STAFF SERVICES MANAGER I

State of California•Sacramento, CA

46d•Hybrid

About The Position

The Department of Health Care Services (DHCS) is the backbone of California's health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies, counties, and partners for the care of low-income families, children, pregnant women, older adults, and persons with disabilities. This is an exciting opportunity to join our diverse team in the following role. If you are interested in joining our team, apply today! The Capitated Rates Development Division (CRDD) is responsible for developing and processing Medi-Cal managed care capitation rates for more than 10 million beneficiaries across California's 58 counties. Under the general direction of the Section Chief, the Staff Services Manager I (SSM I) manages the daily and long-term activities of a Financial Management Unit (FMU). The FMU has primary responsibility for non-actuarial, capitated rate-related functions with regard to Medi-Cal managed care plans (MCPs). These functions include, but are not limited to, the development, analysis, and implementation of Medi-Cal managed care capitation rates; oversight of MCPs' financial viability and compliance with statutory, regulatory, and contractual requirements regarding financial matters; development of complex fiscal analyses and policy changes required for Medi-Cal budget assumptions (Local Assistance Estimate); development of payment policy, regulation, and monitoring and evaluation of Medi-Cal managed care delivery system waiver initiatives, including Special Terms and Conditions; development and/or review of State Directed Payments, Medical Loss Ratio (MLR) or other risk mitigation calculations; and implementation of and ongoing compliance with federal Centers for Medicare and Medicaid Services (CMS) regulations and guidance related to managed care rate setting. The SSM I is required to coordinate with multiple internal and external entities to meet all requirements for various CRDD programs. These entities include, but are not limited to, CMS, MCPs, counties, hospitals, health care districts, medical centers, MCP and provider associations, and accounting, budget, fiscal forecasting, and other internal Department of Health Care Services divisions. This advertisement includes two or more vacancies within Financial Management (FM) Unit B1 and FM Unit K. Candidates need only apply to this one Job Control to be considered for all vacancies within the units described below. Unit B1: Responsible for overseeing the Public Provider Ground Emergency Medical Transportation (PP-GEMT) Program. Key functions include collecting, analyzing, and reviewing historical and current cost and utilization data from managed care plans (MCPs) for the purpose of calculating prospective invoice and reconciliation amounts through financial modeling. Develop project plans, deliverables timelines, implementation schedules, flowcharts, and other documents. Maintain all communication mechanisms surrounding the program, including but not limited to, the PP-GEMT website, FAQs within said site, addressing emails from relevant parties to answer questions, handling logistics questions surrounding invoicing, tracking wire transfer payments and interfacing with MCPs and public providers to ensure timely reimbursements. Unit K: Responsible for key functions related to the development and oversight of the Directed Payments Program within the Medi-Cal managed care delivery system. The team conducts analytical studies, develops policies and procedures, and provides recommendations on financial and programmatic matters. Staff also examine financial reports, analyze fiscal transactions and utilization data, and maintain detailed records of contracts, funding pools, and policy documentation to ensure program integrity. Additionally, the team may engage directly with external stakeholders-including hospitals, managed care plans, associations, and the Centers for Medicare & Medicaid Services (CMS)-for reporting, program inquiries, and data-related activities. For more information about each vacancy being advertised, please view the 'Duty Statement' documents. Have questions and/or need assistance? Contact [email protected], we are here to help walk you through the state hiring process! Pending HRD/Budget approvals. You will find additional information about the job in the Duty Statement.

Nice To Haves

Finance, economics, accounting, or budgets background preferred.
Experience working with large amounts of data.
Moderate to advanced Microsoft Excel formula skills.
Experience with comparative analysis.
Excellent communication with various internal and external stakeholders.
Experience researching policy, statute, or legislation.
Excellent attention to detail.
Initiative driven and accountable individual.
Ability to track multiple projects or assignments.
Excellent written and verbal communication.
Ability to work on a high-functioning team.

Responsibilities

Manages the daily and long-term activities of a Financial Management Unit (FMU).
Development, analysis, and implementation of Medi-Cal managed care capitation rates
Oversight of MCPs' financial viability and compliance with statutory, regulatory, and contractual requirements regarding financial matters
Development of complex fiscal analyses and policy changes required for Medi-Cal budget assumptions (Local Assistance Estimate)
Development of payment policy, regulation, and monitoring and evaluation of Medi-Cal managed care delivery system waiver initiatives, including Special Terms and Conditions
Development and/or review of State Directed Payments, Medical Loss Ratio (MLR) or other risk mitigation calculations
Implementation of and ongoing compliance with federal Centers for Medicare and Medicaid Services (CMS) regulations and guidance related to managed care rate setting
Coordinate with multiple internal and external entities to meet all requirements for various CRDD programs.