In the Department of Social Services this class is accountable for directing the Certificate of Need and Rate Setting, Medical Operations, Medical Policy and Medical Consult units and assisting the Director of Medical Care Administration.
Receives administrative direction from the Director of Medical Care Administration or other administrative official of higher grade.
Assists in directing staff of division.
EXAMPLES OF DUTIES
Assists in directing staff and operations of the division;
Assists in coordinating, planning and managing activities;
Assists in formulating program goals and objectives;
Develops or assists in development and modification of related policy;
Interprets and administers pertinent laws;
Prepares or assists in preparation of unit's budgets;
Maintains contact with individuals within and outside of division who might impact on program activities;
Interprets federal regulations and prepares waivers;
Makes recommendations on proposed legislation;
Administers and oversees implementation of federal and state legislation and policy initiatives;
Provides guidance on medical policy and regulations;
Develops state health care plans for Medicaid and state children's health insurance programs and other health services;
Develops regulations related to health insurance coverage and implementation of billing procedures;
Directs development of new program initiatives involving health care;
Negotiates agreements for medical care services with professional groups and service providers;
Administers coverage, utilization and quality management and oversees new initiatives;
Oversees provider services, provider enrollment and reenrollment, customer call centers, provider representatives and provider training;
Oversees certificate of need reviews for nursing facilities and residential care homes including receivership and bankruptcies with regard to restructuring, transfers to new owners and closures;
Develops and/or administers contracts for data information systems;
Prepares revenue projections and analyzes agency changes for impact on revenue;
Ensures compliance with all federal and state reporting requirements for federal reimbursement;
Oversees implementation and ongoing support for operations of all fee for services;
Oversees establishment of payment rates for medical and residential services;
Directs staff and operations in obtaining reimbursement of health care services;
Directs training related to billing and reimbursement;
Acts for Director in his or her absence;
Leads the recruitment and hiring of staff, including outreach, interview and selection;
Performs related duties as required.
KNOWLEDGE, SKILL AND ABILITY
Considerable knowledge of
and ability to apply management principles and practices;
relevant state and federal laws, statutes and regulations;
principles, methods and procedures in medical care administration including planning, organizing, financing, evaluating and controlling costs;
principles and practices of public welfare administration;
federal reimbursement procedures;
clinical systems and their relationship to billing;
oral and written communication skills;
Considerable ability to analyze data and develop projections.
MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE
Ten (10) years of experience in the health service field involving the administration or coordination of health care programs.
MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE
Two (2) years of the General Experience must have included management responsibility for a large division with budget responsibility of at least one million dollars.
MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED
College training may be substituted for the General Experience on the basis of fifteen (15) semester hours equalling one-half (1/2) year of experience to a maximum of four (4) years for a Bachelor's degree.
A Master's degree in health care, business or public administration, public health or a closely related field may be substituted for one (1) additional year of the General Experience.
JOB CLASS DESIGNATION
(1)-Officials And Administrators
As defined by Sec. 5-196 of the Connecticut General Statutes, a job class is a position or group of positions that share general characteristics and are categorized under a single title for administrative purposes. As such, a job class is not meant to be all-inclusive of every task and/or responsibility.
This replaces the existing specification for the class of Director of Medical Administration in Salary Group MP 72 approved effective December 2, 2011. (Revised to add Acknowledgement section and modify content) Final No. 22-007