Human Srvs Prog Branch Manager
About The Position
The Department for Medicaid Services (DMS), Division of Health Plan Oversight, is seeking a Human Services Program Branch Manager to lead the Appeals and Complaints Branch. The branch manages and coordinates External Independent Third-Party Reviews (EITPRs), administrative hearings, and state fair hearings. The manager ensures appeals and hearing-related activities are handled effectively, consistently, accurately, and on time in accordance with federal and state requirements, Medicaid policies, and agency procedures. The position oversees staff and branch operations, monitors workload and performance, reviews complex or sensitive cases, coordinates with internal and external stakeholders, identifies trends and recommends improvements, and supports training and quality assurance. The position is located in Frankfort, Kentucky. The agency may authorize hybrid telework, but the employee is required to work from the office three days per week; telework arrangements may be modified or ended by the agency. Duties are typically performed in an office setting.
Requirements
- Bachelor's degree from a college or university, or qualifying experience substituted year for year.
- Five years of professional experience in administration of human services programs, emergency management services, emergency medical technician work, paramedic work, or a related field.
- A master's degree in social work, health administration, labor relations, public or business administration, or a related field may substitute for one year of required experience.
- Administrative or business experience, or professional, subprofessional, or clerical work in a human services area, emergency management services, emergency medical technician work, paramedic work, or a related field may substitute for the required education year for year.
- Knowledge of Medicaid programs, policies, eligibility requirements, and managed care operations.
- Knowledge of federal and state laws, regulations, and requirements governing Medicaid appeals, complaints, and administrative hearings.
- Knowledge of case management, quality assurance, and regulatory compliance principles and practices.
- Knowledge of Kentucky Medicaid programs and the health care delivery system.
- Knowledge of state and federal requirements related to beneficiary rights and access to health care services.
- Skills in data collection, analysis, reporting, and performance monitoring.
- Knowledge of supervisory and management principles, including staff development, workload management, performance management, and team building.
- Skills in conflict resolution, problem-solving, and effective communication with internal and external stakeholders.
- Knowledge of process improvement principles and methods for improving efficiency, consistency, and quality.
- Knowledge of records management, confidentiality, and appropriate handling of sensitive information.
- Special requirements: None.
Responsibilities
- Provide leadership, direction, and oversight for the Appeals and Complaints Branch.
- Manage and coordinate EITPRs and administrative hearing activities.
- Ensure EITPRs and hearing-related matters are processed accurately and within established federal and state timeframes.
- Supervise, coach, and develop branch staff while promoting a collaborative and accountable work environment.
- Monitor workload, performance measures, case status, and deadlines to ensure timely resolution of matters.
- Review complex or sensitive cases and provide guidance and direction to staff.
- Coordinate with internal DMS divisions, legal representatives, program staff, health plans, providers, beneficiaries, and other stakeholders as appropriate.
- Identify recurring issues and trends and make recommendations for process improvements.
- Ensure branch operations comply with applicable laws, regulations, Medicaid requirements, policies, and procedures.
- Develop and implement procedures that promote consistency, efficiency, quality, and appropriate documentation.
- Prepare and review reports, correspondence, and other materials related to EITPRs and administrative hearings.
- Represent the branch in meetings and workgroups and communicate program requirements and operational needs to leadership.
- Support the development and implementation of training and quality assurance activities.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
