What are the responsibilities and job description for the ADMINISTRATOR FOR MEDICAL SERVICES position at State of Rhode Island?
To assist the Associate Director for Medical Services in: the development and revision of rules, regulations, procedures and fee and cost standards governing the procurement and payment of medical services and supplies; conferences with appropriate professional groups, and other state medical and dental services for the purpose of effecting common understanding and general acceptance thereon and to reconcile discrepancies and irregularities as well as continuous or aggravated violations involving charges, rules and regulations, standards or procedures of such medical care program; the preparation of manuals based on such rules, regulations, procedures and fee cost standards for the benefit of members of the medical, dental, or other services in order to assist them in preparing and submitting requests for payment to the state for such medical services and/or supplies.
To plan, supervise and review the work of a professional staff and the overall responsibility of a clerical staff.
To participate in program analysis and evaluation.
To assist the Associate Director for Medical Services in community activities in medical care and health planning.
To collect various statistical data relative to the medical care program and prepare reports on the various trends involving such medical care.
To coordinate the activities of the Medical Assistance Program staff and the Data Processing Unit in order to effect programming changes and refinements required to ensure continued effective administration of the Medical Assistance Program and compliance with new federal regulations and requirements.
To assist in the development of departmental policy and a state plan for the Medical Assistance Program which conforms with applicable federal regulations; such a plan is necessary in order for the state to continue to qualify for full federal matching funds.
To relate to federal officials of the Department of Human Services; this activity involves telephone and personal contacts with program, audit and fiscal staff members of HHD.
To respond to inquiries from the news media, participate in local television programs and speak to community groups.
To be responsible for assisting the Associate Director for Medical Services in the development of the annual budget for the Medical Assistance Program and to participate in departmental, public and legislative hearings pertinent to the budget.
To understand and ensure compliance with appropriate state statutes and to assist in the development of position statements on legislation which would impact on the program.
When requested, to participate in collective bargaining and contract negotiations leading to the adoption of contractual agreements as well as the enforcement of the several provisions of such contracts dealing with grievances, training, discipline, etc., in accordance with the Personal Rules.
To assist the Associate Director for Medical Services in the preparation of the annual report for the Rhode Island Medical Assistance Program and special reports, as required.
To be responsible for a public relations and information program which includes speaking engagements, serving on community committees, legislative committees, and meeting with consumer groups and demonstrators.
To assist in analyzing the impact of new federal and state legislation on the Medical Assistance Program.
To be responsible for recruiting and training staff personnel.
To do related work as required.
KNOWLEDGES, SKILLS AND CAPACITIES: A thorough knowledge of approved principles and practices of health care financing administration and the ability to apply such knowledge in the planning and administration of a statewide medical care program including such activities as the development and implementation of rules, regulations, procedures, and fee and cost standards governing the procurement and payment of medical services and supplies; a familiarity with the practices and procedures of hospitals, nursing homes and other institutions providing medical care and treatment; the ability to relate to members of the medical and dental professions, social service staff and other interested parties for the purpose of explaining the philosophy, objectives and operations of a medical care program and to provide consultative services and advice as required; the ability to collect information relative to a medical care program and prepare various trend data for statistical purposes; the ability to plan, supervise and review the work of a professional, technical, fiscal and clerical staff; the ability to establish and maintain effective working relationships with professional groups, consumer groups, the community, the legislature and other public and private agencies; and related capacities and abilities.
EDUCATION AND EXPERIENCE:
Education: Such as may have been gained through: graduation from a college of recognized standing and possession of a Master's degree from an accredited institution of higher education in the field of Medical Care Administration, Public Administration, Social Work, Public Health Administration or Business Administration; and
Experience: Such as may have been gained through: employment as a Chief Medical Care Specialist; or employment in a responsible supervisory position in the field of public health, medical care administration or social work.
Or, any combination of education and experience that shall be substantially equivalent to the above education and experience.
Administrator for Medical Services
The Executive Office of Health and Human Services (EOHHS) seeks a Director of Transportation and Oral Health Programs to lead the management and oversight of two critical Medicaid programs: Non-Emergency Medical Transportation (NEMT) and the Rite Smiles Oral Health Program. This role includes ensuring compliance with state and federal regulations, managing incident reporting processes, developing standard operating procedures (SOPs), leading procurement activities, and advancing programmatic goals. The Director will oversee a diverse portfolio of contracts, maintain strong legal and compliance practices, and collaborate with stakeholders to enhance service delivery and access to care. The role may include managing one of acute care managed care contracts.
Key Responsibilities
Program Oversight and Compliance
- Provide strategic direction and operational management for the NEMT and Rite Smiles Oral Health programs, ensuring efficient and effective delivery of services.
- Monitor and enforce compliance with federal and state regulations for both programs.
- Develop, implement, and maintain comprehensive standard operating procedures (SOPs) to ensure consistent program operations and regulatory adherence.
- Oversee robust incident reporting, grievance resolution, and appeals processes to ensure accountability and member satisfaction.
Contract and Vendor Management
- Manage contracts for NEMT and oral health services, ensuring vendors meet performance standards and adhere to contractual obligations.
- Conduct regular performance evaluations and implement corrective actions or penalties as necessary to maintain high-quality services.
- Collaborate with internal teams to ensure contracts align with program objectives, compliance requirements, and best practices.
Procurement Leadership
- Lead procurement activities for the division, including drafting requests for proposals (RFPs), managing bid evaluations, and executing contracts.
- Ensure all procurement processes comply with state and federal regulations and support the operational goals of NEMT and oral health programs.
Program Development and Innovation
- Identify and implement strategies to enhance access, quality, and efficiency within both NEMT and Rite Smiles programs.
- Develop and oversee project plans, timelines, and deliverables to ensure successful implementation of program improvements.
- Stay informed about industry trends and best practices to guide program development.
Stakeholder Collaboration
- Build and maintain strong relationships with internal Medicaid divisions, state agencies, providers, and advocacy organizations.
- Collaborate with transportation vendors, dental providers, and other stakeholders to improve service delivery and member outcomes.
- Leadership and Staff Management
- Lead and manage a multidisciplinary team, fostering accountability and ensuring deliverables are met.
- Provide mentorship and professional development opportunities for staff to strengthen team capabilities.
Preferred Qualifications
- At least five years of experience in a healthcare, legal, or Medicaid environment, with an emphasis on program oversight, compliance, and project management.
- Expertise in developing and implementing standard operating procedures (SOPs) to ensure operational consistency and compliance.
- Demonstrated knowledge of federal and state compliance requirements for NEMT and oral health programs.
- Experience with incident reporting systems, grievance resolution, and appeals processes.
- Expertise in procurement processes, including developing RFPs and managing vendor contracts.
- Proven project management skills, with the ability to lead cross-functional teams and meet deadlines effectively.
- Strong analytic, problem-solving, and organizational skills.
- Excellent written and verbal communication skills, with the ability to present complex information clearly and effectively.
- Familiarity with Medicaid policies and oral health initiatives such as the Rite Smiles Program.
- Demonstrated ability to collaborate with diverse stakeholders, including providers, vendors, and government agencies.
This position offers an exciting opportunity to lead critical Medicaid programs, ensuring access to quality transportation and oral health services while maintaining a strong focus on compliance and operational excellence.
Salary : $110,585 - $128,405
