Careers

Director III, Deputy Director of Program Policy, Medicaid and CHIP Services, Texas Health and Human Services Commission

 

Job Posting:https://jobshrportal.hhsc.state.tx.us/ENG/careerportal/Job_Profile.cfm?szOrderID=568056

 

Posting Number: 568056

 

Job Description

The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) division seeks a highly qualified candidate to fill the position of Deputy Director of Program Policy. MCS is driven by its mission to deliver quality, cost-effective services to Texans. The Deputy Director is a key leadership position within MCS that oversees the 75-person Program Policy unit responsible for policy strategy, analysis, development, and implementation within the Medicaid and CHIP programs. This position has major accountability for the achievement of key goals for the programs, thus making a significant contribution to MCS’ mission. Reporting to the Deputy Associate Commissioner for the Office of Policy, the Deputy Director provides both day to day leadership and long-term strategic vision of Medicaid and CHIP Program Policy. This includes leading complex high-profile initiatives; ability to interpret state and federal law, regulations, and policy documents; collaborating across divisions and agencies; negotiating on behalf of the agency; ensuring compliance with state and federal requirements; promoting high-quality work products; ensuring team accountability; fostering a growth-oriented culture in Program Policy; and spearheading team building, motivational activities, and staff recognition.The functions under the Deputy Director of Program Policy rely on honed analytical skills, critical thinking skills, producing and editing high quality written documents, complex problem solving, leading the MCS division’s extensive legislative process for bill and fiscal analysis, development of policies and procedures for programs as well as staff continuous improvement and retention. The Deputy Director also supports the Deputy Associate Commissioner in overseeing all aspects of department operations for the Office of Policy, to include developing and managing the division budget, oversight of staff, policies and procedure, and agency initiatives. The ideal candidate for this role is a self-directed leader, a skilled communicator with proven experience in stakeholder relations and public speaking, and a leader experienced in developing other leaders. A candidate versed in managing multiple programs, dealing with ambiguity, and providing vision and strategic leadership in a public environment. The Deputy Director of Program Policy must have excellent communication skills, be adaptable, possess experience in highly complex analysis, and working collaboratively across complex, diverse subject areas. Works under minimal supervision with extensive latitude for the use of initiative and independent judgment.

Requisition No: 799090

Agency: Agency for Health Care Administration

Working Title: 68063596 – ASSISTANT DEPUTY SECRETARY FOR HEALTH CARE FINANCE (CHIEF FINANCIAL OFFICER)

Position Number: 68063596

Salary:  $5,000.00 – $5,576.92 Biweekly

Posting Closing Date: 04/16/2023

Agency Overview:

 

The Agency for Health Care Administration (AHCA) is Florida’s chief health policy and planning entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities, and empowering consumers through health care transparency initiatives.

Under the direction of the Agency Secretary, AHCA is focused on advancing Governor DeSantis’ vision for Florida’s health care system to be the most cost-effective, transparent, and high-quality health care system in the nation. Current Agency initiatives include implementing Florida’s groundbreaking Canadian Prescription Drug Importation Program, overhauling Florida’s healthcare technological ecosystem, and increasing insight in the cost of health care services.

The Medicaid program provides low-income families and individuals with access to health care.  If you have a desire to use your talent and skills at an organization that provides critical services to millions of individuals and families across the state, AHCA invites you to apply to become an essential member of our team. As one of Florida’s leading state agencies, AHCA’s diverse workforce community of more than 1,400 employees is proud of its efforts to serve the people of Florida.

Agency Objectives:

HIGH QUALITY

Emphasizing quality in all that we do to improve health outcomes, always putting the individual first.

TRANSPARENT

Supporting initiatives that promote transparency and empower consumers in making well informed healthcare decisions.

COST-EFFECTIVE

Leveraging Florida’s buying power in delivering high quality care at the lowest cost to taxpayers.

Position Overview:-

This position is pending a reclassification to an Assistant Deputy Secretary for Health Care Finance (Chief Financial Officer).

This is an exciting opportunity to help shape the quality of health care in Florida. We are seeking to hire an Assistant Deputy Secretary for Health Care Finance who desires to work to enhance the delivery of health care services through health care finance at AHCA.  This position requires a candidate who is creative, flexible, innovative, and who will thrive in a fast-paced, team-based work environment.

This position is located in the Division of Health Care Finance and Data.  This position is one of two Assistant Deputy Secretaries reporting to the Deputy Secretary for Health Care Finance and Data, and this position has full line authority with respect to the Bureaus of Medicaid Program Finance and Financial Services.

This position is responsible for

Directs the planning, development and implementation of uniform policies, procedures and regulations governing administration related to finance and accounting, budget, grants, revenue management, disbursement under the Bureau of Financial Services.

Directs Medicaid expenditure and enrollment forecasting regarding the $37.6 B Medicaid Budget, payments made through the Low-Income Pool (LIP) program, the Hospital Directed Payment Program, the Disproportionate Share program, the Graduate Medical Education program, and other supplemental and directed payment programs including physician and public hospital supplemental payments, the Public Emergency Medical Transportation program, and the Florida Cancer Hospital Program, oversees the setting of institutional and all other fee-for-service rates for the Medicaid program, and oversees financial monitoring of Medicaid managed care plans under the Bureau of Medicaid Program Finance.

This position is responsible for communicating with, motivating, training, and evaluating employees, and planning and directing employees’ work. The incumbent in this position has the authority to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, and discipline employees or effectively recommend such action.

Consults and advises the Secretary of AHCA, the Chief of Staff and Deputy Secretaries regarding legislative budget requests, Directs the planning and development of the Agency’s legislative budget requests, Agency operational budget, and tracking expenditures and rate activities are consistent with statutory authority, legislative intent, Agency goals/priorities and revenue projections. Recommends modifications when needed. Directs the Agency transfer of appropriations pursuant to Section 216.292, F.S., and Section 216.282, F.S.

Serves as one of the Agency liaisons with the Office of the Governor and the Office of Policy and Budget regarding legislative budget requests, budget amendments, requests legislative proposals that affect the Agency, other State agencies and the general public.

Assists the Secretary, Chief of Staff, and Deputy Secretary in analyzing legislative bills and proposes legislation needed to improve operational efficiency or to support the accomplishment of Agency goals.

Represents the Deputy Secretary before the Legislature and other federal, state, and local government officials. Attends hearings, conferences, and other public meetings on behalf of the Secretary and Deputy Secretary of Health Care Finance and Data. Advises the Secretary, Chief of Staff and Deputy Secretaries as appropriate in the administrative component in each division; works with all Agency Deputy Secretaries to resolve critical issues.

Directs, plans, and administers the overall activities of the comprehensive provision of administrative support for the Agency’s program and operations, conducts on-site visits statewide to determine needs, provide support and ensure that the administrative functions are operating as an integral part of the Agency and assess needs for improvement or areas which need attention.

Act as public records custodian related to the functions within the Division of Health Care Finance organizational structure in compliance with Section 119.021, Florida Statutes.

Directs the appropriate personnel to evaluate proposals and replies, as well as necessary persons to conduct negotiations during a competitive sealed-reply procurement, pursuant to section 287.057 (16), Florida Statutes and in conjunction with the Agency’s Contract Administration Unit.

Performs other duties as assigned.

Benefits of Working for the State of Florida:

Working for the State of Florida is more than a paycheck. The State’s total compensation package for employees features a highly competitive set of employee benefits including:

• State Group Insurance Coverage Options, including health, life, dental, vision, and other supplemental insurance options;

• Flexible Spending Accounts;

• State of Florida retirement options, including employer contributions;

• Generous annual and sick leave benefits;

• 9 paid holidays a year and 1 Personal Holiday each year;

• Career advancement opportunities;

• Tuition waiver for courses offered by Florida’s nationally ranked State University System;

• Training and professional development opportunities;

• And more!

For more information about the Medicaid Director’s Office, please visit our website at http://ahca.myflorida.com/Medicaid/index.shtml.

Join us at the Agency for Health Care Administration in fulfilling our mission to provide “Better Health Care for all Floridians.”

KNOWLEDGE, SKILLS, AND ABILITIES

• Strong working knowledge of health care systems.

• Excellent communication skills, with the ability to communicate effectively both verbally and in writing including ability to speak or present in front of large audiences.

• Strong management skills, with knowledge of management principles and practices.

• Ability to analyze data in order to develop alternative recommendations, solve problems, document workflow and other activities relating to the improvement of operational and management practices.

• Ability to conduct fact-finding research.

• Ability to utilize problem-solving techniques.

• Ability to work independently, as well as in a group/team setting.

• Ability to understand and apply applicable laws, rules, regulations, policies, and procedures relating to operational and management analysis activities.

• Ability to plan, organize and direct work assignments, while motivating and developing staff.

• Ability to establish and maintain effective working relationships and build consensus among diverse interests.

• Ability to apply Governmental Accounting Standards set by Governmental Accounting Standards Board (GASB).

• Ability to plan, coordinate, develop and implement the Agency’s budget management, budget control and Legislative Budget Request process.

• Knowledge of Business Analysis principles and project management methodology.

• Experienced at meeting, planning and organization management.

• Experience in contract management and negotiation.

• Ability to travel with or without accommodations.

MINIMUM QUALIFICATIONS REQUIREMENTS

At least four years experience managing large programs and initiatives.

At least four years of experience in health care systems or Medicaid Financing or Governmental Accounting/ Finance.

A Bachelor’s Degree and applicable work experience in a Finance related field or Accounting, Economics, Statistics from a four-year college or university is preferred.

A Master’s degree and Certified Public Accountant (CPA) is preferred.  However, a Bachelor’s degree from an accredited college or university in a related Finance field or Accounting, Economics, Statistics can substitute on a year-for-year basis.

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

N/A

CONTACT:   JAMIE SKIPPER (850) 412-3900

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

Nearest Major Market: Tallahassee

Job Posting closes:  April 20, 2023

Kansas Department of Health and Environment:  

Our agency is led by Secretary Janet Stanek, who was appointed by Gov. Kelly in Dec 2021. KDHE is comprised of three divisions: Public Health, Environment, and Health Care Finance (which includes the State’s Medicaid program, KanCare). We are the only agency in the nation to have these three entities under one roof which allows us to take a holistic approach to improving and protecting the health and well-being of all Kansans.

http://www.kdhe.ks.gov/

About the Position

• Who can apply:  Anyone (External)
• Classified/Unclassified Service:  Unclassified
• Full-Time/Part-Time:  Full-Time
• Regular/Temporary:  Regular
• Work Schedule:  Monday-Friday, 8am-5pm (Flexible schedules available)
• Eligible to Receive Benefits:  Yes
• Veterans’ Preference Eligible:  Yes
• Search Keywords: 

Employment Benefits

• Comprehensive medical, mental, dental, vision, and additional coverage
• Sick & Vacation leave
• Work-Life Balance programs: parental leave, military leave, jury leave, funeral leave
• Paid State Holidays (designated by the Governor annually)
• Fitness Centers in select locations
• Employee discounts with the STAR Program
• Retirement and deferred compensation programs

Visit the Employee Benefits page for more information…

Position Summary & Responsibilities

Position Summary:  

The position (K0221729) The Kansas Department of Health & Environment (KDHE) is seeking an experienced and enthusiastic leader to serve as the Deputy Secretary of Agency Integration.  This new position will report directly to the Secretary of KDHE and will have primary responsibility for integration and alignment of health-focused activities throughout the KDHE enterprise and will oversee all aspects of the State’s Medicaid Program (KanCare), and the Children’s Health Insurance Program (CHIP). This position will play a critical role in advancing health improvement initiatives for the State consistent with the Healthy Kansans 2030 goals and will work in partnership with agency and other state leaders/stakeholders in improvement activities related to the State Health Rankings.

Qualifications

• Education:
  • Bachelor’s degree with related experience
• Licensing & Certification:  
  • Valid Driver’s License – Incumbent is required to have and maintain a valid driver’s license when operating a state vehicle, a private vehicle, or a rental vehicle for the benefit of the State.
• Minimum Qualifications:  
  • 5 years in a business or executive management role
• Preferred Qualifications:  
  • Master’s degree in Business Administration or similar field and related experience preferred
  • Word, Excel, PowerPoint, Access
  • Proofreading, editing, attention to detail
  • Communication skills both oral and written
  • Ability to gather relevant information to compile reports and develop presentations
  • Analytical skills
  • Problem solving
  • Experience planning and leading strategic initiatives
  • Proven experience organizing and directing multiple teams and departments
  • Nimble business mind with a focus on developing creative solutions
  • Strong project reporting skills, with a focus on interdepartmental communication

Recruiter Contact Information

• Name: Lamar Leon
• Email: Lamar.Leon@ks.gov
• Mailing Address: 1000 SW Jackson St. Suite 580 Topeka, KS 66612

Job Application Process

• First Sign in or register as a New User.
• Complete or update your contact information on the Careers> My Contact Information page. *This information is included on all your job applications.
• Upload required documents listed below for the Careers> My Job Applications page. *This information is included on all your job applications.
• Start your draft job application, upload other required documents, and Submit when it is complete.
  • Manage your draft and submitted applications on the Careers> My Job Applications page.
• Check your email and My Job Notifications for written communications from the Recruiter.
  • Email – sent to the Preferred email on the My Contact Information page
  • Notifications – view the Careers> My Job Notifications page

Helpful Resources at jobs.ks.gov: “How to Apply for a Job – Instructions” and “How to Search for a Job – Instructions”

Required Documents for this Application to be Complete

Upload these on the Careers – My Job Applications page

• Transcripts
• DD214 (if you are claiming Veteran’s Preference)

Upload these on the Attachments step in your Job Application

• Resume
• Cover Letter

Helpful Resources at jobs.ks.gov: “How, What, & Where do I Upload Documents”

How to Claim Veterans Preference

Veterans’ Preference Eligible (VPE): Former military personnel or their spouse that have been verified as a “veteran”; under K.S.A. 73-201 will receive an interview if they meet the minimum competency factors of the position.  The veterans’ preference laws do not guarantee the veteran a job.  Positions are filled with the best qualified candidate as determine by the hiring manager.

Learn more about claiming Veteran’s Preference

Equal Employment Opportunity

The State of Kansas is an Equal Opportunity Employer.  We value diversity, equity, and inclusion as essential elements that create and foster a welcoming workplace.  All qualified persons will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, political affiliation, disability or any other factor unrelated to the essential functions of the job.

If you wish to identify yourself as a qualified person with a disability under the Americans with Disabilities Act and would like to request an accommodation, please address the request to the agency recruiter.

The Office of the Medical Director is seeking a qualified candidate to serve as the lead dental clinician for the Medicaid/CHIP Services Division. The position is now posted on the HHS Jobs Portal:

https://jobshrportal.hhsc.state.tx.us/ENG/careerportal/Job_Profile.cfm?szOrderID=563130&szReturnToSearch=1&&szWordsToHighlight=dentist

The Medicaid Dental Director will be instrumental in the development of dental benefits policy and program policy, analyzing relevant legislation, and collaborating with both internal and external stakeholders (among other key duties and assignments).

Please share the above link/posting information with anybody that you think would be interested in applying for this important position. The posting will close on Monday, April 17, 2023.

                   DEPUTY MEDICAID DIRECTOR #9U404 (JOB ID: 30022)

State of New Hampshire Job Posting

Department of Health and Human Services

Division of Medicaid Services

Concord, NH

 

DEPUTY MEDICAID DIRECTOR

LG HH

#9U404

$86,502.00-$120,562.00

 

The State of New Hampshire, Department of Health and Human Services, Division of Medicaid Services has a full time vacancy for Deputy Medicaid Director.

SUMMARY:

Leads the development and administration of the strategy, goals, and objectives of the Division of Medicaid Services (DMS) in close coordination with the Medicaid Director.  Authorizes and directs senior-level policy development, evaluation, and administration; program operations; and the implementation of DMS policies and procedures. Translates Medicaid program strategy to Department goals and operations. Leverages expertise on national trends and best practices in Medicaid policy strategy and execution to enhance the DMS strategic plan, identifying and evaluating alternatives for enhancing program and business operations, and leading the Director level staff to achieve through an effective team of professionals for the DMS Division objectives and assists the DMS Director in the support of DHHS Divisions with Medicaid related initiatives. Acts as Medicaid Director in the absence of the Director.

 

RESPONSIBILITIES:

In coordination with the Medicaid Director, ensures that DMS strategy and operations align with the goals and objectives of the Division and Department, including monitoring and evaluating operational activities for compliance with regulatory mandates, efficient and effective allocation of Division resources, and the achievement of evidence-based, measurable outcomes.  Generates opportunities for alignment and integration through outcome based evidence in the pursuit of opportunities for improvement across the Division, drawing upon external expertise, publicly-available data sources, academic literature, and relevant reports.

 

Reports directly to the Medicaid Director and oversees the Directors of Medicaid Enterprise Development and Director of Policy and Clinical Programs. Provides direct supervision and professional development guidance to subordinate Directors and Management staff.  Evaluates work performance, assesses training needs, and assures timely performance evaluations are conducted. Independently administers assigned program objectives and directs staff activities to accomplish desired results.

 

Oversees and provides leadership to the Division Directors in their day to day operations in program management with a focus on the Medicaid Care Management Program, Operation and Finances of Federal Waivers for the Medicaid Program, the State Plan and amendments, Medicaid Management Information System and State and Federal level rule-making. – clinical and non-clinical, service delivery, contracts, MMIS financial management, and budget.  Oversees the development and implementation of strategies to improve business and program operations.  Authorizes internal operational policies and procedures and reviews recommendations for enhancements.

 

Prepares initial drafts of budget materials in collaboration with the Finance Director and Medicaid Director to address Division and Department needs. Monitors budgets and expenditures and imposes fiscal controls as required.

 

Leads across DMS operations, establishing short-term and long-term priorities for managed care programs, clinical programs, Federal and State policy, system enhancements, high-impact Division procurements and cross-agency collaboration.

 

Partners with the Medicaid Director and other Department leadership to develop legislative strategy and activities, drafts legislation, and presents testimony at legislative hearings. Leads legislative initiatives with Department-wide or cross-Department impacts as assigned by the Medicaid Director.

 

Oversees the administration and coordination of policy and rule-making for program efforts through Division Directors with other DHHS sections/units to ensure agency compliance with federal and state regulations by ensuring coordination and maintenance of NH administrative rules and State Plan Amendments and Waivers that deal with Medicaid benefits.

 

Analyzes, interprets, and integrates program, regulatory, financial and outcome data, and metrics to inform planning efforts and decision making.  Prepares reports and communicates findings and recommendations to the Director.

 

Acts as the official representative of the Department and Division.  Meets with government officials, medical professionals, and other key stakeholders to explain and develop DMS policy and operating positions. Provides information and guidance to state agencies, the legislature, Governor’s Office and the general public regarding agency activities and responsibilities.  Presents testimony at legislative and regulatory hearings to provide information and speak in support of agency goals.

 

Frequently interfaces with federal and state agencies, community partners, and constituents including the Centers for Medicare and Medicaid Services.  Troubleshoots and resolves received/referred issues from DMS stakeholders and beneficiaries.

 

MINIMUM QUALIFICATIONS:

Master’s degree from a recognized college or university with a major study in public administration, health policy, finance, public health, public policy, law or a related field of study, and eight years of work experience in public administration, policy administration, business, management or a related field.

 

OR

 

Bachelor’s degree from a recognized college or university with a major study in public administration, health policy, finance, public health, public policy, law or a related field of study, and nine years of work experience in public administration, policy administration, business, management or a related field.

 

LICENSE/CERTIFICATION: Valid driver’s license and/or access to transportation for travel as required by the position duties.

 

SPECIAL REQUIREMENTS: Requires specialized knowledge of Medicaid, state government, strategic planning and agency administration. Must be able to work under minimal supervision with extensive latitude for the use of initiative and independent judgment. Knowledge of local, state, and federal laws and regulations specifically knowledge of CMS regulations and processes for state plan, institutional and waiver programs. Knowledge of the principles and practices of public administration and management or health management and finance.  Demonstrated ability to direct and organize program activities; to establish program goals and objectives that support the strategic plan; to identify problems, evaluate alternatives and implement effective solutions; to develop and evaluate policies and procedures; to direct the development of agency policies and procedures; to prepare concise reports; to make presentations and testify at hearings; and to plan, assign, and/or supervise the work of others.

 

PREFERRED QUALIFICATIONS: Preference will be given to candidates with public administration, public health, law or health care policy background who have worked within a State and/or Federal medical assistance program.

 

DISCLAIMER STATEMENT:  The supplemental job description lists typical examples of work and is not intended to include every job duty and responsibility specific to a position.  Any employee may be required to perform other related duties not listed on the supplemental job description provided that such duties are characteristic of that classification.

 

For further information please contact Henry Lipman, Medicaid Director, Henry.D.Lipman@DHHS.NH.GOV, 603-271-9434.

 

 

 

*TOTAL COMPENSATION INFORMATION

 

The State of NH total compensation package features an outstanding set of employee benefits, including:

 

HMO or POS Medical and Prescription Drug Benefits:

The actual value of State-paid health benefits is based on the employee’s union status, and employee per pay period health benefit contributions will vary depending on the type of plan selected.

 

See this link for details on State-paid health benefits: https://das.nh.gov/hr/benefits.html

 

Value of State’s share of Employee’s Retirement:  14.53% of pay

 

Other Benefits:

o   Dental Plan at minimal cost for employees and their families ($500-$1800 value)

o   Flexible Spending healthcare and childcare reimbursement accounts

o   State defined benefit retirement plan and Deferred Compensation 457(b) plan

o   Work/life balance flexible schedules, paid holidays and generous leave plan

o   $50,000 state-paid life insurance plus additional low cost group life insurance

o   Incentive-based Wellness Program (ability to earn up to $500)

 

Total Compensation Statement Worksheet:

https://das.nh.gov/documents/hr/JobSearch/FINAL_TOTAL_COMP_STATEMENT_ISSUE.xlsx

 

Want the specifics?  Explore the Benefits of State Employment on our website:

https://das.nh.gov/hr/documents/BenefitBrochure.pdf

https://das.nh.gov/hr/index.aspx

 

 

*See total compensation information at the bottom of announcement.

YOUR EXPERIENCE COUNTS – Under a recent change to the rules, an applicant’s relevant experience now counts towards formal education degrees referenced in the posting See Per 405.1.

 

18 Months of additional relevant experience = Associate’s degree

36 Months of additional relevant experience = Bachelor’s degree

54 Months of additional relevant experience = Master’s degree

Find more information here.

Hiring Range: $150,200 – $156,900

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 the Provider Reimbursement Division Director. The selected competitive candidate will provide exceptional delivery of services to the agency’s Provider Reimbursement Division. Job responsibilities will include, but are not limited to: Provides 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 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: Requires extensive experience with Medicaid rate setting for both managed care and fee-for-service programs, supplemental payments, and cost settlements. Requires extensive knowledge of health care delivery systems, program planning and organizational management principles. General knowledge of Medicaid and health care programs is also required. Considerable work-related experience in project management, planning and evaluation skills of complex programs is required. Must have proven supervisory and human resource management experience. Demonstrated ability to direct multiple and diverse operations. Must have excellent oral and written communication skills. Requires exceptional skills in decision making.

Preferred Qualifications:

Competitive candidates should meet these preferred qualifications: Bachelor’s degree from an accredited college/university with major study in Health Administration, Economics, Accounting, Public or Business Administration or related field or an equivalent combination of education and experience is preferred. Master’s degree in Accounting, Economics, Health Administration or Policy, Finance, Public or Business Administration, or a related degree from an accredited college or university is also preferred. Experience working in a large, complex public sector financial agency desired.

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 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. 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. This position requires the submission of a Statement of Economic Interest (financial disclosure).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. This position requires travel (intra­ and inter-state) for meetings, conferences and/or trainings.

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.

 

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

To Apply: Submit your application at https://www.omb.nd.gov/team-nd-careers/career-openings. Application deadline is 11:59pm, Thursday, March 9, 2023.

 

Drive strategy that ensures access to health care for some of North Dakota’s most vulnerable citizens and help North Dakota become the healthiest state in the nation.

 

The ND Department of Health and Human Services, the state’s largest agency, is seeking an executive leader for the Medical Services Division. As the Executive Director of DHHS’ Medical Services Division, you will provide strategic leadership and management of several major sections including Medicaid, Children’s Health Insurance Program, and Utilization Review. Also, you’ll provide direct and indirect management of more than 100 team members.

 

Furthermore, you’ll be part of an 11-member Executive Team, reporting directly to the agency’s Commissioner. As an executive team member, you’ll participate in agency strategic planning, as well as build and maintain collaborative relationships with stakeholders across the state and country. In addition, you’ll lead legislative activities for the division.

 

To thrive in this position, you must be a strategic thinker who has been highly successful in policy development and stakeholder collaboration. You employ collaborative and diverse decision-making processes to engage others in a vision and initiatives. And you are very committed to effectiveness of program delivery and that commitment shows in your leadership.

 

To be considered for this position, you must have a Bachelor’s degree and five years of senior management level experience in the administration of Medicaid programs, other major human service funding, or reimbursement programs (such as Public Assistance, Supplemental Nutrition Assistance Program [ SNAP], Child Support, etc.); OR a Bachelor’s degree and five years of senior level management experience in healthcare administration including extensive experience with Medicaid regulations and reimbursement.

 

Experience must have included program implementation and management, supervision of professional level staff, budget development, and management.

 

 

Location: This is a position located in Bismarck, ND that has the ability to work onsite at the North Dakota State Capitol in Bismarck as well as from home.

 

About Medical Services: The Division is responsible for program oversight and direction, strategy and policy development, utilization review, program integrity, research and exploration of innovative practices, and implementation of federal and state initiatives and mandates. The Division and Medicaid biennial budget exceeds $4 billion.

 

About DHHS: The Department of Health integrated with the Department of Human Services in September 2022 to become North Dakota Department of Health and Human Services (ND DHHS). ND DHHS strives to make North Dakota the healthiest state in the nation by reinforcing the foundations of well-being: physical, economic, and behavioral. Those services are to be delivered as close to home as possible with a focus on dignity and respect. The keys to delivery of those services are the 2800 committed, compassionate ND DHHS team members and more than $5 billion in funding from nearly 200 different federal, state, and special sources.

 

The State of North Dakota is committed to providing team members with a strong and competitive benefits package that support you, your health and your family. Benefits include learning and development opportunities, 100% employer paid health insurance for the entire family, generous time-off, career growth, and a sound retirement system.

 

To Apply: Submit your application at https://www.omb.nd.gov/team-nd-careers/career-openings. Application deadline is 11:59pm, Thursday, March 9, 2023.

 

For more information or if you need an accommodation, please contact Robin Thorstenson at 701.328.2397 or at rthorstenson@nd.gov.

 

Equal Employment Opportunity

The State of North Dakota and this hiring agency do not discriminate on the basis of race, color, national origin, sex, genetics, religion, age or disability in employment or the provisions of services and complies with the provisions of the North Dakota Human Rights Act.

You can read the full job description here. This job posting closes March 8.

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Director Eligibility and Enrollment Services. The selected competitive candidate will provide exceptional delivery of services to the agency’s Eligibility and Enrollment Services Division.Job responsibilities will include, but are not limited to:This position is responsible for providing executive leadership, oversight, strategic direction and program management for the Division of Eligibility and Enrollment Services (EES).In this role, the incumbent is responsible for supporting the Deputy of Administration in all aspects of eligibility and enrollment to report out to the Centers for Medicaid and Medicare Services (CMS), Secretary of Health and Human Resources (HHR), the General Assembly, stakeholders, and other vital partners in Virginia’s public health care programs such asthe Virginia Department of Social Services.The Eligibility and Enrollment Services Director works closely with federal partners to include CMS to maintain the agency’s verification plan, interpret federal policies andregulations, and provide detailed reporting related to the Cover Virginia Operations, eligibility determination systems, the federal and state-based exchanges, and the development and maintenance of related State Plan pages in coordination with the Policy, Regulations, and Member Engagement Division.The Eligibility and Enrollment Services Director serves as the primary monitor of the Interagency Agreement with the Department of Social Services and is charged with the development and implementation of a performance management program for eligibility processing as it pertains to the local Department of Social Services agencies.This includes the day-to-day oversight, development, updating and implementation of eligibility policy, operations of eligibility services provided through contracts and under the Memorandum of Understating with the Department of Social Services, who provides the oversight of eligibility processing by local agencies.This work includes close coordination with the Office of Internal Audit to oversee federal and state level reviews of enrollment in the VaCMS and MES systems as well as the development and implementation of corrective action plans as needed.This position works with the Medicaid Benefit Program team at theDepartment of Social Services to develop and review trainings, implement new programs and policy changes which impact eligibility and enrollment into the Medicaid program, and to provide needed communications.This position is responsible for the oversight of the Facilitated Enrollment program in partnership with the Virginia Department of Taxation, the State Based Exchange in partnership with the State Corporation Commission.Serves as the CHIP Director for the agency with all necessary federal, national and stateentities, including collaborating with PRME’s CHIP SME on implementation and maintenance of CHIP programs and funding streams.In addition to coordination and close collaboration with the Department ofSocial Services, this position is responsible for the oversight of the Cover Virginia Operation which operates the state-wide Medicaid call center, the Central Processing Unit, which processes Medicaid applications, and the Cover Virginia Incarcerated Unit, which requires close work and collaboration with the Department of Corrections and local and regional jails.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:Comprehensive knowledge of the Medicaid and CHIP programs, the history, federaland state policies and regulations and major initiatives and the populations served.Extensive knowledge of Modified Adjusted Gross Income (MAGI) and Aged, Blind, and Disabled (ABD) (to include Long-term Supports and Services and patient pay) Medicaid eligibility policy experience is required.Operational experience and knowledge to include experience with oversight of call centers, processing units, and systems requests.Candidate must be innovative and be able to apply creative problem skills, effectuate change, and provide data driven results.Recent leadership experience and a demonstrated history of successively responsiblemanagement positions.Experience with managing professional employees, developing high performing teams,setting goals and managing resources to achieve results.Must possess history of managing large-scale complex projects to successful outcomes.Demonstrated ability to communicate orally and in writing to varied audiences and to serve as an effective spokesperson for the agency and the work of the division.Successful experience working collaboratively with diverse stakeholders toward the achievement of agency and Commonwealth goals.Experience implementing new programs to include project management and ability to work with collaboratively with internal teams to ensure effective communications.Outreach with stakeholders, members, and the general public, system changes, obtaining state and federal authority, development and approval of trainings, manual and policy updates.Experience utilizing data to formulate or analyze proposals, evaluate programs, measureperformance, and improve outcomes.Must possess ability to manage multiple budgets, plan and forecast forfuture years, and work closely with Budget, Procurement, Contract teams to ensure the needs of the division are met.Position required extensive work during the General Assembly session to include completion of financial impact statements, drafting decision packages, and working with finance teams to develop cost analysis.

Preferred Qualifications:

Competitive candidates should meet these preferred qualifications:Individual must have strong contract management skills, experience in contract monitoring preferred.Graduation from an accredited college/university with a major course work in social work, health services, business, public administration or related field.Graduate level degree strongly preferred.

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 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.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.This position requires the submission of a Statement of Economic Interest (financial disclosure).This position requires a fingerprint based Criminal History Background Check, Education Checks, 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.

 

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

 

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

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.

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.

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

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

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.