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MEDICAL CARE PROGRAM BENEFITS MANAGER (#PJ8 )

Apply as a Transfer/Demotion applicant

$46.27-$61.49 hourly / $8,020.00-$10,658.00 monthly / $96,241.60-$127,899.20 yearly


Definition

Under general direction, to plan, organize, direct and manage activities which may include finance and administrative activities in health benefit programs across the Health Services Agency, and to do other work as required.

Distinguishing Characteristics

Under the policy direction of the Health Services Agency Director, this class coordinates and oversees multiple health benefit programs, administrative and financial tasks in mental health and substance abuse, and supervises staff in service delivery and execution of administrative tasks. The position develops, implements, monitors, and evaluates health benefit programs and mental health administration to achieve defined fiscal and programmatic objectives. Assignments also include developing and monitoring budgets, grants, audits and contracts. This class is distinguished from the Senior Health Services Manager class in that its focus is on working extensively with health insurance programs and mental health administration and having knowledge of eligibility, billing, and cost reports and claims linked to MediCal, Medicare, targeted case management, and third party insurances.

Typical Tasks

Plans, organizes, directs, administers and evaluates assigned health and mental health benefit programs and finances. Participates with Agency Director and Division Directors in the planning, implementation, and ongoing evaluation of the quality and effectiveness of client benefit services; develops and manages budgets, contracts and financial reporting for mental health and substance abuse services and health benefits; reviews staffing and resource needs; acts as liaison for the health benefit program within the Health Services Agency, the Human Resources Agency, federal, state, and local government; participates in inter- and intra-agency meetings and organizations to provide necessary health benefit and medical services to Agency clients; prepares proposals for grants and funding sources to support and enhance health and medical benefits for Health Services Agency clients, and clients served by community agencies, schools, and community clinics; conducts staff meetings to coordinate health benefit program resources, enrollment and retention procedures; conducts long and short range planning for health benefits that include implementation of major new initiatives. Supervises; assigns and reviews work, resolves problems and interprets program policy; conducts performance evaluations; makes budget and staffing recommendations; collects statistical data on health benefit program activities and prepares written reports, program summaries and correspondence as requested.

Employment Standards

Knowledge:

  • Working knowledge of theories, principles, goals, and objectives of health benefit programs and administration; 
  • Working knowledge of principles, practices, funding sources, laws and regulations, and administrative requirements in health, mental health and substance abuse programs; 
  • Working knowledge of principles, practices, and techniques of health and mental health benefit program planning, development, and evaluation; 
  • Working knowledge of principles and procedures of budget preparation and monitoring, including budgets involving grants, contracted services, and state and federal funding; 
  • Working knowledge of contract administration principles and practices; 
  • Working knowledge of cost reports and audit procedures; 
  • Some knowledge of governmental medical care systems, regulations and procedures governing health benefit programs and services; 
  • Some knowledge of information systems and software to support health program functions;  
  • Some knowledge of public assistance and social service agencies and medical or welfare eligibility systems; 
  • Some knowledge of public relations; 
  • Some knowledge of legal and billing issues associated with health benefits programs and insurance;
  • Some knowledge of data and administrative systems used in health.

Ability to:

  • Plan, organize, coordinate, and evaluate complex health and mental health program, fiscal and administrative activities and diverse staff; 
  • Train, supervise, and evaluate the work of staff; 
  • Develop and monitor short and long range budget plans that accurately reflect health benefit program needs; 
  • Identify the need for and develop proposed changes in current program practices, policies, and procedures; 
  • Build and sustain coalitions to promote health, mental health and substance abuse resources in the community; 
  • Exercise sound judgment in solving administrative and technical problems within program guidelines;  
  • Establish and maintain effective public relations with health benefit program clients and contract service providers;  
  • Collect and analyze statistical data;  
  • Direct cost reports, claims, and audits for mental health and substance abuse; 
  • Conduct public relations on behalf of the Health Services Agency on issues related to mental health and substance abuse finance and administration, as well as health insurance, enrollment, and policy;
  • Prepare written reports and correspondence.

Training and Experience: Any combination of training and experience that would provide the required knowledge and abilities is qualifying.

Typical ways to acquire the knowledge and abilities would be:

  • Possession of a Bachelor’s Degree from an accredited college or university in health care administration, a public health field, health science, or in a management field such as public or business administration,

AND

  • Six years of experience in a health care or medical social services organization performing supervision, program coordination, or program management.

Special Requirements:

  • Possession and maintenance of a valid California Class C driver’s license or the ability to provide suitable transportation approved by the appointing authority; 
  • Physical and mental capability to performing the position’s essential functions as summarized in this specification’s Typical Tasks section.

Miscellaneous

Bargaining Unit: 11
EEOC Job Category: 02
Occupational Grouping: 57
Workers' Compensation Code: 0290
Analyst: GLD
Revised Date (s): 06/04

CLASS: PJ8; EST: 2/1/1984; REV: 11/1/2004;