develop information that can be used to help make determinations on new program alternatives. Reviews and evaluates policies and projects in order to determine their impact.
11. Has an in-depth understanding of the Medicaid and Medicare programs and uses data to show how to better coordinate these services, improve quality of care, and remove disconnects.
12. Perform the necessary oversight of the CHC-MCOs’ data collection and reporting activities that include HEDIS©, CAHPS©, Pennsylvania Performance Measures (P4P), and required quality improvement metrics.
13. Collaborate with OLTL Leadership and the OLTL Medical Director to provide oversight of the CHC-MCOs Pay for Performance (P4P), Value Based Purchasing Programs, and the Nursing Facility Quality Incentive program.
14. Support the CHC-MCOs submission of operational reporting related to the External Quality Review (EQRO) federal regulations.
15. Manage, direct, analyze and provide technical assistance or corrective action plan oversight for CHC -MCOs for Quality Assurance and Program Analytics areas of responsibility under the Community HealthChoices Agreement.
16. Travels to meetings and trainings.
17. Performs other duties and job-related activities as requested.

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.

Responsible for analyzing and evaluating the Office of Long Term Living's LTSS and NFI programs to determine the extent to which the goals and objectives are being met. Participates in creation of new program ideas and designs. Researches and develops a resolution for issues in the following areas: identifying new or existing data source to be used in performing analysis; creates database structure and layout; establishing proper statistical tests; presents findings; expanding the scope of research associated with a project; evaluating results and identifying problems with both data and analysis; determining relevant data needs and data extraction methods; recommending additional data needed to complete review; researching and preparing a formal response for management’s signature; and monitoring the accuracy and completeness of vendor provided data. Determines what data to include in final request analysis packet, determines if additional information is needed; and responsible for conducting additional research and data analysis.

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:

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

1.	Compiles, analyzes and evaluates Medicare and Medicaid data.
2.	Prepares proposals and summaries.
3.	Develops comprehensive reports, graphs, tables and maps.
4.	Maintains historical trend data.
5.	Performs quantitative and qualitative analysis.
6.	Interprets laws, regulations and directives.
7.	Use database applications, SAS, Microsoft Office Suite and other analytical and statistical software.
8.	Travel as needed, including to areas that may not be accessible by public transportation.
9.	Communicate outcomes and findings clearly and effectively, orally and in writing.
10.	Conduct program or project review in order to discover new trends and initiatives.