Medical Care Program Supervisor

State of Maryland•Baltimore City, MD

17h•Onsite

About The Position

The primary function of the Eligibility Determination Specialist Supervisor (Medical Care Program Supervisor) is to lead, manage and monitor the Problem Resolution Unit (PRU). The PRU is responsible for reviewing and resolving escalated cases, ensuring appropriate representation before Administrative Law Judges, appropriate preparation for administrative hearings, and quality assurance reviews of tasks completed by Eligibility Determination Associates. Successful management and monitoring of the Unit include developing, analyzing, implementing, and applying federal and State regulations and policies, training materials, and standard operating protocols. The Supervisor must be able to develop and maintain electronic tools to track and assess data to monitor key performance indicators to identify workflow efficiencies and gaps to ensure compliance with federal and State regulations, improve operational performance, and conduit reviews of tasks completed by Eligibility Determination Division team members including Eligibility Determination Associates, Lead Workers, Supervisors, and Specialist (Medical Care Program Associates I and/or II, Medical Care Associate Lead Worker, Medical Care Associate Supervisors, and Medical Care Program Specialist I and/or II ) and overall performance. The Eligibility Determination Specialist Supervisor must continuously be knowledgeable of federal and State Medicaid regulations and policies. This knowledge is imperative to the Supervisor’s success to analyze eligibility determinations to ensure regulations and policies were interpreted and applied accurately and timely. The Supervisor’s quality assurance assessment tool must measure accuracy of analyzed and authenticated verifications including but not limited to, applications, technical verifications, income, asset, resource, financial verifications, and clearances in the appropriate federal and state data systems for compliance when rendering eligibility decisions. This knowledge is also required when the Supervisor is training team members, responding to internal and external inquiries, drafting Standard Operating Protocols (SOP), providing technical assistance, researching, and resolving provider payment concerns, and serving as the Department’s expert witness at administrative appeals hearings or subject matter expert during systems development sessions. The Supervisor may participate in the administrative appeal hearing process by conducting pre-hearing conferences, providing expert testimony based on accurate analysis of federal and State regulations and policies at administrative appeals hearings and ensuring compliance to the Administrative Law Judge’s dispositions. At all times, this position will provide customer service to both internal and external customers that meet or exceed the standards by EDD, the Department, and or State. Travel throughout the state is required. This position must maintain a valid driver’s license and meet the Department’s requirements to drive a state vehicle or have their own transportation when needed.

Requirements

Eight years of administrative or professional experience developing or applying policies and regulations in medical assistance, health insurance, federal or State entitlement programs.
One year of this experience must have been in a medical assistance program.
Possession of a valid driver’s license.

Nice To Haves

Experience interpreting medical assistance policies, regulations and procedures.
Experience working with consumers and other stakeholders resolving concerns.
Experience preparing cases including preparing concise hearing summaries and presenting.
Experience presenting information and evidence in a concise manner to uphold the Department's position based on regulations and policies before an Administrative Law Judge or other entity.
Experience meeting established deadlines.
Experience managing and training staff.

Responsibilities

Lead, manage and monitor the Problem Resolution Unit (PRU).
Review and resolve escalated cases.
Ensure appropriate representation before Administrative Law Judges.
Ensure appropriate preparation for administrative hearings.
Conduct quality assurance reviews of tasks completed by Eligibility Determination Associates.
Develop, analyze, implement, and apply federal and State regulations and policies, training materials, and standard operating protocols.
Develop and maintain electronic tools to track and assess data to monitor key performance indicators.
Identify workflow efficiencies and gaps to ensure compliance with federal and State regulations.
Improve operational performance.
Conduct reviews of tasks completed by Eligibility Determination Division team members.
Continuously be knowledgeable of federal and State Medicaid regulations and policies.
Analyze eligibility determinations to ensure regulations and policies were interpreted and applied accurately and timely.
Measure accuracy of analyzed and authenticated verifications including but not limited to, applications, technical verifications, income, asset, resource, financial verifications, and clearances in the appropriate federal and state data systems for compliance when rendering eligibility decisions.
Train team members.
Respond to internal and external inquiries.
Draft Standard Operating Protocols (SOP).
Provide technical assistance.
Research and resolve provider payment concerns.
Serve as the Department’s expert witness at administrative appeals hearings or subject matter expert during systems development sessions.
Participate in the administrative appeal hearing process by conducting pre-hearing conferences.
Provide expert testimony based on accurate analysis of federal and State regulations and policies at administrative appeals hearings.
Ensure compliance to the Administrative Law Judge’s dispositions.
Provide customer service to both internal and external customers that meet or exceed the standards by EDD, the Department, and or State.