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State Jobs

NAMD collects and updates job opportunities in Medicaid offices across all U.S. states and territories.

January 2023- TennCare Associate Medical Director

TennCare is recruiting for an Associate Medical Director to lead clinical innovation, population health, and guide policy changes to improve the quality of care and improve the member and provider experience for all TennCare members. Having physician and clinical leadership at the table at TennCare as they tackle opportunities like social determinants of health, value-based payment, maternal, infant, and behavioral health is critical for success. View the full job posting below and apply here.

TENNCARE OVERVIEW

TennCare is Tennessee’s managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities. TennCare provides coverage for approximately 1.5 million Tennesseans and operates with an annual budget of approximately $13 billion.

WHY WORK AT TENNCARE?

TennCare’s mission is to improve the lives of Tennesseans by providing high-quality cost-effective care. To fulfill that purpose, we equip each employee for active participation and empower teams to communicate and work collaboratively to improve organizational processes in order to make a difference in the lives our members. Because of the positive impact TennCare has on the lives of the most vulnerable Tennesseans, TennCare employees report that their work provides them with a sense of meaning, purpose, and accomplishment. TennCare leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency.

The Division of TennCare is dedicated to providing our employees with a hybrid work environment. All TennCare positions have a combination of work from home and work in the office, which varies by position, department, and business need. You may review the specific expectations with our hiring team.

JOB AND DEPARTMENTAL OVERVIEW

TennCare is committed to improving the quality of health care for its members while maximizing the value of every dollar spent. Since its founding, TennCare has been a leader in innovation through clinical care models and delivery system payment reform. TennCare’s Chief Medical Office is integral to this mission by leading clinical quality and operations and strategic clinical innovation for the agency. Operationally, the Medical Office is comprised of 7 teams and 160 employees. The Medical Office is responsible for all medical, dental, behavioral health, and pharmacy policy and operations as well as quality improvement and population health programming. It also administers all member medical appeals and oversees provider registration and engagement. Finally, through partnerships with providers, the managed care organizations, and other stakeholders, the Medical Office is responsible for designing and implementing strategic clinical initiatives to improve care and health outcomes for its members. The Associate Medical Director will work directly to support the Chief Medical Officer and the Medical Office leadership. The role will have high visibility across the Medical Office and TennCare executive leadership to partner and lead priority initiatives to fulfill TennCare’s ultimate vision of a healthier Tennessee. The Associate Medical Director also plays an integral role in representing TennCare and partnering with key stakeholders, including the provider community, in advancing the mission of TennCare.

RESPONSIBILITIES:

Lead Strategic TennCare Clinical Initiatives and Policy Development

• Develop comprehensive policies and approaches focused on high impact clinical areas that affect TennCare’s members. Areas of recent focus include substance use disorder treatment, improving maternal and child health outcomes, integration of oral and physical health, improving population health efforts and addressing social risk factors.

• Participate in the development and implementation of Payment Reform programs which include existing initiatives (Episodes of Care, Primary Care Transformation, and Health Link Homes) and development of new innovative value-based payment models

• Lead policy and data analysis to inform key strategic decisions and identify opportunities for quality improvement across high impact clinical areas affecting TennCare members.

• Design and implement programmatic changes focused on provider engagement in partnership with TennCare Provider Experience team

• Create strategic frameworks, budget analyses, and presentation materials to implement highpriority improvement efforts. Provide hands-on project management to ensure progress and advancement of key initiatives. Provide Strong Management and Oversight of Clinical Operations in Partnership with TennCare Managed Care Organizations (MCO)

• Interact regularly with MCO medical directors and population health teams to support efficient and effective managed care operations and program implementation• Partner with Chief Pharmacy Officer and Chief Dental Officer to identify opportunities to improve integration of oral health and medication access in partnership with TennCare Dental Benefits Manager (DBM) and Pharmacy Benefits Administrator (PBA)

• Review complex clinical cases involving TennCare members and provide guidance and oversight to MCOs on care coordination and medical management

• Oversee key MCO activities and functions and reporting. Perform clinical research on emerging issues and support other high priority projects as requested by the CMOServe as Clinical Subject Expert on behalf of TennCare with Key Internal and External Stakeholders

• Provide strategic and clinical guidance to TennCare pharmacy, oral health, quality improvement, and provider services teams within the Medical Office and support needs across all other departments of TennCare

• Participate in medical committees including the Pharmacy Advisory Committee, Medical Care Advisory Committee, TN Initiative for Perinatal Quality Care Collaborative and state-wide meetings requiring TennCare clinical leadership representation

• Review clinical cases involving medical appeals, eligibility for Emergency Medical Assistance, Breast and Cervical Cancer, Disability Eligibility for institutional Medicaid, Independent Review Medical Consults, and other elevated risk clinical cases

• Analyze proposed state and federal legislation and policies, testify at legislative committees, and represent TennCare at national meetings

• Engage in state-wide collaborations with clinical and non-clinical staff in other state agencies including the Departments of Health, Intellectual Disabilities, Children’s Services, and Mental Health and Substance Abuse Services.

• Support team development and staff professional development across all CMO teams and personnel

• Other duties as assigned by the CMO and TennCare executive leadership

MINIMUM QUALIFICATIONS

• M.D. or D.O degree from an accredited medical school

• Completed residency training with board certification in a medical specialty. (Board certification in pediatrics, psychiatry, OB/GYN, family medicine or internal medicine is valuable)

• Substitution of Educational Requirements: Advanced Practice Clinical Degree or Doctorate with 5+ years in direct clinical practice and 3+ years in clinical administration, quality improvement, or health policy roles will be considered

• TN Medical License in good standing and and/or eligible to be licensed in TN

• Proficiency in Microsoft Office software including Word, Excel, and PowerPoint

• Excellent interpersonal, oral, and written communication skills

• Strong organizational, time management, analytical skills.

DESIRABLE QUALIFICATIONS

• Masters in Public Health, Masters in Business Administration, or Masters in Health Administration

• Experience in health care delivery and administration (hospital, physician practice, etc.) or state/federal health agency and policies

• Experience in managed care and/or quality improvement

• Experience with primary care transformation or value-based payment reforms

• Experience with health services and outcomes research and analytics

Position Status:

Executive Service

Pursuant to the State of Tennessee’s Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State’s policy to provide an environment free of discrimination and harassment of an individual because of that person’s race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran’s status or any other category protected by state and/or federal civil rights laws

January 2023 - Maine - MaineCare Medical Director

MaineCare Medical Director

CODE: N/A RANGE: N/A SALARY: Negotiable

(Note: this is a contracted position without state benefits)

OPENING DATE: January 3, 2023

CONTACT: Lisa M. Letourneau MD, MPH

CLOSING DATE: January 31, 2023

TELEPHONE: (207) 415-4043

Agency Information: The Department of Health and Human Services (DHHS) provides supportive, preventive, protective, public health and intervention services that help families and individuals meet their needs. DHHS strives to provide these programs and services while respecting the rights and preferences of individuals and families. The Office of MaineCare Services (OMS) within DHHS administers the state’s Medicaid program, which provides health insurance coverage for low-income families, adults and children so they can access the important health care services they need to be healthy and be a part of the community through work, caring for family, going to school, and more. OMS works collaboratively within DHHS, with other Departments and the Office of the Governor, with MaineCare members, with providers, and with other health care purchasers on statewide healthcare improvement initiatives. OMS is committed to advancing health equity efforts to improve access to care and health outcomes for all low-income Mainers. OMS provides benefit coverage and support services that operate in alignment with Department goals, federal requirements and State policy. OMS also provides oversight necessary to ensure accountability and efficient and effective administration.

Core Responsibilities: The MaineCare Medical Director is responsible for providing clinical leadership and guidance to the MaineCare program, including to enrolled providers, to support MaineCare goals and objectives established in coordination with the MaineCare Director and the Commissioner’s Office of DHHS. The Medical Director supports development, implementation, and operations of policy, programs, and initiatives that aim to improve health outcomes for MaineCare members, achieve greater health equity across different population groups, and promote high value care. The Medical Director directly communicates with healthcare providers in the state, participates in relevant advisory groups, leads certain initiatives to improve internal care coordination functions as well as to reform the broader external delivery system, and, when needed, interacts with the state legislature at the direction of OMS and DHHS leadership.

Key priorities for this position include:

  • Ensuring that OMS coverage policies are well-grounded in clinical evidence and well-positioned to effectively serve all MaineCare members, including those covered through more recent initiatives (e.g. Medicaid expansion, expanding eligibility for populations served under the Children’s Health Insurance Program (CHIP), and providing coverage for children who would otherwise qualify for Medicaid but for their immigration status)
  • Supporting the advancement of MaineCare’s focus on value-based care and alternative payment models
  • Providing clinical leadership and oversight to improve the effectiveness of care coordination and utilization management for high-need MaineCare members provided by MaineCare staff, external vendors and through healthcare delivery system initiatives
  • Collaborating with MaineCare and DHHS analytics, research and evaluation teams and DHHS Office of Population Health Equity to help direct and interpret efforts to identify and address areas of health inequity, with an emphasis on inequities that relate to race and ethnicity

Typical responsibilities for this position include:

  • Assist with the development of quality standards and performance measures to assess provider performance and member health outcomes
  • Assist with the development of and, in certain cases, lead MaineCare strategic initiatives to promote delivery system reform and/or the elimination of health inequities
  • Support Maine’s Medicaid program through participation in national leadership and learning opportunities to inform and stay current on Medicaid best practices and foster state to-state learnings, including Medicaid Medical Director networks, national technical assistance opportunities, and presentations at local and national meetings
  • Participate in DHHS cross-office initiatives that require input from the MaineCare Medical Director
  • Provide clinical guidance on day-to-day MaineCare operations, projects and grant applications
  • Participate as a member of MaineCare senior leadership
  • Represent OMS and DHHS to internal and external stakeholders, including, but not limited to, other DHHS offices, MaineCare providers, advocacy associations and organizations, and MaineCare vendors

Minimum Qualifications: The position is expected to be 0.8-1.0 FTE and allows for remote work up to three days per week; in office work is based in Augusta, Maine.

To qualify, your background must include the following:

  • Medical degree (MD or DO) from an accredited school of medicine; OR a Master of Nursing from an accredited school of nursing; OR a Master of Science, Physician Assistant, from an accredited university
  • Active State of Maine medical, nurse practitioner, or physician assistant license
  • Relevant board certification
  • Minimum of five (5) years of direct patient care experience, and relevant medical knowledge, with particular experience in adult primary care for Medicaid-eligible populations

Additionally, the following experience is preferred:

  • Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low-income populations,
  • Lived experience with and/or work experience focused on Medicaid and/or other health-related social needs common to individuals and families in need of Medicaid coverage, including experience balancing the tension between acute clinical needs and broader “wellbeing,” particularly among populations that have experienced historical trauma through clinical structures (women, BIPOC, LGBTQIA+) that MaineCare disproportionately serves
  • Prior experience in medical leadership, in a management or supervisory role (e.g. practice or organizational Medical Director) within a large, complex organization, working with cross functional teams, including operations
  • Advanced training or experience in health care management, public health, public policy, and/or business administration
  • Prior experience in the analysis, interpretation, development, and implementation of policy, programs and data predominantly benefiting lower income populations at the state or federal level

The background of well-qualified candidates will demonstrate the following competencies:

  • Ability to problem solve and make decisions to address complex clinical, compliance, policy, and operational issues
  • Capacity to balance and negotiate between multiple, changing priorities
  • Ability to be data driven, with a working knowledge of medical coding and claims, including the ability to interpret and present statistical and outcome-based data analysis at a high level
  • Solid written and oral communication and presentation skills, including the ability to articulate issues in a concise manner that is understandable to a wide range of audiences
  • Effective interpersonal influence, collaboration, and listening skills
  • Management skills necessary to inspire, seek consensus, build teams, and manage conflict
  • Leadership skills necessary to analyze and articulate complex policy concepts, envision change, and promote creative and innovative approaches and collaboration

Applicant Information: For additional information about this position please contact Lisa Letourneau MD, MPH, DHHS Senior Advisor at (207) 415.4043 or by e-mail at lisa.letourneau@maine.gov. To apply, please email a current resume and cover letter to lisa.letourneau@maine.gov that addresses the qualifications and competency areas identified in the Requirements Section.

Note: this is a contracted position without state benefits.

The Department of Health and Human Services is an Equal Opportunity/Affirmative Action employer. We provide reasonable accommodations to qualified individuals with disabilities upon request.

October 2022 - Delaware - Pharmacy Administrator

Pharmacy Administrator

Recruitment #101922-MDJZ02-350200

Introduction

Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families in a variety of life areas.

We offer numerous career opportunities and are dedicated to attracting and retaining highly talented individuals who are ready to make a difference in their community today. DHSS is a great place to kick-start your profession.

For more information, please visit https://dhss.delaware.gov/dhss/ today!

Summary Statement

The Director of Pharmacy is the Division’s primary source of clinical pharmaceutical expertise. The director oversees policy and processes around clinical editing tools, prior authorizations and clinical edits, Preferred Drug List edits, and performs evidence-based therapeutic class reviews. The director provides oversight of the managed care organization (MCO) pharmacy programs, working closely with pharmacists at each MCO to ensure consistency across the program where appropriate. The director works closely with other clinical staff, especially the Chief Medical Officer and quality department, to ensure that pharmaceutical policy aligns with other clinical policies. The Director of Pharmacy interacts with key stakeholders on a regular basis, representing DMMA at public meetings, the legislature, state and national committees/boards, and others as appropriate.

Essential Functions

  • Lead the division’s policy management with regard to pharmacy, and assist with related programs such as durable medical equipment.
  • Ensure clinical best practices are met in the development and application of clinical criteria.
  • Work closely with division personnel as well as contracted clinical personnel and vendors.
  • Ensure Quality Assurance and Clinical Appropriateness of Services in both fee-for-service (FFS) and MCOs.
  • Provide general direction and oversight of the FFS pharmacy program via the contracted fiscal agent.
  • Remain informed of current clinical best practices.
  • Ensure compliance with CMS pharmaceutical policy.
  • Management and oversight of PDL development and supplemental rebate acceptance as part of a multi-state negotiating consortium.
  • Create and Implement Medicaid Initiatives Designed to Create a Best in Class Medicaid Program that Provides Needed Services to the State’s Most Vulnerable Population in a Sustainable Fashion.
  • Act as the primary Division delegate responsible for presentation of clinical recommendations at Pharmacy Program advisory group meetings.
  • Offers pharmacy program updates for budget and clinical initiatives, as well as specific edit criteria to the Pharmacy & Therapeutics Committee and Drug Use Review Board for discussion and adoption by vote.
  • Performs evidence-based therapeutic class reviews which are incorporated into the Division recommendations for the Preferred Drug List and Clinical Edit programs.

Job Requirements

  1. Possession of a Pharmacist license in any state.

Additional Posting Information

Please attach a resume with your online application or use the resume tab in DEL to provide a detailed description of how your education, training and/or experience meets each job requirement including employer, experience/responsibilities and dates (month/year) of employment/training.

Due to a new requirement from the Centers for Medicare & Medicaid Services (CMS) the following mandate is effective January 27, 2022: As a condition of employment, employees providing health care services and/or support services in covered facilities must show proof that they have received the dose of a single J&J dose or the 1st dose of Moderna/Pfizer two-dose vaccine effective date January 27, 2022, and proof of the single J&J dose or the 2nd dose of Moderna/Pfizer two-dose vaccine by February. 28, 2022. Employees may not provide any care, treatment, or other services until proof is provided.  Based on CMS guidance, the date for compliance may extend into March due to the health care facilities high vaccination rate of staff.  If you accept a position with the facility, your Human Resources representative can provide more guidance.  The only exception to these requirements is for those employees granted medical or religious exemptions from the COVID-19 vaccine as recommended by the Centers for Disease Control and Prevention, which may require weekly COVID-19 testing. This will be in effect until further notice.  More information can be found here.

Conditions of Hire

Applicants must be legally authorized to work in the United States. The State of Delaware participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. For more information refer to our Job Seeker Resources.

DHSS does not provide employment-based sponsorship.

Benefits

To learn more about the comprehensive benefit package please visit our website at https://dhr.delaware.gov/benefits/

Selection Process

The resumes are evaluated based upon a rating of your education, training and experience as they relate to the job requirements of the position.  It is essential that you provide complete and accurate information on your application and the resume to include dates of employment, job title and job duties.  For education and training, list name of educational provider, training course titles and summary of course content.   Narrative information supplied in response to the questions must be supported by the information supplied on the application including your employment, education and training history as it relates to the job requirements.

Once you have submitted your application on-line, all future correspondence related to your application will be sent via email.  Please keep your contact information current.  You may also view all correspondence sent to you by the State of Delaware in the “My Applications” tab at StateJobs.Delaware.gov.

Accommodations

Accommodations are available for applicants with disabilities in all phases of the application and employment process.  To request an auxiliary aid or service please call (302) 739-5458. TDD users should call the Delaware Relay Service Number 1-800-232-5460 for assistance.

The State of Delaware is an Equal Opportunity employer and values a diverse workforce. We strongly encourage and seek out a workforce representative of Delaware including race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression.

Fill out the Application NOW using the Internet.

Upload Resume to Start an Application

Contact us via conventional means: For further assistance, you may contact us by phone at (302) 739-5458, or e-mail at jobs@delaware.gov.

October 2022 - Washington, D.C. - Medical Director

Washington, D.C. is hiring a Medical Director

POSITION:

The Medical Director, DC Medicaid Program is located in the Department of Health Care Finance (DHCF), Office of the Director. The Medical Director has responsibility for the medical administration of the District of Columbia’s Title XIX (Medicaid), SCRIP, and Alliance Programs.

As the Medical Director of the DC Medicaid Program, the incumbent develops and maintains professional relationships with the provider community and other professional organizations, including the DC Medical Society, the DC Hospital Association, the DC Primary Care Association, and the DC Health Care Association. In addition, this person will:

▪ Collaborate with DHCF senior staff on peer review and quality improvement activities; and conducts medical reviews, medical necessity, prior authorization and individual consideration determinations

▪ Collaborate and advise the Director and DHCF senior staff on policy development including the development of medical necessity criteria, patient safety and health technology assessments

▪ Serve as Chairperson of the DC Medicaid pharmacy and therapeutics committees and advises the Director on the maintenance of the DHCF formularies and preferred drug lists

▪ Participate in the accomplishments of administrative and program responsibilities set forth by the Director of the Department of Health Care Finance (DHCF)

▪ Assist the Director in the execution of Department programs, and in planning and coordinating the execution of programs within the framework of overall policy determinations of the Mayor and the City Council. These areas include the Medicaid State Plan

▪ Provide Community and Professional Organization Collaboration and Communications as the Medical Director of the DC Medicaid Program

▪ Develop and maintain professional relationships with the provider community and other professional organizations, including the DC Medical Society, the DC Hospital Association, the DC Primary Care Association, and the DC Health Care Association

▪ Medical Reviews – Collaborate with DHCF senior staff on peer review and quality improvement organizations; and conducts medical reviews, medical necessity, prior authorization and individual consideration determinations

▪ Policy Development – Collaborate and advise the Director and DHCF senior staff on policy development including the development of medical necessity criteria, patient safety and health technology assessments

▪ Health Technology Assessments – Develop and implement written policies and procedures for conducting health technology assessments and/or analyses of evidence-based medical literature for new technologies, drugs and therapeutics as assigned by the Health Services Administrator and/or as support for medical reviews

▪ Pharmacy and Therapeutics Committees – Serve as Chairperson of the DC Medicaid pharmacy and therapeutics committee and advises the Director on the maintenance of the DHCF formularies and preferred drug lists

▪ Keep abreast of current health services programs conducted in other areas, both nationally and internationally, as well as, advances in professional knowledge in the field

▪ Serve as consultant and participant internally within DHCF for other initiatives that require medical and health technology assessment expertise. Also serve as consultant to other external Departments and agencies and maintains contact with high level officials of the Federal Government, medical societies, medical specialists, and private and civic groups and organizations to explain programs, suggest solutions to problems, and to secure their support and cooperation in carrying them out

▪ Represent the Director and the District Government at professional and civic meetings as assigned by the Director. Provide consultative services to community health agencies, both public and private, as assigned by the Director

▪ Performs other related duties as assigned

POSITION DESCRIPTION:

▪ This position requires a qualified licensed physician who possesses a license to practice Medicine and Surgery in the District of Columbia. The incumbent shall possess at least five (5) years of demonstrated experience in a supervisory or managerial position in a public health agency

▪ This position requires a qualified physician by virtue of the fact that the programs under the supervision of the incumbent will involve and demand a broad knowledge of a wide variety of medical fields and application of medical administrative skills and abilities

▪ Expert professional knowledge and experience with quality improvement, performance improvement and clinical guidelines▪ Expert knowledge of public health policy and the ability to negotiate in order to arrive at an equitable resolution of problems in the area of health disparity and access to care and services

▪ Expert knowledge of federal, regional, state, and local governmental structure, services, and facilities, and of governmental rules, regulations, policies, and procedures

▪ Extensive experience in management techniques and the ability lead, mentor, manage, and provide direction for a diverse professional and administrative staff

▪ Expert knowledge of the requirements and practices to protect the security and confidentiality of private health information

▪ Strong analytical skills are needed in order to evaluate and synthesize information, to develop necessary plans, and to assess programs, activities, and services

▪ Excellent interpersonal skills are required because of the need to develop effective high-level working relationships throughout DHCF and with other District and Federal Government agencies and other stakeholders

July 2022 - Wyoming - State Medicaid Agent

Open Until Filled

Salary
$8,815.73 – $11,018.80 Monthly

Location
Cheyenne, WY

Job Type
Full Time

Department
048-Div. of Healthcare Financing – Administration

Job Number
2022-03883

GENERAL DESCRIPTION:

The Wyoming Department of Health is looking for a strong leader to serve as its new State Medicaid Agent. The ideal candidate will have deep expertise in Medicaid or health insurance, demonstrate superior leadership and communication skills, and be driven by a compelling big-picture vision of Medicaid’s role in Wyoming’s health and human services sector.

The Department’s mission is to promote, protect, and enhance the health of all Wyoming residents. The department has four operating divisions – Behavioral Health, Aging, Public Health, and Healthcare Financing – and oversees five state-owned healthcare facilities.

The State Medicaid Agent oversees the Division of Healthcare Financing, which includes the Wyoming Medicaid and CHIP programs, and is responsible for providing medical and long-term care insurance to approximately 80,000 enrolled members.

This position has responsibility for all components of the division and provides executive leadership, overall direction, and strategic vision for Medicaid statewide. The position is based in Cheyenne, Wyoming, and reports to the Director of the Wyoming Department of Health with a formal appointment from the Governor of Wyoming.

Human Resource Contact: Anissa French wdhrecruit@wyo.gov

ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function which may be performed at the job level.

Oversee all aspects of the Division of Healthcare Financing at the Wyoming Department of Health, including management of the Wyoming Medicaid and CHIP programs.

Lead personnel in all operating sections of the division
Ensure the smooth continued implementation of the WINGS project, which is Wyoming’s Integrated Next-Generation System – a redesigned and modularized replacement to Wyoming’s Medicaid Management Information System (MMIS)

Drive strategic planning and performance management for the division

Manage the division’s budget of approximately $1,500,000,000
Participate in the department’s senior leadership team
Streamline cross-divisional, and intradepartmental Medicaid processes to ensure seamless operations for high-priority and shared clients

Qualifications

PREFERENCES:

Preference will be given to candidates with at least ten years of experience in healthcare administration (preferably in Medicaid programs), public administration, or a related field.

KNOWLEDGE:

Healthcare administration
Public administration
Budget development and management
Legislative processes

MINIMUM QUALIFICATIONS:

None – See “Preferences”

Necessary Special Requirements

PHYSICAL WORKING CONDITIONS:

Typically, the employee will sit comfortably to perform the work, however, there may be some walking, standing, bending, and carrying light items

NOTES:

FLSA: Exempt
The Wyoming Department of Health is an E-Verify employer.
Supplemental Information

048-Wyoming Department of Health – Division of Healthcare Financing

Click here to view the State of Wyoming Classification and Pay Structure.

URL: http://agency.governmentjobs.com/wyoming/default.cfm

The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.

Class Specifications are subject to change, please refer to the A & I HRD Website to ensure that you have the most recent version.

Agency
State of Wyoming

Address
See Human Resource Contact Information
in the General Description Section
Statewide, Wyoming, 82002

Website
http://agency.governmentjobs.com/wyoming/default.cfm

July 2022 - Nevada - Medicaid Medical Division / Sr. Physician

MEDICAID MEDICAL DIRECTOR/SR. PHYSICIAN

Division of Health Care Financing and Policy

Salary: up to $176,943 (Employee/Employer Paid Retirement Schedule)

The Nevada Division of Health Care Financing and Policy (DHCFP) is seeking to fill the position of Medicaid Medical Director. This is a full-time (40 hours per week) permanent unclassified position and will be housed in either Northern Nevada (Carson City or Reno) or Clark County (Las Vegas), depending on the location of the most qualified candidate. Statewide travel will be required.

The mission of DHCFP is to purchase and provide quality health care services to low-income Nevadans in the most efficient manner; promote equal access to health care at an affordable cost to the taxpayers of Nevada; restrain the growth of health care costs; and review Medicaid and other state health care programs to maximize potential federal revenue.

THE POSITION: This position is within the Division of Health Care Financing and Policy, commonly known as Nevada Medicaid. The Medicaid Medical Director supervises the Medical and Pharmaceutical teams within DHCFP. This position reports directly to and serves at the pleasure of the Administrator of DHCFP.

The Medicaid Medical Director is responsible for identifying ways to improve health outcomes for beneficiaries, for example, by identifying inefficiencies in current benefit coverage and addressing health disparities among beneficiaries; recommending policy changes to better align state medical assistance programs with evidence-based best practices; and recommending actions to improve quality and access to care for beneficiaries, with an emphasis on maternal and infant health and primary care services. Policy development and other oversight: Manages policy development activities of clinical and pharmaceutical teams. Manages oversight of managed care entity utilization management decisions, review processes and quality performance. Works with managed care organizations to address clinical policy issues and assists DHCFP team as needed with supporting provider capacity to engage in value-based payment and delivery models in the Medicaid program. Performs other oversight activities as assigned by the Administrator. Assists in responding to requests for information from legislators, other state agencies, and stakeholders. Collaborates with other Department of Health and Human Services agencies to identify opportunities to improve healthcare access, health equity, health outcomes, and efficiencies in the Nevada Medicaid delivery system. Quality improvement: Participates and oversees program reviews through identification and analysis of medical information to develop interventions and policies to improve quality of care and health outcomes. Promote quality improvement by working with management team to analyze current operations. Participate in the federally mandated hearings program and assist with defending actions taken by Nevada Medicaid at Administrative Law Hearings. This includes, but is not limited to: attending internal and external meetings, Fair Hearings, and Hearing Preparation Meetings for both recipients and providers; providing a detailed explanation of the basis for actions taken by Nevada Medicaid, to include the clinical rationale when the action is related to medical necessity; Page 2 of 2performing additional clinical reviews upon request for hearing related matters, providing expert witness testimony at hearings (in person, telephone and videoconference) that is consistent with the action taken by Nevada Medicaid; modifying or adjusting actions taken in accordance with decisions issued by the Hearing Officer.

Participate in independent professional reviews of providers to determine the quality of care, compliance with patient rights, and appropriateness of placement as assigned. Provide guidance to Health Care Coordinator RN staff in reviewing physician progress notes and medical records to ensure the requested service, treatment, equipment or supplies are medically necessary and in compliance with Medicaid criteria.

QUALIFICATIONS: Medical Doctor or Doctor of Osteopathy (M. D. or D. O. degree) and current, unrestricted license to practice medicine in the State of Nevada, or ability to obtain a license to practice in the State of Nevada are required. Minimum of five years of successful clinical practice experience. Health plan or capitated provider experience is preferred, but not required with exposure to: utilization management, quality management, peer review, case management, denial/appeals, disease management, HEDIS reporting, and provider relations. This position requires domestic travel (up to 50%, location dependent).

An ideal candidate is someone who has interest in population health and the link between social determinants of health (SDH) and clinical outcomes; is an effective communicator; and is capable of analyzing and synthesizing relevant information and presenting in a concise and policy-relevant manner.

BENEFITS: Medical, dental, vision care, life and disability insurance program; paid holidays; generous leave benefits and contribution to the secure defined-benefit retirement plan (NV PERS). State employees do not contribute to Social Security. Long-term employees enjoy additional benefits. For additional information, please visit the Nevada Division of Human Resource Management at http://hr.nv.gov/, the Nevada Public Employees Benefits at http://pebp.state.nv.us/, and the Public Employees Retirement System of Nevada at http://nvpers.org/.

SPECIAL NOTES: Fingerprinting and a background investigation through the FBI and DPS are required. The employee is responsible for all background check fees upon hiring, plus additional fees for rolling fingerprints.

TO APPLY: Please submit your Curriculum Vitae which details your experience, responsibilities, the nature and size of the organization/programs you worked for, salary history, reasons for leaving prior employment, and professional references to: Logan Kuhlman

Division of Health Care Financing and Policy1100 E William St, Suite 101, Carson City, Nevada 89701Ph: (775) 684-3688; Fax: (775) 684-3893Lkuhlman@dhcfp.nv.gov

SELECTION PROCESS: Application material will be screened based on the qualifications; those candidates deemed most qualified will be invited to interview. Announcement will remain open until recruitment needs are satisfied.

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