JOB TITLE: MANAGED CARE FINANCIAL MANAGER, DHS

JOB CODE: 44156

DEFINITION: This is professional and administrative work directing policy development, financial management, contract management, and rate setting for statewide capitated managed care programs in the Department of Human Services (DHS).

An employee in this job directs and monitors rate setting, fiscal policy development and implementation, institutional provider cost reporting, and financial management for departmental managed care and fee-for-service programs. Work involves directing the development of policies and procedures relating to rate development, budgetary projections, third party collections, stop-loss provisions, reinsurance and other forms of risk limitation, and financial monitoring plans for managed care organizations or fee-for-service providers. Work also involves planning, organizing, and directing rate development; directing payments and developing and implementing new program payment processes; directing the management of risk pools, contract specific funding pools, escrows, rates, and supplemental payments to providers; tracking change of ownership entities through sale or merger; providing guidance to hospitals to ensure supplemental payments do not exceed established federal and state limits; and directing the financial reporting by managed care organizations and the analysis of financial data to understand costs, to determine financial strength, and to determine contract compliance. Supervision is exercised over professional program, accounting, or fiscal staff. Work is performed under the general direction of an administrative supervisor and is reviewed 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.)

• Directs the management and monitoring of actuarial support services.

• Directs the development and implementation of Requests for Proposals (RFPs), and evaluation criteria for the statewide expansion of mandatory capitated managed care.

• Directs the contracting process for health care consulting services.

• Directs and participates in the administration, control, and monitoring of managed care reserve accounts.

• Negotiates rates and supplemental payments with providers for DHS review and approval.

• Issues, negotiates, and processes Medicaid managed care or behavioral health agreements between DHS and behavioral health managed care primary contractors.

• Monitors provider name and ownership changes for system updates and DHS staff notifications.

• Projects carry-forward budget requirements of the Medicaid-funded physical and behavioral health service for the capitated managed care program.

• Resolves Medicaid and capitated managed care or fee-for-service issues with consulting groups, contractors, and providers.

• Represents the department on various Medicaid managed care committees and stakeholder groups.

• Directs the development of financial reporting and audit requirements for physical and behavioral health services.

• Directs the analysis of financial reports and data to understand necessary costs and make informed decisions regarding program policy and rate development.

• Performs the full range of supervisory duties.

• An employee in this job may participate in the performance of their subordinates' work consistent with operational or organizational requirements.

• Performs related work as required.

ENTRY LEVEL KNOWLEDGES, SKILLS, AND ABILITIES:

• Knowledge of governmental accounting and financial management principles and methods and their application to managed care or fee-for-service accounting systems.

• Knowledge of the goals and objectives of Medicaid managed care programs.

• Knowledge of the principles and methods of actuarial and statistical analysis.

• Knowledge of the principles and methods of rate formulation.

• Knowledge of the principles and practices of employee supervision.

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

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

• Ability to prepare, analyze, and interpret financial reports and statements.

• 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)

• Six years of professional accounting and financial management experience, including three years in a supervisory capacity, and a bachelor’s degree in accounting, finance, or a closely related field, which includes or is supplemented by twelve college credits in accounting;

or

• An equivalent combination of experience and training which includes three years of professional supervisory experience in accounting and financial management and twelve college credits in accounting.