Assistant Director, Policy And Compliance

State of Maryland•Baltimore City, MD

About The Position

The primary purpose of the position is to direct and coordinate all activities of agency specific Medicaid programs: Policy & Compliance programs include the Telehealth Program, Excluded/Sanctioned Provider Program, Interoperability Rule, Medicaid Regulations, and the State Plan with which each state Medicaid agency must submit to CMS and receive CMS approval to enable Medicaid agencies to pull federal funds for Medicaid activities—both existing and evolving and as Medicaid creates new activities and oversees other Special Projects within Provider Services. For such programs, this position establishes policies and procedures, oversees implementation, and approves revisions. It establishes and evaluates program goals, standards, and controls to meet program objectives. It oversees and manages the personnel (14 PINs & 11 SPPs) and financial resources of the programs and determines organizational structure and staffing needs of the programs. It develops short and long-range plans for program operations and resources. It oversees development and training of program staff and broader policy training for providers regarding enrollment and general communications. This position plans, coordinates, supervises, and evaluates the work of subordinate supervisors. It represents the Department in a liaison capacity with managers and officials of other agencies including MSDE; MDE; OIG; MFCU; Public Health; DHS; MHCC; and CMS concerning program activities. Additionally, it promotes the programs and informs interested groups and the general public including CMS, CRISP, HealthChoice Managed Care Organizations, Maryland Hospital Association, and various medical professional organizations. Under the Provider Policy & Communications Division, this position oversees and manages all Medicaid regulations, State Plan Amendments (SPAs) and Provider Transmittals simultaneously ensuring compliance with SPAs to pull down federal funds; establishes overall policies, procedures and oversees implementation for oversight and compliance among providers; and promotes the program by improving understanding via sub-regulatory guidance and communication to providers. Additionally, the position directs and coordinates the writing of reports and represents the Department in liaison capacity in high level meetings, committees, and workgroups both internal and external to identify future provider policy needs and develop short and long-range plans. This position also establishes and evaluates goals and standards of highly political provider programs, and coordinates as needed with OGA. Additionally, this Division leads and supports various special projects as they come up within the Administration and across programs and other Administrations. Under the Medicaid Provider Compliance Program, it directs and coordinates compliance related activities and evaluates broader Medicaid standards and controls to ensure Medicaid is meeting Medicaid provider objectives and Federal objectives to comply with audits and program integrity sanction provider requirements. Additionally, this position develops short and long-range plans for operations by means of corrective action plans and resource planning resulting from CMS and state audit findings and evolutions to sanction provider policy. This position represents the Medicaid provider sanction actions, distinct from other Medicaid program integrity actions, with officials from Office of the Inspector General (OIG), the Medicaid Fraud and Compliance Unit (MFCU), and executive level MDH directors and secretaries regarding program activities and opportunities to improve Agency mission of program integrity within the provider sanction authority. This position evaluates the Provider Compliance Program goals and standards to minimize risk for monetary penalties resulting from non-compliance via audits and engages in preventative compliance work to prevent future audit findings. Additionally, this position oversees the Long-Term Care Provider Resolution Unit (LTCPRU). The Assistant Director is responsible for planning, organizing, implementing, administering, and supervising the interpretation and application of agency policies, directives and procedures designed to accomplish the mission of the agency. This position is responsible for program or project review, development, evaluation, and coordination. This position is responsible for evaluating the efficiency of operations and develops, revises new policies, standards, and workflow procedures, using new technology where appropriate; interprets and applies or oversees the application of agency policies, rules and regulations to accomplish the work of the unit or division; implements new regulations and policies as directed by upper management; sets goals and deadlines and oversees the workflow of the unit; coordinates workflow with administrators of other units in areas of work spanning multiple units, administrations and State Agencies. This position is also responsible for overseeing or coordinating agency operations and supervise staff comprised HPA, MCPS, MCPA and OSC who provide assistance to public and private agencies regarding Medical Care Program services who are responsible for the performance of qualitative or quantitative analysis Medical Care Program with a knowledge of principles of health care policies and the administration and practices to audit, analyze, and interpret health care reports and documents to effectively prohibit incorrect/inaccurate reimbursement and protect the health and safety of Medicaid/Medicare participants. The position is responsible for tracking and implementing process improvements and best practices. The position work closely across other MDH and DHS to successfully implement policies and procedures and maintain the program integrity. This position works as the liaison with internal and external stakeholders on provider issues. In addition, this position is responsible for high priority policy analysis of recipient eligibility, provider payments and enrollment including controlled correspondence, weekly reports and advising senior MDH staff with policies, budgets, and cost savings analysis.

Requirements

Qualified candidates should possess a Bachelor's degree from an accredited college or university and six years of health or human services administrative or professional experience, including three years at a supervisory or managerial level.
A Master's degree from an accredited college or university will substitute for one year of the general experience and a Doctorate will substitute for two years of the general experience.
Additional experience will substitute on a year-for-year basis for the college degree.

Nice To Haves

Expertise and oversight of Medicaid Regulatory Promulgation Process
Experience with a State Medicaid Agency in Provider Compliance related activities
Experience and oversight of Medicaid LTCPRU activities