MEDICAL CARE PROGRAM MANAGER III

Introduction

GRADE

20

LOCATION OF POSITION

MDH - Office of Medical Benefits Management, Managed Care 201 W. Preston Street Baltimore, MD 21201

Main Purpose of Job

The Division Chief of HealthChoice Provider Network Management assists the Deputy Director of Managed Care by coordinating processes necessary for the operation of the Maryland HealthChoice Program (Maryland's statewide Medicaid Managed Care Program) across the Maryland Department of Health and by serving as a technical advisor for the Managed Care Organizations (MCOs) for all matters related to network management and managed care reimbursement, including MCO network adequacy. This position is also responsible for the daily supervision of the Division of HealthChoice Provider Network Management, including monitoring and directing unit operations; coordinating and approving leave and staff coverage; hiring and evaluating employee performance; and implementing corrective action. The Division of HealthChoice Provider Network Management receives and resolves HealthChoice billing complaints from providers and enrollees. The Division also assists with new managed care organizations applying to join the HealthChoice program, managed care reimbursement questions and policy, and HealthChoice provider inquiries. This position plans, organizes, and supervises the Division as it handles projects such as MCO provider terminations, service area openings and closures, and enrollment freezes, including coordination with other MDH offices and monitoring MCO enrollment changes because of these actions. This position oversees MCO network consolidation and network capacity projects, along with the monitoring and analysis of MCO submitted claims monitoring reports. This position tracks all MCO network and provider related reports, in addition to changes in CMS requirements, to advise the Deputy Director when departmental action is required. This position may coordinate with other division chiefs, fee-for-service Medicaid offices and administrations, administrative services organizations, and vendors performing Medicaid functions which impact the HealthChoice Program to assure adherence to managed care policy as it relates to network contracting, management, and reimbursement. This position may perform other special projects as assigned, including but not limited to MCO reimbursement audits and claims coordination projects.

MINIMUM QUALIFICATIONS

Education:���A Bachelor’s degree from an accredited college or university. Experience: Four�years of experience supervising employees in developing and applying policies and regulations or directing a program or project in a medical care program. Notes: 1. Candidates may substitute additional administrative or professional experience developing or applying policies and regulations in medical care, health insurance, federal or State entitlement programs or in a health or human service program�on a year-for-year basis for the required education. 2.�Candidates may substitute U.S. Armed Forces military�service experience at a rank of Corporal/Petty Officer or higher as a commissioned officer in Health Care Administration classifications or Health Services Management specialty codes in the health-related field of�work on a year-for-year basis for the required experience and education.

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should possess the following: Experience with Medicaid Managed Care� Experience with Health Insurance Provider Networks and Network Contracting Experience with Claim Reimbursement principles and Customer Service principles

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Employees in these classifications may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator’s license valid in the State of Maryland.

SELECTION PROCESS

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position.�Therefore, it is essential that you provide complete and accurate information on your application.�Please report all related education, experience, dates and hours of work.�Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview).� Complete applications must be submitted by the closing date.�Information submitted after this date will not be added.� Incorrect application forms will not be accepted.�Resumes will not be accepted in lieu of a completed application. Candidates may remain on the�certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

STATE OF MARYLAND BENEFITS

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online,�the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201.�Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted. If additional information is required, the preferred method is to upload.� If you are unable to upload, please fax the requested information�to 410-333-5689.�Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time. For questions regarding this recruitment, please contact the�MDH Recruitment and Selection Division at 410-767-1251. If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 or�Application.Help@maryland.gov.� Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258. We thank our Veterans for their service to our country. People with disabilities and bilingual candidates are encouraged to apply. As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity. MDHMedCare

Salary : $78,919 - $102,996