Program Specialist V

Program Specialist V
Broad knowledge of Medicare, Medicaid and State Licensing rules relating to Home and Community Support Services Agencies (HCSSA) and Prescribed Pediatric Extended Care Centers (PPECC). Broad knowledge of complex disease processes and treatments for pediatrics, adults, and geriatrics. Applies analytical and critical thinking skills, using the Issue, Rule, Application and Conclusion (IRAC) method, in the review of state licensing violations for HCSSA and PPECC, and Medicare deficiencies for HCSSA to ensure accuracy pursuant to state licensing standards for HCSSA and PPECC, and Medicare Conditions of Participation rules and regulations for HCSSA.
Performs review of statement of licensing violations (SOV) and statement of deficiencies (SOD) and Opportunity to Show Compliance (OSC) packets and determines if enforcement action is supportable and warranted. Performs review of Medicare Condition of Participation deficiencies and determines appropriate sanctions.
Performs Informal Dispute Resolution (IDR) reviews of home health and hospice licensing violations and Medicare Condition-level deficiencies and prepares detailed narrative of decisions and rationales.
Provides consultation, interpretation and or clarification of standards and rules relating to HCSSA and PPECC. Participates in work groups and meetings related to HCSSA and PPECC..
Performs quality management of assignments including proofing, follow-up, tracking and monitoring, and data entry in the TULIP and SharePoint data systems. Attends enforcement case pre-hearing conferences and hearings related to enforcement actions of HCSSA and PPECC. Must be able to communicate on a complex level with others internally and externally. Must attend and complete all required training related to the home health, hospice and prescribed pediatric extended care centers programs. Cross trains into other long-term care and non-long term care enforcement programs.

Essential Job Functions:
Performs clinical review and analysis of Home and Community Support Services Agencies (HCSSA) and Prescribed Pediatric Extended Care Centers (PPECC) state licensing violations. Implements the Issue, Rule, Application and Conclusion (IRAC) method to determine whether the documented evidence and packets supports a determination of noncompliance and whether violations warrant enforcement action. Performs clinical review and analysis of Home and Community Support Services Agencies (HCSSA) federal deficiencies to determine noncompliance with Medicare Conditions of Participation (CoP) and Standard and whether federal sanctions and or Medicare termination is warranted. 40%
Conducts Informal Dispute Resolution (IDR) reviews of Medicare Condition-level Home Health deficiencies and State Licensing violations. Communicates with regional staff and IDR requestors for clarifications and additional information as needed. Prepares detailed narrative of rationale and decision. Utilizes all resources, peers, and literature for clarification. 15%
Reviews Opportunity to Show Compliance (OSC) packets to determine if the recommended action is warranted and supportable. Prepares detailed narrative of rationale and decision. Utilizes all resources, peers, and literature for clarification. 15%
Maintains systems for follow-up and tracking of assignments and performs data entry in the TULIP and SharePoint data systems. 15%
Communicates with regional and state office staff to provide consultation, interpretation, guidance, and clarification of Home and Community Support Services Agencies (HCSSA) and Prescribed Pediatric Extended Care Centers (PPECC) standards and rules. Participates in workgroups representing Home and Community Support Services Agencies (HCSSA) and Prescribed Pediatric Extended Care Centers (PPECC) enforcement. 5%
Attends enforcement case pre-hearing conferences and hearings related to enforcement actions of Home and Community Support Services Agencies (HCSSA) and Prescribed Pediatric Extended Care Centers (PPECC). 5%
Attends and completes all required state and federal trainings applicable to the home health, hospice, and Prescribed Pediatric Extended Care Centers programs. Attends work on a regular and predictable schedule. Other duties as assigned. 5%

Knowledge Skills Abilities:
Experience in, or knowledge related to, the administration of and provision of care to patients in home health agencies, hospice care, Prescribed Pediatric Extended Care Centers, and/or long-term care facilities.
Knowledge of Medicare, Medicaid and state licensing rules relating to Home Health, Hospice, Prescribed Pediatric Extended Care Centers, and long-term care providers.
Experience in or knowledge of regulatory services including surveys, investigation and enforcement of home health, hospice, Prescribed Pediatric Extended Care Centers, or long-term care facilities.
Ability to gather, organize and analyze facts; to compile and prepare reports; to develop and evaluate policies and procedures and initiate modifications as needed.
Ability to perform work independently and operate effectively within established guidelines and timeframes.
Ability to establish and maintain effective working relationships with managers, team members, external stakeholders and others.
Ability to communicate effectively both orally and in writing.
Skill in operating computers and in using computer software.

Registration or Licensure Requirements:
None required.

Initial Selection Criteria:
Graduation from an accredited College or University with a degree in a related field of health care or social services. Work experience in home health or hospice services, including regulatory services, may substitute for education. Applicants will initially be screened for experience with long-term care services, including surveys, investigations and/or enforcement with a primary focus on home health and hospices.

An in-basket exercise using the Issue, Rule, Application and Conclusion (IRAC) process is required.

Additional Information:
Work schedule is Monday - Friday, 8:00 a.m. - 5:00 p.m. This position may telework according to the agency policy. The position may be located in any LTCR region within the State.
This position will be required to cross train into other long-term care and non-long term care enforcement programs.

MOS Code:
68C, 66H/P/S/T/W, 290X, 46FX/NX/SX, 88B0.