Medicaid Program Specialist 3 (Surveillance Utilization Reviewer-PCN 060246)

This Individual Position is Exempt from the Hiring Freeze. Qualified Applicants are Encouraged To Apply.

Welcome to the Department of Health! 

We’d be delighted to have you join our team. 

If you envision yourself in this role and are ready to start an exciting career with us, apply today!

The Health Care Services mission is to: Provide all eligible Alaskans with access to and oversight of the full range of appropriate Medicaid services. We also protect Alaska’s most vulnerable populations through our certification and licensing programs.

The Health Care Services vision is to: Innovate health plans that improve quality of health care for all Alaskans, attract excellent providers, and deliver outstanding customer service. Division of Health Care Services’ core values: Through quality service, prudent use of resources, and satisfied, productive employees, we will promote good health for the people we serve, via ACCESS:

•Articulate

•Competent

•Constructive

•Ethical

•Strategic

•Sincere

• Writing: Recognizes or uses correct English grammar, punctuation, and spelling; communicates information (for example, facts, ideas, or messages) in a succinct and organized manner; produces written information, which may include technical material, that is appropriate for the intended audience.
• Self Management: Sets well-defined and realistic personal goals; displays a high level of initiative, effort, and commitment towards completing assignments in a timely manner; works with minimal supervision; is motivated to achieve; demonstrates responsible behavior.
• Decision Making: Makes sound, well-informed, and objective decisions; perceives the impact and implications of decisions; commits to action, even in uncertain situations, to accomplish organizational goals; causes change.

Competency-Based Minimum Qualifications Instructions
This job class uses competency-based minimum qualifications.  Please ensure your application (through work history, volunteer experience (duties summary), training, education, licenses, certifications, etc.) supports how you have gained the knowledge, skills, abilities, and behaviors (competencies) and that you possess the minimum required competencies for the job class.

Competency Description           
The competency description(s) listed below have been designed to promote a common understanding of the essential elements of the job class. They highlight the more general and customary knowledge, skills, abilities (KSAs), tasks, and behaviors used to describe the competency. They typically list expectations rather than specific tasks and are to be used only as parameters and guidelines. A competency’s description is not intended to exclusively define every KSA, task, and behavior needed to successfully meet the competency, but rather to provide the manager/agency with a broad reference of options as to how an applicant can meet the job expectation.

Please ensure your application (through work history, training, education, licenses, certifications, etc.) supports/demonstrates that you possess the minimum required competencies for the job class.  

Any combination of education and/or experience that provides the applicant with competencies in 

Equivalent to those typically gained by:

Progressively responsible professional experience such as supporting the administration of a Medicaid or Medicare program, health insurance service, health insurance management information system, health insurance finance or accounting program, Supplemental Security Income benefits or vocational rehabilitation program; auditing or monitoring medical or public assistance programs for fraud or quality assurance; processing medical claims using medical coding and medical billing knowledge; designing, developing, testing for quality assurance, and implementing an information system and/or training or education which includes such course work as business administration, computer sciences, economics, healthcare, legal studies, medical billing or coding, public health, public assistance, psychology.

Special Note:

“Competencies” means a combination of interrelated knowledge, skills, abilities, and behaviors that enable a person to act effectively in a job or situation.

“Professional experience” means work that is creative, analytical, evaluative, and interpretive; requires a range and depth of specialized knowledge of the profession's principles, concepts, theories, and practices; and is performed with the power or right to decide or act according to one's own judgment.  

“Progressively responsible” means indicating growth and/or advancement in complexity, difficulty, or level of responsibility.

“Training” and “education” in this guidance are synonyms for the process of acquiring knowledge and skills through instruction. It includes instruction through formal and informal methods (such as classroom, on-line, self-study, and on-the-job), from accredited and unaccredited sources, and long-duration (such as a post-secondary degree) and short-duration (such as a seminar) programs. 

“Typically gained by” means the prevalent, usual method of gaining the competencies expected for entry into the job.  

At the time of the interview, please provide the following:

1. Three (3) professional references, whom we may contact by phone, are required. One (1) of these references must be your current or most recent supervisor, if not already provided in the application.

2. Copies of your 3 most current performance evaluations, if available.
3. A copy of academic transcripts (unofficial is okay; please ensure that the institution name/URL is listed on the transcripts) is used to support that you meet the minimum qualifications competencies.