Rate Setting Manager

State of Maine • Augusta, ME

4d • $71,843 - $101,587 • 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. This role’s responsibilities will include: • 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.

Requirements

• 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).
• Six weeks of fully paid parental leave for all employees welcoming a child—including non-birthing and adoptive parents.
• Additional, unpaid leave may also be available, under the Family and Medical Leave Act.

What This Job Offers

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