1/16/90 A

This is the second class in the Medicaid Operations Director series for positions that plan and direct a major organizational component within the Department of Medical Assistance Services. Positions in this class are responsible for planning, implementing, managing, organizing and evaluating the most complex organizational component within Medical Assistance Services. This class is distinguished from the Medicaid Operations Director by the Director Senior’s responsibility for planning and directing a more diverse, complicated and higher dollar intensive federally sponsored health care program.

Complexity of Work: Performs work of unusual difficulty in managing, planning, evaluating and implementing a federally sponsored health care program involving manual and automated medical claims processing, provider and recipient relations, provider enrollment, recipient eligibility quality control, hospital utilization review, third party liability, and claims processing control. Positions in this class direct statewide delivery of services performed by a staff of managers, physicians, dentists, nurses, and physical therapists and manage payment authorizations and quality assurance for complex medical institutional and community based care programs. Positions interpret federal and state laws and directive and policy requirements; evaluate and develop division goals and objectives, design diverse work units, budgets, policies and legislative recommendations affecting operations and services.

Supervision Given: Provides direction to unit managers and diverse health care professionals in the management and implementation of Medicaid program components.

Supervision Received: Receives direction from the Medical Assistance Services Deputy Director-Operations who evaluates the work in terms of completion of broad program objectives and effective program implementation.

Scope: Positions manage diverse components of the division’s programs relating to proper delivery and authorization of health care services for Medicaid clients.

Impact of Actions: Managing division operations affect the adequate delivery of appropriate health care services by individual and institutional providers through federal funding. Administrative errors can result in the assessment of significant financial penalties on the agency, loss of federal funding or adversely impact client’s well being.

Personal Contacts: Frequent internal and external contacts are made with federal, state and local officials; legislators; providers; clients; advocacy groups; and others to exchange information, promote understanding of programs, discuss program or service changes and to resolve any conflicts or concerns related to the federally funded program.

Knowledge: Considerable knowledge of program and organizational planning and management methods and procedures; information management, and information management system designs, federal and state laws and regulations related to medical assistance, health care delivery systems, and employee relations management and principles.

Skills: None identified for this class.

Abilities: Demonstrated ability to plan and direct work of subordinate managers, interpret federal and state laws related to medical assistance programs, analyze complex health care issues, direct others in preparing reports on health care issues and legislative or regulatory initiatives, and to conduct formal presentations.

QUALIFICATIONS GUIDE*

Licenses or Certification: None.

Education or Training: Graduation from an accredited college or university with major course work in business, public or health administration, or other related field.

Level and Type of Experience: Considerable 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 revised by the Department of Medical Assistance Services, effective January 1990.