Position Description

Commonwealth of Pennsylvania
POSITION DESCRIPTION FOR JOB POSTING
Position Number: 50704601	Description Activated On: 9/8/2026 2:35:02 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 Office of Mental Health and Substance Abuse Services (OMHSAS) is a program office within the Department of HumanServices (DHS). OMHSAS’ Bureau of Policy, Planning and Program Development is responsible for providing a full range ofpolicy and regulatory planning, services and system design, and research within OMHSAS. This is completed in collaborationwith other state agencies, stakeholder groups, counties, federal agencies, managed care organizations, and communityagencies that provide services to individuals with mental illness and substance use disorders.
The Division of Behavioral Health Medicaid Policy has the responsibility for management of a wide array of behavioral healthMedicaid policy work including In-Lieu of Services, Supplemental Services Review Committee, Value Based Purchasing,Community Based Care Management, PA 67 Waiver, Policy Clarifications, the Medicaid State Plan, HealthChoices Contracts,Medicaid Member Handbooks, supporting maintenance of the Behavioral Health Services Reporting Classification Codes,Mental Health Parity, implementation of federal Final Rule implementation, Medicaid re-entry programs, Federally QualifiedHealth Centers, Institutions of Mental Diseases, Medial Necessity Criteria, responding to federal Notice of Public RuleMaking, HR 1 Implementation, and providing Medicaid expertise for all OMHSAS bulletins, legislative analysis andregulations. The Division also manages an 1115 Medicaid Waiver for substance use disorder. The Division includes twosections, Medicaid Development and Medicaid Program Management. This position serves within the Section for MedicaidDevelopment.
The Section of Medicaid Development is responsible for applications for and maintenance of all Federal Medicaid Waivers.This includes the PA67/1915B waiver and any additional waivers, such as 1115 waivers, that OMHSAS pursues. Currentlythis includes responsibility for an 1115 waiver permitting payment for substance use disorder (SUD) treatment within aninstitution of mental disease (IMD) that is valued at $100M to the Commonwealth. The section providers subject matterexpertise regarding SUD. In addition, the section is responsible for maintenance of the Medicaid State plan, includingidentifying and completing state plan amendments as needed. This section has a leadership role in the contract committee, across Bureau working group that establishes contract language for the Behavioral Health HealthChoices agreement withPrimary Contractors. This section is responsible for reviewing federal notices of public rule making and final form rules todetermine impact on OMHSAS and lead required changes to the behavioral health Medicaid program in Pennsylvania toensure compliance. This section leads the drafting of policy clarifications, operations memorandum, bulletins and other policydocuments related to their areas of expertise. In addition, the section provides input on other policy documents includinglegislative analysis and regulations related to their areas of expertise.
In order to complete their responsibilities, the Medicaid Analyst is expected to have the following skills:
•Knowledge of the functions and objectives of human services programs, specifically behavioral health and Medicaidprograms.
•Knowledge of the laws and regulations governing behavioral health services and Medicaid.
•Knowledge of available resources for behavioral health Medicaid providers.
•Knowledge of the principles and methods of data collection and analysis.
•Knowledge of the use and functionality of Microsoft Office Suite software.
•Ability to analyze and interpret program and fiscal data related to behavioral health Medicaid.
•Ability to analyze and interpret policies, procedures and regulations relevant to behavioral health Medicaid.
•Ability to establish and maintain effective working relationships.
•Ability to communicate effectively orally.
•Ability to communicate effectively in writing.

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 functions as a Medicaid Analyst within the Section for Medicaid Development.Responsibilities include:
•Analyzes and interprets proposed and new federal and state legislation and regulations to anticipate effects on the behavioralhealth Medicaid program and advises on implementation strategies.
•Analyzes program operations and recommends the development and modification of policies to achieve greater programefficiency and effectiveness for the behavioral health Medicaid.
•Develops and implements policies governing programs and services within the behavioral health Medicaid program.
•Develops, revises, and interprets planning documents, policy memos, communications memos, policy interpretationbulletins, and other documents to ensure policies are interpreted and applied consistently across the behavioral healthMedicaid program.
•Performs analyses for policy and program proposals and develops effective recommendations for executive decision makingfor the behavioral health Medicaid program.
•Serves as a consultant to program staff during system development and redesign to interpret policies and their impacts onsystems related to behavioral health Medicaid program.
•Conducts reviews of behavioral health managed care organizations and other providers to determine operational readinessand contract compliance.
•Evaluates effectiveness of provider service descriptions and offers consultative guidance to provider staff on thedevelopment and revision of service descriptions for behavioral health Medicaid providers.
•Works with behavioral health managed care organizations to address non-compliance issues and directs them on how toachieve compliance.
•Evaluates program performance against stated goals and objectives, identifies factors that facilitate or impair effectiveness,and develops policy recommendations to support program improvements for the behavioral health Medicaid program.
•Analyzes systems data to determine if policies are correctly applied in the various systems, conducts research to addressidentified issues, and advises on appropriate solutions.
•Provides consultation and direction on policy interpretation and implementation for the behavioral health Medicaid program.
•Develops and executes program performance measures to determine if policies are implemented appropriately within thebehavioral health Medicaid program.
•Provides policy analysis and interpretation to inform the development of requests for proposals and other solicitations andserves on evaluation committees to select providers related to the behavioral health Medicaid program.
•Develops and implements training programs and policies related to the behavioral health Medicaid program.
Performs 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 in this position carries out responsible and professional work under the direction of the Section Chief forMedicaid Development. Work is performed with limited guidance under the general direction of the Section Chief and is reviewed through conferences and reports.

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.

1.	Communicates both orally and in writing in a clear, comprehensible fashion.
2.	Conducts formal training sessions as well as facilitates workgroups and meetings.
3.	Interprets instructions and departmental, state and federal regulations related to Medicaid.
4.	Interprets trend analysis data.
5.	Composes original documents, bulletins, correspondence, and reports.
6.	Communicates with people from a variety of educational and social backgrounds (i.e. healthcare providers, consumers,and office and bureau personnel).
7.	Reviews large volumes of documentation such as regulations, manuals, bulletins, and reports.
8.	Travels, as necessary, in the performance of the aforementioned duties and responsibilities
9.	Other duties as assigned.
10.