Job Title: Program Specialist – Enhanced Member Support Unit

Location: Must live in PA.  (Required in office one day per month. Possible travel to Harrisburg/Camp Hill/Mechanicsburg area.)

Pay Rate: $22/hr.
Schedule: Monday-Friday, 8:00 AM - 4:00 PM

Benefits: Health, Dental, Vision, Life Insurance, and short-term disability after 90 days

For more information, please contact Breanna D. directly at bdrollinger@alinestaffing.com

We are seeking a Program Specialist to join the Enhanced Member Support Unit (EMSU) of the Bureau of Managed Care Operations. This vital role will focus on coordinating services and resolving issues for HealthChoices members with special healthcare needs. The Program Specialist will be responsible for monitoring the compliance of Managed Care Organizations (MCOs), coordinating care, and addressing issues related to case management for members, including children in substitute care.

Key Responsibilities:

• Monitor Compliance: Ensure compliance of Physical Health MCO’s Enhanced Member Support Units (EMSUs) for assigned MCOs.
• Resolve Member Issues: Facilitate the resolution of member issues referred by various stakeholders (e.g., legislative offices, hospitals, doctor’s offices), following through until resolution.
• Collaboration: Work closely with various DHS offices and external stakeholders, including the Office of Developmental Programs (ODP), Office of Long-Term Living (OLTL), Office of Mental Health and Substance Abuse Services (OMHSAS), Office of Children, Youth, and Families (OCYF), Adult Protective Services (APS), and Bureau of Fee for Services (FFS) to ensure timely and effective service delivery.
• Data Sharing & Reporting: Review and analyze reports to identify trends and needs. Ensure that MCOs meet program standards and report findings to management.
• Contract Management: Participate in contract management activities, including quarterly meetings with MCOs and stakeholder meetings.
• Specialized Support: Serve as a backup for Resource Facilitation Team (RFT) and age-out issues, providing support as needed.
• Documentation: Maintain accurate documentation for member cases, including meeting outcomes and tracking efforts to address cases.
• Meetings & Trainings: Coordinate and schedule meetings, participate in webinars, and provide regular updates to supervisors, managers, and directors.

Minimum Qualifications:

• One year of professional experience in developing, implementing, or evaluating human services, sociology, public health, healthcare services, or health insurance programs.
• Bachelor's degree in human services, education, or a related field, OR any equivalent combination of experience and training that includes at least one year of professional experience in relevant areas.

Desired Qualifications:

• A working knowledge of Medicaid/Medical Assistance is a plus, though not required.

JOB ID#: 149399

Keywords: Program Specialist, Enhanced Member Support Unit (EMSU), Bureau of Managed Care Operations, HealthChoices, Special healthcare needs, Managed Care Organizations (MCOs), Case management, Member issue resolution, Compliance monitoring, Medicaid/Medical Assistance, Data analysis, Stakeholder collaboration, DHS offices, Office of Developmental Programs (ODP), Office of Long-Term Living (OLTL), Office of Mental Health and Substance Abuse Services (OMHSAS), Office of Children, Youth, and Families (OCYF), Adult Protective Services (APS), Bureau of Fee for Services (FFS)