Job description
Job Introduction:
Pre-work is necessary prior to visiting any sites to ensure the provider is eligible for the site visit after checking other State and Federal systems as well as ensuring the provider is at the location they attest to practicing on their applications.Job Description Summary:
Job Summary:
As part of the Provider Enrollment & Revalidation efforts for the State of Hawaii, the Field Investigator is responsible for traveling to provider offices to conduct on-site visits for Moderate and High-Risk providers, as determined by CMS and the State of Hawaii. The purpose of the visit is to ensure the providers are acting in accordance with policies what they attested to on their application prior to enrolling them as a Medicaid Provider for the State of Hawaii. Site visits are primarily on Oahu, however, the project covers all Hawaiian Islands, so some off-Oahu travel is required. Periodic mainland travel may be necessary, although rare.
Pre-work is necessary prior to visiting any sites to ensure the provider is eligible for the site visit after checking other State and Federal systems as well as ensuring the provider is at the location they attest to practicing on their applications.
Essential Duties and Responsibilities:
- Work closely with the cross functional areas and levels to resolve difficult and complex cases related to critical issues.
- Initiate, establish, and maintain a productive relationship with each of the participating managed care organizations.
- Establish and maintain ongoing communication with the health plans.
- Log, track, and manage all communication to and from health plans related to individual issues in a timely manner.
- Work with operating divisions to communicate complex and critical incidents, and to receive feedback to be communicated to the appropriate managed care organizations.
- Provide the Project Manager and state policy staff with updates regarding complex and critical managed care organization issues.
- Perform other duties as may be assigned by management.
Minimum Requirements:
- Bachelor's degree with 3+ years of experience.
- May have additional training or education in area of specialization.
- Develop solutions to a variety of problems of moderate scope & complexity.
- General application of concepts & principles.
- Contribute to the completion of organizational projects & goals.
- Frequent use and general knowledge of industry practices, techniques, and standards.
- Apply knowledge and skills to complete a wide range of tasks.
- Communicate on complex or sensitive issues or draft responses for supervisor or manager.
- Candidate must reside on the island of Oahu.
- Other than visiting provider sites, position is entirely remote.
- Must be professional and presentable – business casual dress required when conducting site visits.
- Serve as a representative of Maximus as a company and the Hawaii Department of Human Services.
- Using personal or public transportation, responsible for self-supervised visits to the provider site locations to conduct a face-to-face comprehensive assessment that site meets the criterion for program enrollment.
- Lead the Site Visit Team to ensure necessary pre-work is done prior to visit is performed.
- Develop necessary reports of findings and interpretations.
- Assistance with prioritizing, organizing, and planning site visits with Manager approval.
- Responsible for adhering to established safety standards.
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