State of Maryland

A Medical Care Program Supervisor is the supervisory level of work developing recommendations and implementing medical care program policies and regulations that impact one or more specific Medical Care Programs for the Maryland Department of Health (MDH).  Employees in this classification supervise a section of lower-level Medical Care Program Specialists, health care professionals and other staff.

Employees in this classification receive general supervision from a Medical Care Program Manager or other designated administrator.

Positions in this classification are evaluated by using the classification job evaluation methodology.  The use of this method involves comparing the assigned duties and responsibilities of a position to the job criteria found in the Nature of Work and Examples of Work sections of the class specification.

The Medical Care Program Supervisor is differentiated from a Medical Care Program Specialist II in that the Medical Care Program Supervisor has supervisory responsibility for lower-level Medical Care Program Specialists, health care professionals and other staff while the Medical Care Program Specialist II performs the full range of duties and responsibilities under general supervision.  The Medical Care Program Supervisor is differentiated from Medical Care Program Managers I-III in that Medical Care Program Managers has supervisory responsibility for Medical Care Program Supervisors and are responsible for supervising two or more sections.

Supervises lower-level Medical Care Program Specialists, health care professionals and other staff;

Plans, coordinates, supervises and evaluates the activities of an assigned section within a Medical Care Program Division;

Plans, directs and completes studies and surveys and prepares reports related to specific Medical Care Program services;

Makes recommendations for the use or control of existing Medical Assistance Program services;

Acts as a liaison with public and private agencies regarding Medical Assistance Program services;

Directs or provides consultation and assistance to public and private providers of service to Medical Assistance Program recipients;

Develops training programs concerning program services such as provider billing or eligibility determinations;

Collaborates with State and federal agencies regarding program compliance;

Develops Medical Care Program regulations and make changes to existing regulations;

Oversees the review and control of the use of services provided to Medical Care Program recipients and refers appropriate cases for investigation;

Develops procedures, forms and interpretive materials used to determine Medical Assistance Program eligibility;

Develops programs for cost avoidance when payments for Medical Care Program services are available from other sources;

Monitors the evaluation of requests for preauthorization for Medical Care Program services;

Develops and maintains enrolled provider files and recipient card production and distribution;

Participates in the development and preparation of the budget for the assigned program;

Attends seminars and conferences on issues pertinent to the program area;

Oversees processes such as batching, storing and retrieving files;

Performs other related duties.

Knowledge of Medical Care Program eligibility, criteria, policies and regulations;

Knowledge of utilization review and control techniques;

Knowledge of Medical Care Program claims adjudication operations, audit principles, recipient needs, management information systems and third-party liability issues;

Knowledge of individual providers, agencies, facilities and community organizations providing services to Medical Care Program recipients;

Ability to conduct and participate in research programs, studies and surveys;

Ability to present concepts and plans to public and professional groups;

Ability to prepare reports outlining program accomplishments;

Ability to plan and supervise the work of Medical Care Program Specialists and others;

Ability to establish and maintain working relationships with medical and allied professionals, volunteer and civic organizations, individuals and staff;

Ability to communicate effectively with employees, volunteers, supervisors, volunteer and civic organizations and the general public.

Experience: Eight years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs. One year of this experience must have been in a medical assistance program.

Notes:

1. Candidates may substitute the possession of a Bachelor's degree from an accredited college or university and four years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs for the required experience.  One year of this experience must have been in a medical assistance program.

2. Candidates may substitute the possession of a Master’s degree from an accredited college or university in the related field of work for the required experience.

3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Operational Analysis classifications or Health Services Management specialty codes in the health-related field of work on a year-for-year basis for the required experience.

Class specifications are broad descriptions covering groups of positions used by various State departments and agencies.  Position descriptions maintained by the using department or agency specifically address the essential job functions of each position.

This is a Skilled Service classification in the State Personnel Management System.  All positions in this classification are Skilled Service positions.  Some positions in Skilled Service classifications may be designated Special Appointment in accordance with the State Personnel and Pensions Article, Section 6-405, Annotated Code of Maryland.

This classification is not assigned to a bargaining unit as indicated by the designation of S (supervisor), M (manager), T (agency head), U (Board or Commission member), W (student), X (Used by agency or excluded by executive order), or Z (confidential).  As provided by State Personnel and Pensions Article, Section 3-102, special appointment, temporary, contractual, supervisory, managerial and confidential employees are excluded from collective bargaining.  Additionally, certain executive branch agencies are exempt from collective bargaining and therefore, all positions in those agencies are excluded from collective bargaining.