Duties Description The Bureau of Health Access, Policy, and Innovation is responsible for coordinating the activities of the Internal Benefit Review Committee (IBRC). This committee reviews requests for consideration of Medicaid coverage of medically necessary new technology and health services. The committee meets once a month to review scientific evidence, clinical information, and relevant policies to guide decisions. The Bureau is seeking a Health Program Administrator to monitor these requests for coverage and conduct comprehensive literature reviews of the Common Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes or medically necessary technology. This position will be responsible for coordinating IBRC activities, conducting comprehensive literature reviews, documenting and presenting the findings to the IBRC, and tracking requests through the coverage determination. This role will also support the management of the Medicaid Clinical Trials program which ensures proper documentation is received for Medicaid members participating in clinical trials. This position will be part of the Innovations team and will also provide support to other initiatives including the Evidence Based Benefit Review Advisory Committee (EBBRAC), Medicaid Advisory Committee (MAC) and Beneficiary Advisory Committee (BAC).
Duties of this position include:
• Receiving and tracking requests for IBRC to review new CPT or HCPCS codes or technology to a shared mailbox. Track workflow of the review process from receipt of the request through coverage determinations.
• Communicate and coordinate with subject-matter experts in other bureaus and divisions as needed
• Conduct evidence-based research and comprehensive literature reviews to inform decision-making processes on Medicaid benefit coverage. Ensure research is evaluated for risk of bias, includes clinical guidance and peer-reviewed studies.
• Summarize reviewed research, clinical guidance, and coverage policies of other state's Medicaid programs and health plans. Present findings to the IBRC during monthly meetings.
• Receive and log clinical trial attestation forms. Review for completeness, accuracy, and adherence to policy. Communicate timely to members and providers.
• Review guidance documents and manuals and make recommendations for revisions.

Minimum Qualifications Permanent Transfer Candidates: Current NYS Department of Health employee with one year of permanent or contingent permanent, competitive, service as a Health Program Administrator, SG-18 OR a current NYS employee with one year of permanent or contingent permanent, competitive, service in a title eligible to transfer under Section 52.6, Section 70.1, or Section 70.4 of the NYS Civil Service Law to Health Program Administrator, SG-18, Health Program Administrator Trainee 1, NS, or Health Program Administrator Trainee 2, NS.

Non-Competitive Candidates via NY HELPS Program:

Health Program Administrator: Six years of experience* in the administration, supervision, and oversight of agency programs including but not limited to the design, implementation, administration, management, operation, and assessment of program effectiveness.

Health Program Administrator, Trainee 2: Five years of experience* in the administration, supervision, and oversight of agency programs including but not limited to the design, implementation, administration, management, operation, and assessment of program effectiveness.

Health Program Administrator, Trainee 1: Four years of experience* in the administration, supervision, and oversight of agency programs including but not limited to the design, implementation, administration, management, operation, and assessment of program effectiveness.

*Substitution: Associate degree may substitute for two years of specialized experience; bachelor's degree may substitute for four years of specialized experience; master's degree may substitute five years of specialized experience; J.D. may substitute for six years of specialized experience.

Preferred Qualifications: Experience with New York State Medicaid programs and policies, experience conducting extensive literature review, presenting findings to Medical Directors and other internal stakeholders.

Additional Comments When reviewing qualifications, omissions and vagueness cannot be interpreted in the candidate's favor. Candidates are responsible for providing accurate and clear descriptions of their experience demonstrating how they meet the minimum qualifications.

A $4,000 location pay will be added in addition to your salary since this position will be located in NYC.

This position is part of the NYS HELPS program. No examination is required.

This position may require travel throughout New York State including overnights to areas not served by public transportation.

We offer a work-life balance and a generous benefits package, worth 65% of salary, including:
• Holiday & Paid Time Off
• Public Service Loan Forgiveness (PSLF)
• Pension from New York State Employees' Retirement System
• Shift & Geographic pay differentials
• Affordable Health Care options
• Family dental and vision benefits at no additional cost
• NYS Deferred Compensation plan
• Access to NY 529 and NY ABLE College Savings Programs, and U.S. Savings Bonds
• And many more...

Name Human Resources Management Group, EW/HPA/46273



Fax 518-473-3395

Email Address [email protected]

Address

Street Corning Tower, Empire State Plaza, Room 2217

City Albany

State NY

Zip Code 12237

Notes on Applying Please submit your resume and cover letter as one (1) document, preferably in PDF format, by email to [email protected], with Reference EW/HPA/46273 included in the subject line or by mail to Human Resources Management Group, EW/HPA/46273, Rm 2217, Corning Tower Building, Empire State Plaza, Albany, NY 12237-0012, or by fax to (518) 473-3395. Failure to include the required information may result in your resume not being considered for this position.