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MEDICAL CARE PROGRAM SUPERVISOR

ELIGIBILITY DETERMINATION MANAGER

Recruitment #24-000931-0002

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Introduction

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 Manager (Medical Care Program Supervisor) is to serve as the primary contact liaison for the five EDD, Non-MAGI units ensuring Maryland citizens who seek solutions to issues with the delivery of services or escalated customer service concerns are addressed timely and accurately.

The Manager 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 monitor Eligibility Determination Supervisors (Medical Care Program Associate Supervisors), Lead Worker (Medical Care Program Associate Lead) and Specialist (Medical Care Program Specialist I and/or II and Medical Care Program Associates I and/or II) overall performance. The Manager will be responsible for reporting this information.

The Manager will also lead, manage, and monitor the eligibility determination and special projects workflows for Non-MAGI and/or MAGI Medicaid Unit(s) in a cohesive and ethical manner as needed. Successful management and monitoring of the Unit(s) includes developing, analyzing, implementing, and applying federal and State regulations and policies, training materials, and standard operating protocols. 

The Eligibility Determination Manager must continuously be knowledgeable of federal and State Medicaid regulations and policies to successfully conduct quality assurance assessments, respond to audit requests and assist with appeals hearings when needed. The Manager’s quality assurance assessment must ensure the Eligibility Determination Supervisors, Lead Workers, Specialist I and/or II, and/or Associates I and/or II accurately 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 accuracy and timeliness compliance when rendering eligibility decisions. This knowledge is also required when the Manager is training Eligibility Determination Supervisors, Lead Workers, Specialist I and/or II and or Associates I and/or II or other internal customers, drafting Standard Operating Protocols (SOP), providing technical assistance, researching, and resolving provider payment concerns, serving as the Department’s expert witness at administrative appeals hearings or subject matter expert during systems development sessions. 

The Manager 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. 

Additionally, the Supervisor must be able to communicate concisely due to their contact with applicants, recipients, authorized representatives, or representatives from federal and State government entities to address concerns.

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.

Candidate will undergo extensive criminal background checks provided by the Department of Public Safety and Correctional Services.  Candidate must have a valid driver's license.

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 managing resources i.e. assigning, monitoring, or conducting quality assurance reviews of assigned tasks 
  • Experience leading or supervising a team to meet the organization's goals 
  • Experience leading meetings, organizing workflows and implementing policies or procedures 
  • Experience using Excel or other software to generate reports 
  • Experience assisting customers from a diverse background with resolving concerns

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.




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