Health Program Director

Responsibilities

• Oversight of the planning, implementation, evaluation, quality and reporting of the NYS Managed Long Term Care (MLTC) programs, including Partial Capitation, Medicaid Advantage Plus, and the Program of All-inclusive Care for the Elderly (PACE).
• Manage day-to-day operations of the bureau and provide leadership to over 30 professional staff who certify and survey managed care organizations (MCOs) to ensure quality, accessible care in compliance with federal and state statutes, regulations and contract requirements.
• Serve as the primary liaison with Medicaid insurers in the State, monitoring managed care surveillance and reporting in collaboration with other bureaus and promoting statewide consistency through policy interpretation and guidance.
• Develop managed care policy regarding the delivery and oversight of home and community-based services to managed care enrollees.
• Provide strategic direction to staff, including formulating a comprehensive approach to meet all program requirements and verifying performance of contract deliverables and compliance with program standards.
• Oversight of staff who coordinate managed long‑term care system tasks, including:
  • Management of enrollment activities, escalations and technical support.
  • System set‑up for the scope of benefits.
  • Coordinating inquiries from providers, MLTC plans and consumers.
  • Coordinating day‑to‑day enrollment, systems, contracting and health‑plan review issues.
• Serve as a liaison between senior‑level executive staff and program staff to advance MLTC system reform, including reviewing and approving policy and program reports for external dissemination, providing policy recommendations to upper‑level management, and responding to critical and high‑profile issues and requests for information.
• Interpret relevant federal and state legislation and develop state legislation, regulations and policies, analyze impact on current policies and initiatives, and develop implementation plans for new initiatives.
• Coordinate with other state and federal offices, such as other bureaus within the Division of Health Plan Contracting and Oversight, the Division of Legal Affairs, the Department of Financial Services, the Office of the Medicaid Inspector General, and the Center for Medicaid and Medicare Services, to advance program objectives and implement policy changes.
• Oversee database development and design, computer systems support, and other record‑retention systems to facilitate office regulatory functions.
• Prepare budget reports for staffing purposes and management reports to support the objectives of the bureau and the Division.
• Make presentations and attend stakeholder meetings on a regular basis.

Eleven years of professional experience, of which two years must have included managerial responsibility for a major health‑related program, or a major administrative function for a large health‑related organization. A bachelor’s degree may substitute for four years of the professional experience described above; a master’s degree in an appropriate field may be substituted for an additional year of that experience.

Significant experience working in the State’s Medicaid program or other health insurance market, including managed care experience, preferably in the government programs (e.g., Medicaid managed care experience), and/or a professional‑level working knowledge and experience associated with all aspects of Medicaid and public health programs, including ensuring compliance with federal and state requirements. Familiarity with the operation and functions of the State's Medicaid managed care program and its relationship with other State agency partners including OMH, OASAS, OMIG, and OPWDD.

Ability to work under high pressure and manage multiple priorities. Excellent writing, communication, collaboration, and organizational skills.

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

• Holiday & Paid Time Off
• Public Service Loan Forgiveness (PSLF)
• Pension from New York State Employees’ Retirement System
• Shift &…