Administrator for Medical Services

Department

Executive Office of Health and Human Services

Division

Healthcare Health & Allied Professionals

Salary

$115,008.00 - $133,541.00

Job Profile

JC-02595600-99 - Administrator for Medical Services (Non-Union Executive Branch)

Scheduled Work Days & Work Hours

Monday - Friday, 8:30am - 4:00pm

35 Hours - Non-Standard

Job Requisition Number

JR103364 Administrator for Medical Services (Open)

Pay Grade

C00141 A

Classification

Administrator for Medical Services

Class Definition

GENERAL STATEMENT OF DUTIES: To assist the Associate Director for Medical Services in the planning, development, supervision, coordination and administration of a statewide medical care program for eligible recipients of medical assistance developed in accordance with the provisions of Title XIX of the Federal Social Security Act and appropriate state statutes; and to do related work as required.

SUPERVISION RECEIVED: Works under the general administrative direction of the Associate Director for Medical Services with wide latitude for the exercise of initiative and independent judgment; work is reviewed upon completion through conferences and reports for conformance to prescribed agency standards.

SUPERVISION EXERCISED: Plans, directs, coordinates, supervises and evaluates the activities of a professional, technical, fiscal and clerical staff engaged in carrying out the responsibilities of the Medical Assistance Program.

ILLUSTRATIVE EXAMPLES OF WORK PERFORMED:

• To assist the Associate Director for Medical Services in:
• the development and revision of rules, regulations, procedures and fee and cost standards governing the procurement and payment of medical services and supplies; conferences with appropriate professional groups, and other state medical and dental services for the purpose of effecting common understanding and general acceptance thereon and to reconcile discrepancies and irregularities as well as continuous or aggravated violations involving charges, rules and regulations, standards or procedures of such medical care program; the preparation of manuals based on such rules, regulations, procedures and fee cost standards for the benefit of members of the medical, dental, or other services in order to assist them in preparing and submitting requests for payment to the state for such medical services and/or supplies.
• To plan, supervise and review the work of a professional staff and the overall responsibility of a clerical staff.
• To participate in program analysis and evaluation.
• To assist the Associate Director for Medical Services in community activities in medical care and health planning.
• To collect various statistical data relative to the medical care program and prepare reports on the various trends involving such medical care.
• To coordinate the activities of the Medical Assistance Program staff and the Data Processing Unit in order to effect programming changes and refinements required to ensure continued effective administration of the Medical Assistance Program and compliance with new federal regulations and requirements.
• To assist in the development of departmental policy and a state plan for the Medical Assistance Program which conforms with applicable federal regulations; such a plan is necessary in order for the state to continue to qualify for full federal matching funds.
• To relate to federal officials of the Department of Human Services; this activity involves telephone and personal contacts with program, audit and fiscal staff members of HHD.
• To respond to inquiries from the news media, participate in local television programs and speak to community groups.
• To be responsible for assisting the Associate Director for Medical Services in the development of the annual budget for the Medical Assistance Program and to participate in departmental, public and legislative hearings pertinent to the budget.
• To understand and ensure compliance with appropriate state statutes and to assist in the development of position statements on legislation which would impact on the program.
• When requested, to participate in collective bargaining and contract negotiations leading to the adoption of contractual agreements as well as the enforcement of the several provisions of such contracts dealing with grievances, training, discipline, etc., in accordance with the Personal Rules.
• To assist the Associate Director for Medical Services in the preparation of the annual report for the Rhode Island Medical Assistance Program and special reports, as required.
• To be responsible for a public relations and information program which includes speaking engagements, serving on community committees, legislative committees, and meeting with consumer groups and demonstrators.
• To assist in analyzing the impact of new federal and state legislation on the Medical Assistance Program.
• To be responsible for recruiting and training staff personnel.
• To do related work as required.

REQUIRED QUALIFICATIONS FOR APPOINTMENT:

KNOWLEDGES, SKILLS AND CAPACITIES: A thorough knowledge of approved principles and practices of health care financing administration and the ability to apply such knowledge in the planning and administration of a statewide medical care program including such activities as the development and implementation of rules, regulations, procedures, and fee and cost standards governing the procurement and payment of medical services and supplies; a familiarity with the practices and procedures of hospitals, nursing homes and other institutions providing medical care and treatment; the ability to relate to members of the medical and dental professions, social service staff and other interested parties for the purpose of explaining the philosophy, objectives and operations of a medical care program and to provide consultative services and advice as required; the ability to collect information relative to a medical care program and prepare various trend data for statistical purposes; the ability to plan, supervise and review the work of a professional, technical, fiscal and clerical staff; the ability to establish and maintain effective working relationships with professional groups, consumer groups, the community, the legislature and other public and private agencies; and related capacities and abilities.

EDUCATION AND EXPERIENCE:

Education: Such as may have been gained through: graduation from a college of recognized standing and possession of a Master's Degree from an accredited institution of higher education in the field of Medical Care Administration, Public Administration, Social Work, Public Health Administration or Business Administration; and

Experience: Such as may have been gained through: employment as a Chief Medical Care Specialist; or employment in a responsible supervisory position in the field of public health, medical care administration or social work.

Or, any combination of education and experience that shall be substantially equivalent to the above education and experience.

Supplemental Information

To serve as the Rural Health Transformation Program (RHTP) Evaluation Lead. Responsibilities include: (1) Evaluation strategy development and framework validation, (2) Overarching evaluation plan design and vetting, (3) Initiative and project-specific evaluation and quality improvement cycles, (4) Performance measurement, including performance management and CMS-required metrics reporting, (5) Data collection, analytics, and reporting, (6) Qualitative data assessment and community feedback validation, (7) Data sharing requests, coordination, and parameter development, (8) Oversight of evaluation supports and consultants, (9) Interagency coordination of evaluation, epidemiology, health economics, and data analytics councils, and (9) CMS and other related dashboard creation and reporting--including on progress, expenditures, and success stories.

https://www.everify.gov/sites/default/files/everify/posters/IER_RighttoWorkPoster.pdf

https://everify.uscis.gov/web/media/resourcesContents/EVerify_Participation_Poster_ES.pdf

The individual hired to fill this position will have access to Federal tax Information (FTI), as defined in IRS Publication 1075, and, as such, must undergo a national fingerprint background screening in accordance with the set forth in regulation 220-RICR-40-00-2 (IRS Publication 1075 - Background Check Process and Criteria available at https://rules.sos.ri.gov/regulations/part/220-40-00-2. Additionally, the individual is being hired to an E-Verify site which contains FTI and must have their employment eligibility validated through E-Verify.

Benefits

For information regarding the benefits available to State of Rhode Island employees, please visit the Office of Employee Benefits' website at http://www.employeebenefits.ri.gov/.

Also, be advised that a new provision in RI General Law 35-6-1 was enacted requiring direct deposit for all employees. Specific to new hires, the law requires that all employees hired after September 30, 2014 participate in direct deposit. Accordingly, any employee hired after this date will be required to participate in the direct deposit system. At the time the employee is hired, the employee shall identify a financial institution that will serve as a personal depository agency for the employee.