Job/Position DescriptionThe Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) division seeks highly qualified candidates to fill two Program Specialist V positions. The Program Specialist V positions report to the Quality Assurance Director and work as part of the Quality Assurance team within Quality and Program Improvement to improve health outcomes for Texas Medicaid and CHIP members. This position assists with the development and implementation of state and federally-required healthcare quality initiatives for Medicaid and CHIP. MCS is driven by its mission to deliver quality, cost-effective services to Texans. These positions make a significant contribution to MCSand#146;s mission by using data-driven evidence-based approaches to hold Medicaid and CHIP MCOs accountable, ensure access to high-quality care, and drive quality-based innovation. The ideal candidates thrive in an environment that emphasizes: teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy.Essential Job Functions(30%) Leads, implements and manages quality improvement projects related to managed care quality assurance and performance improvement initiatives that evaluate, monitor, and directly impact the performance of MCOs and DMOs. Manages complex processes to identify quality gaps to improve reporting, track quality improvements and enhance current systems. Coordinates project design, planning, analysis and reporting.(20%) Compiles, reviews, tracks, monitors and assists with the analysis of MCO's quality deliverables and reports. Reviews quality deliverables for completeness and accuracy of data and documentation, and helps ensure compliance with established procedures, contract requirements, laws and regulations. Provides consultative services and technical assistances to MCOs and DMOs on applicable topics and works with MCOs staff to resolve quality-related policy and operational issues. Works with multiple stakeholders on complex quality issues. Develops materials for the preparation or follow-up to workgroups and meetings.(20%) Develops internal policies and procedures; works with other program staff in determining trends and resolving technical problems; works closely with staff across areas in MSC and HHS and with contractors to ensure operational processes and systems are coordinated. Works with staff and external stakeholders to identify risks/issues and develop mitigation strategies and solutions. (20%) Performs complex analyses of Medicaid and CHIP managed care performance data and reports related to Healthcare Effectiveness Data and Information Set (HEDIS) quality metrics, potentially preventable events, and member surveys. Reviews technical reports, datasets and analyses completed by Texasand#146;s external quality review organization (EQRO). Analyzes, monitors, and reports on deliverables from the EQRO. Prepares a variety of high-quality memos, summaries, policies and other deliverables containing analyses of Medicaid managed care quality data. Provides oral presentations related to these written materials and reports.(10%) Analyzes the impact of state and federal laws and regulations on managed care quality. Conducts research on policy implications and helps analyze the effectiveness of the Medicaid and CHIP program. Identifies and operationalizes new requirements fo https://jobshrportal.hhsc.state.tx.us/ENG/CareerPortal/job_profile.cfm?szOrderID=605775 Copy the URL in the preceding sentence to an Internet Explorer browser to apply to the job directly through the Texas Health and Human Services Career Portal.