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MEDICAL CARE PROGRAM MANAGER III

Division Chief, HealthChoice Provider Network Mgmt.

Recruitment #21-000934-0003

GRADE

19

LOCATION OF POSITION

MDH, Medical Benefits Management Administration, 201 W. Preston Street, Baltimore, MD

Main Purpose of Job

This position will assist the Deputy Director by coordinating processes necessary for the operation of the Program across the Department and by serving as a technical advisor for the Managed Care Organizations (MCOs) for all matters related to network management, including MCO network adequacy. This position will also be responsible for the daily supervision of the Division of HealthChoice Provider Network Management, including coordinating and approving leave and staff coverage; hiring and evaluating employee performance; and implementing corrective action. The Division of HealthChoice Provider Network Management receives and resolves HealthChoice billing complaints from providers and enrollees. The Division also assists with new organizations applying to join the HealthChoice program and other HealthChoice provider inquiries. This position will review and develop policy; review and implement procedures; and interpret current managed care policy and procedures for MCOs and other internal and external stakeholders. This position will also plan, organize, implement and evaluate and coordinate managed care compliance activities. This position will plan, organize, and supervise the Division as it handles projects such as MCO provider terminations, including coordination with other MDH offices and monitoring MCO enrollment changes as a result of the termination. This position will oversee MCO network consolidation and network capacity projects, along with the monitoring and analysis of MCO-submitted claims monitoring reports. This position will track all MCO network and provider related reports and CMS requirements to advise the Deputy Director when departmental action is required. This position may coordinate with other division chiefs, ASOs, and vendors performing Medicaid functions which impact the HealthChoice Program to assure adherence to managed care policy as it relates to network management. This position also assures that the MCO provider network and benefit information is accurately uploaded to the Maryland Health Connection for external stakeholders. This position may perform other special projects as assigned.

MINIMUM QUALIFICATIONS

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

Experience: Four 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. 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 may be substituted 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.

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should have experience in medical billing, policy recommendations and data analysis.

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Employees in these classifications may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator’s license valid in the State of Maryland.

SELECTION PROCESS

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview). 

Complete applications must be submitted by the closing date. Information submitted after this date will not be added. 

Incorrect application forms will not be accepted. Resumes will not be accepted in lieu of a completed application.

Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201. Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

If additional information is required, the preferred method is to upload.  If you are unable to upload, please fax the requested information to 410-333-5689. Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.

For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410-767-1251.

If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 or Application.Help@maryland.gov

Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258.

We thank our Veterans for their service to our country.

People with disabilities and bilingual candidates are encouraged to apply.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.