Medical Policy Manager jobs in Georgia

The Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) is the state agency that focuses solely on policies, programs, and services for people with mental health challenges, substance use disorders, intellectual and developmental disabilities, or any combination of these. As Georgia’s public safety net, DBHDD operates six field offices and five hospitals throughout the state within three program areas: behavioral health, developmental disabilities and hospital services.

The main office for DBHDD is located in downtown Atlanta.

Job Description

Job Title:  IDD Policy Manager

Pay Grade: M

Job Summary:

Under broad supervision of the Director of Community Services, the I/DD Policy Manager develops and updates all I/DD Divisional policies and procedures in accordance with federal, state and I/DD divisional standards. Monitors the compliance for Authorizing, Accessing, and Documentation of the Developmental Disability services for individuals participating in Home and Community Based and state funded services. Promotes customer satisfaction and serves as policy content specialist on Community NOW/COMP waivers services, State Funded services, and delivery for Division of Developmental Disabilities.

Job Responsibilities & Performance Standards:            

1.     Serve as a specialist on NOW/COMP waiver services and engage in compliance management functions with State Office and Regional Field Offices to promote efficient and effective use of services delivered by DD providers within the Regional Field Office.

a.     Serves as content expert on NOW & COMP Waiver Services for developmental disabilities and helps DD providers institute best practices. Will engage in the strategic planning and policy development for any new waiver services.

b.     Under the direction of the Director of Community/Waiver Services, develops, updates, and implements policy on behalf of the Division of Developmental Disabilities.

c.      Provides education, training and technical assistance to DD providers concerning service delivery design/utilization and authorization/billing practices.

d.     Partners with Central Office and Regional Office staff members to address policy and procedural issues, standard operating procedures development and updates.

e.     Acts as state representative for DBHDD Division of IDD for various stakeholder meetings (e.g. CMS, NASDDDs). Responsible for memorializing content of various meetings and disseminating as appropriate.

2.     Engage and Coordinates in Division compliance management functions via the Letter of Agreement with Department of Community Health

a.     Participates in quarterly utilization review meetings with DCH.

b.     Works closely with the Quality Management Team in preparation of reporting performance measures for the monthly and quarterly meetings.

c.      Prepares reports regarding Waiver compliance to DCH according to the reporting standards in the NOW/COMP waiver application.

d.     Prepare for evidence reports/audits concerning NOW/COMP waivers.

e.     Assist with the NOW/COMP waiver amendments and renewals to the Centers for Medicare and Medicaid Services.

3.     Supervises staff in the Office of Community Services in the absence of the Director.

This is to include but not be limited to Motivating and Developing Teams, Communication, Decision-Making, Performance Management, Compliance, and other supervision tasks based on staff needs and requirements.

4. Work with Division of Developmental Disabilities staff in a team approach to provide technical assistance to service recipients, Regional Field Offices, service providers, Division & Department staff and other stakeholders on issues related to Medicaid Waiver Services and/or State Funded policy.

a.     Participates in maintenance of creating documentation to amend and renew policy and protocols.

b.     Leads and/or participates in and/or facilitates research initiatives including focus groups, work groups, etc., to obtain feedback on employment and day services and new approaches to incorporate best practices for these services.

c.      Creates concept and issues papers-based research findings to support new initiatives, contract amendments, policy changes, etc.

d.     Plans and coordinates statewide meetings and trainings to gather and share pertinent information.

e.     Assists in development of policies and procedures, which promote smooth and effective implementation of project outcomes.

f.      Assist with the development and management of timelines, tasks, and benchmarks associated with project implementation and completion.

g.     Compile internal and external data, complete analysis and utilize information for project completion.

h.     Performs all other tasks and duties as assigned.

5. Maintains a consistent, high quality, customer-focused orientation when conducting business and providing services or products to clients, the public and other external customers.

a.     Treats customers with respect, courtesy, and tact; actively listens to and interact with customers as a person while maintaining business relationship.

b.     Communicates with customers and obtains all required information necessary to determine and address their specific needs; tactfully explains why if service cannot be provided.

c.     Providers clear, accurate information; explains procedures or materials or provides supplemental information; anticipates problems and questions.

·       Entry Qualifications:

·       Ability to author, train and provide consultation regarding policies and procedures.

·       Ability to assess compliance and quality assurance.

·       Excellent verbal and written communication skills

·       Excellent customer service skills

·       Proficient in health care research, data analysis, and public communication.

·       Must be able to work independently and self-directed - independent tasks include state/federal policy review independent research/report out (i.e. “white papers”)

Preferred Qualifications:
Preference will be given to applicants who, in addition to meeting the minimum qualifications, possess the following:

Post Graduate degree in Human Service field from an accredited university with at least 4 years of experience and training in working with individuals with Developmental Disabilities, bachelor’s degree in public health, Bachelors Degree in Public Policy, Bachelors Degree in Health Care Administration, Bachelors Degree in Business Administration or related degree/field. 

Benefits

In addition to a competitive salary & benefits, GA Department of Behavioral Health and Developmental Disabilities is part of a statewide initiative called Total Rewards that seeks to attract and retain employees by supplementing their base pay and benefits with programs designed to improve the quality of their work environment and lead to greater job satisfaction and work/life balance. Eligible employees are offered generous benefits, including health and dental insurance; retirement and savings plan options; and paid holidays, vacation and sick leave. For more information, visit https://dbhdd.georgia.gov/benefits

Employment Requirements
To ensure the safety and wellbeing of our employees, individuals and communities we serve, certain positions within DBHDD may require evaluations, vaccinations, professional licensure and certifications. Licenses must be current and enable providers to practice within the State of Georgia.

The following are a listing of evaluations and vaccinations that may be required for employees, including those not involved with direct care:

• Drug Screening
• TB Evaluation
• Annual Influenza*

*Limited exemptions may be made for documented medical contraindications or religious beliefs that object to vaccinations.

DBHDD is an Equal Opportunity Employer
It is the policy of DBHDD to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law.

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.

This position is subject to close at any time once a satisfactory applicant pool has been identified.

FOR THIS TYPE OF EMPLOYMENT, STATE LAW REQUIRES A NATIONAL AND STATE BACKGROUND CHECK AS A CONDITION OF EMPLOYMENT.  

When applying for this position, you will be asked if you meet the minimum qualifications for this position as stated below and may possibly be presented with additional questions to assess preferred qualifications. Preference will be given to applicants who meet one or more of the preferred qualifications and have demonstrated relevant experience clearly indicated in their work history.