DIRECTOR OF MEDICAL SERVICES

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The Director of Medical Services works under administrative direction of the Department of Human Services (DHS) Director for the Division of Medical Services (DMS) and is responsible for directing operations of the State Medicaid programs by developing and establishing work priorities, standards of performance, reviewing and approving managerial decisions, and monitoring budgetary needs and expenditures for the Division. The Director of Medical Services is the State Medicaid Director as recognized by the federal financing agency, the Centers for Medicare and Medicaid Services (CMS), and is the primary liaison with CMS, the Legislature, the Governor's Office, approximately 27,000 Medicaid providers, provider associations, professional associations, as well as other State Medicaid Directors. This position is governed by state and federal laws and agency policy.

Class Code:

N181N

Job Grade:

SE02

Special Job Requirements:

Typical Functions:

Develops and reviews Medicaid operating and program policies and procedures, reviews and evaluates programs and services with departmental leaders, and makes recommended changes as necessary. Plans and directs state Medicaid activities by establishing goals, objectives, and short or long-range plans to ensure consistency with overall agency goals. Monitors DMS budget, reviews and approves expenditures, advises management of potential budget issues, and makes recommendations, including assuring that the state Medicaid budget is correctly forecast and that appropriation and funding is received in the correct categories. Gathers data and researches technical information for monthly reports, studies and presents to appropriate authorities, and assures that Medicaid data is used to inform research and decisions in many areas within and outside DMS, including CMS, DHS, and other state agencies, hospitals, associations, etc. Provides Medicaid technical assistance, guidance, and information to internal and external agency contacts, legislators, vendors, and other customers by researching and interpreting federal and state laws, along with agency policies and procedures. Represents Medicaid in meetings, discussions, and negotiations with individual Medicaid providers as well as provider organizations which represent some of the more than 32,000 enrolled providers. Works with other DHS divisions on common initiatives. Oversees the Office of Long Term Care that includes nursing home survey and certification and licensing functions, which are unique among state Medicaid programs and requires specialized knowledge. Conducts and attends meetings, conferences, and/or workshops to disseminate technical information relating to Medicaid practices and plans. Coordinates activities with other state and federal personnel, responds to requests for information from executive and legislative officials, and serves on committees or task forces to express ideas and needs or provide recommendations/solutions. Responds to media requests about Medicaid programs, providers, and other issues through the DHS Communications Office. Directs the activities of a professional and administrative support staff through lower level managers including interviewing applicants, approving hire recommendations, and evaluating and reviewing work performance of incumbents. Performs other duties as assigned.

Knowledge, Abilities, and Skills:

Knowledge of business and management principles involved in strategic planning, resource allocations, human resources, leadership techniques, production methods, and coordination of people and resources. Knowledge of the principles and practices of personnel and fiscal management, including budget development, purchasing, and asset management. Knowledge of state and federal laws, rules and regulations as it pertains to Medicaid. Knowledge of Medicaid policies and applicable laws. Ability to work within a political environment. Ability to plan and assess the impact of programs and services and devise modifications as necessary. Ability to prepare a budget and monitor expenditures. Ability to effectively communicate both orally and in writing. Ability to prepare and present oral and written information and reports. Ability to interpret and apply laws, policies, and procedures. Ability to investigate complaints, identify problems, and design corrective measures. Ability to monitor and evaluate the effectiveness and compliance of administrative operations and programs.

Minimum Qualifications:

The formal education equivalent of a bachelor’s degree in finance, business administration, public administration, or a related field, plus nine years of progressively more responsible experience in Medicaid operations, including five years in a professional management capacity.

Required Certificates:

Exempt:

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