Job Code Pay Scale Group Pay Scale Type Bargaining Unit Civil Service or Non-Civil Service Last Executive Board Change Executive Board Change History
43940 11 ST A3 N 771-11 03/26/2021
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JOB CODE: 43940

DEFINITION: This is highly responsible administrative work directing the development and modification of policies, regulations, and planning initiatives for the Office of Medical Assistance Programs (OMAP) in the Department of Human Services (DHS).

The employee in this job directs the development, modification, and evaluation of program policies, regulations, and services in the Medical Assistance (MA) fee-for-service and managed care health care delivery systems. Work includes designing and developing policies and program regulations; interpreting policy and service requirements for medical service providers, managed care health care organizations, other DHS offices, the legislature, legal office, client advocates, and the public; developing, reviewing, and maintaining Medicaid waivers; coordinating and planning activities among OMAP bureaus; developing program measures; and serving as OMAP's lead liaison with federal, state, and local governments, service provider associations, regulatory review entities, legislative staff, and staff from the Governor's and the Department's Offices of Policy regarding policy and program development. The employee in this job also updates and maintains Pennsylvania’s Medicaid State Plan to ensure regulatory compliance with federal requirements to maximize federal financial participation and ensure maximum availability of program funding; and participates in the development and maintenance of automated systems that support MA programs and operations. Supervision is exercised over a professional, administrative, and technical staff; and work is reviewed by the Deputy Secretary for OMAP through conferences, reports, and evaluation of program effectiveness.

EXAMPLES OF WORK: (NOTE: The examples of work are representative of the work, but every position classified to this job may not perform all examples of work listed. Conversely, this is not an all-inclusive list of work examples.)

• Plans, organizes, and directs the development of comprehensive program policy and regulations, service planning, and evaluation for the MA fee-for-service and managed care health care delivery systems.

• Defines concepts, methodology, and administrative procedures for policy and regulation development, modification, and evaluation.

• Ensures that program policies and regulations are compliant with state and federal laws and regulations.

• Coordinates the analysis of federal and state legislation and directs the development of program policies and regulations in collaboration with federal officials, other state Medicaid agencies, consumer organizations, advocacy groups, provider organizations, other DHS program managers, legal office staff, and the public.

• Develops and reviews federal Medicaid managed care waivers.

• Analyzes and develops new programs and program initiatives.

• Develops federal policy recommendations in collaboration with the Governor's Office of Policy and the federal government to reflect DHS' position on policy issues.

• Evaluates the policies, goals, and standards governing MA programs and advises on conflicts and differences to develop comprehensive health care delivery systems.

• Serves as Ex-Officio Co-Chair and facilitates the operation of the Medical Assistance Advisory Committee (MAAC) and Consumer Subcommittee; and provides administrative support and guidance to the subcommittees of the MAAC facilitated by OMAP bureaus and the Office of Long-Term Living.

• Represents DHS in coordination with the legal office staff regarding claims against the Commonwealth, matters of litigation, or other legal issues requiring the development and negotiation of legal positions; and directs activities related to compliance with judicial decisions affecting OMAP.

• Reviews and analyzes State Plan amendments, public notices, and bulletins and collects data for the preparation of federal reporting requirements.

• Directs the monitoring of service expenditures and utilization, and designs and develops regulatory and operational proposals.

• Participates in developing new automated systems applications and statistical reporting formats designed to provide data for purposes of policy development and program planning.

• Directs research, policy, procedure, and regulation development and oversees the development and analyses of MA health care services and program delivery systems.

• Performs the full range of supervisory duties.

• The employee in this job may participate in the performance of subordinates’ work consistent with operational or organizational requirements.

• Performs related work as required.


• Knowledge of the principles, practices, and methods of program planning and policy development, implementation, administration, and evaluation.

• Knowledge of the provisions, objectives, and goals of legislation and policies applicable to the MA program.

• Knowledge of the principles and methods of program administration related to the provision and planning of MA services and programs.

• Knowledge of research techniques and methods.

• Knowledge of the principles and practices of employee supervision.

• Knowledge of the use and functionality of Microsoft Office Suite software.

• Ability to think critically and solve business problems.

• Ability to read and interpret written and numerical information.

• Ability to read and interpret policies, procedures, and regulations.

• Ability to establish and maintain effective working relationships.

• Ability to communicate effectively orally.

• Ability to communicate effectively in writing.

MINIMUM EXPERIENCE AND TRAINING: (NOTE: Based on the Entry Level Knowledges, Skills, and Abilities)

• Five years of professional experience in MA, health care insurance, or health care services including three years of supervisory experience developing, implementing, and evaluating MA, health care insurance, or health care services, and a bachelor's degree;


• An equivalent combination of experience and training which includes three years of professional supervisory experience developing, implementing, and evaluating MA, health care insurance, or health care services.