Director III
2 months ago
The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Utilization Review (UR) Intellectual and Developmental Disabilities (IDD) Waiver and Community Services (WCS) Director III. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS’s mission by providing strategic direction and guidance for Utilization Review of several Medicaid fee-for-service programs with an emphasis on delivery of the most effective type and amount of service and ensuring cost effectiveness and timeliness of services.
The Director III reports to the Deputy Associate Commissioner of UR and is responsible for providing utilization review of six Medicaid fee-for-service programs: Home and Community-based Services, Community Living Assistance and Support Services, Texas Home Living, Deaf Blind with Multiple Disabilities, Community Attendant Services, and Hospice. This position is directly responsible for strategic direction and day-to-day management of five teams: Waiver/Community Services Utilization Review; Quality Assurance and Operations; Hospice; Budget and Support Services; and IDD Waivers UR. The Director III directly supervises the directors and managers of these teams and indirectly supervises approximately staff, many of whom are professionals with nursing and other clinical licenses and certifications.
The UR IDD WCS Director III functions as part of the Office of Medical Director (OMD) leadership team and will help drive the scope of the UR team to provide broad oversight or and support for fee-for-service programs. This position provides direction and guidance in strategic operations and planning to achieve the goals and objectives for UR with a priority focus on cases with the highest health and fiscal risk. The Director III l works under minimal supervision, with extensive latitude for the use of initiative and independent judgment.
The ideal candidate thrives in an environment that emphasizes: teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, demonstrates integrity critical thinking for effective execution.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
20% Directs UR activities to ensure Medicaid and CHIP fee-for-service programs are delivered efficiently and effectively and are in compliance with federal and state laws, regulations, policies, and waiver requirements and guidelines. Oversees enrollment functions for the Deaf Blind with Multiple Disabilities program. Prioritizes activities that have the highest impact on health outcomes and cost savings.
20% Directs, manages, hires and develops professional and management staff for designated fee-for-service UR units. Provides effective direction and leadership to staff within the fee-for-service UR team and holds them accountable for achieving performance expectations, stated program goals and legislative mandates.
15% Represents the agency at business meetings, hearings, trials, legislative sessions, conferences, and seminars or on boards, panels, and committees. Responds to external stakeholder inquiries on behalf of the agency.
15% Develops fee-for-service UR strategic plan, program goals, strategies and initiatives to align with the Medicaid and CHIP and HHSC strategic plans. Provides oversight of associated workplans.
15% Develops and implements techniques for evaluating program activities, and reports findings and recommendations for improvements to executive staff. Oversees the collection and analysis of complex data sets along with resulting reports.
10% Provides effective communication to include: keeping the UR Deputy Associate Commissioner, Medicaid and CHIP Chief Medical Director, MCS leadership, and other OMD/UR staff informed of program issues; communicating program goals, objectives and changes to program staff; establishing and maintaining effective working relationships; and responding to requests for information in a timely manner.
5% Develops and manages departmental budget and HHSC resources efficiently and effectively. Assist in the development of HHSC legislative appropriations requests, federal funding requests and grant requests to ensure adequate support and funding for UR functions.
Knowledge Skills Abilities:
Experience in managing and directing complex programs, including experience in an executive or senior management capacity.
Experience with Texas Medicaid fee-for-service programs.
Knowledge of the role of federal and state laws, regulations, policies, and procedures in management of publicly funded health care services.
Knowledge of UR and management federal and state laws, regulations, policies, and HHSC contracts and guidance.
Ability to develop and implement strategic plans, goals, objectives, and evaluation tools and reports to monitor progress and ensure accountability.
Ability to monitor and direct multiple interrelated projects and initiatives through appropriate project/program management techniques.
Ability to effectively manage employees; i.e. recruit, hire, develop, performance management, ensure accountability, and motivate to build morale.
Skill in the application of risk management strategies including the ability to routinely identify, manage and effectively mitigate risks.
Knowledge of quality assurance oversight functions in a business environment.
Ability to facilitate effective issue resolution through dialogue, alternative analysis and consensus building techniques.
Ability to communicate effectively, verbally in formal and informal settings and in writing to include emails and complex reports.
Ability to build and maintain effective working relationships, negotiate with individuals and groups internally and externally, develop professional networks with other organizations, and to identify the internal and external dynamics that impact the work of the organization.
Ability to develop and manage department budgets and resources.
Ability to work collaboratively with other divisions of the enterprise on procurements and contracts.
Ability to effectively oversee outsourced projects including approval of project timelines, deliverables, implementation and operations as well as the vendor performance required under the contract.
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