Duties Description The Health Program Director 1 will serve as the Bureau of Medical Review Director and will report directly to the Deputy Director of the OHIP Division of Medical and Dental Directors (DMDD). The Bureau of Medical Review Director will be responsible for directing all activities relating to the bureau.

The incumbent will be responsible for overseeing the day-to-day operations which include all functions of the bureau: prior approval of medical services and supplies, non-standard claims processing, customer service, and interfacing with providers, members, and other stakeholders. Directs, implements, maintains, and communicates directives and policy changes to Medicaid members, healthcare providers and other stakeholders; and oversees implementation to ensure consistent interpretation and application of the policy, and compliance with federal and State laws, rules, and regulations. This position will supervise the Bureau staff to ensure all duties and responsibilities are met. The incumbent will have oversight over contract administration and performance monitoring. The position will oversee strategies to measure bureau performance including fiscal review and be responsible for the review and monitoring of the bureau functions and staff including program integrity and make recommendations to executive staff for improvement.

Minimum Qualifications Eleven years of professional level work experience, two of which must have included managerial, decision-making, and/or oversight of a major health-related program or in the direction of a major administrative function of a large health related organization. A bachelor's degree may be substituted for four years of the general professional experience; a master's degree in an appropriate field may be substituted for an additional year of that experience.

Preferred Qualifications: Experience administering Medicaid or other health care programs, including policy development and regulatory compliance.
Experience supervising staff and managing program operations.
Experience collaborating with stakeholders and overseeing contracts to support program implementation and improvement.
Thorough knowledge of Medicaid program administration, including prior authorization of medical services and supplies, claims processing, federal and State regulatory requirements, and the policy development process as it relates to healthcare delivery and compliance.
Skilled in directing and supervising professional and administrative staff, managing day-to-day bureau operations, monitoring program and fiscal performance, and communicating policy directives clearly and consistently to diverse audiences including providers, members, and stakeholders.
Demonstrated ability to oversee contract administration, evaluate program integrity, identify operational deficiencies, and develop and present recommendations to executive leadership for program improvement.

Additional Comments Telecommuting may be considered after one year of employment for individuals not currently employed within the Bureau of Medical Review or Division of Medical and Dentals Directors.

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



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 ST/HPD1/63159 included in the subject line or by mail to Human Resources Management Group, ST/HPD1/63159, 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.