Medicaid Program Manager 1-B

LDH-Medical Vendor Administration; Baton Rouge (LA); On-site; USD 70,000 - 100,000; Full time

Job summary

The Louisiana Department of Health is seeking a qualified professional to manage statewide Clinical Quality Measure (CQM) projects within the Medicaid Quality Improvement Section in East Baton Rouge Parish. The role focuses on improving healthcare quality, access, and outcomes for Medicaid enrollees.

You will plan, implement, monitor, and evaluate quality improvement initiatives, coordinate data collection and reporting, and provide guidance to Medicaid staff and providers to strengthen

Qualifications

• Seven years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services.
• Experience substitution: Every 30 semester hours earned from an accredited college or university will be credited as one year of experience toward the six years of full-time work experience.
• Bachelor’s degree plus 4 years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services.
• Advanced degree or a Juris Doctorate plus 3 years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services.

Responsibilities

• Manages and coordinates statewide Clinical Quality Measure (CQM) projects and initiatives, ensuring compliance with project deliverables, quality strategies, CMS requirements, contracts, accreditation standards, and regulatory requirements.
• Plans, implements, monitors, and evaluates quality improvement projects and processes to improve the quality, access, and outcomes of healthcare services for Medicaid enrollees.
• Oversees the collection, analysis, monitoring, and reporting of quality-related data and performance measures, ensuring accuracy, consistency, and efficiency across the Medicaid enterprise.
• Provides technical assistance, consultation, and guidance to Medicaid staff, healthcare providers, contractors, and other stakeholders regarding CQM initiatives, quality improvement activities, and corrective action plans.
• Coordinates project charters, work plans, meetings, reports, and supporting documentation; identifies and resolves project issues and develops strategies to monitor progress and achieve established goals.
• Evaluates contractor deliverables and quality improvement initiatives, recommends corrective actions, and ensures ongoing compliance with program objectives, policies, and contract requirements.
• Develops and maintains partnerships with internal and external stakeholders to support quality improvement initiatives, health information technology projects, and the sustainable implementation of Medicaid quality programs.

Skills

Project management

Quality improvement

Data analysis

Healthcare regulation

Education

Bachelor's degree

Advanced degree or JD

Job description

The mission of the Louisiana Department of Health is to protect and promote health and to ensure access to medical, preventive, and rehabilitative services for all residents of the State of Louisiana.

Learn more about Louisiana Department of Health

Make an Impact on Medicaid Quality & Healthcare in Louisiana!

Join the Louisiana Department of Health's Bureau of Health Services Financing (BHSF) and play a key role in improving healthcare for nearly 1.7 million Medicaid enrollees across Louisiana. As part of the Medicaid Quality Improvement Section, you'll contribute to meaningful data collection, reporting, and analysis that helps measure and strengthen the quality of healthcare provided to Medicaid members. If you're ready to use your skills to make a real difference in the health and well-being of Louisianans, we want you on our team!

• Seven years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR
• Six years of full-time work experience in any field plus four years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR
• A bachelor’s degree plus 4 years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR
• An advanced degree or a Juris Doctorate plus 3 years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services.

EXPERIENCE SUBSTITUTION: Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.

The official job specifications for this role, as defined by the State Civil Service, can be found here.

Job Duties:

• Manages and coordinates statewide Clinical Quality Measure (CQM) projects and initiatives, ensuring compliance with project deliverables, quality strategies, CMS requirements, contracts, accreditation standards, and regulatory requirements.
• Plans, implements, monitors, and evaluates quality improvement projects and processes to improve the quality, access, and outcomes of healthcare services for Medicaid enrollees.
• Oversees the collection, analysis, monitoring, and reporting of quality-related data and performance measures, ensuring accuracy, consistency, and efficiency across the Medicaid enterprise.
• Provides technical assistance, consultation, and guidance to Medicaid staff, healthcare providers, contractors, and other stakeholders regarding CQM initiatives, quality improvement activities, and corrective action plans.
• Coordinates project charters, work plans, meetings, reports, and supporting documentation; identifies and resolves project issues and develops strategies to monitor progress and achieve established goals.
• Evaluates contractor deliverables and quality improvement initiatives, recommends corrective actions, and ensures ongoing compliance with program objectives, policies, and contract requirements.
• Develops and maintains partnerships with internal and external stakeholders to support quality improvement initiatives, health information technology projects, and the sustainable implementation of Medicaid quality programs.

Position-Specific Details:

Location: Medical Vendor Administration/ Quality Improvement and Innovations/ East Baton Rouge Parish

Appointment Type: This position may be filled as aProbationary appointment, Promotional appointment, or Detail to Special Duty

Cost Center: 3052030601

Position Number(s): 50400605

Contact Information:

Shambrielle Pooler

[e-mail]

LA Department of Health (LDH)

Division of Human Resources

PO Box 4818

Baton Rouge, LA 70821

225-342-6477

This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.

LDH supports Louisiana's commitment to being a State as a Model Employer (SAME) by promoting the recruitment, hiring, and retention of individuals with disabilities.

Information on the Louisiana Works, Louisiana Rehabilitation Services is available here.

LDH is an equal opportunity employer and seeks to recruit a highly productive and diverse workforce and will provide equal employment opportunities to all employees and prospective employees. Employment decisions shall be based strictly on merit and without regard to religious or political beliefs, sex, race, or any other non-merit factor.