Job Description

Posting number: 193458

Department: Department of Health and Human Services

Division: Health Programs Operations

Job classification: Nurse Supervisor, Non-Institutional

Posting type: Open

Categories: Health Services, Public Health, Nursing, Human Services, Customer Service, Health Care Support, Office and Administrative Support

Summary

The Agency's mission is to be boldly innovative in improving the health and quality of life for South Carolinians.

This position is located in Office of Medical Directors, Richland County.

This is an in-office role and not a telecommute or remote position.

Are you the One? We are looking for a Nurse Supervisor, Non-Institutional (Policy Analyst) who will serve as a Policy Analyst and subject matter expert for the Physician-administered Drugs (PAD) Policy within the Agency and report to the Director of Pharmacy Services. The Policy Analyst will work to monitor and analyze federal and state policy actions, including federal and state regulations, legislation, executive and agency actions, and legal cases. The Policy Analyst will have the opportunity to produce written analysis, policy memos, fact sheets, and comment on proposed regulations, and other materials. Additionally, this position will evaluate existing policies and procedures and recommend program improvements; review utilization trends and analyze data to inform development of cost analysis and fiscal impact proposals for new or updated Medicaid services and benefits; work with the Bureau of Policy to update provider services manuals, procedure codes and provider fee schedules; and collaborate directly with vendors and Agency stakeholders to identify physician-administered drugs requiring prior authorizations, develop and adjust related criteria, and maintain accurate HCPCS coding in compliance with federal and state laws.

• Interpret healthcare policies of programs jointly administered by federal (Centers for Medicare & Medicaid Services (CMS)) and state agencies. Review, analyze, develop, and make recommendations for State Plan services. Evaluate existing policies for effectiveness and compliance with state and federal mandates. Research any unintended outcomes, either positive or negative. Inform the development of cost analysis for existing policies based on utilization and in collaboration with Finance. Apply industry and academically accepted research and evaluation methods. Identify problems, evaluate potential solutions and make recommendations using surveys, cost-benefit analysis, focus groups, and other tools to forecast outcomes. Write policy briefs and memos. Assist in the State Plan amendments process.
• Conduct provider manual and fee schedule reviews and work with Bureau of Policy and other Agency stakeholders to update as necessary to ensure publications reflect policy. Review and request system updates during quarterly CMS code updates or ad-hoc updates as necessary. Provide policy and medical coding expertise in projects related to Medicaid system updates or operational projects. Maintain assigned manuals in collaboration with Bureau of Policy. Ensure policy changes are announced following communication protocols.
• Serve as policy expert for assigned area. Maintain knowledge of federal and state regulations and ensure agency maintains compliance. Ensures Managed Care Organization (MCO) compliance with the Physicians-Administered Drug Policy. Works directly with vendor(s) to determine PADs requiring prior authorizations (PAs) and their criteria and SC DHHS' fee schedule. Addresses any internal or external stakeholder concerns about PADs, PAs, and the fee schedule. Ensures vendor(s) maintains federal and state compliance.
• Leads or supports other projects proactively or as assigned by Agency leadership. Assigned projects may require driving to location outside of regular office location. Continuously engages in process improvement to support Agency, Division, and Bureau-wide strategies, objectives, and initiatives. Collaborates with other policy team members in research, development, implementation, and evaluation activities for services, projects, and agency initiatives as assigned. Performs other related duties as required.

The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:

• Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children
• 15 days annual (vacation) leave per year
• 15 days sick leave per year
• 13 paid holidays
• State Retirement Plan and Deferred Compensation Programs

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Examples of duties

A Bachelor’s degree and three (3) years of relevant experience in healthcare delivery, management or administration.

Experience may be substituted with a Master’s degree in Public Health, Nursing, Health Administration, or other relevant healthcare fields with prior State Human Resources approval.

All degrees must be from a college or higher education institution recognized by the U.S. Department of Education & Council for Higher Education Accreditation (CHEA).

Preferred Qualifications: Master’s degree in Public Health (MPH), Public Administration (MPA), Healthcare Administration (MHA, MBA/HC) or MA, MS, MN. Experience with Medicaid or Medicare claims billing processes.

NECESSARY SPECIAL REQUIREMENT: Current licensure as a Registered Nurse by the State Board of Nursing for South Carolina.

Additional Requirements:

• Sitting or standing for long periods of time.
• Lifting requirements: 20 lbs.
• Valid driver's license.
• In-office role.

Qualifications

• Knowledge of laws, regulations, policies and procedures relevant to the area of employment.
• Ability to interpret and apply laws, regulations, policies and procedures.
• Ability to comprehend and analyze large and complex amounts of information including data sets, budget reports and evidence-based literature.
• Ability to effectively communicate through written reports, bulletins and policy briefs, and must demonstrate strong writing, verbal and presentation skills.
• Ability to exercise judgment and discretion.
• Ability to establish and maintain effective working relationships.
• Ability to work in a complex, fast-paced, and cross-functional team environment.

Supplemental information

Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.