Rate Manager

Overview

The Rate Setting Manager supports the ongoing implementation and operations of a comprehensive, streamlined, and coherent system of reimbursement for Maine Care services and programs. This role leads the Rate Setting team, maintaining and improving processes and procedures.

• Supervise and provide guidance to unit staff who administer rate setting processes for Maine Care’s claims processing system, MIHMS.
• Be responsible for ensuring that rates established for Maine Care programs and services are properly entered into MIHMS.
• Provide cost analyses and subject matter expertise for services contracted by the Department to determine reimbursement rates and methods.
• Provide fiscal analyses of departmental costs associated with reimbursement for Maine Care and other DHHS programs.
• Review proposed legislation and prepare fiscal estimates related to this legislation, implementing adopted legislation or regulations.
• Provide contractual oversight for vendors performing the rate system evaluation, rate assessments, and actuarial analysis of rates and savings payments within specific initiatives.

• Eight (8) years of combined education and/or experience, including a Master’s Degree in Business Administration, Public Policy, or a closely related field and two (2) years of responsible experience in quantitative analysis. Directly related professional experience may be substituted for education on a year‑for‑year basis.
• Preferred experience includes:
  • Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low‑income populations.
  • Lived experience with Medicaid and/or other health‑related social needs common to individuals and families receiving Medicaid coverage.
  • Experience as a direct supervisor.

• Work‑Life Fit: 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually; vacation leave accrual increases with years of service; overtime‑exempt employees receive personal leave.
• Health Insurance Coverage:
  The State of Maine pays 85%–100% of employee‑only premiums (annual value $12,845.82–$15,112.76) depending on salary.
• Health Insurance Premium Credit:
  Participation decreases employee‑only premiums by 5%.
• Dental Insurance:
  The State pays 100% of employee‑only dental premiums ($395.72 annual value).
• Retirement Plan:
  State contributes the equivalent of 18.91% of the employee’s pay to Maine Public Employees Retirement System.
• Parental Leave:
  Six weeks of fully paid parental leave for all employees welcoming a child, including non‑birthing and adoptive parents; additional unpaid leave may be available under FMLA.

Note:

Benefits may vary according to specific collective bargaining agreements and are prorated for part‑time positions.

As an Equal Opportunity employer, Maine State Government embraces a culture of respect and awareness. We are committed to creating a strong sense of belonging for all team members, ensuring an inclusive environment for applicants of all backgrounds, including race, color, sex, sexual orientation or gender identity, physical or mental disability, religion, age, ancestry, national origin, familial status, or genetics. Reasonable accommodations are provided to qualified individuals with disabilities upon request.