68022240 - Senior HUMAN Services Program Specialist

Senior Human Services Program Specialist

This is an exciting opportunity to help shape the quality of health care in Florida. We are seeking to hire a Senior Human Services Program Specialist who desires to work to enhance the delivery of health care services through the Florida Medicaid Program. This position requires a candidate who is creative, flexible, innovative, and who will thrive in a fast-paced, team based work environment. This is a professional position in the Medicaid Helpline Contact Center, within the Bureau for Recipient and Provider Assistance (RPA) within the Division of Medicaid, Agency for Health Care Administration (Agency). The incumbent in this position performs professional work in the Medicaid Contact Center, which includes performing as a Choice Counselor for the Statewide Medicaid Managed Care (SMMC) programs and attending Medicaid RPA Outreach events.

The incumbent in this position answers an ongoing pro-rata share of recipient, provider and escalation calls, per the need of the Agency, and assignments, including assigned tasks, special projects and initiatives, as assigned, and to meet established performance measures and contact center metrics. The incumbent maintains high quality and professional consumer service standards, handles all calls with respect and dignity, listens carefully, maintains confidentiality, and provides unbiased information. In the role of Choice Counselor, provides unbiased education and assistance when enrolling potential enrollees into a participating Health Plan and PCP provider as requested.

The incumbent answers questions and educates Medicaid recipients and the general public in a timely, unbiased manner about the (SMMC) programs, Medicaid covered services, and available Health Plan choices. The incumbent enters all enrollment activity and logs all interactions into the appropriate system (i.e., Health Track), using the correct documentation and call reasons. S/He arranges for necessary translation assistance at the time of call, including: TDD or TYY and Interpreter Vendor services. Complaints, requests for fair hearings, and escalation issues, etc. are referred timely and appropriately.

Maintains up to date knowledge concerning the Florida Medicaid Program; pertinent federal laws and regulations, state statutes and rules; the Florida Medicaid State Plan and its amendment processes; Medicaid Managed Care Waivers; and Medicaid program manuals. Remains informed about Choice Counseling procedures, including the For Cause process. Remains informed about the operations of the Medicaid fiscal agent. Remains informed about Medicare, Medicaid, and related programs, research and demonstration projects, innovations for special populations, alternative financing and service delivery systems models, etc. Maintains knowledge about the Medicaid State Plan, waivers, regulations, and processes.

This position is not a remote or telework position.