DISTINGUISHING FEATURES OF THE CLASS: This is an administrative position involving responsibility for the planning, coordinating, supervising and management of the activities of the Medicaid, Managed Care, and Long Term Care units. The work involves assuring compliance with Federal, State and Local rules/regulations as well as the implementation and interpretation of legislative and administrative directives for these programs. Work is performed under supervision of the Director of Eligibility. Supervision is exercised over a number of professional and clerical support staff. Performs related work as required.
TYPICAL WORK ACTIVITIES: (Illustrative only)
- Plans, coordinates, supervises and manages the activities of the Medicaid Unit, Managed Care Program, and the Long Term Care Unit;
- Administers the Medical Assistance, Managed Care, Personal Care and Long Term Home Health Care programs under Title XIX and in accordance with Federal, State and Local rules and regulations;
- Assists in establishing local district written policy and procedures for these programs;
- Trains unit workers in their job responsibilities and in the basic principles and practices of social service financial and medical service programs;
- Reviews decisions and authorizes eligibility and recertification for medical assistance;
- Monitors direct personal care service proprietary provider agencies for ability to deliver service in compliance with New York State program requirements;
- Authorizes range of services including specific functions of aides, number of service units per case based upon physicians' orders, nursing and social assessments;
- Prepares annual local district plan to monitor and audit delivery of personal care services;
- Reviews long term home health care programs, care plans, budgets and case management procedures;
- Files annual grant applications as required to maximize 100% Federal funding for Managed Care;
- Provides or arranges for client education and outreach;
- Ensures that all managed care providers are meeting quality assurance guidelines;
- Establishes and develops interagency and community relationships to maintain efficient rendering of medical and long term care program services;
- Serves on a consultative basis to entire agency staff to interpret medical, managed care, and long term care administrative standards, policies and procedures;
- Consults with the Director of Eligibility in the formulation of agency procedures to insure maximum reimbursement to the County;
- Negotiates certain terms of contracts with providers, negotiates changes at renewal, administers provisions of contracts;
- Performs a variety of related activities as required.
Typical Work Activities are intended only as illustrations of possible types of work that might be appropriately assigned to an incumbent of this title. Work activities that do not appear above are not excluded as appropriate work assignments, as long as they can be reasonably understood to be within the logical limits of the job.
FULL PERFORMANCE, KNOWLEDGE, SKILLS AND ABILITIES AND PERSONAL CHARACTERISTICS: Thorough knowledge of Federal, State and Local social service laws rules and regulations as they pertain to medical assistance, managed care, personal care, services and long term home health care programs; thorough knowledge of programs and services available for medical assistance recipients and long term home health care recipients; good knowledge of the agency's overall programs, policies and procedures; good knowledge of the principles of supervision; ability to plan, coordinate, supervise and evaluate the work performance and activities of others; the ability to prepare reports; initiative; tact and courtesy; good judgment; leadership.
MINIMUM QUALIFICATIONS: Either
- Master’s degree in psychology, sociology, business administration, nursing or a related field, and one (1) year of experience in the provision of social service programs or substantially similar work, which was in a supervisory or administrative capacity;
- Bachelor's degree in psychology, sociology, business administration, nursing or a related field, and three (3) years of experience in the provision of social service programs or substantially similar work, one (1) year of which was in a supervisory or administrative capacity; or
- Bachelor's degree, and five (5) years of experience in either the provision of social service programs or substantially similar work, or examining or evaluating claims for assistance under a program with established criteria for eligibility or substantially similar work, one (1) year of which was in a supervisory or administrative capacity; or
- Possession of a current license to practice as a Registered Professional Nurse in New York State, and five (5) years of post-degree, fulltime paid experience as a Registered Professional Nurse, one (1) year of which was in a supervisory or administrative capacity; or
- An equivalent combination of experience and training as indicated above.
PLEASE NOTE: Your degree must have been awarded by a college or university accredited by a regional, national, or specialized agency recognized as an accrediting agency by the U.S. Department of Education/U.S. Secretary of Education.
SPECIAL REQUIREMENT: Access to transportation may be required to complete possible field work assignments in a timely and efficient manner.
12/95; 3/96; 11/07; 9/21