Manager V
Manager V reports to the Director of Claims Administrator - Operations Management office in the Medicaid CHIP Services Division.
Manager performs senior level managerial work overseeing the daily operations and activities of staff completing fee-for-service policy implementation, oversight and direction for modifications and updates to current fee-for-service claims payment, prior authorization, and Managed Care changes.
Manages communications and project coordination with the Health and Human Services (HHS) enterprise programs, stakeholders, and with the Medicaid Claims Administrator.
Responsible for ensuring timely communication of operation issues and coordinating corrective activities.
Supervises staff including hiring, training, evaluating, developing and counseling.
Develops performance standards and monitors individual and area performance on an ongoing basis.
Oversees staff work planning and scheduling, assigns tasks and projects to staff, and establishes priorities for projects and assignments.
Works under minimal supervision, with extensive latitude for the use of initiative and independent judgment.
Essential Job Functions:
Hires and trains staff in the Daily Operations Department.
Manages the daily activities of staff completing Traditional Medicaid policy implementation, and oversight for modifications to the fee-for-service claims system.
Provides guidance and plans, assigns, prioritizes, and supervise the work of staff.
Creates staff development plans and activities and monitors staff compliance with established guidelines, policies, and procedures.
Prepares management and productivity reports for the unit.
Establishes productivity goals for the Daily Operations staff.
Prepares management and productivity reports for the unit.
Produces and completes the well written, logical drafts and documents.
Identifies solutions to required vendor system changes and any impacts to Traditional Medicaid, Medicaid Managed Care, and other HHS programs.
Provides operations oversight of Contract Administrator deliverables.
Analyzes and oversees the analysis of legislation and rules to determine area impact.
Coordinates compliance with program policies and procedures, statutes, and rules and takes corrective action(s) as needed.
Communicates with Medicaid Policy and Claims Administrator Contract Oversight Unit.
Ensures clear and prompt communication of operation issues and coordinating corrective and ongoing activities.
Prioritizes staff activities to coordinate and collaborates with other units to implement changes and operational updates.
Pro-actively participates in vendor governance activities to facilitate prompt communication with all parties about operational project priorities and key activities.
Manages and works to mitigate operation risks and issues.
Performs other duties as assigned by the Director of Operations Management Claims Administrator including administrative functions and/or serving in a supporting capacity for the Medicaid/CHIP division.
Make independent decisions that will resolve complex issues across and provides guidance to staff in implementation of new methods and procedures.
Knowledge Skills Abilities:
Knowledge of federal laws, rules, and policies related to Medicaid.
Knowledge of Medicaid service delivery models.
Knowledge of fee-for-service claims payment.
Knowledge of information technology, systems, and business services Skills in effective oversight to include planning, development, and implementation of systems and processes.
Skills in managing multiple and competing priorities.
Skills in problem solving and conflict resolution.
Skills in working collaboratively and cooperatively with diverse groups.
Skill in communicating effectively both orally and in writing.
Skill in establishing and maintaining effective working relationships.
Skills in effective oversight to include planning, development and implementation of systems and processes.
Ability to provide leadership and direction in a team environment.
Ability to manage projects.
Ability to manage activities, establish goals and objectives, and devise solutions to administrative problems.
Ability to prepare reports and communicate effectively.
Ability to train, schedule, assign, supervise and/or prioritize the work of others.
Ability to identify and analyze problems, evaluate alternatives and propose effective solutions.
Ability to use Microsoft Office products.
Registration or Licensure Requirements:
Initial Selection Criteria:
Graduation from an accredited college or university with a bachelor's degree in a field related to the assignment, plus 3 years of experience in the health and human services field.
Experience leading teams and/or management experience.
Education and experience may be substituted for one another.
Additional Information:
Requisition# 485675.
MOS Code:
There are no direct military occupation(s) that relate to the responsibilities, and registration or licensure requirements for this position.
All active duty, reservists, guardsmen, and veterans are encouraged to apply if they meet the qualifications for this position.
HHS agencies use E-Verify.
You must bring your I-9 documentation with you on your first day of work.
I-9 Form - Click here to download the I-9 form.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability.
If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747.
If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
Salary:
$40.
07 - $76.
88.
Estimated Salary: $20 to $28 per hour based on qualifications.
Manager performs senior level managerial work overseeing the daily operations and activities of staff completing fee-for-service policy implementation, oversight and direction for modifications and updates to current fee-for-service claims payment, prior authorization, and Managed Care changes.
Manages communications and project coordination with the Health and Human Services (HHS) enterprise programs, stakeholders, and with the Medicaid Claims Administrator.
Responsible for ensuring timely communication of operation issues and coordinating corrective activities.
Supervises staff including hiring, training, evaluating, developing and counseling.
Develops performance standards and monitors individual and area performance on an ongoing basis.
Oversees staff work planning and scheduling, assigns tasks and projects to staff, and establishes priorities for projects and assignments.
Works under minimal supervision, with extensive latitude for the use of initiative and independent judgment.
Essential Job Functions:
Hires and trains staff in the Daily Operations Department.
Manages the daily activities of staff completing Traditional Medicaid policy implementation, and oversight for modifications to the fee-for-service claims system.
Provides guidance and plans, assigns, prioritizes, and supervise the work of staff.
Creates staff development plans and activities and monitors staff compliance with established guidelines, policies, and procedures.
Prepares management and productivity reports for the unit.
Establishes productivity goals for the Daily Operations staff.
Prepares management and productivity reports for the unit.
Produces and completes the well written, logical drafts and documents.
Identifies solutions to required vendor system changes and any impacts to Traditional Medicaid, Medicaid Managed Care, and other HHS programs.
Provides operations oversight of Contract Administrator deliverables.
Analyzes and oversees the analysis of legislation and rules to determine area impact.
Coordinates compliance with program policies and procedures, statutes, and rules and takes corrective action(s) as needed.
Communicates with Medicaid Policy and Claims Administrator Contract Oversight Unit.
Ensures clear and prompt communication of operation issues and coordinating corrective and ongoing activities.
Prioritizes staff activities to coordinate and collaborates with other units to implement changes and operational updates.
Pro-actively participates in vendor governance activities to facilitate prompt communication with all parties about operational project priorities and key activities.
Manages and works to mitigate operation risks and issues.
Performs other duties as assigned by the Director of Operations Management Claims Administrator including administrative functions and/or serving in a supporting capacity for the Medicaid/CHIP division.
Make independent decisions that will resolve complex issues across and provides guidance to staff in implementation of new methods and procedures.
Knowledge Skills Abilities:
Knowledge of federal laws, rules, and policies related to Medicaid.
Knowledge of Medicaid service delivery models.
Knowledge of fee-for-service claims payment.
Knowledge of information technology, systems, and business services Skills in effective oversight to include planning, development, and implementation of systems and processes.
Skills in managing multiple and competing priorities.
Skills in problem solving and conflict resolution.
Skills in working collaboratively and cooperatively with diverse groups.
Skill in communicating effectively both orally and in writing.
Skill in establishing and maintaining effective working relationships.
Skills in effective oversight to include planning, development and implementation of systems and processes.
Ability to provide leadership and direction in a team environment.
Ability to manage projects.
Ability to manage activities, establish goals and objectives, and devise solutions to administrative problems.
Ability to prepare reports and communicate effectively.
Ability to train, schedule, assign, supervise and/or prioritize the work of others.
Ability to identify and analyze problems, evaluate alternatives and propose effective solutions.
Ability to use Microsoft Office products.
Registration or Licensure Requirements:
Initial Selection Criteria:
Graduation from an accredited college or university with a bachelor's degree in a field related to the assignment, plus 3 years of experience in the health and human services field.
Experience leading teams and/or management experience.
Education and experience may be substituted for one another.
Additional Information:
Requisition# 485675.
MOS Code:
There are no direct military occupation(s) that relate to the responsibilities, and registration or licensure requirements for this position.
All active duty, reservists, guardsmen, and veterans are encouraged to apply if they meet the qualifications for this position.
HHS agencies use E-Verify.
You must bring your I-9 documentation with you on your first day of work.
I-9 Form - Click here to download the I-9 form.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability.
If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747.
If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
Salary:
$40.
07 - $76.
88.
Estimated Salary: $20 to $28 per hour based on qualifications.
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