{"code":"00156","codeVariants":["00156","156"],"title":"HEALTH CARE CONSULTANT","variant":null,"jurisdiction":"S","class_of_service":"U","work_week":"NL","state_class_code":"98","local_class_code":null,"salary_range":null,"note":null,"salaryInferred":false,"synthetic":false,"syntheticReason":null,"full_description_html":"<b>HEALTH CARE CONSULTANT</b>\n\n<b>Unclassified\nN.J.S.A. 11A: 3-4(l)</b>\n\n<b>DEFINITION</b>\n\nUnder general direction of a supervisory official, performs the necessary \nresearch to prepare an analysis to set medical or medically related rates; \nperforms the necessary research and analysis to develop plans, procedures, \nand contracts to oversee managed care or other medical models utilized by \nthe state for their clients; does related work.\n\n<b>NOTE:</b> The definition and examples of work for this title are for illustrative \npurposes only. A particular position using this title may not perform all \nduties listed in this job specification. Conversely, all duties performed on \nthe job may not be listed.\n \n<b>EXAMPLES OF WORK:</b>\n\nIndependently operate and performs complex tasks for a unit responsible \nfor developing complex rates needed for managed care, other medical \nprograms, and social programs.\n\nMay perform the complex tasks of developing rates for managed care or \nother medical or social programs.\n\nDevelops procedures for state oversight of contracted managed care \nprograms or other medical or social programs.\n\nCompares Medicaid rates to commercial rates.\n\nEvaluates how capitation payments to Health Maintenance Organizations \n(HMO's) translate into reimbursement to providers.\n\nDevelop state capitation data sources for design, development, and \nimplementation of rates for specialized populations (developmentally \ndisabled long-term care, behavioral health, and so forth.)\n\nEstablish methodologies for monitoring and managing quality care and \naccess to care by monitoring quality and access in a Medicaid managed \ncare plan from both a staff and IPA perspective, setting up specific quality \nindicator standards (accessibility of services, following up on continuity of \ncare, ensuring appropriateness and frequency of periodic screenings and \nidentifying underutilization of services), creating systems to support and \nimprove quality at the individual practice level.\n\nEstablish plans and programs to better mainstream Medicaid clients by \nestablishing, in a cooperative effort, ways for HMO's to deal with the \nspecial needs of Medicaid patients by: a) working to reduce barriers to \npreventive care through better member and physician education; \nb) implementing with our HMO partners effective outreach and hands-on \ncase management for culturally diverse populations; c) working on client \ncommunications in an arena of low literacy and residential transiency; \nd) working to ensure a culturally competent provider network.\n\nDevelops integration strategies for providers to encourage their movement \ninto Medicaid managed care.\n\nDevelops designs for better management information system utilization for \ntracking and monitoring HMO staff, patients, and other providers for cost \nand quality control.\n\nAnalyzes and assesses comprehensive multi-disciplinary medical records \nto identify individual Medicaid recipient's health care programs and needs.\n\nConfers with nursing consultants, provides consultation, and in-service \neducation to health care facilities for the purpose of maintaining and/or \nimproving quality nursing services.\n\nMonitors development of required services, additional resources, training \nprograms, and provides technical problem-solving advice to certified \nfacilities.\n\nAnalyzes care activities in Medicaid health facilities including but not \nlimited to social services, patient activities, patient rights, psychosocial \nservices, residential services, therapeutic recreation, services to families, \nand interventions which impact on patient health.\n\nWill be required to learn to utilize various types of electronic and/or \nmanual recording and information systems used by the agency, office, \nor related units.\n\n<b>REQUIREMENTS:</b>\n\n<b>EDUCATION:</b>\n\nGraduation from an accredited college or university with a Bachelor's \ndegree in Accounting, Economics, Finance, Health Care Administration, \nHospital Administration, Public Administration, Public Health Administration, \nMathematics, or Statistics.\n\n<b>EXPERIENCE:</b>\n\nFive (5) years of experience in the research, analysis, development, and/or \nadministration of plans, procedures, and contracts pertaining to managed \nhealth care, and/or other medical or social programs.\n\n<b>NOTE:</b> A Master's degree in any of the above disciplines may be substituted \nfor one (1) year of experience.\n\n<b>LICENSE:</b>\n\nAppointees will be required to possess a driver's license valid in New Jersey \nonly if the operation of a vehicle, rather than employee mobility, is necessary \nto perform the essential duties of the position.\n\n<b>KNOWLEDGE AND ABILITIES:</b>\n\nKnowledge of Federal and State applicable statutes, regulations, policies and \nprocedures. \n\nKnowledge of the principles and practices of modern research methods, \nevaluation techniques, methodology of technical analyses, and the \ninterpretation of results and findings.\n\nKnowledge of statistical techniques, modern laboratory automation systems \nmethodology, procedures pertaining to the area of specific research, and \nmethods of ensuring conformance therewith.\n\nKnowledge of the specialty area assigned, including knowledge of the most \ncurrent analytical instrumentation utilized in specialty areas.\n\nKnowledge of appropriate federal regulations and procedural methods and \nrequirements.\n\nAbility to plan, direct, and evaluate research activities.\n\nAbility to exercise good judgment in evaluating situations and making \ndecisions concerning research and administrative problems.\n\nAbility to maintain cooperative working relationships with personnel assigned \nto other units within the department and divisions and with others concerned \nwith the work of the research unit.\n\nAbility to prepare clear, scientifically sound, clinically accurate, informative \nreports of tests and other reports containing findings, conclusions, and \nrecommendations.\n\nAbility to write scientific articles and take an active part in meetings and \nconferences.\n\nAbility to prepare official correspondence in connection with the research \nprogram.\n\nAbility to learn to utilize various types of electronic and/or manual recording \nand information systems used by the agency, office, or related units.\n\nAbility to read, write, speak, understand, and communicate in English \nsufficiently to perform the duties of this position. American Sign Language \nor Braille may also be considered as acceptable forms of communication.\n\nPersons with mental or physical disabilities are eligible if they can perform \nthe essential functions of the job with or without reasonable accommodation. \nIf the accommodation cannot be made because it would cause the employer \nundue hardship, such persons may not be eligible.\n\n<b>This job specification is applicable to the following title code:</b><b>Job<br />Spec<br />Code</b><b>Variant</b><b>State,<br />Local or<br />Common</b><b>Class of<br />Service</b><b>Work<br />Week</b><b>State<br />Class<br />Code</b><b>Local<br />Class<br />Code</b><b>Salary<br />Range</b><b>Note</b>00156SUNL98N/AP98-<br />This job specification is for <b>state</b> government use only.<br />Salary range is only applicable to state government.<br />Local salaries are established by individual local jurisdictions.<br /><br /> 1/4/2020","sections":{"DEFINITION":"Under general direction of a supervisory official, performs the necessary \nresearch to prepare an analysis to set medical or medically related rates; \nperforms the necessary research and analysis to develop plans, procedures, \nand contracts to oversee managed care or other medical models utilized by \nthe state for their clients; does related work.","NOTE":"The definition and examples of work for this title are for illustrative \npurposes only. A particular position using this title may not perform all \nduties listed in this job specification. Conversely, all duties performed on \nthe job may not be listed.\n\nA Master's degree in any of the above disciplines may be substituted \nfor one (1) year of experience.","EXAMPLES_OF_WORK":"Independently operate and performs complex tasks for a unit responsible \nfor developing complex rates needed for managed care, other medical \nprograms, and social programs.\n\nMay perform the complex tasks of developing rates for managed care or \nother medical or social programs.\n\nDevelops procedures for state oversight of contracted managed care \nprograms or other medical or social programs.\n\nCompares Medicaid rates to commercial rates.\n\nEvaluates how capitation payments to Health Maintenance Organizations \n(HMO's) translate into reimbursement to providers.\n\nDevelop state capitation data sources for design, development, and \nimplementation of rates for specialized populations (developmentally \ndisabled long-term care, behavioral health, and so forth.)\n\nEstablish methodologies for monitoring and managing quality care and \naccess to care by monitoring quality and access in a Medicaid managed \ncare plan from both a staff and IPA perspective, setting up specific quality \nindicator standards (accessibility of services, following up on continuity of \ncare, ensuring appropriateness and frequency of periodic screenings and \nidentifying underutilization of services), creating systems to support and \nimprove quality at the individual practice level.\n\nEstablish plans and programs to better mainstream Medicaid clients by \nestablishing, in a cooperative effort, ways for HMO's to deal with the \nspecial needs of Medicaid patients by: a) working to reduce barriers to \npreventive care through better member and physician education; \nb) implementing with our HMO partners effective outreach and hands-on \ncase management for culturally diverse populations; c) working on client \ncommunications in an arena of low literacy and residential transiency; \nd) working to ensure a culturally competent provider network.\n\nDevelops integration strategies for providers to encourage their movement \ninto Medicaid managed care.\n\nDevelops designs for better management information system utilization for \ntracking and monitoring HMO staff, patients, and other providers for cost \nand quality control.\n\nAnalyzes and assesses comprehensive multi-disciplinary medical records \nto identify individual Medicaid recipient's health care programs and needs.\n\nConfers with nursing consultants, provides consultation, and in-service \neducation to health care facilities for the purpose of maintaining and/or \nimproving quality nursing services.\n\nMonitors development of required services, additional resources, training \nprograms, and provides technical problem-solving advice to certified \nfacilities.\n\nAnalyzes care activities in Medicaid health facilities including but not \nlimited to social services, patient activities, patient rights, psychosocial \nservices, residential services, therapeutic recreation, services to families, \nand interventions which impact on patient health.\n\nWill be required to learn to utilize various types of electronic and/or \nmanual recording and information systems used by the agency, office, \nor related units.","EDUCATION":"Graduation from an accredited college or university with a Bachelor's \ndegree in Accounting, Economics, Finance, Health Care Administration, \nHospital Administration, Public Administration, Public Health Administration, \nMathematics, or Statistics.","EXPERIENCE":"Five (5) years of experience in the research, analysis, development, and/or \nadministration of plans, procedures, and contracts pertaining to managed \nhealth care, and/or other medical or social programs.","LICENSE":"Appointees will be required to possess a driver's license valid in New Jersey \nonly if the operation of a vehicle, rather than employee mobility, is necessary \nto perform the essential duties of the position.","KNOWLEDGE_AND_ABILITIES":"Knowledge of Federal and State applicable statutes, regulations, policies and \nprocedures. \n\nKnowledge of the principles and practices of modern research methods, \nevaluation techniques, methodology of technical analyses, and the \ninterpretation of results and findings.\n\nKnowledge of statistical techniques, modern laboratory automation systems \nmethodology, procedures pertaining to the area of specific research, and \nmethods of ensuring conformance therewith.\n\nKnowledge of the specialty area assigned, including knowledge of the most \ncurrent analytical instrumentation utilized in specialty areas.\n\nKnowledge of appropriate federal regulations and procedural methods and \nrequirements.\n\nAbility to plan, direct, and evaluate research activities.\n\nAbility to exercise good judgment in evaluating situations and making \ndecisions concerning research and administrative problems.\n\nAbility to maintain cooperative working relationships with personnel assigned \nto other units within the department and divisions and with others concerned \nwith the work of the research unit.\n\nAbility to prepare clear, scientifically sound, clinically accurate, informative \nreports of tests and other reports containing findings, conclusions, and \nrecommendations.\n\nAbility to write scientific articles and take an active part in meetings and \nconferences.\n\nAbility to prepare official correspondence in connection with the research \nprogram.\n\nAbility to learn to utilize various types of electronic and/or manual recording \nand information systems used by the agency, office, or related units.\n\nAbility to read, write, speak, understand, and communicate in English \nsufficiently to perform the duties of this position. American Sign Language \nor Braille may also be considered as acceptable forms of communication.\n\nPersons with mental or physical disabilities are eligible if they can perform \nthe essential functions of the job with or without reasonable accommodation. \nIf the accommodation cannot be made because it would cause the employer \nundue hardship, such persons may not be eligible."},"searchable_text":"HEALTH CARE CONSULTANT Unclassified N.J.S.A. 11A: 3-4(l) DEFINITION Under general direction of a supervisory official, performs the necessary research to prepare an analysis to set medical or medically related rates; performs the necessary research and analysis to develop plans, procedures, and contracts to oversee managed care or other medical models utilized by the state for their clients; does related work. NOTE: The definition and examples of work for this title are for illustrative purposes only. A particular position using this title may not perform all duties listed in this job specification. Conversely, all duties performed on the job may not be listed. EXAMPLES OF WORK: Independently operate and performs complex tasks for a unit responsible for developing complex rates needed for managed care, other medical programs, and social programs. May perform the complex tasks of developing rates for managed care or other medical or social programs. Develops procedures for state oversight of contracted managed care programs or other medical or social programs. Compares Medicaid rates to commercial rates. Evaluates how capitation payments to Health Maintenance Organizations (HMO's) translate into reimbursement to providers. Develop state capitation data sources for design, development, and implementation of rates for specialized populations (developmentally disabled long-term care, behavioral health, and so forth.) Establish methodologies for monitoring and managing quality care and access to care by monitoring quality and access in a Medicaid managed care plan from both a staff and IPA perspective, setting up specific quality indicator standards (accessibility of services, following up on continuity of care, ensuring appropriateness and frequency of periodic screenings and identifying underutilization of services), creating systems to support and improve quality at the individual practice level. Establish plans and programs to better mainstream Medicaid clients by establishing, in a cooperative effort, ways for HMO's to deal with the special needs of Medicaid patients by: a) working to reduce barriers to preventive care through better member and physician education; b) implementing with our HMO partners effective outreach and hands-on case management for culturally diverse populations; c) working on client communications in an arena of low literacy and residential transiency; d) working to ensure a culturally competent provider network. Develops integration strategies for providers to encourage their movement into Medicaid managed care. Develops designs for better management information system utilization for tracking and monitoring HMO staff, patients, and other providers for cost and quality control. Analyzes and assesses comprehensive multi-disciplinary medical records to identify individual Medicaid recipient's health care programs and needs. Confers with nursing consultants, provides consultation, and in-service education to health care facilities for the purpose of maintaining and/or improving quality nursing services. Monitors development of required services, additional resources, training programs, and provides technical problem-solving advice to certified facilities. Analyzes care activities in Medicaid health facilities including but not limited to social services, patient activities, patient rights, psychosocial services, residential services, therapeutic recreation, services to families, and interventions which impact on patient health. Will be required to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units. REQUIREMENTS: EDUCATION: Graduation from an accredited college or university with a Bachelor's degree in Accounting, Economics, Finance, Health Care Administration, Hospital Administration, Public Administration, Public Health Administration, Mathematics, or Statistics. EXPERIENCE: Five (5) years of experience in the research, analysis, development, and/or administration of plans, procedures, and contracts pertaining to managed health care, and/or other medical or social programs. NOTE: A Master's degree in any of the above disciplines may be substituted for one (1) year of experience. LICENSE: Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform the essential duties of the position. KNOWLEDGE AND ABILITIES: Knowledge of Federal and State applicable statutes, regulations, policies and procedures. Knowledge of the principles and practices of modern research methods, evaluation techniques, methodology of technical analyses, and the interpretation of results and findings. Knowledge of statistical techniques, modern laboratory automation systems methodology, procedures pertaining to the area of specific research, and methods of ensuring conformance therewith. Knowledge of the specialty area assigned, including knowledge of the most current analytical instrumentation utilized in specialty areas. Knowledge of appropriate federal regulations and procedural methods and requirements. Ability to plan, direct, and evaluate research activities. Ability to exercise good judgment in evaluating situations and making decisions concerning research and administrative problems. Ability to maintain cooperative working relationships with personnel assigned to other units within the department and divisions and with others concerned with the work of the research unit. Ability to prepare clear, scientifically sound, clinically accurate, informative reports of tests and other reports containing findings, conclusions, and recommendations. Ability to write scientific articles and take an active part in meetings and conferences. Ability to prepare official correspondence in connection with the research program. Ability to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units. Ability to read, write, speak, understand, and communicate in English sufficiently to perform the duties of this position. American Sign Language or Braille may also be considered as acceptable forms of communication. Persons with mental or physical disabilities are eligible if they can perform the essential functions of the job with or without reasonable accommodation. If the accommodation cannot be made because it would cause the employer undue hardship, such persons may not be eligible. This job specification is applicable to the following title code: Job Spec Code Variant State, Local or Common Class of Service Work Week State Class Code Local Class Code Salary Range Note 00156 S U NL 98 N/A P98 - This job specification is for state government use only. Salary range is only applicable to state government. Local salaries are established by individual local jurisdictions. 1/4/2020","snippet":"HEALTH CARE CONSULTANT Unclassified N.J.S.A. 11A: 3-4(l) DEFINITION Under general direction of a supervisory official, performs the necessary research to prepare an analysis to set medical or medicall...","salary_meta":null,"education_level":"bachelor","experience_years":5,"has_license_requirement":true,"license_types":["driver"],"pension_system":"PERS","revision_date":"2020-01-04","erg_prefix":null,"erg_schedule":"A-P-R-S","range_number":null,"erg_name":null,"erg_union":null,"familyId":null,"familyName":null,"level":null,"specialization":null,"prefix":null,"isSupervisory":false}