Tricare Insurance Jobs in Colorado (NOW HIRING)

Department Information This position is open to current Colorado residents only Please note: This recruitment may be used to fill multiple vacancies. Work Location: 100% Remote Most State of Colorado employees are eligible for a great benefit package. Please see the Supplemental Information section below for details.

Division of Child Welfare: Provider Services Unit The position is located in the Division of Child Welfare, Provider Services Unit. The Division is responsible for the ongoing implementation of child welfare services in Colorado and supervises county departments of human/social services in the administration of Child Welfare programs, as well as privately operated 24-hour child care facilities. The Provider Services Unit exists to license, manage, supervise, and provide statewide oversight for privately operated 24-hour childcare facilities and agencies, to include Residential Child Care Facilities, Secure Residential Treatment Centers, Qualified Residential Treatment Programs (QRTPs), Psychiatric Residential Treatment Facilities (PRTFs), Homeless Youth Shelters, Specialized Group Homes and Centers, Child Placement Agencies, Adoption Agencies, Respite Child Care Centers (RCCC), and Day Treatment Facilities across the State of Colorado.

The goals of the unit are to ensure the health, safety, and well-being of the youth served in those facilities. The work unit is responsible for comprehensive integrated (Interagency) licensing and monitoring of the 24-hour child care facilities, and to audit and investigate reports/allegations involving licensing violations, facility or agency culpability, and to ensure the safety of children in out-of-home placements using Volume 7 rules and regulations, the Licensing Act, and all other applicable rules and statutes. Description of Job This position is deemed 100% Remote Work.

About this position: This position is a pacesetter in the field who has a unique level of technical expertise in creating the landscape for the creation of interagency collaboration with Health Care Policy and Financing (HCPF) and related billing experts, and the design of policies, procedures, and regulations impacting requirements in ABA Clinic settings. Management routinely relies on the essential consultation of this position before deciding essential, wide-ranging, critical program policy or direction to ensure clinic practice complies with required standards. This position implements the Division's audit process to include sample reviews, technical assistance and training, issuing reports of inspection, issuing fines, authorizing licensure, and recommending adverse action against a facility, agency, or clinic.

This includes researching and staying up-to-date on policies, procedures, and requirements related to payment sources, including collaborating with the Office of Children, Aging, and Community Services (OCACS) Medical Team, the HCPF Children's Habilitation Residential Program (CHRP) team, private insurance companies, Tricare insurance for military families, and other paying entities to best align requirements with regulation and practices when possible. This position determines whether the agencies are operating in compliance with applicable internal guidelines, rules, policies, regulations, and standards. This position identifies and recommends opportunities for improving standards of practice for programs to meet operational expectations.

This position is responsible for ongoing collaboration with HCPF and tracking all bills and rules that have the potential to impact the licensed ABA clinics. This position is responsible for collecting information across entities and subject matter experts related to payment and providing support to other Licensing Specialists and other staff within the Division of Child Welfare when it comes to Medicaid, CHRP, and payment within licensed ABA clinics. This position ensures that youth are receiving safe and adequate care and treatment by evaluating the physical plant, treatment planning, staff and care provider qualifications, training, and supervision, as well as financial stability, interviews with youth in care, and required corrective actions.

This position is also responsible for handling and safeguarding confidential information regarding youth in care, as well as for specific provider staff background checks. Summary of Job Duties: Licensing of Agencies and Facilities and Technical Assistance Provide or research options for and coordinate technical assistance to licensed facilities and agencies to support the delivery of quality care to youth and to increase their compliance with State and Federal rules, with particular focus on child protection and safety. Oversee and direct providers to improve programming to ensure the safety, care, and well-being of children in placement.

This position is a technical assistance expert for the Division of Child Welfare in the areas of licensing, child care/child welfare, and treatment planning related to these populations. Serve as the staff authority on child care and child welfare treatment and the protocols necessary to assure resident safety and well-being. This position is responsible for developing and overseeing best practices, implementation, tracking, and oversight of billing, reimbursement, and insurance payment methodologies, processes, and policies for services rendered in ABA Clinics.

Management relies on this position's expertise for determining best practices for obtaining and reviewing background records for all staff members, foster parents, adults over the age of eighteen years living in foster homes, and volunteers working directly with children/youth in agencies licensed under the Provider Services Unit. Evaluate the quality of programming, practices and policies, and compliance with providers of out-of-home care; specifically, conduct building and site inspections, ensure staff and care providers are supervised and trained according to their individual needs and the needs of the youth served in the facility or agency, assess treatment planning, observe milieu, assess quality of home study evaluations, assess behavioral interventions utilized by facilities, examine medication administration requirements, examine restraint and/or seclusion practices, examine financial documentation to ensure stability of agencies and facilities and that the needs of the youth are being met, and conduct interviews with staff, foster families, and youth to determine quality of care provided. This position is responsible for researching applied behavior analysis (ABA) therapy practices and implementing national and state standards and safety as they relate to day treatment settings overseen by the Provider Services Unit, as well as Applied Behavior Analysis Clinics.

This position provides support to the other Licensing Specialists concerning issues specific to ABA therapy reimbursement through Medicaid or private insurance provided within the Unit's licensed facilities and agencies. Corrective Action Compile and interpret data on patterns of provider deficiencies or gross incidents of non-compliance with Volume 7 to determine when adverse licensing actions are warranted. Provide documentation and testimony in summary suspension situations and other adverse action cases.

Issue expert opinions, as authorized by the Division of Child Welfare, on child protection and safety that occur within agencies and facilities to prompt further actions by other entities within the Department and in the provider community. Advise management on action steps necessary to rectify ongoing concerns and violations at the agency, and when adverse action is indicated. Provide follow-up and increased on-site licensing until provider deficiencies are resolved and abuse/neglect or other safety concerns are alleviated.

Stakeholder Involvement Participate in the development and implementation of integrated and consistent licensing protocols within the Division of Child Welfare as well as with other divisions and stakeholders, including Administrative Review, Behavioral Health Administration, Office of Behavioral Health, and the Division of Youth Services. Consult as necessary regarding these protocols with county departments of human services, and other government agencies, including the Department of Public Health and Environment, the Department of Education, Colorado Department of Public Safety, Department of Regulatory Agencies, Health Care Policy and Finance, Department of Early Childhood, and the Office of Management Improvement. Develop, test, and refine review instruments in order to ensure that the Department child safety concerns are addressed.

Ensure that facility self-assessment tools are developed, treatment standards are detailed in the rule, and integrated (interagency) processes are maintained and enhanced. Provide licensing technical consultation and assistance to all Divisions responsible for out-of-home child placements to develop new rules, statutes, or revise rules to improve county and provider performance and to assure children's health, safety, and well-being. Initiate Volume 7 rule revisions and updates to reflect current practice and statute changes.

Position is relied on to be the expert opinion on how Volume 7 is interpreted and implemented, and when Volume 7 rules need to be modified to reflect changes in evidence-based practices and research publications. Identify when policy or rule revisions to Administration as a result of developing corrective action plans with facilities and agencies in which licensing visits reveal consistent and willful deficiencie Licenses, Continuation, and Renewals Approval Evaluate and license programs both for initial and ongoing licensure. Evaluate programs initially to determine the most appropriate license type to serve the populations the provider seeks to support.

Thoroughly analyze policies and procedures, behavior management and discipline, staff qualifications, medication administration, and plans for educational, community, and recreational activities, treatment and services to be provided, and site compliance and quality via inspections and interviews. Ensure that facilities meet mandatory requirements of external entities that also oversee facilities: CDPHE, zoning and planning, and fire departments. Conduct reviews at minimum annually, reviewing staff and youth files to ensure compliance with licensing requirements.

Complete reports of inspection to identify rule violations. Ensure agency response and timely correction of violations. All other duties as assigned from leadership within the Division of Child Welfare.

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights Minimum Qualifications: Experience Only: Seven (7) years of relevant experience in an occupation related to the work assigned to this position OR Education and Experience: A combination of related education and/or relevant experience in an occupation related to the work assigned equal to seven (7) years. Preferred Qualifications: Bachelor's degree in Human Services, Social Work, Psychology, or Sociology. Two (2) or more years of work experience related to human services or licensing.

Demonstrated knowledge of child welfare policies and practices, residential best practice standards, and licensing regulations and statutes. Experience in an advisory or consultative role. Proven ability to direct research, analyze, and report on complex issues.

Outstanding skills and abilities in verbal and written communications; ability to adapt a style to fit audiences of varying technical levels, and at various levels within an organization, in groups and individual settings. Demonstrated ability to establish collaborative partnerships and effective working relationships with a variety of internal and external customers and diverse public and private stakeholders. Demonstrated proficiency working collaboratively with internal teams; and national, state, and community partners.

Knowledge of Volume 7 Rules and Regulations. Demonstrated knowledge working in CCCLS, TRAILS, I-LINX, and multiple databases and scanning systems. Applied Behavior Analysis work with children/youth with Autism Spectrum Disorder (ASD) and/or Intellectual and Developmental Disabilities (IDD).

Conditions of Employment Full Background CDHS employees (all Direct contact with vulnerable persons): CBI name check and fingerprint check, ICON Colorado court database, Medicare fraud database, Reference Checks, Professional License verification (licensure requirements), Drug Screen, PREA (Division of Youth Services), Trails check (direct contact with children), CAPS (direct contact with adults - Mental Health Institutes, Regional Centers, Veterans Community Living Centers) This position requires State of Colorado residency at the time of application (unless otherwise identified in the posting), and residency within the state throughout the duration of employment in this position. Motor Vehicle Check , if the employee will drive a state-owned vehicle, either in an ongoing capacity while performing their normal day-to-day job duties OR on occasion for training/meetings/client visits/etc. Must possess a valid, non-restricted Colorado Driver's License or a non-restricted U.S

Driver's License for positions within 30 miles of the CO state border Out-of-State Driver's License holders must obtain a valid, non-restricted Colorado Driver's License within 30 days of employment start date. Travel - This position currently works 100% remotely from home address and will be required to use a personal vehicle for frequent travel to the CDHS office, assigned agencies/facilities, and other identified locations for the purpose of related primary job duties as assigned. This position may be required to complete overnight travel and infrequent extended travel within the State of Colorado.

Auto insurance is also required. Other - This position is designated as remote. Employees must maintain a home office, internet, and possibly phone service.

Former State employees who were disciplinarily terminated or resigned in lieu of termination must (1) disclose that information on the application (2) provide an explanation why the prior termination or resignation should not disqualify the applicant from the current position, (3) provide the employee number from the applicant's prior State employment. Absent extraordinary circumstances, prior disciplinary termination or resignation in lieu of termination and failure to provide this information will disqualify the applicant from future State employment with CDHS. CDHS Selection Process Explanation Employment history is calculated on a full-time basis (40/hrs per week).

Part-time employment is calculated on a prorated basis to determine qualif...