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#21-000934-0001
Supplemental Questionnaire

Last Name
First Name

 

**Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**

 


1

Do you possess four (4) years experience supervising employees in developing and applying policies and regulations or directing a program or project in a medical care program?

Yes No
2

Describe your experience supervising employees in developing and applying policies and regulations or directing a program or project in a medical care program.  If you do not possess this experience, please indicate N/A.

3

If you do not possess a bachelor's degree, then additional administrative or professional work experience developing or applying policies and regulations in a medical care, health insurance, federal or State entitlement program or in a health or human service program (in addition to the required experience) may be substituted on a year-for-year basis for the required education.

Please describe relevant experience (as noted above) in the field below.  Please note the information must be linked to the work history of your application, including employer information, hours worked per week and dates of employment.  Otherwise, you will not receive full credit for the education requirement.

4

Describe your working knowledge of Medicaid mandatory managed care enrollment process and function.

This experience must also be included on your application. Please be sure to include name of employer, job title, dates of employment and hours worked per week. If you do not possess experience in this area, indicate N/A.


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