Pay Grade: M

The Georgia Department of Community Health (DCH) is one of Georgia's four health agencies serving the state's growing population of over 10 million people. DCH serves as the lead agency for Medicaid, oversees the State Health Benefit Plan (SHBP) and Healthcare Facility Regulation, impacting one in four Georgians.

Through effective planning, purchasing and oversight, DCH provides access to affordable, quality health care to millions of Georgians, including some of the state's most vulnerable and under-served populations. Six enterprise offices support the work of the agency’s three program divisions. DCH employees are based in Atlanta, Cordele and across the state.

The Department of Community Health is currently seeking a qualified Compliance Specialist 3 – PeachCare for Kids® Program in the Policy and Provider Services Unit of the Medicaid Division, which accounts for approximately three billion dollars annually of the State's budget, is dedicated to advancing the health, wellness, and independence of those they serve by providing access to quality care and resources statewide to approximately 1.7 million Georgians. This is a hybrid position based in Atlanta that requires in-office and remote work with the approval of the supervisor. The days and frequency in the office can change at any time during employment based on the business needs of the organization.

Job Summary:
Under broad supervision of the PeachCare for Kids® Director, the Compliance Specialist 3 (CS3) provides subject-matter expertise in Policy and Eligibility for the PeachCare for Kids unit. The CS3 position assists in reviews, monitoring and ensuring compliance with State and Federal Rules and Regulations for PeachCare for Kids®.

Essential duties and responsibilities:

Knowledge of the PeachCare for Kids® policies and regulations.

Working knowledge of Georgia Gateway, specific to reviewing cases, and reports

Working knowledge of the Georgia Medicaid Management Information System (MMIS) specific to reporting capabilities and member data.

Review data to ensure that it is accurate. Work with stakeholders to improve quality of data.

Be a subject matter expert for PCK and represent the unit at UAT and JAD sessions to ensure that regulations are followed.

Monitor programs for quality management and effectiveness through data analysis.

Participate in program policy and procedure manual updates related to or resulting from quality measure analysis.

Review state, federal and other regulatory information relative to the program area to assure compliance with related or complimentary regulations or laws.

Work with the Director in preparation and submission of the PeachCare for Kids® State Plan Amendment.

Conduct case reviews to ensure that clients eligibility is properly determined.

Work closely with members of the team to help investigate, track, and resolve compliance issues.

Assist in developing and implementing training on PeachCare for Kids® eligibility rules for case workers, case managers, and other key stakeholders.

Minimum Qualifications

Master's degree in a related field from an accredited college or university AND Two years of related experience OR Bachelor's degree in a related field from an accredited college or university AND Four years of related experience OR Associate's degree in a related field from an accredited college or university AND Five years of experience, Two years of which in a position directly related to the area of assignment OR Two years of experience required at the lower level Complnc Specialist 2 (RCP061) or position equivalent. Note: Some positions may require a certification or licensure. Note: Some positions may require a valid driver's license.

Preferred Qualifications:

• Knowledge of the Medical Assistance Program with emphasis on PeachCare for Kids®
• Specific course work in quality improvement, project management or public health
• Ability to apply policy and regulations as it relates to reviewing cases for compliance
• Experience working in Quality Improvement or Project Management within the Medical Assistance Program.
• Experience working in complex information technology systems
• Ability to work independently and exhibit innovative problem-solving skills
• Successful applicant should have verified experience in working closely with internal and external teams to collect, review and relay performance measure data and resolve compliance issues

Additional Information

EARN MORE THAN A SALARY! In addition to a competitive salary, the Georgia Department of Community Health offers a generous benefits package, which includes employee retirement plan; paid holidays annually; vacation and sick leave; health, dental, vision, legal, disability, accidental death and dismemberment, health and child care spending account.

Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail. All qualified applicants will be considered, but may not necessarily receive an interview. Selected applicants will be contacted by the hiring agency for next steps in the selection process. Applicants who are not selected will not receive notification.

THIS POSITION IS SUBJECT TO CLOSE AT ANY TIME ONCE A SATISFACTORY APPLICANT POOL HAS BEEN IDENTIFIED. APPLICATIONS WITHOUT WORK EXPERIENCE LISTED WILL NOT BE CONSIDERED. CURRENT GEORGIA STATE GOVERNMENT EMPLOYEES WILL BE SUBJECT TO STATE PERSONNEL BOARD (SPB) RULE PROVISIONS. THE POSITION MAY BE FILLED AT A LOWER OR HIGHER POSITION LEVEL.

This position is unclassified and employment is at-will. Candidates for this position are subject to a background history, reference check, and credit check. For more information about this job contact: http://dch.georgia.gov

Job Type: Full-time

Pay: $46,310.72 - $66,158.17 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

COVID-19 considerations:
Wear masks, sanitize stations available, social distancing practiced.

Ability to commute/relocate:

• Atlanta, GA 30303: Reliably commute or planning to relocate before starting work (Preferred)

Experience:

• Pharmacy technician experience: 1 year (Preferred)
• Customer service: 1 year (Preferred)

License/Certification:

• Pharmacy Technician License (Preferred)
• Pharmacy Technician Certification (Preferred)

Work Location: In person

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