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Job Description: Summary: The Safety Net (SN) Compliance Specialist develops and executes the Health Plan's Health Home (HH) Performance Oversight program for Medicaid enrolled adults and children. The Incumbent will ensure that the program is compliant with New York State (NYS) Department of Health Medicaid Managed Care Model Contract, the HH Standards and Requirements for Health Homes, Care Management Providers, and Managed Care Organizations. The SN Compliance Specialist, with oversight from management, will facilitate the Plan's oversight of the HH and the HH service providers. The incumbent will develop strategy to capitalize on opportunities to attain best practice. This role will also assess impact of regulatory and Model Contract changes and ensure changes are operationalized in accordance requirements and timelines. Essential Accountabilities: • Responsible for development and execution of the SN HH monitoring program and reporting. Administers the HH auditing program, which may include a chart review, to assess, build out program metrics, monitor program metrics, and provide a summary for management to review on program performance. Oversees development and monitoring of corrective action plans, if needed, to ensure regulatory compliance., • Maintains centralized documentation for all HH oversight related activities., • Maintains all EHP SNPS HH policies, procedures, and standardized communications such as member welcome letters., • Acts as back-up and single point of contact for Health Home and state regulatory issues. Assesses changes in the state and federal regulatory landscape including NYS budgetary actions, Strategic Roadmaps, and Federal Waivers. Identifies emerging trends and their implications and develops plans to address., • Collects, reviews, analyzes, and summarizes claims data (gaps in care, Emergency Department and Inpatient admissions) demographic information, performance data, encounter data, and billing trends. Produces internal reports and summaries to identify actionable trends/insights to monitor program effectiveness and any recommended enhancements., • Works closely with Health Home Lead Agencies, Case Management Agencies, Local Department of Social Services (LDSS), and Foster Care Agencies. Establishes good working relationship with agency contacts. Produces and distributes daily reports to the lead Health Homes., • Incumbent will become proficient in use of the Psychiatric Services and Clinical Knowledge Enhancement System for Medicaid (PSYCKES-Medicaid) to support quality improvement and clinical decision-making., • Incumbent will become proficient in use of the Medicaid Analytics Performance Portal (MAPP) Health Home Tracking System. MAPP is a performance management system that provides tools to the Health Home network to support providing care management for the Health Home population., • Works in collaboration with member services, SN care management, SN utilization management, provider relations, customer advocacy unit, and special investigations unit., • Addresses any Health Home issues or member complaints, working collaboratively to achieve timely and effective resolution., • Monitors the Health Home mailbox and respond promptly to inquiries or escalates issues as appropriate., • Assists with enrollment, disenrollment, and access to care issues (including facilitation of single case agreements when applicable)., • Participates in meetings such as the Health Plan's quarterly meetings with HH network to review the data performance issues through agendas, case summaries, and reporting. NY State sponsored meetings and summaries provided to management and input given to DOH proposed contract or procedural changes., • Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements., • Develops a "culture of ownership" and risk management excellence in the department., • Promotes communication and information flow through all needed levels of department, with external stakeholders and Health Plan leadership that will allow for input into SN BH Segment strategy planning and execution., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular and reliable attendance is expected and required., • Performs other functions as assigned by management. Minimum Qualifications: • Three or more years of progressive product/project management or process improvement experience. Bachelor's degree in relevant field with two years of experience preferred. A combination of advanced education and experience may be considered., • Demonstrated knowledge of state government programs such as Medicaid., • Proficiency in data visualization and reporting tools such as Excel, Power BI and Cognos., • Strong analytic skills and ability to interpret complex healthcare data., • Strong written and oral communication and group presentation skills. Skillful in assessing an audience and delivering/presenting complex information in an easy-to-understand format., • Strong organizational and project leadership/management skills. Ability to manage multiple priorities simultaneously., • Ability to work well with all levels of management. Physical Requirements: • Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer., • Ability to travel across the Health Plan service region for meetings with providers and/or state agencies as needed. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Minimum: $62,400 - Maximum: $106,929 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Description: Summary: The Document Solutions team focuses on the design and creation of correspondence and transactional statements using various software programs. The Publishing Systems Engineer operates in a business analyst/document-generation specialist role as part of the Document Solutions team. This role focuses on programming within the various systems utilized by our Solutions Team. Essential Primary Responsibilities/Accountabilities: Level I: • Develops code; analyzes, researches, and resolves system issues for electronic publishing-related problems., • Creates, maintains, and follows all documented processes and standards., • Builds new and updates existing workflows and documents using xml and text data in variable data composition systems based on the requirements and functional specifications., • Documents functional specifications and solutions for work to be performed., • Develops or assists in the development of systems testing and implementation plans. Reviews test results to ensure compliance with design specifications., • Participates in business requirement planning and analysis sessions., • Identifies best practices and participates in creation of Organizational Standards., • Performs basic maintenance of document composition tools utilized at the Health Plan., • Participates in on-call production support rotation., • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs., • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures., • Regular and reliable attendance is expected and required., • Provides Second Tier troubleshooting of electronic publishing applications., • Analyzes, researches, and resolves data-related issues within Document Services., • Identifies best practices and drives creation of Organizational Standards., • Participates in strategic discussion and decision-making when called upon to do so., • Communicates with outside departments to develop and maintain first-hand knowledge of their plans, operations, problems, and opportunities., • Participates on projects as a Subject Matter Expert for transactional documents and correspondence., • Performs advanced maintenance of document composition tools utilized at the Health Plan., • Maintains familiarity with latest tools and techniques for project management, system analysis, system design, and programming - specifically as related to electronic publishing., • Assists with software and system design and architecture within the assigned portfolio., • Monitors and maintains appropriate levels of hardware and operating software that serves as platforms for supported electronic publishing systems., • Administers electronic publishing related computer systems and processes - MISPrint, Q-Direct, StreamWeaver, and uses document archival systems such as Control-D, Filenet, Alfresco, etc., • Reviews service requests and consults with executive sponsors, requesters, and/or user representatives to clarify intent, discuss problematic areas, and consider alternate solutions., • Assists the business with planning for document generation, printing and mailing so they can meet mandated deadlines., • Identifies ways to automate manual processing steps and works with other team members and the business owners in implementing that automation., • Mentors Associate and Mid-Level Developers; provides limited mentorship to other Senior Developers in their technical area(s) of expertise. Minimum Qualifications: NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels: • Bachelor's Degree in Computer Science or related field. In lieu of Bachelor's Degree, an Associate degree in Computer Science or Electronic Printing with two or more years' experience in computer science, electronic publishing, or related field, or a combination of experience and education with programming., • Experience using Variable Data composition. Knowledge of integration tools such as HP Command Center, HP Exstream, Elixir Tango, GMC Inspire is a plus., • Demonstrated analytical and problem-solving skills, excellent proofreading skills, and ability to work well as part of a team., • Knowledgeable of publication layout and design., • Demonstrated creativity and competence in design techniques., • Familiarity with database structures: SQL, Oracle, DB2, or similar., • Familiarity with XML, SGML, HTML, or similar data structures., • Familiarity with JAVA and shell scripts, or other web programming language., • Familiarity with Control-D, Filenet, Alfresco. Similar systems considered., • Demonstrated proficiency in desktop publishing, word processing, and electronic office systems., • Ability to establish effective working relationships with all levels of internal staff and outside professionals., • Strong organizational skills, ability to prioritize assignments, and ability to handle confidential information with discretion., • Good visual acuity, manual dexterity, and typing skills., • Demonstrated ability to "think outside the box.", • Four or more years of progressive experience in computer science, electronic publishing, or related field. In lieu of degree, a minimum of six years of progressive experience in computer science, electronic publishing, or related field., • Six or more years of progressive experience in computer science, electronic publishing, or related field. In lieu of degree, a minimum of eight years of progressive experience in computer science, electronic publishing, or related field., • Demonstrated experience in graphic arts, desktop publishing, visual communications, or similar discipline., • Experience in Visual Basic, C, Java, or similar advanced programming languages. Object-oriented programming language experience a plus., • Experience with the UNIX operation system and ability to program shell scripts., • Experience in structured systems analysis and design, user relations, data gathering techniques, and management information systems., • Knowledge of Control-D, Filenet, or Alfresco desired. Similar experiences considered., • Requires a high degree of logic, accuracy, and communications skills. Physical Requirements: • Regular office/desk job environment. In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): Level I E2 - Min 60,410 Mid 76,300 Max 96,081 Level II E5 - Min 71,880 Mid 100,632 Max 129,384 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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