Quality Improvement Organization Program & Oversight Manager (Program Manager II) - F/T Contractual
Maryland Department of Health Baltimore, MD Contract Health Care Provider
Posted on May 13, 2022
This position serves as the sole Quality Improvement Organization (QIO) Program and Oversight Manager for the Developmental Disabilities Administration’s (DDA) QIO program. The purpose of the QIO is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. The QIO provides oversight of the DDA’s Case Management System known as Coordination of Community Services. The Program Manager will report to the Developmental Disabilities Administration (DDA) Director of Administrative Services and will provide weekly updates to the Developmental Disabilities Administration’s Deputy Secretary and Director of Program Services. This position is responsible for managing the implementation of the QIO program by the contracted vendor and ensuring that the QIO vendor is performing according to the contract scope and providing utilization reviews and quarterly audits to ensure that the State pays only for services that are reasonable and necessary based on what has been approved in a participants Person-Centered Plan (PCP) and supported by sufficient documentation and case note activities. This position also works in concert with the Case Management Manager in ensuring timely submission of Person-Centered Plans (PCPs). This position also works closely with other team members to address and rectify audit findings related to services rendered by the CCS agencies.
Coordination of Community Services are provided for various home and community-based services. The DDA operated Medicaid waiver programs include Family Supports, Community Supports, and Community Pathways. These three programs are designed to provide integrated support services to participants and their families, which enable participants to work toward self-determination, independence, productivity, integration and inclusion in all facets of the community across their lifespans. The DDA programs are designed to provide Medicaid eligible individuals with community supports and services to help enable people with intellectual and developmental disabilities to receive services in their communities.
This position is responsible for the oversight and management of the Coordination of Community Services (CCS) compliance funded through the federal Targeted Case Management model, and collaborating with the QIO vendor to examine and analyze the business records and accounting systems of State agencies, grantees, businesses or other entities as appropriate to verify reliability, accuracy and compliance with generally accepted accounting principles and with statutes or contract provisions to ensure compliance with COMAR 10.09.48.01-.08 and COMAR 10.22 .02.02; 10.22.02.00, 10.22.02.14 regulations and State Plan.
The purpose of this position is to oversee all aspects of the QIO and CCS programs and act as a representative of DDA in discussions with the QIO vendor, coordination providers, individuals, families, and other stakeholders.
Qualified applications must possess a bachelor's degree from an accredited college or university and 6 years of professional experience in health services, including at least three years of professional work experience related to treatment and development of developmentally disabled clients and three years must have been at the managerial or supervisory level.
All applications must be submitted online by June 1, 2022, at 11:59:00 PM.
Apply to Recruitment#: 22-005477-0019