PURPOSE OF JOB CLASS (NATURE OF WORK)
In the Department of Social Services this class is accountable for directing staff involved in determining state reimbursement rates for services covered by department assistance programs; auditing of provider cost reports; performing certificate of need reviews for nursing facilities and Intermediate Care Facilities for the Persons with Intellectual Disabilities (ICF/MR) development projects and determining maximum public charges for home health services.
Receives administrative direction from the Social Services Director of Medical Care Administration or other administrative official of a higher grade.
Directs the staff of the Rate Setting and Certificate of Need Division.
EXAMPLES OF DUTIES
Directs the staff and operations of the Rate Setting and Certificate of Need Division; coordinates, plans and manages division activities; formulates program goals and objectives; develops related reimbursement policies; develops and/or negotiates rates for long term care facilities and other provider groups; oversees certificate of need reviews for construction and renovation activity at nursing facilities and intermediate care facilities for the persons with intellectual disabilities; interprets and administers pertinent laws; recommends legislation and presents testimony before legislative committees; evaluates staff; participates in preparation of the division budget; directs and supervises desk and field audits or acts as liaison with Quality Assurance Division and contractual auditing organizations to assure charges to the state are reasonable and related to provision of care to Medicaid supported patients; responsible for supervision of contractors; directs preparation of evidentiary records for use in rate appeal hearings; maintains contact with parties within and outside the agency who impact program activities; performs related duties as required.
KNOWLEDGE, SKILL AND ABILITY
Considerable knowledge of and ability to apply management principles and techniques; considerable knowledge of and ability to apply relevant state and federal laws, statutes and regulations; considerable knowledge of principles of health care administration and financial management; considerable knowledge of health care budgeting principles; considerable knowledge of principles of cost analysis; considerable ability in preparation and interpretation of financial and statistical reports; considerable interpersonal skills; considerable oral and written communication skills.
MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE
Ten (10) years' professional experience in a social services agency, health related facility or health insurance industry.
MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE
Two (2) years of the General Experience must have been in a managerial capacity involving cost filing preparation, reimbursement and rate setting policies.
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 accounting, business administration, hospital administration 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 Sept 23, 1996. (Revised to modify Experience and Training)