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MEDICAL CARE PROGRAM SUPERVISOR

ELIGIBILITY DETERMINATION SUPERVISOR

Recruitment #25-000931-0005

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GRADE

17

LOCATION OF POSITION

MDH - Eligibility Determination Division
6 St. Paul Street
Baltimore, MD 21202

Main Purpose of Job

The primary function of the Eligibility Determination Specialist Supervisor (Medical Care Program Supervisor) is to lead, manage and monitor the Problem Resolution Unit (PRU). The PRU is responsible for reviewing and resolving escalated cases, ensuring appropriate representation before Administrative Law Judges, appropriate preparation for administrative hearings, and quality assurance reviews of tasks completed by Eligibility Determination Associates.

Successful management and monitoring of the Unit include developing, analyzing, implementing, and applying federal and State regulations and policies, training materials, and standard operating protocols. The Supervisor must be able to develop and maintain electronic tools to track and assess data to monitor key performance indicators to identify workflow efficiencies and gaps to ensure compliance with federal and State regulations, improve operational performance, and conduit reviews of tasks completed by Eligibility Determination Division team members including Eligibility Determination Associates, Lead Workers, Supervisors, and Specialist (Medical Care Program Associates I and/or II, Medical Care Associate Lead Worker, Medical Care Associate Supervisors, and Medical Care Program Specialist I and/or II) and overall performance.

The Eligibility Determination Specialist Supervisor must continuously be knowledgeable of federal and State Medicaid regulations and policies. This knowledge is imperative to the Supervisor’s success to analyze eligibility determinations to ensure regulations and policies were interpreted and applied accurately and timely. The Supervisor’s quality assurance assessment tool must measure accuracy of analyzed and authenticated verifications including but not limited to, applications, technical verifications, income, asset, resource, financial verifications, and clearances in the appropriate federal and state data systems for compliance when rendering eligibility decisions. This knowledge is also required when the Supervisor is training team members, responding to internal and external inquiries, drafting Standard Operating Protocols (SOP), providing technical assistance, researching, and resolving provider payment concerns, and serving as the Department’s expert witness at administrative appeals hearings or subject matter expert during systems development sessions. 

The Supervisor may participate in the administrative appeal hearing process by conducting pre-hearing conferences, providing expert testimony based on accurate analysis of federal and State regulations and policies at administrative appeals hearings and ensuring compliance to the Administrative Law Judge’s dispositions. 

At all times, this position will provide customer service to both internal and external customers that meet or exceed the standards by EDD, the Department, and or State. 

Travel throughout the state is required. This position must maintain a valid driver’s license and meet the Department’s requirements to drive a state vehicle or have their own transportation when needed.

MINIMUM QUALIFICATIONS

Experience: Eight years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs. One year of this experience must have been in a medical assistance program.

Notes:

1. Candidates may substitute the possession of a Bachelor's degree from an accredited college or university and four years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs for the required experience.  One year of this experience must have been in a medical assistance program.

2. Candidates may substitute the possession of a Master’s degree from an accredited college or university in the related field of work for the required experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Operational Analysis classifications or Health Services Management specialty codes in the health-related field of work on a year-for-year basis for the required experience.

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should possess the following:
  • Experience interpreting medical assistance policies, regulations and procedures.  
  • Experience working with consumers and other stakeholders resolving concerns. 
  • Experience preparing cases including preparing concise hearing summaries and presenting. 
  • Experience presenting information and evidence in a concise manner to uphold the Department's position based on regulations and policies before an Administrative Law Judge or other entity. 
  • Experience meeting established deadlines. 
  • Experience managing and training staff.

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator’s license valid in the State of Maryland.

SELECTION PROCESS

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview). 

Complete applications must be submitted by the closing date. Information submitted after this date will not be added. 

Incorrect application forms will not be accepted. Resumes will not be accepted in lieu of a completed application.

Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201. Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

If additional information is required, the preferred method is to upload.  If you are unable to upload, please fax the requested information to 410-333-5689. Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.

For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410-767-1251.

If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 or Application.Help@maryland.gov. 

Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258.

We thank our Veterans for their service to our country.

People with disabilities and bilingual candidates are encouraged to apply.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.

MDHMedCare



Click on a link below to apply for this position:

Fill out the Supplemental Questionnaire and Application NOW using the Internet. Apply Online
View and print the Supplemental Questionnaire. This recruitment requires completion of a supplemental questionnaire. You may view and print the supplemental questionnaire here.
Apply via Paper Application. You may also download and complete the Paper Application here.

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