drjobs Medical Care Program Manager III

Medical Care Program Manager III

Employer Active

1 Vacancy
drjobs

Job Alert

You will be updated with latest job alerts via email
Valid email field required
Send jobs
Send me jobs like this
drjobs

Job Alert

You will be updated with latest job alerts via email

Valid email field required
Send jobs
Job Location drjobs

Ore, TX - USA

Monthly Salary drjobs

Not Disclosed

drjobs

Salary Not Disclosed

Vacancy

1 Vacancy

Job Description

Introduction

GRADE

20

LOCATION OF POSITION

MDH Office of Medical Benefits Management Managed Care
201 W. Preston Street
Baltimore MD 21201

Main Purpose of Job

The Division Chief of HealthChoice Provider Network Management assists the Deputy Director of Managed Care by coordinating processes necessary for the operation of the Maryland HealthChoice Program (Marylands statewide Medicaid Managed Care Program) across the Maryland Department of Health and by serving as a technical advisor for the Managed Care Organizations (MCOs) for all matters related to network management and managed care reimbursement including MCO network adequacy. This position is also responsible for the daily supervision of the Division of HealthChoice Provider Network Management including monitoring anddirecting unit operations; coordinating and approving leave and staff coverage; hiring andevaluating employee performance; and implementing corrective action.

The Division of HealthChoice Provider Network Management receives and resolvesHealthChoice billing complaints from providers and enrollees. The Division also assists withnew managed care organizations applying to join the HealthChoice program managed carereimbursement questions and policy and HealthChoice provider inquiries. This positionplans organizes and supervises the Division as it handles projects such as MCO providerterminations service area openings and closures and enrollment freezes includingcoordination with other MDH offices and monitoring MCO enrollment changes because ofthese actions.

This position oversees MCO network consolidation and network capacity projects alongwith the monitoring and analysis of MCO submitted claims monitoring reports. This positiontracks all MCO network and provider related reports in addition to changes in CMSrequirements to advise the Deputy Director when departmental action is required. Thisposition may coordinate with other division chiefs feeforservice Medicaid offices andadministrations administrative services organizations and vendors performing Medicaidfunctions which impact the HealthChoice Program to assure adherence to managed carepolicy as it relates to network contracting management and reimbursement. This positionmay perform other special projects as assigned including but not limited to MCOreimbursement audits and claims coordination projects.

MINIMUM QUALIFICATIONS

Education:A Bachelors degree from an accredited college or university.

Experience: Fouryears of experience supervising employees in developing and applying policies and regulations or directing a program or project in a medical care program.

Notes:

1. Candidates may substitute additional administrative or professional experience developing or applying policies and regulations in medical care health insurance federal or State entitlement programs or in a health or human service programon a yearforyear basis for the required education.

2.Candidates may substitute U.S. Armed Forces militaryservice experience at a rank of Corporal/Petty Officer or higher as a commissioned officer in Health Care Administration classifications or Health Services Management specialty codes in the healthrelated field ofwork on a yearforyear basis for the required experience and education.

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should possess the following:
  • Experience with Medicaid Managed Care
  • Experience with Health Insurance Provider Networks and Network Contracting
  • Experience with Claim Reimbursement principles and Customer Service principles

LICENSES REGISTRATIONS AND CERTIFICATIONS

Employees in these classifications may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operators 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 thecertified 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 onlinethe paper application (and supplemental questionnaire) may be submitted to MDH Recruitment and Selection Division 201 W. Preston St. Room 114B 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 informationto.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 theMDH Recruitment and Selection Division at.

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 ator.

Appropriate accommodations for individuals with disabilities are available upon request by calling: or MD TTY Relay Service.

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 States diversity.

MDHMedCare


Required Experience:

Manager

Employment Type

Full-Time

About Company

Report This Job
Disclaimer: Drjobpro.com is only a platform that connects job seekers and employers. Applicants are advised to conduct their own independent research into the credentials of the prospective employer.We always make certain that our clients do not endorse any request for money payments, thus we advise against sharing any personal or bank-related information with any third party. If you suspect fraud or malpractice, please contact us via contact us page.