Job Information
State of Colorado Clinical Pharmacy and FQHC Policy Specialist in Statewide, Colorado
Clinical Pharmacy and FQHC Policy Specialist
Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4548469)
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Clinical Pharmacy and FQHC Policy Specialist
Salary
$57,708.00 - $75,024.00 Annually
Location
Statewide, CO
Job Type
Full Time
Job Number
UHA 4590 - 6.2024
Department
Department of Health Care Policy and Financing
Division
Health Programs Office
Opening Date
06/18/2024
Closing Date
7/1/2024 11:59 PM Mountain
FLSA
Determined by Position
Type of Announcement
This position is open only to Colorado state residents.
Primary Physical Work Address
303 East 17th Avenue, Denver, CO
Department Contact Information
Sarah LaRue Talent Acquisition Specialist sarah.larue@state.co.us
How To Apply
Please submit an online application for this position at https://www.governmentjobs.com/careers/colorado. Reach out to the Department Contact to apply using a paper application, including any supplemental questions. Failure to submit a complete and timely application may result in the rejection of your application. Applicants are responsible for ensuring that application materials are received by the appropriate Human Resources office before the closing date and time listed.
Description
Benefits
Questions
Department Information
STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATION
NOTE: This announcement may be used to fill multiple openings.
The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.
We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.
As part of the State of Colorado, HCPF offers a competitive benefits package: (https://dhr.colorado.gov/state-employees/state-of-colorado-employee-benefits)
PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans
Medical (https://dhr.colorado.gov/state-employees/state-employee-benefits/medical-benefits) , Dental (https://dhr.colorado.gov/state-employees/state-employee-benefits/dental-insurance) , and Vision (https://dhr.colorado.gov/state-employees/state-employee-benefits/vision-insurance) insurance coverage
Automatic Short-Term and Optional Long-Term Disability Coverage (https://dhr.colorado.gov/state-employees/state-employee-benefits/disability-insurance)
Life and AD&D Insurance
Flexible Spending Accounts (https://dhr.colorado.gov/state-employees/state-employee-benefits/flexible-spending-accounts) (FSAs)
Family Medical Leave Act (FMLA) (https://dhr.colorado.gov/state-employees/time-off-leave/family-medical-leave-act-fmla) job protection and State of Colorado Paid Family Medical Leave (PFML)
11 Paid Holidays Annually and Accrued Annual and Sick Leave (https://dhr.colorado.gov/state-employees/time-off-leave)
Accrued Sick Leave for State of Colorado Temporary Employees
Flexplace and Flextime work arrangements
Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program
Free RTD EcoPass (https://www.rtd-denver.com/fares-passes/ecopass) to all eligible State Employees
Reduced college tuition through CSU Global (https://csuglobal.edu/cost/tuition-discounts/employer-partners/state-colorado)
Credit Union of Colorado Membership Eligibility
Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, go to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs . https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs
We are looking for a Clinical Pharmacy & FQHC Policy Specialist for the Benefit Management Division of the Health Policy Office (HPO)!
HPO is responsible for the administration and performance of Medicaid State Plan benefits and services, and the Child Health Plan Plus (CHP+). Staff within HPO are responsible for fee for service benefits implementation and administration, stakeholder relations, perinatal, youth and child health, policy development and implementation, contract management and performance, program administration and overall Medicaid program performance. HPO plays an instrumental role in achieving HCPF's mission to improve access to cost-effective, quality health care services for Health First Colorado members.
The Benefits Management Section is responsible for ensuring that benefit coverage decisions are based on the best available clinical evidence and that all benefit coverage policies promote the improved health and functioning of Medicaid clients. The Section is the lead on Medical Assistance Rules, analysis of program rules and regulations and overall benefit coverage determinations of the Medicaid program. The Section is responsible for maximizing the overall performance of Medicaid services and programs.
This position can work fully remotely from anywhere in the State of Colorado.
Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment.
Description of Job
Description of Job:
WHAT YOU'LL BE DOING AS CLINICAL PHARMACY & FQHC POLICY SPECIALIST:
Subject Matter Expert responsible for Clinical Pharmacy and Federally Qualified Health Centers (FQHCs) and overall benefit policy management activities for the Benefit Management Section for assigned benefits and policies.
Coordinates policy development for Clinical Pharmacy Benefits, FQHCs, and Non-Physician Administered Drug benefits on the Health First Colorado fee schedule.
Manages policy concerns and provider support for the benefits and policies listed, including working with other sections to identify and establish metrics and/or benchmarks to monitor policy changes, track and monitor utilization and expenditures, provide or participate in quality improvement reviews.
Ensures compliance with applicable federal and state rules by guiding the implementation of policy across differing benefits and teams.
Advises members, providers, stakeholders and other staff on issues related to benefits coverage, billing, and reimbursement for assigned benefits and policies, guiding them to appropriate resources.
Collaborates with the Pharmacy Office to manage projects and implement HB21-1275, which includes providing reimbursement for the professional services rendered by pharmacists.
Identifies issues that require additional clarification and drafts necessary Provider Bulletin articles and makes necessary updates and revisions to respective billing manuals.
Develops comprehensive work plans including performance metrics and deliverables, ensuring project and program deadlines are met.
Investigates complaints, addressing certain provider billing issues when necessary, addressing client issues, and representing HCPF as needed.
Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights
MINIMUM QUALIFICATIONS:
There are two ways to qualify for this position:
Option 1:
Experience Only:
Six (6) total years of professional experience in policy analysis, health care administration, public health, or an occupational field closely related
Option 2:
Education and Experience:
Bachelor's degree from an accredited institution in Health Care Administration, Public Health, Political Science, or a field of study related to the work assignment
AND
Two (2) years of professional experience in policy analysis, health care administration, public health, or an occupational field closely related.
Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following:
An associates will count as two years of experience
A bachelors will count as four years of experience
A masters degree will count for six years of experience
A doctorate or juris doctorate degree will count for seven years of experience
PREFERRED QUALIFICATIONS
Previous relevant professional state experience
Masters Degree in Public Administration, Health Care Administration, Public Health, or related field
Professional experience with:
Analyzing, implementing and evaluating policy, legislation and/or regulations of health care policy
Using written skills to communicate complex information
Stakeholder engagement and public speaking
Project management
SKILLS TO SUPPORT SUCCESS
A team-oriented mindset, as well as the ability to embrace diversity and build and maintain quality professional relationships
Ability to work independently, be curious about a wide range of health related topics, and be willing to learn.
Ability to independently identify opportunities for program and process improvement
Ability to skillfully problem solve and manage disagreement
Ability to learn complex issues, apply knowledge and assume increasing responsibility.
DEFINITION OF PROFESSIONAL EXPERIENCE: Work that involves exercising discretion, analytical skill, judgment, personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods.
CONDITIONS OF EMPLOYMENT
All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.
Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.
APPEAL RIGHTS:
If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.
An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email ( dpa_state.personnelboard@state.co.us ), postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed (303.866.5038) within ten (10) calendar days from your receipt of notice or acknowledgement of the department’s action.
For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov ; contact the State Personnel Board for assistance at (303) 866-3300; or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.
Supplemental Information
How to Apply (https://careers.colorado.gov/how-to-apply) (PLEASE READ CAREFULLY)
Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.
Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.
Comparative Analysis Process
The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email.
Failure to submit properly completed documents by the closing date will result in your application being rejected.
ADAAA Accommodations : The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.
The Department of Health Care Policy & Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Virginia Miller, at virginia.miller@state.co.us (debra.becerra@state.co.us) .
The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.
The State of Colorado offers permanent employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program. Please click the following link for detailed information: www.colorado.gov/pacific/dhr/benefits
Please note that each agency's contact information is different; therefore, we encourage all applicants to view the full, official job announcement which includes contact information and class title. Select the job you wish to view, then click on the "Print" icon.
01
All HCPF positions are security sensitive positions and require potential employees to undergo a criminal record background check. As a condition of employment, you will be required to submit to pre-employment screening if offered the position. Are you willing to meet this requirement?
Yes
No
02
Do you have any relatives or significant others working at the Department of Health Care Policy & Financing? If so, please list their names here. Otherwise, please list N/A.
03
If you are a current or former State of Colorado employee, please provide your EID (employee identification numbers will start with 99...). If not, please type N/A.
04
Are you willing to accept an offer in the posted salary range?
Yes
No
05
Former state employees who were disciplinarily terminated or resigned in lieu of termination must disclose the information on the application. In the space below, please provide an explanation as to why the prior termination or resignation should NOT disqualify your application from the current position. Otherwise, please list N/A.
06
Please describe your experience interpreting and/or complying with Medicaid policies.
07
Please describe any experience you have working with Federally Qualified Health Centers.
08
List any additional relevant experience you would like us to consider in determining if you meet the qualifications of this position. Please, include the months and years relevant to the experience you describe.
Required Question
Agency
State of Colorado
Address
See the full announcement by clicking
the "Printer" icon located above the job title
Location varies by announcement, Colorado, --
Website
https://careers.colorado.gov/
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