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Managed Care Program Supervisor

2 months ago

Albany, New York, United States New York State Full time

Job Title: Managed Care Program Supervisor

Company: Division of Health Care Plan Contracting & Oversight

  • Required Qualifications: Current NYS Department of Health employee with permanent or contingent-permanent, competitive status as a Health Program Administrator 3, G-27 OR a NYS employee with one year or more of permanent or contingent-permanent, competitive service in a title at or above a G-25 and deemed eligible for transfer under Section 70.1 or Section 52.6 of the NYS Civil Service Law.

Preferred Qualifications:

  • Familiarity with Medicaid Programs, Managed Care Delivery Models, Public Health Law and Regulations, along with experience in interpreting governing laws, regulations, or policies, Project management, and proficiency in Microsoft Office Applications.

Duties Description: The individual in this position will oversee personnel responsible for a diverse array of tasks related to the certification and oversight of Managed Care Organizations (MCO) to guarantee adherence to Public Health Law Articles 44 and 49. This position entails acting as the intermediary with affiliated agencies to ensure compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA). Specific responsibilities of the unit include:

  • Behavioral Health Parity
  • Utilization Review
  • Fraud, Waste, and Abuse
  • Worker's Compensation Preferred Provider Organizations

The incumbent will be tasked with evaluating state and federal legislation concerning managed care and assessing its impact on current program operations. They will identify and implement necessary adjustments in existing operations to facilitate the execution of new legislation, regulations, and contract stipulations. Additionally, the individual will continuously review and assess existing procedures affecting unit activities and propose modifications to enhance efficiency. Responsibilities also include monitoring assignments given to unit staff, identifying potential challenges, and ensuring that quality standards and deadlines are consistently met. The supervisor will guide, develop, and assess unit personnel and act as a liaison with other bureaus, state agencies, and stakeholders to effectively implement managed care policies.