Member Care Quality Specialist - Medicaid Services
Apply NowCompany: State of Wisconsin
Location: Waukesha, WI 53188
Description:
Introduction
The Department of Health Services (DHS) strives to protect and promote the health and safety of all people of Wisconsin through the efforts of a dedicated and diverse workforce. DHS works to ensure access to individuals, families, and communities to achieve positive health outcomes in the areas of abuse prevention, mental health, public health, family care, long-term care, and much more.
The Division of Medicaid Services (DMS) , Bureau of Quality and Oversight (BQO) is recruiting for a Member Care Quality Specialist. The position offers the option to work remotely up to 5 days per week and will be headquartered at the 1 W. Wilson Street office in downtown Madison or141 N.W. Barstow Street in Waukesha. This schedule may vary based on training or operational need.
This position requires some travel throughout Wisconsin including overnight travel.
As an employee of the State of Wisconsin, you'll also have access to an amazing benefits package , including:
Position Summary
As the Member Care Quality Specialist, you will provide state oversight of programs that demonstrate consumer-responsive ways of reforming health and long-term care systems. As part of the Program Oversight Team, this position will provide program and administrative support to managed care organization(s) (MCOs), Tribal agencies and other providers of Department programs and services in assuring individuals have access to all needed supports and services. You will assure coordination, communication and collaboration among entities so that the use of federal and state resources are used in the most cost-efficient and effective manner.
As the Member Care Quality Specialist, you will serve as the primary point of contact between assigned MCOs and BQO, with primary responsibility for assuring the MCOs are meeting contracted Department program requirements and continually improving its performance in meeting the outcomes of its members. This position will provide consultation in quality improvement activities, compliance with performance and outcome standards to assure that services are integrated, available, and accessible and efficiently delivered to all enrollees.
Salary Information
The starting pay is between $37.50 and $40.25 per hour (approximately between $78,000 and $83,700 per year) depending on qualifications, plus excellent benefits. A 12-month probationary period is required.
Pay for current or former state employees will be set based on the rules that apply to compensation for the applicable transaction. This position is classified as a Human Services Area Coordinator and is in pay schedule and range 07/03.
Job Details
Qualifications
Minimally qualified applicants will have all of the following:
Well-qualified applicants will also have one or more of the following:
Your letter of qualifications is limited to one (1) page. For a guide on developing your resume and letter of qualifications and what should be included in these materials, click here .
How To Apply
Applying is easy! Click "Apply for Job" to start the application process. Sign in to your account or click "Register Now" to create an account before applying for the job. Follow the steps outlined in the application process and submit your application.
Helpful Information:
Veterans are encouraged to apply. For complete information on veterans' hiring programs with the WI Department of Veteran's affairs, click here .
Deadline to Apply
The deadline to apply is 01/10/25 by 11:59 pm. Applicants are strongly encouraged to allow ample time to finalize their applications keeping in mind that technical assistance is only available Monday through Friday 7:45 am - 4:30 pm. Late or incomplete applications will not be accepted.
The Department of Health Services (DHS) strives to protect and promote the health and safety of all people of Wisconsin through the efforts of a dedicated and diverse workforce. DHS works to ensure access to individuals, families, and communities to achieve positive health outcomes in the areas of abuse prevention, mental health, public health, family care, long-term care, and much more.
The Division of Medicaid Services (DMS) , Bureau of Quality and Oversight (BQO) is recruiting for a Member Care Quality Specialist. The position offers the option to work remotely up to 5 days per week and will be headquartered at the 1 W. Wilson Street office in downtown Madison or141 N.W. Barstow Street in Waukesha. This schedule may vary based on training or operational need.
This position requires some travel throughout Wisconsin including overnight travel.
As an employee of the State of Wisconsin, you'll also have access to an amazing benefits package , including:
- 3.5 weeks of vacation, 9 paid holidays and ample sick time.
- Top rated health plan options starting at $42/month for single plans and $104/month for family plans, after 2 months of state service.
- Premium pension plan with a 6.95% employer match in 2025. Plus, a tax advantaged supplemental retirement savings plan which allows you to save money directly from your paycheck for retirement. Use this Total Rewards Calculator to see the total value of our competitive benefits package!
- Several flex spending accounts: medical, dependent care, commuter, parking and High Deductible Health Savings.
- A casual office atmosphere, flexible work schedules, and telework options depending on the position's requirements.
- Well Wisconsin Wellness Program
- A free and confidential employee assistance program that offers employees and their immediate family dependents a variety of tools, resources, and professional consultation services to support their health, goals, and overall well-being.
- Public Service Loan Forgiveness Program employer.
Position Summary
As the Member Care Quality Specialist, you will provide state oversight of programs that demonstrate consumer-responsive ways of reforming health and long-term care systems. As part of the Program Oversight Team, this position will provide program and administrative support to managed care organization(s) (MCOs), Tribal agencies and other providers of Department programs and services in assuring individuals have access to all needed supports and services. You will assure coordination, communication and collaboration among entities so that the use of federal and state resources are used in the most cost-efficient and effective manner.
As the Member Care Quality Specialist, you will serve as the primary point of contact between assigned MCOs and BQO, with primary responsibility for assuring the MCOs are meeting contracted Department program requirements and continually improving its performance in meeting the outcomes of its members. This position will provide consultation in quality improvement activities, compliance with performance and outcome standards to assure that services are integrated, available, and accessible and efficiently delivered to all enrollees.
Salary Information
The starting pay is between $37.50 and $40.25 per hour (approximately between $78,000 and $83,700 per year) depending on qualifications, plus excellent benefits. A 12-month probationary period is required.
Pay for current or former state employees will be set based on the rules that apply to compensation for the applicable transaction. This position is classified as a Human Services Area Coordinator and is in pay schedule and range 07/03.
Job Details
- All applicants who may be appointed will be required to allow DHS to conduct a background check to determine whether the circumstances of any conviction may be related to the job being filled.
- Employees must have access to secure high-speed internet for remote work option. Mileage reimbursement to the employee's headquarter location is not provided. Remote work flexibility will be discussed in more detail during the interview process.
- DHS does not sponsor work visas for this position, thus, in compliance with federal law, selected candidates will be required to verify eligibility to work in the United States by completing the required I-9 form upon hire.
- For positions that allow remote working flexibility, working outside of Wisconsin or in bordering cities will not be allowed except in extremely limited circumstances due to the need to report to an office location in Wisconsin on short notice.
Qualifications
Minimally qualified applicants will have all of the following:
- Experience working with Medicaid Managed Care or long-term care service delivery systems.
- Experience with program or policy analysis, development, implementation, monitoring, or evaluation techniques.
- Experience preparing and presenting materials on policy, system, or administrative issues in a variety of forums (e.g., internal and external meetings, training sessions, conferences, seminars, etc.).
Well-qualified applicants will also have one or more of the following:
- Experience working with managed care organizations (MCOs) that deliver Medicaid Managed Care.
- Experience in quality assurance or quality compliance , including monitoring of quality improvement plans or corrective action plans.
- Experience working in a leadership role with Family Care or Family Care Partnership programs in Wisconsin.
Your letter of qualifications is limited to one (1) page. For a guide on developing your resume and letter of qualifications and what should be included in these materials, click here .
How To Apply
Applying is easy! Click "Apply for Job" to start the application process. Sign in to your account or click "Register Now" to create an account before applying for the job. Follow the steps outlined in the application process and submit your application.
Helpful Information:
- Once your application is submitted, no changes are allowed. Click "Save" to allow changes to your application as needed before submitting by the deadline.
- You may want to save a copy of the job posting for referencing after the deadline.
- Submitted materials will be evaluated by a panel of job experts according to the qualifications above.
- Please monitor your email for communications related to this position.
- Current or former permanent, classified, state employees must complete the online application process to be considered.
- If viewing through an external site, please apply directly at Wisc.Jobs .
- For technical assistance and general information, please see Frequently Asked Questions . For questions about the position, to request a copy of the full position description, or for other employment inquiries, please contact Allyvia Vang in Human Resources at [redacted] .
Veterans are encouraged to apply. For complete information on veterans' hiring programs with the WI Department of Veteran's affairs, click here .
Deadline to Apply
The deadline to apply is 01/10/25 by 11:59 pm. Applicants are strongly encouraged to allow ample time to finalize their applications keeping in mind that technical assistance is only available Monday through Friday 7:45 am - 4:30 pm. Late or incomplete applications will not be accepted.