Assistant Director, Nursing & Waiver Services

State of Maryland • Baltimore City, MD

1d • Hybrid

About The Position

The Assistant Director plans and directs the functional operations and processes of the Division of Provider Integrity, Claims, and Compliance; Division of Clinical Support; Division of Participant Enrollment and Service Review; and Division of Nursing Services within the Office of Long-Term Services and Supports. The role also oversees implementation, monitoring, and oversight of the Financial Management and Counseling Services contract, manages the case management hierarchy, and coordinates services for dually enrolled Medicaid participants.

The first three divisions operate the Community First Choice, Community Personal Assistance Services, Increased Community Services, and Community Options programs. Their work includes maintaining federal program authorities; engaging stakeholders; developing and implementing regulatory and subregulatory guidance; and conducting analyses to inform program decisions. Provider Integrity, Claims, and Compliance monitors provider compliance with the HCBS settings rule, conducts onsite visits and desk reviews, offers technical assistance, initiates disenrollment for noncompliance, processes manual claim adjustments, and assists providers with billing and Medicaid enrollment. Clinical Support conducts utilization reviews of medically complex service plans, provides expert witnesses for appeal hearings, investigates reportable events, oversees nurse monitoring, and oversees interRAI assessments and PASRR Level II assessments performed by local health departments. Participant Enrollment and Service Review conducts plan-of-service reviews, manages the Community Options registry and monthly invitation waves, reviews technical eligibility, processes program authorizations, and oversees the Competitive Solicitation for Comprehensive Case Management.

The Division of Nursing Services administers home health services, home care for disabled children under a Model Waiver, medical day care for children, and EPSDT nursing services for individuals under 21. The Assistant Director directly supervises the chiefs of the four divisions and ensures they complete assigned responsibilities within required timeframes. The position performs personnel duties, including performance monitoring and staff onboarding and offboarding; participates in long-term care reform planning; and works with CMS on quality and compliance activities for federal HCBS programs. The programs under the role’s responsibility represent more than $613 million in annual Medicaid expenditures and serve a large portion of the Medical Assistance population.

The position reports to the Deputy Director of OLTSS and may act for the Deputy Director during their absence or as assigned. The work is conducted in a hybrid telework manner, with office and remote days as directed by the appointing authority. This is a Management Service position serving at the pleasure of the Appointing Authority.

Requirements

• Bachelor's degree from an accredited college or university; additional professional-level health or human services experience may substitute at 30 credit hours per year, for up to four years.
• Six years of professional health or human services experience.
• At least two years of experience working with a Medicaid program.
• At least three years of supervisory or managerial experience.
• Submit a resume with the application.

Nice To Haves

• Experience leading or managing Medicaid LTSS, HCBS, waiver programs, nursing services, or other complex healthcare programs.
• Knowledge of federal Medicaid requirements, including HCBS waiver authorities, the HCBS Settings Rule, CMS Ensuring Access Rule, quality reporting requirements, and Medicaid program integrity standards.
• Experience supervising managers and leading multidisciplinary teams responsible for policy development, program operations, clinical review, compliance, or provider oversight.
• Experience developing and implementing strategic initiatives, regulations, policies, State Plan Amendments, waiver amendments, or other federal and State programmatic requirements.
• Ability to collaborate with executive leadership, federal partners, providers, advocates, legislators, and other stakeholders to resolve complex operational and policy issues.

Responsibilities

• Plan and direct operations and processes for four divisions: Provider Integrity, Claims, and Compliance; Clinical Support; Participant Enrollment and Service Review; and Nursing Services.
• Oversee implementation, monitoring, and management of the Financial Management and Counseling Services contract.
• Manage the case management hierarchy and oversee coordination of services for dually enrolled Medicaid participants.
• Direct operations of the CFC, CPAS, ICS, and Community Options programs and oversee maintenance of their federal authorities, stakeholder engagement, guidance, and program analyses.
• Ensure provider compliance with the HCBS settings rule through oversight of site visits, desk reviews, technical assistance, and provider disenrollment when necessary.
• Oversee manual claim adjustments and provider assistance with billing and Medicaid enrollment.
• Oversee clinical utilization review, appeal hearing support, reportable-event investigations, nurse monitoring, interRAI assessments, and PASRR Level II assessments.
• Oversee plan-of-service review, registry management and monthly invitation waves, technical eligibility reviews, program authorizations, and the Competitive Solicitation for Comprehensive Case Management.
• Oversee Medicaid nursing programs including home health services, home care for disabled children under a Model Waiver, medical day care for children, and EPSDT nursing services for individuals under 21.
• Directly supervise four division chiefs and ensure each division meets its responsibilities and mandatory timeframes.
• Perform personnel responsibilities, including performance monitoring and onboarding and offboarding staff.
• Participate in long-term care reform planning and work with CMS on quality and compliance activities for federal HCBS programs.
• Act for the Deputy Director when absent or when assigned.

Benefits

• Medical, vision, prescription, and dental health benefits
• Flexible spending accounts for dependent care and health care
• Leave benefits, including 6 personal days, 12 regular holidays, annual leave, and 15 sick days
• Retirement
• Paid parental leave
• Flexible work schedules where applicable
• Free mass transit in the Baltimore metro area

What This Job Offers

• Job Type: Full-time
• Career Level: Manager