Eligibility Program Manager 2

Open to the public.

Agency New York State Department of Health
Title Eligibility Program Manager 2
Salary $90,684
Salary Grade 29
Negotiating Unit PEF 05
Location NYS Department of Health- Office of Health Insurance Programs Division of Eligibility and Marketplace Integration, Albany, New York
Minimum Qualifications Nine (9) years professional level experience as described below, three (3) 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, Child Health Plus (CHPlus), and Family Health Plus (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; ability to work well independently and under pressure, and to meet deadlines; and possess strong writing, verbal communication, interpersonal, and analytical skills.
Responsibilities The Division of Eligibility and Marketplace Integration is looking to fill multiple positions that will focus on assuming some of the functions currently performed by the Local Departments of Social Services (LDSS) for the Medicaid program. These positions will help ensure that the process of determining Medicaid, FHPlus and CHPlus eligibility is efficiently and effectively transitioned from LDSS and the participating CHPlus health plans to a centralized processing unit. Specific duties and responsibilities include, but are not limited to, the following: supervise and direct subordinate staff and oversee a significant unit or area; implement and ensure adherence to Federal regulations and State requirements regarding health insurance eligibility; assist in the development and implementation of program policies, procedures and guidelines for eligibility determinations; oversee program review and management evaluation processes; oversee program participation; develop, review and update material used to train local district staff and other entities assigned with determining eligibility and program enrollment; provide information for and direction to health care provider staff and recipients of Medicaid, CHPlus and health insurance programs; interpret State and Federal laws and regulations in order to develop instructions, eligibility policy statements, directives, analysis and other materials; oversee program implementation; and develop policy, review program legislation, comment on bills related to Medicaid for working individuals with disabilities.
Conditions of Employment Provisional, Full-Time
Application Procedure Submit resume to Human Resources Management Group, RD/EPM 2/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/EPM 2/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 # EPM2 OPEN VARIOUS
Issued January 31, 2014