State of Connecticut Executive Branch

In the Office of the Health Care Advocate this class is accountable for managing programs and activities related to promoting and protecting interested individuals covered under managed care health plans in Connecticut.

Receives administrative direction from an administrative or executive official of a higher grade.

Manages the staff and operations of assigned programs.

• Develops, implements and manages programs and activities related to promoting and protecting interests of individuals covered under managed care health plans in Connecticut; 
• Educates and assists consumers with external appeal process; 
• Facilitates complex consumer complaints especially those involving medical necessity; 
• Reviews and resolves consumer complaints; 
• Provides assistance to consumers in managed care plan selection; 
• Directs staff and operations of assigned program(s); 
• Coordinates and plans programs(s) activities; 
• Formulates or assists in formulation of program(s) goals and objectives; 
• Develops or assists in development of related policy; 
• Interprets and administers pertinent laws and regulations; 
• Assists in preparation of program budget; 
• Maintains contacts with individuals both within and outside of division who might impact program activities; 
• Develops, implements and manages training programs for assigned staff consisting of on-the-job training, in-house training programs and form education; 
• Resolves disciplinary issues; 
• Performs related duties as required.

• Considerable knowledge of
  • and ability to apply relevant state and federal laws, statutes and regulations; 
  • financial and business operations, statutory accounting and financial procedures related to insurers, hospital and medical service corporations and health maintenance organizations; 
  • health benefits, case management, utilization review and managed care appeal process; 
  • consumer issues in area of health insurance or managed care; 
  • program development and management in areas of health care, health insurance and customer service; 
• Knowledge of
  • and ability to apply management principles and techniques; 
  • business operations of health care providers and health maintenance organizations; 
  • methods used by other state insurance regulatory bodies; 
  • in-service training and instructional methods;
  • economic and research techniques; 
  • state legislative process; 
• Considerable
  • interpersonal skills; 
  • oral and written communication skills; 
• Ability to interpret proposed legislation and determine application and impact on program.

Eight (8) years of experience in health care advocacy, insurance regulation, the insurance industry, nursing, managed care and/or health care administration.

At least two (2) years of the General Experience must have been in a lead capacity or consultative capacity.

• College training may be substituted for the General Experience on the basis of fifteen (15) semester hours equaling 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 advocacy, health care management, nursing, business administration, insurance, finance, public administration, public health or other related areas may be substituted for one (1) additional year of the General Experience.

• Incumbents in this class may be required to travel.
• Incumbents in this class may be required to possess and retain a valid Motor Vehicle operator's license.