Managed Care Program Supervisor

1 week 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 Legislation 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 monitoring of Managed Care Organizations (MCO) to ensure adherence to Public Health Law Articles 44 and 49. This position entails acting as the intermediary with affiliated agencies to assess 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, and Worker's Compensation Preferred Provider Organizations.

The incumbent will be tasked with:

  • Analyzing state and federal legislation pertinent to managed care and evaluating its implications on current program operations.
  • Identifying and executing necessary modifications in existing operations to align with new legislation, regulations, and contract stipulations.
  • Continuously reviewing and assessing existing procedures that affect unit activities and proposing enhancements to boost efficiency.
  • Monitoring assignments delegated to unit staff, recognizing potential challenges, and ensuring adherence to quality standards and timelines.
  • Supervising, developing, and evaluating unit personnel.
  • Acting as a liaison with other bureaus, state agencies, and stakeholders to effectively implement managed care policies.

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