What are the responsibilities and job description for the Director II position at Texas Health and Human Services Commission?
Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.
Functional Title: Director II
Job Title: Director II
Agency: Health & Human Services Comm
Department: Med Svcs-Quality Review TK
Posting Number: 4038
Posting Audience: Internal and External
Salary Group: TEXAS-B-27
Shift: Day
Additional Shift: Days (First)
Telework:
Travel: Up to 20%
Regular/Temporary: Regular
Full Time/Part Time: Full time
FLSA Exempt/Non-Exempt: Exempt
Facility Location:
Job Location City: AUSTIN
Job Location Address: 4601 W GUADALUPE ST
Other Locations:
MOS Codes:
8003,8040,8041,8042,10C0,111X,112X,113X,114X,20C0,30C0,40C0,611X,612X,621X,631X,641X,648X,90G0,91C0
91W0,97,SEI15
Job Description:
The Director of Surveillance Utilization Review (SUR) is selected by and reports to the Deputy Inspector General (DIG) for SUR. The Director performs highly advanced, senior-level managerial work providing strategic planning, guidance, and direction as well as overseeing key operations and activities for multiple SUR program areas. Work involves understanding and interpreting federal and state requirements, policy, and Texas Administrative Code governing HHS agency programs and utilization review responsibilities; developing strategic plans, goals, and objectives in alignment with OIG leadership priorities; establishing policies, procedures, standards, schedules, priorities, program metrics, and other tracking tools to determine progress in meeting division objectives; reviewing policies, procedures, guidelines, rules, and regulations; coordinating, evaluating, and monitoring staff review activities; recommending needed changes to business processes to facilitate efficient and effective program operations; and assisting in developing, reviewing, and finalizing budgets. Work also includes drafting annual performance plans and coordinating with other OIG division directors to ensure the work of the SUR is performed effectively and efficiently. The Director hires, oversees, and trains staff; plans, assigns, and supervises the work of managers; and provides direction and guidance to staff across multiple OIG SUR programs and functions. Work is performed under minimal supervision, with extensive latitude for the use of initiative and independent judgment.
Essential Job Functions:
(40%) Performs highly advanced senior-level work and provides ongoing direction in managing the OIG Surveillance Utilization Review team in accordance with applicable professional standards, OIG, and SUR policies and procedures; leads, directs, and supervises managers and professional staff; hires, develops, coaches, evaluates, and manages performance of staff following established HHS, OIG, and SUR policies and procedures; outlines and communicates performance expectations to staff; completes performance evaluations of direct reports; develops and manages direct reports’ continuing professional education and training plans; creates and presents in-house training on internal policies, processes, and other ad hoc topics; plans, develops, approves, and directs projects and other activities, including schedules and priorities; plans the work and directs managers and staff in efficient and effective approaches to achieving objectives, monitors performance measures, and manages workload throughout the annual review cycle; and performs quality assurance evaluations, monitors quality performance, and implements operational enhancements.
(30%) Provides leadership, planning, and overall coordination of the retrospective payment review and other SUR program functions; establishes systems for setting priorities, planning activities, and organizing staff to accomplish goals; demonstrates initiative and provides significant input into the development and attainment of review function goals and performance targets; participates in the development and implementation of SUR goals, objectives, strategic plans and operations, and budgets; recommends, prepares, and evaluates operational policies, procedures, standards, and performance measures; interprets, understands, and identifies non-compliance with state and federal requirements and contract provisions; provides direction in the review of medical records, management activities, programs, and processes; provides guidance in defining review requirements and processes, documenting the results of reviews, and making recommendations for improvement; participates, as part of the SUR management team in the development, revision, and implementation of SUR goals, objectives, policies, procedures, guidelines, and performance measures, and in staff development.
(15%) Communicates and coordinates effectively with all levels of management in a variety of settings; represents SUR at briefings, meetings, legislative committees, and other internal and external stakeholder engagements; routinely briefs SUR Deputy Inspector General, Chief, and other agency executives on division results and emergent issues as requested; provides guidance and direction to program and project managers in the development of formal communications and the review and approval of deliverables, including reports and related oral presentations to management; may periodically brief the Inspector General (IG) on project status, results, and other matters; coordinates with OIG divisions and with internal and external stakeholders.
(15%) Prepares and provides leadership with reporting on a routine and ad hoc basis to demonstrate progress toward division goals; develops and implements techniques to evaluate team performance and progress; utilizes technology to develop individual and team status reports; ensures staff have tools and information needed to fulfill their responsibilities; ensures that manual and automated tools required to achieve OIG objectives are relevant, available, and functioning as intended.
- Knowledge of local, state, and federal laws and regulations relevant to Medicaid.
- Knowledge of professional health care services; structure and function of health care service delivery organizations, such as managed care organizations; and current trends pertaining to health care.
- Knowledge of the Medicaid Program.
- Knowledge of state and federal programs that serve Medicaid clients.
- Knowledge of local, state, and federal laws and regulations and of the principles of public administration and management.
- Knowledge of the legislative process and experience analyzing legislation.
- Ability to perform program policy review and medical literature research, and to draft program policy.
- Ability to communicate effectively, both orally and in writing in a virtual work environment as necessary.
- Ability to effectively testify at administrative hearings in support of decisions rendered in the medical record review process.
- Ability to coordinate activities among public, private, and professional groups, express ideas clearly and concisely, address audiences effectively, and exercise judgment in evaluating situations and making recommendations.
- Ability to interact with senior executive leadership and external entities.
- Ability to manage projects effectively and produce quality work within short deadlines.
- Ability to plan, assign and supervise the work of others.
- Ability to communicate effectively in written and oral form and be polite, courteous, and discreet.
- Ability to think strategically and creatively to develop creative and workable solutions to complex problems.
- Ability to work independently within the context of role expectations and responsibilities.
- Ability to establish program goals and objectives that support the strategic plan.
- Ability to identify problems, evaluate alternatives, and implement effective solutions.
- Ability to gather, assemble, correlate, and analyze facts; devise solutions to problems; prepare reports; and develop, evaluate, and interpret policies and procedures.
- Ability to develop work plans, organize and direct work/program activities, prioritize time, and manage multiple projects and supervise the work of others.
- Skill in the use of computer software, specifically Microsoft Outlook, Word, Excel, and Power Point.
- Skill in researching, developing, and writing professional reports and/or presentation material.
- Skill in problem solving and independent decision making.
- Skill in leading staff work processes, setting priorities, and monitoring progress.
- Strong skills in analyzing and evaluating complex federal and state legislation, program, policy, and operational issues.
- Skills in developing and evaluating policies and procedures; assessing risks and developing contingency plans.
- Skill in establishing plans and setting objectives and goals that support an overall business strategy.
- Skills in program management and the ability to lead project teams and work with multiple stakeholders.
- Skill in written and oral communication, including the ability to make public presentations, write technical information in an understandable format, and produce sophisticated reports.
- Skill in synthesizing complicated and technical information and translating it into understandable and concise documents and oral presentations.
- Skill in interpersonal relationships, including the ability to work with people under pressure, negotiate among multiple parties, resolve conflicts, and establish and maintain effective working relationships.
- Strong planning and organizational skills.
Registration or Licensure Requirements:
Applicant must be RAC-CT (Resident Assessment Coordinator) certified or be willing to obtain certification within six (6) months of start date.
Initial Selection Criteria:
- Graduation from a four-year college or university.
- Minimum five years experience in management, executive leadership, leading a program or organization, or serving as a member of a senior executive management team.
- Experience may be substituted for education up to four years.
- Experience in a program or service area related to hospital, nursing facility and/or managed care.
- Experience with nursing facility and hospital reimbursement methodology.
- Licensure as a registered nurse or degree in other health care field preferred.
- Texas Health and Human Services experience preferred.
Additional Information:
**This position may be located at any OIG location in the State. **
The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in the provision of HHS in Medicaid and other HHS programs. Potential employees of OIG are subject to criminal background checks in accordance with the HHS Human Resources policy. Selected applicants must complete a national fingerprint-based criminal background check through the Texas Department of Public Safety (TDPS) and Federal Bureau of Investigations (FBI) to determine if they have criminal history record information that constitutes a bar to employment.
The posted salary range reflects the minimum and maximum allowable by state law. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual.
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888—894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC.
Active Duty, Military, Reservists, Guardsmen, and Veterans:
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.
ADA Accommodations:
In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
Pre-Employment Checks and Work Eligibility:
Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.
HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form
Telework Disclaimer:
This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.
Nearest Major Market: Austin
Salary : $7,015 - $10,537
