Heritage Health Program Specialist

The work we do matters!

Hiring Agency:

Health & Human Services - Agency 25

Location:

Lincoln NE

Hiring Rate:

$24.862

Job Posting:

JR2026- Heritage Health Program Specialist (Open)

Applications No Longer Accepted On (If no date is displayed job is posted as open until closed):

0

Job Description:

Join the dynamic team at the State of Nebraskas Department of Health and Human Services Division of Medicaid and Long-Term Care Plan Management as a full-time Heritage Health Program Specialist. We are seeking individuals who are organized possess outstanding customer service skills and are dedicated to supporting our team in providing excellent service.

The Medicaid program provides medical coverage for low income or disabled individuals. To help fulfill the agency goal of Helping People Live Better Lives this position is necessary to ensure the proper administration of the Medicaid program. Program Specialists are responsible for researching reviewing analyzing the Heritage Health contract and both federal and state regulations to assist providers and members with inquiries or issues such as problems with claims or credentialing/contracting with an MCO. They are also responsible for analyzing how regulations could impact the Medicaid program.

The Heritage Health Program Specialist will be part of the managed care unit. The successful candidate will be responsible for implementation of program plans goals and objectives for Medicaid managed care and will assist with the monitoring of the Managed Care Organization (MCO) vendor contracts.

You have the passion; we have the opportunities lets make a difference for Nebraskans!

As the Heritage Health Program Specialist you will:

• Monitor day-to-day activities including all activities related to contract performance and assuring compliance with State and Federal requirements.
• Review analyze and monitor reporting requirements and quality improvement activities of the managed care plan.
• Work with the managed care contractors to meet the requirement of 42 CFR 438 and State regulations.
• Will work with the Plan Management team and other MLTC departments to evaluate the impact of quality assurance programs on the health care services provide to Managed Care enrollees.
• Participate in the competitive procurement process and assist in completing readiness reviews.
• Provide liaison between and confers with other MLTC departments and divisional personnel.
• Explain clarify and interpret operational practices policies procedures federal and state regulations contract requirements and activities related to assigned program(s) to agency staff community organizations members of the general public and contractors/service providers.
• Other duties as assigned.
  

Hire Rate: $24.862 per hour non-exempt

Work Schedule: Monday Friday; 8:00 AM 5:00 PM

Dress Attire: Business Casual

Location: Lincoln - Nebraska State Office Building

No remote work

Requirements / Qualifications:

Minimum Qualifications: Bachelors degree OR equivalent coursework/training in public administration social/behavioral sciences healthcare human services or other program related field. Professional experience working in a human/social service or health care agency with responsibility for planning or evaluation services programs or operational policies and practices may substitute in lieu of the educational requirement.

Preferred Qualifications:

• Experience working in or knowledge of Medicaid programs or other Health Insurance programs.
• Experience in contract management claims and communications.
• Experience with data and/or quality analysis spreadsheet software programs and/or data software programs.

Knowledge Skills and Abilities:

Knowledge of: managed healthcare delivery systems; principles and practices of management business and Management principles including planning budgeting resource allocation; techniques of research planning and evaluation; work performance or other standards of development program analysis/evaluation; policy development.

Skill in: communicating to convey information so others will understand; performing quality assessment reviews and evaluating program effectiveness; identifying problems and developing options for solutions. The successful candidate will possess excellent communication skills organizational skills and problem-solving ability as well as the ability to work on a team.

Ability to: work collaboratively in a team setting; establish and maintain positive relationships with agency staff and external partners; communicate effectively to promote explain discuss and interact with interested groups on various program issues; prepare and review documents such as summaries of state and federal regulations and reports; understand interpret and apply laws rules policies and procedures pertinent to the program; exercise independent thinking skills; maintain liaison with community representatives and other governmental agencies.

If youre currently employed by the State of Nebraska please dont apply through this external career site. Instead log in to Workday and open the Jobs Hub - Internal Apply app from your home landing page. You can access Workday anytime through the Link web page: offer a comprehensive package of pay benefits paid time off retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation.

Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position agency and employment status. For more information on benefits please visit: Opportunity Statement

The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity inclusion and belonging. We recruit hire train and promote in all job classifications and at all levels without regard to race color religion sex. age national origin disability marital status or genetics.