director, medical benefits management

GRADE

25

LOCATION OF POSITION

MDH, Office of Health Care Financing, Baltimore, MD

Main Purpose of Job

The primary purpose of the Director, Office of Medical Benefits Management Administration (OMBM) is to direct the operation of the Maryland Medical Assistance Program's managed care, behavioral health, acute care and primary care services. This involves overseeing three Deputy Directors (Acute Care, Behavioral Health and Managed Care) and includes eleven divisions: HealthChoice Quality Assurance; HealthChoice Provider Network Management; Community Liaison and Care Coordination; HealthChoice Complaint Resolution; Hospital Services; Dental, Clinics and Labs; Professional Services Policy; Children's Services; Healthy Kids/EPSDT; Behavioral Health; and the Medicaid Recovery Hospital Claims Audit Contractor (RAC). There are approximately one hundred employees in the Office of Medical Benefits Management.

Responsibilities include design, development, oversight and management of HealthChoice and acute care policy, as well as managing the implementation of professional quality and medical necessity reviews of health services. Responsibilities also include directing the monitoring and oversight of nine Managed Care Organizations (MCO) contracts and regulations, the Department's RAC contract, REM contract, Dental Administrative Services Organization (DASO) contract, and grants to all Local Health Departments for coordination of care services. The Director oversees procurement functions related to the enrollment of MCOs, implementation of dental services, external quality review organization and quality vendors, behavioral health administrative services organization (BHASO), and the RAC. Additionally, this position is responsible for the management of preauthorization of services, the EPSDT program, quality assurance for HealthChoice, ongoing program evaluation, program specific complaint resolution for providers and recipients, appeals for specific programs, and resolution of legislative audit/ internal provider audit issues.

MINIMUM QUALIFICATIONS

Qualified candidates must possess an advanced degree from an accredited college or university with major study in health care administration, business administration, public health, public policy or a related field and Seven (7) years of Medicaid experience, three (3) years of which included managerial and supervisory responsibilities for program administration, program planning and evaluation or related management experience.

A bachelor's degree in the above listed fields and an additional 3 years of experience in Medicaid will substitute for the advanced degree.

DESIRED OR PREFERRED QUALIFICATIONS

Preferred candidates should possess the following:

• Demonstrated ability to lead and provide direction for a large diverse professional, clinical, and administrative staff.
• Demonstrated ability to make strategic decisions on issues impacting benefit coverage policies and operations in alignment with Medicaid Program goals.
• At least 5 years of experience in a clinical operations or health plan leadership role.
• Advanced knowledge of State and Federal regulations impacting benefit coverage areas of the Maryland Medicaid Program.

SELECTION PROCESS

This is a Management Service position, and serves at the pleasure of the Appointing Authority. A resume must accompany your application.

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview).

Complete applications must be submitted by the closing date. Information submitted after this date will not be added.

Incorrect application forms will not be accepted.

Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

The Maryland Department of Health offers the following benefits:

• Meaningful Work
• Excellent Health Benefits Package, including Medical, Vision, Prescription and Dental
• Flexible Spending Accounts (Reduced Child and Health Care)
• Generous Leave Benefits (6 Personal Days, 12 Regular Holidays, Annual Leave, 15 Sick Days)
• Retirement
• Paid Parental Leave
• Flexible Work Schedules (where applicable)
• Free Mass Transit (Baltimore metro area)

For a full list of the benefits of working for the State of Maryland, please click the link below:

STATE OF MARYLAND BENEFITS

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

If additional information is required, the preferred method is to upload. If you are unable to upload, please fax the requested information to Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.

For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at

If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at or

Appropriate accommodations for individuals with disabilities are available upon request by calling: or MD TTY Relay Service

We thank our Veterans for their service to our country.

People with disabilities and bilingual candidates are encouraged to apply.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.

---