State of Maryland

A Medical Care Program Manager I is the first of three managerial levels of work developing and applying medical assistance policies and regulations for the Maryland Department of Health (MDH).  Employees in this classification plan and coordinate the application of medical assistance policies and regulations for Medical Care Assistance Programs.  Employees in this classification supervise Medical Care Program Supervisors and health care professionals and through them indirectly supervise subordinate staff engaged in developing and applying medical assistance policies and procedures.

Employees in this classification receive managerial supervision from the Director of Medical Care Compliance Administration, the Director of Medical Care Operations Administration, the Director of Medical Care Policy Administration or other designated administrator.

Position allocation within the Medical Care Program Manager classification series is determined on the basis of relative job evaluation among similarly functioning positions.  The job evaluation factors include: qualifications; nature and purpose of personal contacts; nature of recommendations, commitments, decisions, and conclusions; creative thought; responsibility for planning; responsibility for administration; and nature of supervision received.

The Medical Care Program Managers I-III are differentiated from the Medical Care Program Supervisor in that the Medical Care Program Managers are responsible for the supervision of two or more sections and supervise Medical Care Program Supervisors, health care professionals and other staff while the Medical Care Program Supervisor has supervisory responsibility for lower-level Medical Care Program Specialists and is responsible for the supervision of a section of health care professionals, paraprofessionals and clerical employees.

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

Plans, coordinates, organizes, supervises and evaluates a major programmatic unit including two or more sections within the Medical Care Compliance Administration, the Medical Care Operations Administration or Medical Care Policy Administration such as Provider Services, Eligibility Services, Program Development, Claims Adjudication, Utilization Review and Control Components;

Reviews and directs the development of programs, policies, rules, regulations, standards and controls regarding Medical Assistance Program Services;

Makes recommendations concerning new or revised federal or State legislation;

Acts as a liaison with officials of federal, State, private and other agencies regarding Medical Assistance Program Services;

Manages and coordinates contracts for the provision of services to Medical Care Program recipients;

Implements methods to improve productivity;

Testifies in the court systems regarding Medical Care Program issues;

Oversees the preparation of budgets for assigned programs;

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;

Knowledge of the principles, practices and procedures of program planning, business and public administration, public relations, organizational structures, staffing patterns and administrative controls;

Skill in conducting and participating in research programs, studies and surveys;

Skill in presenting concepts and plans to public and professional groups;

Ability to plan and supervise the work of others;

Ability to prepare reports outlining program accomplishments;

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.

Education:   A Bachelor’s degree from an accredited college or university.

Experience: Two years 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 program on a year-for-year basis for the required education.

2. Candidates may substitute U.S. Armed Forces military service 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 health-related field of work on a year-for-year basis for the required experience and education.

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 all positions in those agencies are excluded from collective bargaining.