Eligibility Program Manager 3 (NY HELPS) - 15425, 15268

Description

Duties Description

The Division of Eligibility and Marketplace Integration is seeking to fill two Eligibility Program Manager G-664 level positions to serve as Bureau Directors within the Bureau of Consumer Relations and Local District Support, and the Bureau of Long-Term Care and SSI-Related Populations. The incumbents will assist the Division Director and higher-level managerial staff in identifying mission critical program objectives and executing program operations.

The Bureau of Consumer Relations and Local District Support manages a team of field staff who provide oversight and technical assistance to local department of Social Services (LDSS) staff, the State Disability Review Unit, and the Operations Unit, which processes transactions for a variety of program areas that require manual intervention.

The Bureau of Long Term Care and SSI-Related Populations is responsible for the interpretation, development and implementation of Medicaid eligibility policy related to the aged, blind and disabled. This includes Medicaid eligibility for long-term care services in the community and nursing homes and oversight of the Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD) and the Medicaid Cancer Treatment Program (MCTP).

The positions will provide oversight of staff responsible for managing the areas of eligibility and enrollment policy and operations respective to the programmatic areas described above, with a focus on activities related to federal legislation impacting the Medicaid application and administration process including H.R. 1 and the ongoing design and implementation of the Medicaid Eligibility and Client Management System (MECM) for complex Medicaid populations.

The preferred candidates should have expert knowledge of New York public health insurance program eligibility and enrollment policies, including working with LDSS, interpreting federal and state laws, rules and guidance; knowledge of the Welfare Management System (WMS), eMedNY, and NY State of Health; a demonstrated ability to manage multiple priorities and meet deadlines; and the ability to lead multi-disciplinary teams; and excellent written and oral communication skills.

Reassignment

Minimum Qualifications

Current NYS Department of Health (DOH) employee with permanent or contingent permanent status as a Eligibility Program Manager 3, M-4.

Permanent Transfer Candidates

Current NYS employee with one year of permanent or contingent permanent competitive service G-29/M-3 in a title eligible for transfer to Eligibility Program Manager 3, M-4 under Section 52.6 of the Civil Service Law.

The transfer cannot be a second consecutive transfer resulting in an advancement of more than two salary grades.

Non-Competitive Candidates Via NY HELPS Program

A bachelor’s degree and six years of professional experience, four years of which must have included second-level supervision of professional staff, performing one or more of the following seven activities* in a program with one or more of the following functions : provides reimbursements for health care services; works with social services program areas; determines eligibility for a consumer assisted program in a hospital or other health care facility; provides health care regulatory oversight; or performs quality assurance and interpretation/application of standards of health care.

• Activities
• Overseeing and directing staff in determining eligibility for a health insurance program or consumer assisted program in which financial eligibility criteria must be met.
• Overseeing and directing staff in performing utilization review, including prepayment or post-payment review of requested health care services, prior approval or authorization activities, adjudication or pricing of claims for payment, or analysis of patterns of health care.
• Overseeing and directing staff in developing mechanisms for the reimbursement and financing of health care services, including rate-setting or approval, capitation reimbursement methodologies, fee schedule development, coding constructs for medical goods and services, or application and processing of reimbursement methodologies.
• Administering and overseeing staff responsible for day-to-day program operations for budgeting, staffing, or program planning.
• Overseeing and directing staff in inspecting, assessing, or monitoring health insurance programs or health care facilities for certification, licensure, or adherence to laws, rules, regulations, and policies.
• Overseeing and directing staff in planning, designing, developing, researching, or evaluating proposals to establish or refine health related programs, with responsibility for interpreting legislation or regulations, defining and describing target populations and local demographics, grant and proposal writing, or developing, reviewing, and evaluating contracts.
• Administering and overseeing staff responsible for performing quality assurance activities such as ensuring compliance with laws, rules, regulations, and policies, as it pertains to activities 1 through 6.
  
  

Preferred Qualifications: Preferred candidates will have professional experience in public health insurance programs, including New York’s Medicaid, and/or Child Health Plus. Preferred candidates will also have excellent verbal and written communication skills; strong analytical skills and attention to detail; strong organizational skills; proficiency in Microsoft Office (Word, Excel, Access); the ability to work well independently and as part of a team, and to manage multiple priorities in order to meet deadlines; experience using electronic data systems, such as eMedNY and NYSOH Back Office; and supervisory experience.

Additional Comments

This position is part of the NYS HELPS program. No examination is required.

The NYS Department of Health is committed to making New York a safer, healthier, and more equitable place to live. Understanding health equity, social determinants of health and health disparities is critical to accomplish our goal of eliminating health disparities. For more information on the NYS Department of Health’s Mission, Vision, Values and Strategic Plan, please visit: https://health.ny.gov/commissioner/index.htm

If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.reasonable.accommodation@health.ny.gov to make a request.

NYS Department of Health does not participate in E-Verify and does not sponsor visa applications.

For new State employees appointed to graded positions, the annual salary is the hiring rate (beginning of the Salary Range) of the position. Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations and negotiated union contracts.