Medicaid Program Manager 1029
The Bureau of Managed Care Reimbursement (BMCR), in the NYS Department of Health, is responsible for the calculation and evaluation of Managed Care (MC) rates, additional MC reimbursement and MC fiscal analysis.
Under the AHCFA’s direction, the incumbent will perform operations management activities and analysis to support MC rate setting activities related to Managed Care Encounters. Encounters are claims paid under a Managed Care capitated rate and there for not paid on a fee for service basis but submitted to the state as data to support rate setting and oversite activities. Additionally, the incumbent will assist in the development and communication of responses to MC encounter related inquiries from stakeholders. The incumbent will also interact and collaborate with other Divisions within the Department of Health, Center for Medicare and Medicaid Services (CMS), and other State agencies. The Bureau cultivates excellence in collaboration, operational support, and special projects.
The Bureau oversees the Managed Care Withhold, which is a process to help improve Encounter Data accuracy. The Bureau is seeking a passionate Medicaid Program Advisor who will report to the Manager of the Encounter Withhold Operations Team, providing strategic support and expertise to the Encounter Withhold Program.
•Serve as direct liaison to Health Plans through the provision of technical assistance and support to ensure compliance with program standards.
•Collaborate and build strong working relationships with The Division of Health Plan Contracting and Oversight (DHPCO) and other NYS DOH groups.
•Support the Encounter Withhold Operations team to assist in moving large- and small-scale strategic initiatives forward.
•Prepare project plans, meeting materials, memoranda, and other communications.
• Meticulously track progress and status of operational tasks and assignments and prepare status reports for management.
•Facilitate meetings, both internally and externally upon request of Medicaid Program Manager.
•Think critically about and submit requests for research, data, and data analysis in support of key initiatives.
•Work independently and identify the need for partnership with the team and others to elicit expertise needed to reach objective of project/assignment.
•Other tasks in support of the Bureau’s mission and goals.
• Bachelor’s Degree
• 8 years of experience
•Strong Organization, Observation and Problem-Solving Skills
•Experience with Microsoft Products including MS Excel
•Project management experience and expertise.
•Experience with Medicaid or public policy, providers, or programs.
•Experience with Medicaid program operations preferred.
•Experience providing technical assistance to an array of providers, stakeholders, or staff.
•Experience with thinking critically about research, data, and data analysis.
•Ability to remain flexible in a changing environment including organizing and prioritizing assignments to meet requirements and deadlines.
•Strong written and communication skills.
•Comfort with being creative, collaborative, and taking initiative; willingness to share opinions, and ideas; willingness to communicate opposing viewpoints in a professional manner.
*Employees must follow established work schedules. The usual work schedule is 40 hours per week, Monday through Friday. Normal work hours are 8:00 a.m. to 4:30 p.m. unless otherwise specified by the supervisor, this includes a half hour unpaid lunch break. Total work hours must equal 40 hours per week.
Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides the following reasonable range of compensation for this role: $68,600-$86,000. In addition, SSO provides a range of benefits for this role.
Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.