JOB TITLE: DIRECTOR, BUREAU OF MANAGED CARE OPERATIONS, OMAP

JOB CODE: 44170

DEFINITION: This is highly responsible administrative and managerial work directing the development, implementation, and evaluation of Medicaid funded managed care programs for the Office of Medical Assistance Programs (OMAP) in the Department of Human Services (DHS).

The employee in this job plans, organizes, directs, coordinates, and evaluates the statewide development and implementation of managed care programs to provide Medical Assistance (MA) benefits to individuals in Pennsylvania. Work involves developing and implementing program policies and ensuring compliance of programs with managed care policy; establishing program goals and objectives; negotiating managed care contracts; recommending the development and revision of regulations required to implement and monitor contracts; and directing the development and issuance of Request for Proposals (RFPs). The employee in this job also identifies needs for operational changes; directs the development, implementation, and evaluation of medical services to special needs populations; coordinates with other commonwealth agencies, federal agencies, local governments, and private health care agencies to provide MA managed care and transportation benefits; ensures MA managed care policy complies with federal and state MA regulations; and serves as the advisor to the Secretary and Deputy Secretary for OMAP on managed care program issues. Supervision is exercised over professional, technical, and clerical 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.)

• Establishes bureau goals and objectives and oversees the formulation of policies required to implement and monitor Medicaid physical health managed care programs.

• Identifies priorities and oversees the implementation and monitoring of managed care programs in coordination with other DHS program offices.

• Directs the oversight and monitoring of all physical health managed care contracts, approves corrective action plans for areas of noncompliance, and implements sanctions and penalties.

• Ensures that managed care contractors meet program, policy, quality assurance, health outcomes, consumer satisfaction, special needs, audit, and financial requirements.

• Directs the review, analysis, and evaluation of federal and state legislation and regulations related to MA managed care programs to ensure program compliance and continuing development.

• Coordinates with other OMAP offices and commonwealth agencies to ensure counties, contractors, and transit agencies that provide or contract out Medical Assistance Transportation Program benefits meet program, policy, consumer, special needs, audit, and financial requirements.

• Directs and oversees the development and definition of contract tasks, negotiations, performance measures, penalties, and sanctions.

• Analyzes and evaluates managed care expenditure data and trends and offers insight for future budgetary and program needs.

• Plans, organizes, and directs reporting systems designed to provide managed care data for policy and program development, evaluation, integration, program administration, and public information.

• Reviews contractor proposals and recommendations to ensure they are compliant with federal, state, and DHS guidelines, regulations, policies, and procedures.

• Represents the Secretary of DHS and the OMAP Deputy Secretary in meetings with legislators, the Departments of Health, Aging, and Insurance, the Offices of Budget and Administration, the Comptroller's Office, federal agencies, local governments, and private health care agencies.

• Oversees the development, monitoring, evaluation, and provision of technical assistance to state, county, and other providers of MA physical health services.

• 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.

ENTRY LEVEL KNOWLEDGES, SKILLS, AND ABILITIES:

• Knowledge of the laws, regulations, and policies governing MA programs and services.

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

• 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 program problems.

• Ability to analyze and interpret written and numerical information.

• Ability to analyze 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)

• Seven years of professional experience in medical assistance, health care insurance, or health care services including four years of supervisory experience, and a bachelor's degree;

or

• An equivalent combination of experience and training which includes four years of professional supervisory experience in medical assistance, health care insurance, or health care services.