PURPOSE OF JOB CLASS (NATURE OF WORK)
In the Department 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 administrator of higher grade.
Assists in directing the staff and operations of the division.
EXAMPLES OF DUTIES
Assists with directing staff and operations of division; assists with 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; evaluates staff; prepares or assists in preparation of unit's budgets; maintains contact with individuals both 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 the 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 direct in his or her absence; performs related duties as required.
KNOWLEDGE, SKILL AND ABILITY
Considerable knowledge of principles, methods and procedures in medical care administration including planning, organizing, financing, evaluating and controlling costs; considerable knowledge of and ability to apply management principles and techniques; considerable knowledge of relevant state and federal laws, statutes and regulations; considerable knowledge of principles and practices of public welfare administration; knowledge of federal reimbursement procedures; knowledge of clinical systems and their relationship to billing; considerable interpersonal skills; considerable 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
1. 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.
2. 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
This replaces the existing specification for the same class in Salary Group MP 70 approved effective July 4, 2008. (Revised to adjust Salary Group and modify content)