The Director of Medical Services reports to the Division Director and in collaboration with the Office of the Secretary on health reform. The incumbent in this position will lead statewide clinical innovation efforts in Medicaid for the state and will collaborate with the Medicaid Director on key strategic efforts to move toward value based payment reform. Additionally, the Director is responsible for the oversight of clinical guidelines, procedures, standards and controls of the Delaware Medicaid Program.
Applicants who do not possess the preferred qualification will still be eligible to compete for this position if job requirements are met.
- Experience in leadership at the national level in policy and legislative affairs.
- Experience in leadership and the ability to work with physician organizations and clinical audiences.
- Clinical experience in Medicaid populations and ability to make clinical decisions.
- Experience in projecting, assessing, evaluating and measuring effective service delivery to meet goals and objectives of the Medicaid program.
- Experience in establishing and maintaining effective working relationships with all stakeholders in the Medicaid program, including interest groups, health care providers, community members, national organizations and professional groups.
- Experience in Grant writing and policy/data analysis.
- Experience supervising a team of both clinical and non-clinical staff.
- Experience exercising judgment and discretion in applying and interpreting policies, procedures, regulations, standards and protocols.
- Knowledge of value based payment, population health, and social determinants of health.
- Knowledge of specific federal Medicaid rules, policies, procedures, and regulations to meet matching requirements.
- Knowledge and/or experience with diseases, treatments, diagnostics and decision-making, along with finance, grants, contracts, budgeting and accounting for medical decision-making.
- Knowledge of community, private, public, state and National health resources and program goals, objectives and funding sources.
- Knowledge of State legislative initiatives impacting health policy and delivery systems.
Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.
- Allocates 100 percent of his/her time to Medicaid-related issues. • Plays a pivotal role in clinical affairs, policy and strategic endeavors within Medicaid.
- Represents the department and leverage relationships in direct engagement with Medicaid's Managed Care Medical Directors, and collaborates and consults with the Medicaid Director and Deputy as well as program directors and managers across DHSS.
- Guides and reviews program evaluation and implementation plans while coordinating across state agencies and private organizations providing similar services.
- Using models from state-led innovations across the county, works collaboratively within DMMA, across DHSS and with the Office of the Secretary to formulate payment policy, delivery system innovations and coordinates the activities for various services within the program.
- Along with the Delaware Health Care Commission, and stakeholder groups, works with clinical and community based initiatives to have population based metrics of quality and data-driven performance indicators.
- Lead the development and implementation of medical policy coverage decisions for Medicaid recipients. Works with the medical directors of the agencies managed care organizations to resolve recipient issues. Develops quality measures and outcome measures to support the states' purchasing efforts. Represents the State of Delaware at the Office of Administrative Hearings and represents the Program at internal and external meetings.
- Reviews and approves all applicants for the Disabled Children’s Program.
- Represents DMMA on local, state and national review boards, committees and conferences at the direction of the Division Director. Provides expertise on medical policies and procedures for staff in DMMA and our sister divisions. Analyzes data and makes recommendations for medical policy changes related to Medicaid, and keeps abreast of legislative and technical developments related to program services.
Please attach a resume with your online application or use the resume tab in DEL to provide a detailed description of how your education, training and/or experience meets each job requirement and preferential requirements including employer, experience/responsibilities and dates (month/year) of employment/training. Applicants must have education, training and/or experience demonstrating competence in each of the following:
- Must be a board-certified medical doctor and hold a current Delaware license.
The application and resume are evaluated based upon a rating of your education, training and experience as they relate to the job requirements of the position. It is essential that you provide complete and accurate information on your application and resume to include dates of employment, job title and job duties. For education and training, list name of educational provider, training course titles and summary of course content. Narrative information supplied in response to the questions must be supported by the information supplied on the application including your employment, education and training history as it relates to the job requirements.
Once you have submitted your application on-line, all future correspondence related to your application will be sent via email. Please keep your contact information current. You may also view all correspondence sent to you by the State of Delaware in the “My Applications” tab at www.delawarestatejobs.com.
Accommodations are available for applicants with disabilities in all phases of the application and employment process. To request an auxiliary aid or service please call (302) 739-5458. TDD users should call the Delaware Relay Service Number 1-800-232-5460 for assistance. The State of Delaware – An Equal Opportunity and Affirmative Action Employer.