Analyst - Federal Compliance Site Review

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Title: Analyst - Federal Compliance Site Review

$60,424.00 - $88,316.80 / Posted Thru: 8/18/2025

Location: Remote/Virtual - Must Live and Work in Michigan

Purpose: The Federal Compliance Site reviewer is responsible for the Pre-paid Inpatient Health Plans (PIHP) 1915(c) Habilitation Supports Waiver (HSW) and 1915(i) State Plan Amendment (SPA) annual site review. The Site Review Analyst is responsible for initiating the annual site review, completing the credentialing and clinical review of Medicaid beneficiary records, compiling results into a comprehensive report, ensuring reporting timeframes are met, analyzing corrective actions plans to ensure compliance and evaluating whether remediation identified are effective. The position must be knowledgeable about state and federal rules and regulations pertaining to the requirements of the HSW and 1915 iSPA and the implementation of service provision provided by the PIHP's/CMHSP's to Medicaid beneficiaries who are receiving HSW or 1915 iSPA services. In addition, the Site Review Analyst must have knowledge of the MDHHS/PIHP contract requirements, Michigan Mental Health Code (MHC) and other laws applicable to services provided to Medicaid beneficiaries with a mental illness, intellectual and developmental disabilities, substance use disorders and children with serious emotional disturbances. The position develops the site review schedule in consultation with team members. The position makes determinations regarding the quality of clinical service delivery to Medicaid beneficiaries, makes decisions as it relates to site review procedures in the field, makes recommendations for approving the site review report, process and implementation. This position will be assigned to five PIHPs to review.

Duties and Responsibilities:

• Serve as the recognized resource for the Behavioral Health Site Review Team which verifies compliance with the regulations for 1915(c) Habilitation Supports Waiver (HSW) and 1915(i) State Plan Amendment (SPA)
• Coordinate site reviews with MDHHS site review and support staff. In preparation for site review, position must review yearly reports generated from previous site review, e.g., PIHP/CMHSP Site Review Report, PIHP Remedial Action Plan and consults with other MDHHS staff as it relates to any other active issues or trends going on with PIHP/CMHSP that impact service provision.
• Work with MDHHS staff and PIHP staff to develop comprehensive site review schedule and review assignments.
• Coordinate distribution of final review schedules.
• Conduct entrance conferences at PIHP's and contractual providers.
• Review individual clinical records via the electronic medical record (EMR) including the individual plan of service (IPOS) to determine if beneficiary preferences were acknowledged and addressed.
• Review administration records and policies and procedures pertaining to service delivery for persons receiving Medicaid behavioral health services.
• May visit program sites as part of compliance review activities.
• May review survey information from survey sources like NCI.
• Coordinate and convene exit conferences where survey findings are communicated in a clear and concise manner to PIHP groups of all sizes and professional disciplines.
• Prepare written reports which identify specific findings and contain recommendations concerning corrective action plans.
• Reviews and evaluates the Remedial Action Plans submitted by PIHP's and provides recommendations concerning the plans acceptability.
• Provides consultation to and coordinates with the Federal Compliance staff within MDHHS in order to improve PIHP compliance and performance.
• Provide ongoing technical assistance verbally or via e-mail regarding approaches to behavioral health services that best meet the needs of beneficiaries.
• Determine acceptability of plans of correction and remediation actions and makes recommendations as necessary.
• Responsible for analyzing all site review reports to determine trends of compliance and non-compliance among PIHPs/CMHSPs.
• Utilize professional expertise to analyze site review reports.
• Recognize and report trends to supervision and other MDHHS staff as needed.
• Coordinate and disseminate information to MDHHS staff.
• Review and evaluate remedial action plans.
• Determine acceptability of plans and make recommendations as necessary.
• Coordinate analysis with other Federal Compliance staff to determine PIHP, CMHSP and provider network compliance with state and federal laws, guidelines as well as mandates relating to health and safety.
• Make adjustments and recommendations to performance measures to address trends and issues.
• Consult with Federal Compliance staff regarding applicable outcomes.
• Participates in special assignments/projects that relate to contract compliance activities.
• Stay updated with federal regulations and mandates from CMS and how they impact the site review process.
• Coordinate with MDHHS Quality Improvement staff to inform and address issues and trends.
• Other duties as assigned.
• Always represent the best interests of MPHI and MDHHS.

Qualifications/Requirements:

Education:Possession of a bachelor's degree required in a healthcare or human service field, Qualified Intellectual Disabilities Professional (QIDP) or Qualified Menal Health Professional (QMHP) is required.

Experience:Two years of public funded behavioral health experience is required.

Important Skills and Characteristics:

• Knowledge and direct firsthand experience working in Michigan's Medicaid behavioral health service system.
• Strong knowledge of HSW, 1915 iSPA, PIHP/MDHHS contract, Medicaid Provider Manual and Federal requirement.
• Ability to develop written reports and communications electronically free of grammatical errors; ability to work independently and as a collaborative team member.
• Possession of excellent analytical, communication and comprehension skills.
• Ability to speak to large audiences.
• Provide training and technical assistance as needed as well as meet strict deadlines. Ability to work with, or learn, a number of computer software applications, including MS Word, PowerPoint and web-based applications like the Waiver Support Application(WSA), CHAMPS, Customer Relationship Management (CRM) and Care Connect 360 (CC360).

Work Environment and Physical Requirements: This hybrid position requires in person work obligations when providing training and technical assistance. In addition, a dedicated home office environment is required. More than 85% of the time will be spent using a laptop or other technology that is provided by the department. Reliable transportation and a valid vehicle driver's license are required to support travel to meetings, conference, and engagements with both internal and external stakeholders. Ability to work evenings and weekends as needed.

RESPONSIBILITY FOR THE WORK OF OTHERS: No assigned responsibility.

IMPACT ON PROJECTS, SERVICES AND OPERATION:This position has a direct impact on the quality of services provided by MPHI to MDHHS. Development and implementation of training for the certification and continuing education of Medicaid providers directly impacts the behavioral health workforce, agencies who employ peer support specialists, and peer recovery coaches, and individuals who receive services

REQUIRED COMMUNICATION

Contact Person/Group	Frequency	Purpose
Federal Compliance Manager -Supervisor	Bi-weekly	Overall direction and Supervision
Other Site Review Analyst	Daily	Coordination and Collaboration
Other Federal Compliance Staff	Daily or Weekly	Collaboration

"For purposes of employment standards, this classification is "Exempt" from overtime provisions of the fair Labor Standards Act."

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