The State of Connecticut, Dept. of Social Services (DSS) is recruiting for a Director of Medical Administration within the Department of Health Services in our Integrated Care Unit. The position is based out of the DSS Central Office, located at 55 Farmington Avenue, Hartford, CT. This is a full time, 40 hour per week hybrid opportunity. The schedule is Monday through Friday. The first shift hours are 8:00 am to 4:30 pm.
About us: Our mission is that we, along with our partners, provide person-centered services to enhance the well-being of individuals, families and communities.
HUSKY is the integrated Medicaid and CHIP health insurance program that covers approximately one-in-four Connecticut residents. Unlike most states, Connecticut does not contract with capitated managed care organizations. Instead, like most large employers, the program is self-insured and uses a managed fee-for-service approach. The state contracts with organizations that provide physical health, behavioral health, dental, transportation, and pharmacy coverage. The Director of Integrated Care oversees these contracts, managing a contracting budget of more than $3b per year. The role is critical for ensuring that these organizations serve the interest of HUSKY members and the state.
This role leads a diverse staff that manage five major components of the Medicaid program; ensures the components are aligned and are fully integrated to better meet the needs of Medicaid members. All these component parts represent a whole person perspective and as such, this position represents an opportunity to break down healthcare silos and promote whole person health that encompasses medical, behavioral health, pharmacy, oral health and transportation to those services. All of these component parts, if working in an integrated manner, promote whole person wellness.
The Integrated Care Unit oversees the following contracts and/or services:
- Medical Administrative Services Organization (ASO) contract
- Behavioral health ASO contract and behavioral health policy
- Dental ASO contract and all oral health policy
- Non-emergency medical transportation (NEMT) broker contract and NEMT policy
- Pharmacy management and policy
In addition, this role supervises five managers, each of which have responsibilities over the health services and policy categories referenced above and leads the innovation of contracts that help manage the Medicaid program and achieve better outcomes for our members.
Our ideal candidate will possess:
- Exceptional organization skills and a proven track record of performance-based contracting.
- Exceptional management skills due to the diverse nature of the staff skills and the diverse nature of the contracts.
- A clinical background in nursing, clinical social work or psychology
We offer competitive benefits including health and dental insurance, a retirement plan, group life insurance, and other supplemental benefits. Paid time off is also offered, including 13 paid holidays per calendar year, in addition to vacation, sick and personal leave accruals. We encourage a healthy work/life balance to all employees.
We hope you take this opportunity to make an impact!
The Department of Social Services participates in the E-Verify system, which is a web-based system that allows enrolled employers to confirm the eligibility of their employees to work in the United States.
Interviews will be limited to candidates whose experience most closely meets the preferred qualifications, so please ensure that your application is complete and details your experience as outlined in this job posting. Please note: You will be unable to make revisions once you submit your application into the JobAps system.
The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.
The minimum experience and training requirements must be met by the close date on the job opening, unless otherwise specified.
In order to comply with Public Act 21-69, the State of Connecticut is no longer asking for resumes during the initial application process.
IMPORTANT NEXT STEP INFORMATION FOR AFTER YOU APPLY:
Although applicants will receive correspondence via email, as a backup they are also encouraged to sign on to their Personal Status Board on a daily basis to monitor their status, view all emailed notices and complete tasks required in the recruitment process.
This posting may require completion of additional referral questions (RQs). You can access these RQs via an email that will be sent to you after the posting's closing date or by visiting your JobAps Personal Status Board (Certification Questionnaires section). Your responses to these RQs must be submitted by the question's expiration date. Please regularly check your email and JobAps Personal Status Board for notifications. Please check your SPAM and/or Junk folders on a daily basis in the event an email provider places auto-notification emails in a user's spam.
At any point during the recruitment process, applicants may be required to submit additional documentation which support their qualification(s) for this position. These documents may include: a cover letter, resume, performance reviews, attendance records, supervisory references, licensure, etc., at the discretion of the hiring agency. Applicants must meet the minimum qualifications as indicated to apply for this position.
All application materials must be received by the recruiting agency by the time specified on the job opening for the position for which you are applying. Late applications may not be submitted and will not be considered. Exceptions are rare and limited to documented events that incapacitate a candidate during the entire duration of the job posting time period. It is the candidate’s obligation and responsibility to request an exception and provide a legally recognized justification to accommodate such exception. Requests should be made to DAS.SHRM@ct.gov.
If you have any questions pertaining to this recruitment please contact Jasmyn Raymond at Jasmyn.Raymond@ct.gov and reference the recruitment number.
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.
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.
Preference will be given to candidates with the following experience:
- Managing high performing and results oriented teams in a healthcare field.
- In performance based contract management on high value contracts.
- Developing, implementing and evolving Diversity, Equity and Inclusion initiatives.
- Supervising managers with a results based orientation.
AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER
The State of Connecticut is an equal opportunity/affirmative action employer and strongly encourages the applications of women, minorities, and persons with disabilities.