PACE Senior Health Care Consultant

#LI-HW1 #LI-Remote

The health care senior consultant will work with the project team analyze healthcare information, research federal and state Medicaid policies and regulations and laws and help monitor compliance. The position will support projects related to policy development, policy analysis, reimbursement, payment models, and outcomes. Specific projects of immediate focus will involve the federal Program of All-Inclusive Care for the Elderly (PACE), and envisioned work will include supporting the team’s work with states on feasibility studies, new program implementations, program expansions, policy development, and state readiness reviews.

Essential Functions and Primary Duties

• Demonstrate an understanding of and working knowledge of PACE programs for state departments of aging or Medicaid agencies and/or government health and human services, including the Centers for Medicare & Medicaid Services, supporting PACE programs

• Research Medicaid and Medicare policies, procedures, code of federal regulations, and best practices of PACE services

• Research and stay abreast of efficacy, outcomes, and emergency trends in PACE services

• Work with health care provider cost and financial data

• Assist with rate and reimbursement calculations

• Work with claims data

• Develop client, project, and policy related subject matter expertise

• Prepare documents supporting professional decisions

• Review applicable federal and state regulations, statutes, and policies

• Demonstrate excellence in communication skills, data gathering, analysis, and reporting

• Maintain security and confidentiality of all protected health information

• Be receptive to learning and working in a team environment

• Must be able to travel on occasion based on business and client needs

• Additional responsibilities as assigned

Preferred Qualifications

• Bachelor’s Degree from accredited college or university required. Degree in economics, health informatics, health administration, accounting, or business administration is preferred.

• Three years-experience, within the last five years, and familiarity with federal Medicaid and Medicare policy, rules, and law is preferred.

• Three years-experience, within the last 5 years, with planning and conducting comparative state Medicaid and Medicare reimbursement studies and analyses is preferred.

• Strong analytical and problem solving skills

• Strong verbal and written communication skills

• Well organized with a high degree of accuracy and attention to detail

• Proficient use of applicable software programs including Microsoft Office suite (i.e. Excel, Access, Word, etc.)

Minimum Qualifications

• High school diploma or GED