Eligibility Program Manager 1

Open to the public.

Agency New York State Department of Health
Title Eligibility Program Manager 1
Salary $81,856
Salary Grade 27
Negotiating Unit PEF05
Location NYS Department of Health- Office of Health Insurance Programs Division of Eligibility and Marketplace Integration Albany, New York
Minimum Qualifications Eight (8) years professional level experience as described below, two (2) years of which must have included second-level supervision. A bachelor's degree may substitute for four (4) years of general experience. Appropriate professional experience is described as performing one or more of the following six activities,** in a program with one or more of the following functions*: *Functions: 1. Reimburses for health care services; 2. Provides health care services; 3. Works with social services program areas; 4. Determines eligibility for a consumer assisted program; 5. Provides health care regulatory oversight; or 6. Performs quality assurance and interpretation/application of standards of health care. **Activities: a) Overseeing and directing staff in determining eligibility for a health care program or a consumer assisted program in which financial eligibility criteria must be met; b) Overseeing and directing staff in performing utilization review, including pre-payment or post-payment review of requested health care services, prior approval or authorization activities, adjudication or pricing of claims for payment, or analysis of patterns of health care; c) Overseeing and directing staff in developing mechanisms for the reimbursement and financing of health care services, including rate-setting or approval, capitation reimbursement methodologies, fee schedule development, coding constructs for medical goods and services, or application and processing of reimbursement methodologies; d) Administering and overseeing staff responsible for day-to-day program operations for budgeting, staffing, planning, or ensuring compliance with laws, rules, regulations, and policies; e) Overseeing and directing staff in inspecting, assessing, or monitoring health care programs or facilities for certification, licensure or adherence to laws, rules, regulations, and policies; f) Overseeing and directing staff in planning, designing, developing, researching, or evaluating proposals to establish or refine programs, with responsibility for interpreting legislation or regulations, defining and describing target populations and local demographics, grant and proposal writing, or developing, reviewing and evaluating contracts.
Preferred Qualifications The preferred candidate will have expertise in public health insurance programs; especially with eligibility and coverage policy issues; expertise with New York's Medicaid, CHPlus, and FHPlus eligibility and coverage policy issues; experience with Medicaid policy and procedures related to the Medicare Savings Program, Family Planning Benefit Program and Third Party Health Insurance; strong written and verbal communication, interpersonal, and organizational skills; experience prioritizing goals, implementing programs, and allocating resources; expertise in public health insurance programs, especially with eligibility and coverage policy issues; ability to function independently and as part of a team; and ability to work well under pressure and meet deadlines.
Responsibilities The Division of Eligibility and Marketplace Integration is looking to fill a position that will focus on assuming some of the functions currently performed by the Local Departments of Social Services (LDSS) for the Medicaid program. Specific duties and responsibilities include, but are not limited to, the following: oversee operations within a unit, assist in the determination of eligibility for public health insurance programs; monitor the quantity and quality of work completed by staff; identify and resolve inaccuracies; establish necessary criteria for determining unit performance and oversee personnel activities including, but not limited to training, performance evaluations and discipline; conduct reviews of program effectiveness and prepare written reports of the results of program reviews; implement efficiency measures as well as cost/benefit analysis; establish and maintain effective working relationships with other divisions of the agency as well as other county agencies and community groups; maintain records and reports in accordance with federal and state requirements; analyze and communicate to staff the impact of a variety of Federal and State laws, codes, policies and procedures relating to eligibility for public health insurance programs; plan and conduct staff training in response to identified needs or when new or revised regulations and procedures are introduced; provide written material, orally explain and answer questions; prepare written correspondence in response to questions from consumers, legislative staff and other interested parties; draft papers to explain problems or deficiencies and solutions needed for more complex applications to managers of the programs; may appear at judicial or administrative proceedings when required to interpret decision.
Conditions of Employment Provisional, Full-Time
Application Procedure Submit resume to Human Resources Management Group, RD/EPM1/OPEN, Room 2217, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012, or by email to resume@health.state.ny.us, or by fax to (518)473-3395 with a subject line RD/EPM1/OPEN. Resume must clearly state how you meet the minimum qualifications as stated above. Vague or missing information could result in your being disqualified for consideration for these positions. Applications will be accepted until the positions are filled.
Submit resumes by Until position is filled.

An affirmative action/equal opportunity employer. Women, minorities and people with disabilities are encouraged to apply.

Item # EPM1 OPEN VARIOUS
Issued January 31, 2014