Medical Policy Specialist jobs in Maine

Augusta, ME OTHER

An overview of the work, briefly summarizing the job, the main purpose, the objectives, and the results expected.

Hearings: Gather program documentation and prepare evidence for hearings related to final agency licensing action. Serve as the department’s representative in fair hearings.

Annotation and Waiver Processes: Process requests for Registry annotations and appeal requests of annotations, petitions for removal of employment bans on the Registry, oversee waiver applications process for the Maine Background Check Center, including drafting and sending letters and following applicant’s due process for any appeal.

Standard Operating Procedures: Assist with writing SOP’s and policy/procedures for various referrals to professional licensing Boards that include relevant statutory references and document confidentiality consistent with statutory requirements.

Conflict Resolution: Assist with preparing, scheduling, and logistics for IDR, IIDR, and informal conferences.

Rulemaking: Assist with revisions to rules, preparing for the rulemaking process, and moving rule revisions forward.

Complaint Referral: Assist with SOP and relevant document review, development, and processes for sharing complaint information with the Office of the Attorney General, Adult Protective Services, and the Office of MaineCare Services Program Integrity Unit.

Memoranda of Understanding: Service as liaison between DLC programs and other state offices and outside entities in the process of updating MOUs.

Legislative Tracking: Listen to and record committee discussion/bill tracking when legislature is in session.

Specific duties required of the resource, as well as any expected deliverables, including necessary travel expectations.

Hearings: Gather program documentation and prepare evidence for hearings related to final agency licensing action. Serve as the department’s representative in fair hearings.

Annotation and Waiver Processes: Process requests for Registry annotations and appeal requests of annotations, petitions for removal of employment bans on the Registry, oversee waiver applications process for the Maine Background Check Center, including drafting and sending letters and following applicant’s due process for any appeal.

Standard Operating Procedures: Assist with writing SOP’s and policy/procedures for various referrals to professional licensing Boards that include relevant statutory references and document confidentiality consistent with statutory requirements.

Conflict Resolution: Assist with preparing, scheduling, and logistics for IDR, IIDR, and informal conferences.

Rulemaking: Assist with revisions to rules, preparing for the rulemaking process, and moving rule revisions forward.

Complaint Referral: Assist with SOP and relevant document review, development, and processes for sharing complaint information with the Office of the Attorney General, Adult Protective Services, and the Office of MaineCare Services Program Integrity Unit.

Memoranda of Understanding: Service as liaison between DLC programs and other state offices and outside entities in the process of updating MOUs.

Legislative Tracking: Listen to and record committee discussion/bill tracking when legislature is in session.

Summary of work schedule, including normal working hours, on-call expectations, allowed time off (which is non-billable), ability to work remote.

Normal working hours flexible, typically 8-5 with 1 hr. lunch.   40 hrs. per week Full Time

Qualifications

Specific qualifications needed to perform the job including, necessary licenses, knowledge, skills, education, experience, training, and technical skills.

Some level of college experience with experience in preparing documents for administrative hearings, experience with/in how administrative hearings are conducted with a strong preference for a paralegal degree or certification.     

Compensation

Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides a reasonable compensation for this role: $24.96 per hour. In addition, SSO provides a range of benefits for this role.

EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.