Rate Setting Manager

Department of Health and Human Services • Augusta, GA

2d • Onsite

About The Position

The Rate Setting Manager supports the ongoing implementation and operations of a comprehensive, streamlined, and coherent system of reimbursement for MaineCare services and programs. This role will provide leadership to the Rate Setting team, working to maintain and improve processes and procedures. The Department of Health and Human Services (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers. The Office of MaineCare Services (OMS) within DHHS administers the state’s Medicaid program, which provides free or low-cost health insurance coverage for low-income Mainers so they can access the health care services they need to work, care for family, go to school, and participate in the community. OMS works collaboratively with other State agencies, the Legislature, the Office of the Governor, MaineCare members, health care providers, and other health care purchasers on statewide healthcare improvement initiatives. OMS is committed to advancing health equity efforts to improve access to care and positive health outcomes for all low-income Mainers. OMS provides benefit coverage and support services in alignment with Department goals, federal requirements, and State statutes. OMS also provides oversight necessary to ensure accountability and efficient and effective administration of the state’s Medicaid program. The Rate Setting unit is located within the OMS Data Analytics team. Rate Setting oversees the implementation and operations of MaineCare’s award-winning rate system reform efforts and other key DHHS reimbursement initiatives. Rate Setting objectives are to streamline, rationalize, and improve MaineCare’s reimbursement system to ensure rates are equitable and adequate to provide all MaineCare members with access to needed, high value healthcare services.

Requirements

• An eight (8) year combination of education and/or experience comprised of a Master’s Degree in Business Administration, Public Policy, or closely related field AND two (2) years of responsible experience in quantitative analysis.
• Directly related professional experience may be substituted for education on a year-for-year basis.
• Extensive knowledge of Medicaid programs, policies, and operations
• Experience effectively leading a team of individuals with different roles, backgrounds, and perspectives to work toward achieving the organization’s goals, including contracted vendors.
• A proven ability to analyze complex quantitative data and translate analyses into concise and understandable reports and recommendations.
• Experience managing contracts and working effectively with vendors.
• An established record of managing complex fiscal issues with successful outcomes.

Nice To Haves

• Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low-income populations
• Lived experience with Medicaid and/or other health-related social needs common to individuals and families receiving Medicaid coverage
• Experience as a direct supervisor

Responsibilities

• Supervise and provide guidance to unit staff members who administer rate setting processes for MaineCare’s claims processing system, MIHMS.
• Be responsible for ensuring that rates established for MaineCare programs and services are properly entered into MIHMS.
• Provide cost analyses and subject matter expertise for services contracted by the Department, which will be used to determine reimbursement rates and methods.
• Provide fiscal analyses of departmental costs associated with reimbursement for MaineCare and other DHHS programs.
• Review proposed legislation and prepare fiscal estimates related to this legislation. Implement adopted legislation or regulations.
• Provide contractual oversight for vendors performing the rate system evaluation, rate assessments, and actuarial analysis of rates and savings payments within specific initiatives.

Benefits

• 13 paid holidays
• 12 days of sick leave
• 3+ weeks of vacation leave annually
• Health Insurance Coverage – The State of Maine pays 85%-100% of employee-only premiums ($12,845.82 - $15,112.76 annual value), depending on salary.
• Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%.
• Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($395.72 annual value).
• Retirement Plan – The State contributes the equivalent of 18.91% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS).
• Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child—including non-birthing and adoptive parents—receive six weeks of fully paid parental leave.

What This Job Offers

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