PROGRAM ADMINISTRATOR - SES

Requisition No: 843377

Agency: Agency for Health Care Administration

Working Title: 68063485 - PROGRAM ADMINISTRATOR - SES

Pay Plan: SES

Position Number: 68063485

Salary: $2,245.19 Biweekly

Posting Closing Date: 12/30/2024

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This is a full-time Selected Exempt Service (SES) management position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5 p.m.

This Program Administrator-SES position is anticipated to be filled at a rate of $2,245.19 bi-weekly and is non-negotiable.

This position may involve travel related activities from 1-25%.

Successful completion of a criminal background investigation is a condition of employment.

The Florida Medicaid program is one of the five largest in the country with an estimated $35 billion annual budget.

Each month Florida Medicaid covers medical services for over 5 million recipients.

To effectively serve this large patient population, one of the Agency goals is to ensure fewer budgeted dollars are lost to fraud, abuse, and waste.

The Bureau of Medicaid Program Integrity (MPI) does this specifically through audits and investigations of Medicaid providers, including managed care plans.

MPI also imposes administrative sanctions for program violations and refers suspected fraud or other criminal violations to appropriate law enforcement agencies for further investigation.

MPI operates with dynamic and fast-paced units that work closely together to serve the overall bureau mission.

MPI units are responsible for developing novel methods and innovative solutions necessary to address the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program.

These highly collaborative units rely on teams with diverse educational and experience backgrounds.

The selected candidate will be responsible for the effective management of team members in the bureau’s Managed Care Unit.

This supervisor is responsible for recruiting, hiring, and evaluating the performance of program staff, as well as motivating, training, planning, and directing employees’ work assignments.

This will include communication, motivation, team building, training and evaluating employees; planning, and coordinating the work initiatives of staff to ensure the timely and efficient performance of assigned duties.

The selected candidate will be responsible for the effective operational management, maintenance, oversight, and compliance with program integrity requirements set forth in state and federal law, along with the provisions of contracts and Medicaid policies as it relates to the operation of the Statewide Medicaid Managed Care plan.

This position is responsible for conducting investigations of possible fraud, waste, or abuse and advising Administrators of appropriate protocols and possible actions.

The confidentiality of investigations and recommendations require knowledge of Florida and Federal Medicaid policy and guidelines along with health plan's regulations and activities.

The incumbent will participate and lead preliminary investigations and inquiries using research and analytical skills utilizing available platforms while working closely with data analysis personnel.

Audits of managed care plans are a vital part of this position and the investigative and communicative skills necessary are crucial to the success of MPI's fraud prevention efforts.

The selected candidate will work collaboratively with all MPI units to include analysts, managers, administrators as well as Managed Care Plan personnel in executing the mission of the Managed Care Unit, MPI and AHCA.

Benefits of Working for the State of Florida:

Working for the State of Florida is more than a paycheck. The State’s total compensation package for employees features a highly competitive set of employee benefits including:

• State Group Insurance Coverage Options, including health, life, dental, vision, and other supplemental insurance options;

• Flexible Spending Accounts;

• State of Florida retirement options, including employer contributions;

• Generous annual and sick leave benefits;

• 9 paid holidays a year and 1 Personal Holiday each year;

• Career advancement opportunities;

• Tuition waiver for courses offered by Florida’s nationally ranked State University System;

• Training and professional development opportunities;

• And more!

For more information on MPI, please visit MPI at: http://ahca.myflorida.com/MCHQ/MPI/index.shtml

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of Florida Medicaid

• Knowledge of Federal Medicaid

• Knowledge of Florida and Federal law related to Program Integrity

• Knowledge of methods of compiling, organizing, and analyzing data

• Ability to understand and apply applicable rules, regulations, policies, and procedures.

• Ability to determine work priorities, assign, work, and ensure proper completion of work assignments

• Ability to communicate effectively using written and verbal communication

• Ability to conduct fact finding research, conduct investigations activities, and accurately document information, conclusions, and findings

• Ability to execute assigned projects timely and accurately within a fast-paced environment

• Ability to demonstrate skills utilizing Microsoft Word, Excel, Outlook, PowerPoint, SharePoint

• Ability to travel with or without accommodations.

MINIMUM QUALIFICATIONS REQUIREMENTS

• Two years of investigative, enforcement, health care, or professional experience in a position within a regulatory, or oversight setting.

• One year of supervisor or managerial experience.

• Preference will be given to candidates with a bachelor's degree or higher from an accredited college or university, particularly in a related field such as: health law, health science, criminology, criminal justice, or a substantially similar discipline.

• Preference will be given to candidates with a program integrity related professional certification, such as: Certified Fraud Examiner, Accredited Healthcare Fraud Investigator; Certified Financial Crimes Investigator; Certified Insurance Fraud Investigator; or Certified Compliance and Ethics Professional.

Professional or nonprofessional experience can substitute on a year-for-year basis for the preferred education.

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

N/A

CONTACT: HELEN GUNN 850-412-4626

BACKGROUND SCREENING

It is the policy of the Florida Agency for Health Care Administration that any applicant being considered for employment must successfully complete a State and National criminal history check as a condition of employment before beginning employment, and, if applicable, also be screened in accordance with the requirements of Chapter 435, F.S., and Chapter 408, F.S. No applicant may begin employment until the background screening results are received, reviewed for any disqualifying offenses, and approved by the Agency. Background screening shall include, but not be limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) and may include local criminal history checks through local law enforcement agencies.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.