Division Chief

State of Maryland•Baltimore City, MD

15h•Onsite

About The Position

This position serves as the Chief for the Division of Hospital Services within the HealthChoice and Acute Care Administration (HACA) of the Maryland Medical Assistance Program. This position is responsible for Program policy, oversight, compliance and reimbursement for Inpatient and Outpatient hospital services in Maryland, the District of Columbia and Out-of-State Hospitals in the Medicaid Program. This Division is responsible for monitoring the acute hospital portion of the federally mandated Utilization Control Agent's (UCA) contract to ensure that Medicaid enrollees receive medically necessary and appropriate services. The UCA contract includes determination of inpatient needs, length of stay and medical appropriateness in acute care hospitals. This Division is responsible for conducting acute hospital appeals, reviewing requests for transplants and out-of-state acute hospitalizations. The Division Chief is responsible for managing a team of professionals including one supervisor, nurses and administrative staff. Additionally, this position plans and provides direction and oversight for one Supervisor who oversees certain aspects of the hospital program and is a Medical Care Program Supervisor and directly supervises Medical Care Program Specialists and contractual review nurses. This position requires constant monitoring and evaluation of services provided by hospitals located in Maryland, the District of Columbia and Out-of-State to ensure compliance with Federal and State laws. Administering the needs of this program includes creating and maintaining rate setting functions that are coordinated with Beacon Health Options (the Administrative Service Organization for Behavioral Health and Substance Use Disorder), the MCOs, and personnel within the Office of Finance.

Requirements

Graduation from an accredited high school or possession of a high school equivalency certificate.
Six years of administrative staff or professional work.
Candidates may substitute 30 credit hours from an accredited college or university for each year up to four years of the required experience.
Candidates may substitute the possession of a Bachelor's degree from an accredited college or university and two years of experience in administrative staff or professional work for the required experience.
Candidates may substitute the possession of a Master's degree from an accredited college or university for five years of the required experience.
Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer involving staff work related to the administration of rules, regulations, policy, procedures and processes, or overseeing or coordinating unit operations or functioning as a staff assistant to a higher ranking commissioned officer on a year-for-year basis for the required experience.
Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator's license valid in the State of Maryland.

Nice To Haves

Experience analyzing research from a quantitative and qualitative perspective to support strategic policy and program development.
Knowledge of applicable state and federal laws, regulations and requirements.
Experience working independently and as part of a team.
Ability to notice and react to trends.
Ability to lead a team.

Responsibilities

Program policy, oversight, compliance and reimbursement for Inpatient and Outpatient hospital services in Maryland, the District of Columbia and Out-of-State Hospitals in the Medicaid Program.
Monitoring the acute hospital portion of the federally mandated Utilization Control Agent's (UCA) contract to ensure that Medicaid enrollees receive medically necessary and appropriate services.
Conducting acute hospital appeals, reviewing requests for transplants and out-of-state acute hospitalizations.
Managing a team of professionals including one supervisor, nurses and administrative staff.
Planning and providing direction and oversight for one Supervisor who oversees certain aspects of the hospital program and is a Medical Care Program Supervisor and directly supervises Medical Care Program Specialists and contractual review nurses.
Constant monitoring and evaluation of services provided by hospitals located in Maryland, the District of Columbia and Out-of-State to ensure compliance with Federal and State laws.
Creating and maintaining rate setting functions that are coordinated with Beacon Health Options (the Administrative Service Organization for Behavioral Health and Substance Use Disorder), the MCOs, and personnel within the Office of Finance.