Careers

Rate Development Director

•  5013200

•  Richmond, Virginia, United States

•  Dept of Med Assistance Svcs

•  Health and Human Services

•  Full-Time (Salaried)

•  Closing at: May 2 2024 at 23:55 EDT
•  Dept of Med Assistance Svcs

Title: Rate Development Director

State Role Title: Gen Admin Manager III

Hiring Range: $150,000 – $164,654

Pay Band: 7

Agency: Dept of Med Assistance Svcs

Location: Dept of Medical Asst Services

Agency Website: www.dmas.virginia.gov

Recruitment Type: General Public – G

Job Duties

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as a Rate Development Director. The selected competitive candidate will provide exceptional delivery of services to the agency’s Provider Rate Development Division.Job responsibilities will include, but are not limited to:Providing leadership across the following units within the Provider Reimbursement division: Managed Care Rate Setting, Provider Rate Setting, Supplemental Payments and Cost Settlement and Audit.This position is responsible for developing, establishing, and maintaining external and internal working relationships across providers, stakeholder groups, and agency teams.This position manages the determination of payments for participating providers in Virginia Medicaid, including calculating, reviewing and updating Medicaid capitation and provider payment rates.The position also manages the settlement and auditing of institutional providers’ cost reports and utilizing both regulatory and market information to determine appropriate and allowable payments.This position reports directly to the Deputy Director of Finance / Chief Finance Officer (CFO) and provides management and strategic planning for all provider reimbursement programs for the Department of Medical Assistance Services, in accordance with state and federal laws and established policies and procedures.This position provides oversight of policy development, interpretation and implementation related to health care policy and, specifically, in the area of Medicaid payment methodologies.This position directs the analysis used to establish provider rates, serves as a liaison and chairs various work groups with provider associations, and provides executive-level briefings.During the annual General Assembly session, ensures accurate and timely responses on fiscal impact statements and coordinates with the Budget Division Director.As an employee of DMAS you are entitled to the many comprehensive benefits the Commonwealth has to offer. This includes health benefits, 12 paid holidays, paid leave, flexible work schedules, & retirement plans. For more specific details please visit https://www.dhrm.virginia.gov/employeebenefitsLocated in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org/The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage.DMAS wants talented individuals who can align their experience with the mission of the agency and its core values – service, collaboration, trust, problem solving and adaptability.At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.

Minimum Qualifications

Competitive candidates will meet these minimum qualifications:Considerable experience with Medicaid rate setting for managed care programs; fee-for-service programs; supplemental payments; cost settlements; health care delivery systems; program planning; and health care programs, including Medicaid. ‘Considerable experience developing processes and procedures for complex financial analysis; calculating fiscal impact of policy changes; analyzing complex data to draw conclusions; using data to make recommendations; and applying statistical and quantitative methods.Considerable experience leading complex projects, from inception to completion in Provider Reimbursement context.Considerable experience in developing, creating, and implementing financial and health care programs and policies.Considerable experience as power user of Excel, including utilizing advanced formulas and aggregating data using PowerQuery, PowerPivot as well as pivot tables.Considerable knowledge of state and federal regulatory processes and applying regulations, law, and policy to financial model development.Considerable experience meeting deadlines.Considerable experience communicating with internal and external stakeholders.Considerable experience in developing, creating, and implementing financial and health care programs and policies.Considerable experience in supervisory and human resource management.Considerable experience in program management and directing direct multiple, diverse operations.

Additional Considerations

Competitive candidates will meet these Additional Considerations:Considerable experience with Medicaid rate setting for managed care programs; fee-for-service programs; supplemental payments; cost settlements; health care delivery systems; program planning; and health care programs, including Medicaid.

Special Instructions

You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position.

The Virginia Department of Medical Assistance Services (DMAS) does not offer employment-based Sponsorship. Selected candidates will have their work authorization completed using the E‐Verify Program.The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth’s Department of Human Resource Management Policy 1.61 Teleworking.This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references.This position requires that candidates submit a Statement of Economic Interest.If you wish to apply for a job with the Department of Medical Assistance Services, an application and/or resume for employment must be submitted electronically through this website. Mailed, faxed, emailed, or hand-delivered applications/resumes will not be accepted. Consideration for an interview is based solely on the relevant information presented in the state application and/or resume submitted before the closing date.Applications and/or resumes should include relevant work history which indicates your qualifications for this position.The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce.In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth’s Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly called a Certificate of Disability) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans may also apply via the AHP if they also provide an AHP Letter. To request an AHP Letter, use this link: https://www.dars.virginia.gov/drs/cpid/PWContact.aspx or call DARS at 800-552-5019, or DBVI at 800-622-2155The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.

Contact Information

Name: DMAS Talent Acquisition Team

Phone: (804)-225-4407

Email: askhcdtalentacq@dmas.virginia.gov

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.

Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.

To learn more and apply click here.

For more information and to apply click here.

 

Title: Health Policy Specialist

State Role Title: Policy Planning Spec II

Hiring Range: $72,237 – $100,240

Pay Band: 5

Agency: Dept of Med Assistance Svcs

Location: Dept of Medical Asst Services

Agency Website: www.dmas.virginia.gov

Recruitment Type: General Public – G

Job Duties

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as a Health Policy Specialist. The selected competitive candidate will provide exceptional delivery of services to the agency’s Policy, Regulation & Member Engagement Division.Job responsibilities will include, but are not limited to:This position is responsible for analyzing, interpreting, and summarizing Medicaid-related policies, laws, regulations, and other health care industry information, and communicating the implications of this information to the supervisor for review and edits before sharing with Department of Medical Assistance Services (DMAS) leadership.Completes non-routine policy research and analysis activities on behalf of agency management on topics of time-sensitive and strategic importance to the agency. Policy analysis services include clear, concise, and actionable recommendations to aid DMAS leadership on decision-making related to DMAS strategic, operations and budget plans, external communications, programs, policies and guidance, and state regulations.This position is also responsible for researching and responding to ad hoc policy-related questions on a variety of Medicaid topics.This position is also responsible for coordinating special projects related to policy analysis, development, and application as assigned by management.Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.orgThe Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage.DMAS wants talented individuals who can align their experience with the mission of the agency and its core values – service, collaboration, trust, problem solving and adaptability.At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.

Minimum Qualifications

Competitive candidates will meet these minimum qualifications:Considerable work-related experience in Medicaid, the Children’s Health Insurance Program (CHIP), Medicare or other federal health care program.Experience in policy analysis to include reading, understanding, and summarizing the implications on a health care-related agency, organization, or system.Work related experience in federal and/or state legislative processes.Considerable work-related experience in project coordination.Considerable work-related experience in responding to health care-related policy questions and developing policy recommendations.Work related experience translating complex health care policy issues into memos, briefs, presentations, or similar resources.Experience utilizing Microsoft Office Products.Considerable experience analyzing, interpreting, and applying state and federal health care laws, policies, programs, and regulations.Experience meeting deadlines.Considerable experience communicating with internal and external stakeholders.

Additional Considerations

Competitive candidates should meet these additional considerations:Experience managing multiple tasks and shifting priorities as new or time-sensitive issues emerge.Knowledge of maternal and child health, long term care, and/or managed care.Experience determining end results based on complex health care policies.Experience drafting accurate and understandable summary documents in very short deadlines.

Special Instructions

You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position.

The Virginia Department of Medical Assistance Services (DMAS) does not offer employment-based Sponsorship. Selected candidates will have their work authorization completed using the E‐Verify Program.The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth’s Department of Human Resource Management Policy 1.61 Teleworking.This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references.If you wish to apply for a job with the Department of Medical Assistance Services, an application and/or resume for employment must be submitted electronically through this website. Mailed, faxed, emailed, or hand-delivered applications/resumes will not be accepted. Consideration for an interview is based solely on the relevant information presented in the state application and/or resume submitted before the closing date.Applications and/or resumes should include relevant work history which indicates your qualifications for this position.The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce.In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth’s Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly called a Certificate of Disability) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans may also apply via the AHP if they also provide an AHP Letter. To request an AHP Letter, use this link: https://www.dars.virginia.gov/drs/cpid/PWContact.aspx or call DARS at 800-552-5019, or DBVI at 800-622-2155The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.

Contact Information

Name:

Phone:

Email:

 

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.

Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.

 

Each agency within the Commonwealth of Virginia is dedicated to recruiting, supporting, and maintaining a competent and diverse work force. Equal Opportunity Employer

Application Deadline Date:  Do not apply online – see instructions.

Req ID:  46412

Department:  Human Services Agency

Location:  Waterbury, VT, US

Position Type:  Exempt

Schedule Type:  Full Time

Hourly Rate:  Commensurate with experience.

How to Apply

*Do not apply online*. Please click here to read more information.

Please send application materials directly to Monica.ogelby@vermont.gov.

Overview

Join the executive team at the Agency of Human Services (AHS) and lead the Health Care Reform Unit in the AHS Secretary’ Office. The Director of Health Care Reform facilitates the State of Vermont’s innovative and nationally recognized efforts to transform health care delivery through a commitment to the State’s goals to: improve the health of Vermonters; improve the quality and experience of care; reduce the growth of health care costs; and provide effective and well-coordinated health and human services to all who need them. Working with stakeholders across the healthcare sector, this position must bring knowledge, innovation and a thorough understanding of the multi-layered nature of healthcare delivery and pressures currently facing this sector. The role requires skills in: strategic planning, project management, research, analysis, and facilitation of stakeholder engagement functions.

Description

The Director of Health Care Reform coordinates internal and external stakeholders in development, design, implementation, and evaluation of health care reform initiatives. A key responsibility is co-leading the State’s negotiations with the federal Centers for Medicare and Medicaid Services (CMS) to develop and advance current and future All-Payer Model and Medicaid Global Commitment for Health 1115 Waiver agreements for Vermont. Extensive interaction occurs with the Agency Secretary, Commissioners, Deputy Commissioners, Division Directors, the Health Care Reform Integration Manager, the Blueprint for Health, Legislators, CMS, the Governor’s office staff, and other interested parties.

Compensation

Commensurate with experience and education.

Equal Opportunity Statement

The State of Vermont celebrates diversity, and is committed to providing an environment of mutual respect and meaningful inclusion that represents a variety of backgrounds, perspectives, and skills. The State does not discriminate in employment on the basis of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, membership in an employee organization, family medical history or genetic information, or family or parental status. The State’s employment decisions are merit-based. Retaliatory adverse employment actions by the State are forbidden.

Application Deadline Date:  *Do not apply online – please see instructions below

Req ID:  48817

Department:  Vermont Health Access

Location:  Waterbury, VT, US

Position Type:  Exempt

Schedule Type:  Full Time

Hourly Rate:  Commensurate with experience and education.

How to Apply

*Do not apply online* Review more information here regarding position.

Qualified applicants should send a resume and a cover letter to Kristin Kellett at kristin.kellett@vermont.gov.

Overview

The Agency of Human Services (AHS) is seeking an innovative executive to lead the Department of Vermont Health Access (DVHA). The Department, which administers Vermont’s publicly funded health plan (Vermont Medicaid), is a national leader in advancing value-based payments for health care and moving away from fee-for-service reimbursement. The Department is also responsible for administering the state’s health insurance marketplace, which offers Vermonters options for obtaining health insurance including through Vermont Medicaid and qualified health plans certified by the Department.

Description

The Commissioner serves as the Chief Executive Officer and is responsible for advancing the mission and priorities of the Department. The Commissioner will join a dynamic and experienced leadership team in overseeing DVHA’s 370 employees.  DVHA’s mission is to improve Vermonters’ health and well- being by providing them with access to high-quality, cost- effective health care. The Department has three main priorities that support achieving the mission: adoption of value-based payments, management of information technology projects to improve and modernize existing systems, and operational performance improvement. In service of these goals, the Commissioner will join with the Agency of Human Services to implement Vermont’s Global Commitment to Health Medicaid demonstration waiver as well as Vermont’s current All-Payer Model (and future potential multi-payer model) initiatives. Both federal agreements are crucial for Vermont’s continued progress towards a statewide health care reimbursement model that emphasizes better health at a lower cost for Vermonters.

The Commissioner is accountable to the Governor of Vermont, the Secretary of the Agency of Human Services, the Vermont Legislature, federal partners, Medicaid members, Medicaid-participating providers, and Vermont taxpayers. The Commissioner is responsible for day -to-day operations of Vermont’s publicly funded health plan (Vermont Medicaid) and collaborates with the State Medicaid Director on strategic direction for the program.  The Commissioner speaks on behalf of the Department, which may include presentations at committees, boards, and national conferences. The Commissioner also provides statements to the media, as well as official testimony at the request of the Vermont Legislature. This position requires a strong leader who is collaborative and who can communicate clearly and effectively with a broad array of audiences.

The Agency of Human Services seeks a leader for the department who is dedicated, responsive, adaptable and who can effectively maneuver through complex policy, process, and people-related organizational dynamics.

Compensation

Commensurate with experience and education.

Equal Opportunity Statement

The State of Vermont celebrates diversity, and is committed to providing an environment of mutual respect and meaningful inclusion that represents a variety of backgrounds, perspectives, and skills. The State does not discriminate in employment on the basis of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, membership in an employee organization, family medical history or genetic information, or family or parental status. The State’s employment decisions are merit-based. Retaliatory adverse employment actions by the State are forbidden.

Title: Senior Management Analyst

State Role Title: Policy Planning Spec III

Hiring Range: $101,934.83 – $110,250

Pay Band: 6

Agency: Dept of Med Assistance Svcs

Location: Dept of Medical Asst Services

Agency Website: www.dmas.virginia.gov

Recruitment Type: General Public – G

Job Duties

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as a Senior Management Analyst. The selected competitive candidate will provide exceptional delivery of services to the agency’s Policy, Regulation, and Member Engagement Division.Job responsibilities will include, but are not limited to:Serves in a senior advisor capacity to the Director of PRME and an advisor to executive leadership through comprehensive state and federal CHIP policy and regulatory analysis, stakeholder and member engagement, and eligibility enrollment policy.Responsible for creative and strategic policy initiatives and projects that will increase access to DMAS programs as well as improve clinical outcomes.Incumbent serves as a Program Manager for the Children’s Health Insurance Program (CHIP)/ Family Access to Medical Insurance Security (FAMIS) Program.As an employee of DMAS you are entitled to the many comprehensive benefits the Commonwealth has to offer. This includes health benefits, 12 paid holidays, paid leave, flexible work schedules, & retirement plans. For more specific details please visit https://www.dhrm.virginia.gov/employeebenefits.Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org/The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage.DMAS wants talented individuals who can align their experience with the mission of the agency and its core values – service, collaboration, trust, problem solving and adaptability.At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.

Minimum Qualifications

Competitive candidates will meet these minimum qualifications:Considerable work-related experience with CHIP and Medicaid.Considerable and progressively responsible work-related experience in health care policy.Considerable work-related experience in responding to healthcare-related policy questions and developing policy recommendations.Considerable experience developing reports, summaries, talking points, and presentations for leadership.Considerable work-related experience in project coordination including planning and/or implementing complex program and/or policy changes.Experience utilizing Microsoft Office Products.Considerable experience analyzing, interpreting, and applying state and federal health care laws, regulations, policies, and programs.Experience meeting deadlines.Experience engaging with internal and external stakeholders.

Additional Considerations

Competitive candidates will meet these Additional considerations:Work-related experience in federal and/or state legislative processes.Work-related experience developing and managing a budget.Experience developing regulatory changes.Experience developing requests for proposals and/or contracts.Knowledge of research methods and their application.

Special Instructions

You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position.

The Virginia Department of Medical Assistance Services (DMAS) does not offer employment-based Sponsorship. Selected candidates will have their work authorization completed using the E‐Verify Program.The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth’s Department of Human Resource Management Policy 1.61 Teleworking.This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references.If you wish to apply for a job with the Department of Medical Assistance Services, an application and/or resume for employment must be submitted electronically through this website. Mailed, faxed, emailed, or hand-delivered applications/resumes will not be accepted. Consideration for an interview is based solely on the relevant information presented in the state application and/or resume submitted before the closing date.Applications and/or resumes should include relevant work history which indicates your qualifications for this position.The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce. Qualified individuals with disabilities are encouraged to apply.The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.

Contact Information

Name: DMAS Talent Acquisition

Phone: 804-225-4407

Email: askhcdtalentacq@dmas.virginia.gov

 

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their Certificate of Disability (COD) provided by a Vocational Rehabilitation Counselor within the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their Certificate of Disability. If you need to get a Certificate of Disability, use this link: Career Pathways for Individuals with Disabilities, or call DARS at 800-552-5019, or DBVI at 800-622-2155.

 

To apply and learn more about this position click here.

Presbyterian Health Plan (PHP) seeks to continue to be a national leader in serving the complex and diverse needs of Medicaid members and in working with State and Federal agencies on designing and implementing new and innovative programs and services to meet the unique needs of this population.

 

The Vice President of Medicaid reports to the President of PHP and is accountable for all aspects of our Medicaid program including as the sole Contractor for Children in State Custody. This leader provides strategic and thought leadership to include best practices, emerging practices and innovations on a national scale that are intentionally connected to a deep understanding and solutioning for the needs of New Mexicans across a diverse set of communities including rural, frontier, Native American sovereignties, and urban centers. The Medicaid program includes provisioning for all the physical, behavioral health, and long-term services and supports (LTSS) of Medicaid members, including dental, vision, pharmacy, etc., and the full spectrum of social determinants of health, to include transportation, and supporting health equity across and within our unique populations.

 

The position offers an exciting opportunity to lead and shape Medicaid programs that have a significant impact on the health and well-being of vulnerable populations. The ideal candidate will possess a combination of strategic vision, operational expertise, leadership skills and government relations experience to drive positive outcomes and advance Presbyterian’s mission of ensuring all our members can achieve their best health.

Qualifications

• Bachelors degree in healthcare administration, public health, business administration or related field.
• Extensive experience (10+ years) in healthcare management, with focus on Medicaid programs.
• In-depth knowledge of full array of Medicaid programs, regulations, policies, best practices, and emerging innovations at Federal and State level.
• Extensive government relations experience is required, preferably within the New Mexico market.
• Strong leadership skills with proven track record of driving organizational change and achieving results through influencing and collaboration.
• Excellent communication, negotiation, and relationship-building skills.
• Strategic thinker, ability to analyze complex issues, and develop innovative solutions.
• Demonstrated ability to collaborate effectively with diverse stakeholders and manage cross-functional teams.
• Experience in budgeting, financial management, and performance measurement.
• Commitment to equity, diversity, and inclusion
• Must live in the New Mexico area.

 

Responsibilities

• Developing and executing strategic plans that meet the needs and expectations of Medicaid members, relevant State of New Mexico agencies including the Healthcare Authority (HCA) and Children, Youth and Families Department (CYFD), CMS and key stakeholders.
• Forming, collaborating with and leading diverse teams across PHP, to ensure effective delivery of Medicaid services while maintaining compliance with regulations and achieving organizational strategies, goals and metrics, as well as the strategies, goals and metrics of HCA and CYFD.
• Providing ongoing surveillance of national and state market changes and developments to ensure that PHP remains competitive and viable in the future.
• Leading the design, development and enhancement of Medicaid programs to meet the evolving needs of beneficiaries and stakeholders, to include for example, evidence-based models applicable to unique populations such as those specific to Children in State Custody and Behavioral Health.
• Provide thought leadership and input on the State’s strategy for achieving their vision and objectives and fostering alignment with Presbyterians capabilities and new business models, to include for example improving access to behavioral health and substance use disorder services and supports and expanding availability of models and services to serve Children in State Custody.
• Overseeing day to day operations for Medicaid programs working in collaboration with executive leaders and operational leaders.
• Leading functional teams to serve our Medicaid members and meet and exceed the needs and expectations of stakeholders without direct reporting relationships, to include for example, network contracting and development, claims, population health inclusive of pharmacy, etc.
• Aligning Medicaid to the Dual Special Needs Plan (D-SNP) requirements to support optimal performance and outcomes.
• Proactively monitoring changes in Medicaid waivers, state plan amendments, policy and legislation to mitigate risks, inform strategies, and maintain program integrity.
• Engaging fully in the government relations process to influence a positive perception of PHP’s Medicaid program.
• Provide strategic direction and alignment with key stakeholders over quality initiatives to improve the quality, efficiency and effectiveness of Medicaid services, including performance measures, outcome evaluation, and continuous process improvement.
• Establishing and overseeing strategic workstreams and deliverables, scorecard metrics including quality, experience, and financial measures, to measure achievement of effective outcomes while maximizing value for members and stakeholders.
• Build and maintain relationships with key stakeholders, including government agencies, healthcare providers, advocacy groups, community organizations, and policymakers.
• Develop and lead high performing teams, providing leadership, guidance and mentorship over a high-functioning team fostering a culture of accountability, innovation, and excellence.
• Leads all Medicaid procurement activities including ongoing market and technology assessments, preparation efforts and resource planning, market positioning, consultant sourcing, marketing and branding, and the response development cycle

Benefits

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

https://www.phs.org/careers/why-work-with-us/benefits

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers’ markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian’s story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state’s largest private employer with nearly 14,000 employees – including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About Our Regional Delivery System

Presbyterian’s Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state’s largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

We are part of New Mexico’s history – and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico

New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture – from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it’s all available among our beautiful wonders of the west.

To Learn more and to apply click here or reach out to emcguill@phs.org.

Principal analysts are seasoned technical experts who lead MACPAC’s analytic work on key policy issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP). They work under the direction of the executive director and policy directors, but are expected to conceptualize and manage significant bodies of work, often involving other team members. Qualified candidates have knowledge and expertise in Medicaid payment and financing policies. This could include experience in policy areas such as fee-for-service base and supplemental payments, managed care capitation rates and directed payments, state approaches to provider payment, and payment and rebates for prescription drugs.

To Learn more and to apply click here.

Senior analysts focus on one or more aspects of the Medicaid and State Children’s Health Insurance Program (CHIP). They work collaboratively with other members of the policy team under the direction of policy directors. Qualified candidates have knowledge and expertise in Medicaid payment and financing policies. This experience could include familiarity in policy areas such as fee-for-service base and supplemental payments, managed care capitation rates and directed payments, state approaches to provider payment, and payment and rebates for prescription drugs.

To Learn more and to apply click here.

ORAU is seeking a Fully Remote, Senior Advisor on Medicaid to work with CMMI as an ORAU employee. This exciting work will last one or more years, and the successful candidate will become a temporary employee of ORAU assigned to the Centers for Medicare and Medicare Services Innovation Center (CMMI). This position is 30- 40 hours per week.

CMMI is seeking assistance in the design and support of current research and development activities related to healthcare delivery and payment reform, in support of Section 1115A(a)(3) of the Social Security Act. Specifically, for CMMI models focused on Medicaid populations, a subject matter expert with extensive expertise in Medicaid is needed to provide CMMI staff with consultative Medicaid policy expertise during new model design and launch during calendar year 2024. This subject matter expert will also assist CMMI leadership and teams as they develop strategies to achieve multi-payer alignment between Medicaid and Medicare, and develop strategies for effective engagement of states in the CMS Innovation Center’s newest models. Additionally, this subject matter expert will use their extensive Medicaid background and experience to assist CMMI SPHG leadership in collaborating-with the Center for Medicaid & CHIP to better identify and foster best practices for cross-component alignment.

This position will provide Medicaid finance and policy expertise during the pre-implementation period of the AHEAD Model. This is to include technical expertise and innovation in Medicaid finance, especially in the construction of Medicaid hospital global budgets (HGB) and treatment of supplemental payments; provide technical assistance to states on potential legal pathways to implement Medicaid HGBs and Medicaid advanced primary care (APC) payment and care delivery models; provide guidance to states on Medicaid considerations in the construction of state all-payer cost growth benchmarking. In addition, serves as a SME for the AHEAD Model team on Medicaid issues and reviews model policy and legal documents that pertain to Medicaid program requirements or policy.

Learn more about this position and apply.

Deputy Director

The deputy director is a key member of the MACPAC leadership team. The incumbent has policy, supervisory, and specific line responsibilities related to health policy, finance, human resources, information technology (IT), and office management, as well as contract administration and procurement for matters other than research and data analysis.

Like all MACPAC employees, the deputy director is expected to:

•  demonstrate and model commitment to team and personal success;
•    work collaboratively with others inside and outside of the organization;
•   adapt behavior in response to feedback and experience;
•   contribute to the growth, expertise, and knowledge of colleagues;
•  hold self and others accountable for meeting expectations in a timely, professional manner; and
•   foster a culture of inclusion and belonging.

Major Duties

The deputy director is expected, on a routine basis, to be able to:

•  play a leadership role in ensuring that operational processes function in a manner that optimally foster accomplishment of MACPAC’s mission and goals by:

–     serving as an advisor to the executive director on major decisions involving organizational culture, strategy, and operations;

–      systematically identifying and prioritizing operational improvements in systems and processes that add value to MACPAC;

–     managing MACPAC’s continuity of operations plan;

–     supervising delegations of signature authority;

–     managing development, implementation, and coordination of operations policies that cross functional lines;

–     managing organization-wide audits;

–     ensuring that members of the operations team can independently perform the majority of their duties, providing support and training as needed to promote high employee engagement and performance; and

–     ensuring that the operations team works effectively together and with other staff teams in support of the organization’s mission.

•  lead organization-wide policy efforts by:

–       developing the strategic vision for MACPAC’s annual retreat in partnership with executive director and policy directors and managing logistical considerations including meeting location, organizing internal and external presentations, among other considerations;

–       organizing agendas for public meetings and developing an executive agenda for Commissioners;

–       reviewing and providing final approval for MACPAC’s data publications, specifically its annual MACStats and Dually Eligibles data book publications; and

–      coordinating with external organizations to review respective analytic agendas.

•    serve as the congressional liaison to manage MACPAC relationships with congressional staff by:

–       coordinating and clearing responses to requests for technical assistance;

–       developing and executing strategy to keep key congressional staff apprised of all aspects of the Commission’s work and policy agenda including briefings, periodic phone calls, and special products; and

–       bringing congressional priorities and perspectives to discussions of MACPAC’s current and future work.

•     oversee the work of the finance team by:

–       providing strategic oversight and guidance to the chief financial officer (CFO) to ensure financial management of Commission resources is aligned with Commission mission and goals;

–       leading preparation of MACPAC’s annual budget request, coordinating across operational functions,  contributing to the annual budget justification to Congress, reviewing submission with the executive director; and

–       analyzing, interpreting, and reporting financial data during any absence of the CFO.

• oversee the work of the IT team by:

–       providing strategic oversight and guidance to the chief information officer (CIO) to ensure that the organization’s IT needs are being met, that security protocols are current, and that plans for the future are based on organizational needs and that selected information technologies are cost-efficient and effective in meeting those needs; and

–       serving as sponsor of the IT change control board.

•  oversee human resources and office management activities by:

–       providing strategic oversight of and guidance to the chief administrative officer to ensure that organizational needs are being met, including maintaining appropriate documentation and updating policies in response to internal or external changes (changes in federal or local laws, directives from the General Services Administration (GSA) or Office of Personnel Management);

–       taking the lead on developing and implementing strategies related to employee retention, professional development, and recruiting;

–       providing advice and securing input from legal counsel as needed to address any sensitive human resources issues as they arise;

–       providing backup for time and attendance certification as needed; and

–       ensuring that appropriate processes are in place to ensure that space, furnishings, equipment, and supplies required for day-to-day functioning of MACPAC are operational and in good working condition.

• serve as contracting officer for procurements other than research and data analysis contracts by:

–       developing and managing requests for proposals or other bids;

–       evaluating proposals and bids, making recommendations to the executive director based on best value to the government;

–       monitoring quality and performance of vendors (unless otherwise delegated);

–       ensuring that administrative contracts are developed and executed in accordance with MACPAC policies;

–       updating procurement policies as needed;

–       serving as a resource to other staff regarding contract administration;

–       coordinating development of proposals for administrative contracts in accordance with MACPAC and legislative branch requirements;

–       negotiating with contractors;

–       administering and monitoring contract and grant awards, in compliance with federal regulations, terms and conditions;

–       approving all contract modifications;

–       coordinating and collaborating with the contracting officer for research contracts on areas such as updating terms and conditions;

–       providing guidance on contract matters to staff acting as contracting officer’s representatives, as needed;

–       collaborating with senior management to ensure institutional compliance with federal and state regulations and interpretation of agency requirements related to contracts;

–       assisting and advising staff with preparation of project budgets and interpretation of contractual terms and conditions for research contracts; and

–       maintaining research contract files including deliverables and contracts.

•    represent and speak on behalf of MACPAC in high-level meetings with other government agencies, property management, and others; and
•    perform other duties as assigned.

Knowledge and Skills

To perform the major duties listed above, the Deputy Director must have:

•   ability to lead the assessment of operations functions, identify where organizational improvements can be implemented to add value, and lead organization wide change activities;
•    ability to prioritize and manage multiple competing responsibilities and tasks while demonstrating a thorough awareness of all areas involved;
•    ability to organize time and resources efficiently and be relied upon to meet firm deadlines;
•    ability to lead individuals whose technical expertise exceeds their own;
•   knowledge of key federal laws and regulations related to federal procurement, travel, human resources, financial management, information technology, and other operations functions relevant to MACPAC;
•   knowledge of federal financial, budgeting, and contracting procedures;
•   ability to analyze financial data and review reports and projections;
•   knowledge of internal controls and risk assessment;
•   experience in IT planning;
•   knowledge of federal legislative and appropriations processes;
•   strong oral and written communication skills;
•   an orientation toward problem solving, teamwork, and accountability; and
•   willingness to engage in learning and development.

Experience and Education

The minimum requirements for the deputy director include:

•   graduate degree in public administration, public policy, business, finance, or other related field;
•    minimum of 10 years of successful professional experience in roles of increasing management responsibility with U.S. government agencies, nonprofit organizations, or other companies doing business with the U.S. government.

Apply

This is a full-time position based in downtown Washington, DC with federal employee health and retirement benefits. Interested applicants should be available to work in the office two days per week with flexibility to attend other in-person events as needed. Salary competitive with those in other federal agencies.

MACPAC employees must meet the CDC’s definition of fully vaccinated for COVID-19 as a condition of employment except in instances of a MACPAC-approved exemption for medical or religious reasons.

A complete application should include a cover letter, resume and two writing samples. To the greatest possible, applicants should send original writing instead of publications that have undergone editing by colleagues or other professionals. We prefer traditional resumes, as opposed to the federal resume required for positions on USAJobs. To apply, click the Apply for this Position button below.

To learn more and apply click here.