State of Florida · 1 month ago
HUMAN SERVICES PROGRAM ANALYST - 64004525 1
St. Petersburg, FL
Full-time
Onsite
Mid Level
$41K/yr - $41K/yr
3+ years expThe State of Florida's Department of Health is seeking a Human Services Program Analyst to work within the Specialty Care Program. The primary responsibility of this role is to generate medical referrals for specialists and ensure cost-effective, quality health care services are maintained for the Pinellas County Health and Health Care for the Homeless Plans.
Government Administration
Responsibilities
Evaluates services to achieve and maintain cost effective, quality health care. Authorized to limit services based on medical necessity and procedural guidelines. Uses professional guidelines for Specialty Care. Develops procedures to evaluate medical necessity
Evaluates authorization requests for specialty care referrals in accordance to the established Specialty Care medical grid(Radiology, Behavioral and other specialties)
Verifies County eligibility
Generates authorization referrals for Specialty Care in accordance with established procedural guidelines in HMS ACG
Generates 15 Referrals daily or meets center capacity demand
Generates letters as needed. Faxes referrals to medical providers as needed
Processes stat referrals as assigned
Verify data requested from source documents is entered with a 95% accuracy rate
Review statistical reports in Logi
Assist the Business Operations Specialist in the development and implementation of guidelines to be used for consistent application of criteria
Liaisons with specialist providers requesting additional medical information as needed
Backs up DOH pharmacy tech to provide pharmacy services to PCHP clients as assigned, to include overrides/prior authorizations or denials
Access pharmacy voicemails and phone calls from medical providers as needed
Use portal information center
Scans and imports medical records in accordance established standards
Participates in quality improvement activities, including chart review, in-service programs, and staff meetings
Faxes Referrals and medical records to providers
Submits employee activities report (EARS) in a timely manner
Enter services and process billing claims
Enters Services and tracking process for Directions Behavioral Health program, review clinical notes match claims and authorization
Qualification
Required
3+ years Experience in a Health Care and / or a Clinical Setting
At least 1 year experience with Advanced skills in Information Technology
5+ years Knowledge and Understanding of Medical Terminology and standard abbreviations
Knowledge of medical terminology
Knowledge of Pinellas County Health and Health Care for the Homeless Plans
Ability to plan, organize and coordinate work assignments
Ability to establish and maintain working relationships with others
Ability to type and/or in a keyboard control data input device and utilize other office equipment
Ability to follow instructions
Ability to review data for accuracy and completeness
Ability to meet and maintain minimum production requirements for speed and accuracy
Ability to communicate effectively both written and verbal
Skills in Information Technology
Preferred
Medical licensure
Bachelor's Degree
Benefits
Annual and Sick Leave benefits
Nine paid holidays and one Personal Holiday each year
State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options
Retirement plan options, including employer contributions
Flexible Spending Accounts
Tuition waivers
And more!
Company
State of Florida
The State of Florida is an online telephone and email directory for state government agencies and employees in Florida.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Richard Herstein, MD, MHA, MBA
Chief Hospital Administrator (CEO) and Chief Medical Officer (CMO)
Jimmy Patronis
Chief Financial Officer
Recent News
Maryland Daily Record
2025-08-29
Press Telegram
2025-08-08
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