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This class directs a major division of the medical assistance services agency. Positions are responsible for directing the planning, implementation, management, organization and evaluation of major operational components and units of a division.

Complexity of Work: Performs work of unusual difficulty in administering several units engaged in automated and manual claims processing and quality control; the enrollment, certification, training, and resolution of problems of providers; third party liability determination and cost recovery; recipient eligibility, appeals and hearings programs; utilization review; administrative activities related to community based care and pre-admission screening; and supporting automated management information and monitoring systems. Positions interpret federal and state laws and program guidelines to ensure operations and procedures confirm to laws, directives and policy requirements; evaluate and develop division goals and objectives, organization and design of work units, budgets, policies, and legislative recommendations affecting operations and services.

Supervision Given: Provides direction to unit managers in the management of program components. Administrative coordination is exercised over medical consultants.

Supervision Received: Receives direction from the agency director who evaluates the work in terms of completion of broad program objectives and effective program implementation.

Scope: Positions manage several components of division programs relating to the proper delivery of and payment for authorized health care services for clients of the medical assistance program.

Impact of Actions: Decisions on the management of division operations affect the adequate delivery of appropriate health care services by individual and institutional providers. Administrative errors can result in the assessment of significant financial penalties on the agency.

Personal Contacts: Frequent contacts with federal, state and local officials, legislators, provider and client groups and others in order to exchange information, promote understanding of programs and discuss program or services changes.

Knowledge: Comprehensive knowledge of federal and state laws and regulations affecting medical assistance, recipient eligibility and health provider coverage. Considerable knowledge of health care delivery systems and administrative procedures and practices regarding health care payment systems. Comprehensive knowledge of program and organizational planning methods and procedures and of program and organizational management principles, techniques and practices. Considerable knowledge of information management and automated information systems design.

Skills: None identified for this class.

Abilities: Demonstrated ability to plan and concurrently direct the work of a variety of professional or technical work units; interpret federal and state medical assistance laws and regulations; analyze and prepare or direct the analysis and preparation of written reports on complex related issues; prepare, or have others prepare, legislative or regulatory initiatives or amendments; and conduct formal presentations.

QUALIFICATIONS GUIDE*

Licenses or Certification: None.

Education or Training: Graduation from a college or university with major coursework in business, public, or health administration.

Level and Type of Experience: Experience in managing a health care financing program through subordinate supervisors.

An equivalent combination of training and experience indicating possession of the preceding knowledge and abilities may substitute for this education and experience.

This class was created in August of 1987 and replaces the class titles of Medical Social Services Division Director and Medicaid Operations and Provider Services Director.