Medicaid Program Manager 1--A

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Medicaid Program Manager 1--A

Salary

$4,784.00 - $9,381.00 Monthly

Location

Baton Rouge, LA

Job Type

Classified

Job Number

MVA/SP/205798

Department

LDH-Medical Vendor Administration

Opening Date

02/14/2025

Closing Date

3/7/2025 11:59 PM Central

• Description

• Benefits

• Questions

Supplemental Information

The Louisiana Department of Health is dedicated to fulfilling its mission through direct provision of quality services, the development and stimulation of services of others, and the utilization of available resources in the most effective manner.

LDH serves as a model employer for individuals with disabilities.

This position is located within the Louisiana Department of Health / Medical Vendor Administration / Director's Office/executive Management Team / East Baton Rouge Parish

Announcement Number: MVA/SP/205798

Cost Center: 3052010100

Position Number: 188350

This vacancy is being announced as a Classified position and will be filled as a Job appointment.

(Job appointments are temporary appointments that may last up to 48 months)

No Civil Service test scoreis required in order to be considered for this vacancy.

To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.

Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.

A resume upload willNOTpopulate your information into your application. Work experience left off your electronic application or only included in an attached resume is not eligible to receive credit

For further information about this vacancy contact:

Shambrielle PoolerShambrielle.Pooler@la.gov

LDH/HUMAN RESOURCES

BATON ROUGE, LA 70821

This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.

Minimum Qualifications

MINIMUM QUALIFICATIONS:

Seven years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR

Six years of full-time work experience in any field plus four years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR

A bachelor’s degree plus four years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services; OR

An advanced degree or a Juris Doctorate plus three years of experience in developing, managing, or evaluating health or social service programs; or in public health, public relations, social services, health services, health regulation, or administrative services.

EXPERIENCE SUBSTITUTION:

Every 30 semester hours earned from an accredited college or university will be credited as one year of experience towards the six years of full-time work experience in any field. The maximum substitution allowed is 120 semester hours which substitutes for a maximum of four years of experience in any field.

Job Concepts

Function of Work:

To administer small and less complex statewide Medicaid program(s).

Level of Work:

Program Manager.

Supervision Received:

Broad from a higher-level manager/administrator.

Supervision Exercised:

May provide functional supervision in accordance with the Civil Service Allocation Criteria Memo.

Location of Work:

Department of Health and Hospitals.

Job Distinctions:

Differs from Medicaid Program Monitor by responsibility for administering small and less complex statewide program(s).

Differs from Medicaid Program Manager 1-B by the absence of supervisory responsibility.

Differs from Medicaid Program Manager 2 by the absence of responsibility for administering medium size and moderately complex statewide program(s).

Examples of Work

This position is within the Medicaid Director’s Office, Louisiana Medicaid Pharmacy Benefits Management (LMPBM) Unit. The LMPBM Unit is responsible for the development, implementation and administration of the Medicaid Pharmacy Program within the BHSF. The LMPBM is the first state-owned and administered Pharmacy Benefit Management (PBM) System in the nation. The LMPBM is charged with the responsibility of assuring quality pharmacy services while developing efficiencies in operation, service and cost, The LMPBM currently achieves over $83 million annually in cost containment through the various state generated initiatives such as state supplemental rebates that have been implemented in the LMPBM System. The LMPBM is responsible for the daily operational activities of pharmacy prescription services, one of the largest service areas under the Medicaid program, with annual expenditures in excess of $1.7 billion for payment of approximately 22 million prescription claims. In addition, the LMPBM, through its federally mandated rebate system and provider fees, generates the largest amount of revenues through the federal rebate system and additional savings are projected to be generated through the prior authorization and state supplemental rebate system) within the Bureau. The pharmacy program covers all Food and Drug Administrative (FDA) approved legend drugs that meet the OBRA '90 and OBRA '93 criteria with a few exceptions. The drug file contains over I20,000 drug products (brand, generic and some over-the-counter). The LMPBM Section determines the reimbursement methodology for both the drug ingredient cost and the dispensing fee for covered outpatient drugs.

In addition, the PBM program is responsible for the development, implementation and administration of the federal and supplemental rebate programs, which generated nearly $300 million in expenditure offsets to the state in State Fiscal Year (SFY) 2021. The PBM program utilizes the services of three contractors: Magellan Medicaid Administration, the Drug Rebate Processing/Preferred Drug List (PDL) contractor, Gainwell (formerly DXC) Information Systems, LLC; and the University of Louisiana at Monroe (ULM), School of Pharmacy:

• Magellan Medicaid Administration - Drug Rebate Processing Contractor / PDL/Supplemental Rebate Contractor

• Performs administrative initiatives to reduce expenditures for the drug rebate programs which includes reconciliation of drug records invoiced to drug manufacturers on a quarterly basis for the federally mandated rebate program and the State supplemental rebate program, pharmacy audit recoupments and pharmacy help desk;

• Provides accounting and audit support for Drug Rebate Program functions, which includes invoicing and reconciliation of over 139,823 invoice records issued to over 600 drug manufacturers quarterly. In SFY 2021, this activity resulted in nearly $1,029,861,495 in federal rebate collections and approximately $98 million in supplemental rebate collections;

• Prepares quarterly financial reports in accordance with federal and state reporting requirements;

• Coordinates research and resolution of drug rebate disputes; and

• Conducts financial analyses as requested in conjunction with departmental initiatives.

• Secures clinical and costing data for drugs in selected therapeutic classes;

• Performs clinical and economic analysis of manufacturer data;

• Manage the regulatory requirements of the contracted unit, accounting staff and contract programmer responsible in the maintenance of the Louisiana Pharmaceutical Rebate Program in carrying out day-to-day responsibilities.

• Reviews and interprets current and proposed state and federal laws/regulations related to Pharmacy services as they affect the reporting, calculation and correction of rebates and the application of auditing procedures.

• Develops, modifies and implements changes in policy, procedures and/or system functions to ensure effectiveness and compliance of pharmacy rebate program with such federal and state laws/regulations.

• Represents the Department or Bureau at various federal, state, and local hearings, conferences and functions including giving testimony to legislative committees or individuals and conducting public hearings on Pharmacy Rebate program or reports.

Program Operations

• Manages contractor performance of drug rebate data by examining statements, invoices, rebate balances, rebate payment amounts, rebate data and other correspondence from drug manufacturers.

• Ensures compliance with federal and/or state policies, rules and regulations regarding pharmacy rebates. Facilitates the preparation of National Drug Code (NDC) level reconciliations for over 40,000 drugs included in the federal CMS drug rebate program. More than 600 drug manufacturers are enrolled in the CMS federal rebate program.

• Manages rebate reconciliation to assure compliance is addressed in accordance with the Omnibus Reconciliation Act of 1990. Makes recommendations for additions/enhancements to audit procedures.

• Maintains current receivables listing and keeps a pulse on outstanding balances and dispute dispositions. Keeps the pharmacy rebate procedure manual updated with all changes in state and federal policy that impacts rebate collections and reporting.

• Provides training to contractor staff, and LDH staff for new procedures consistent with changes in law and executive management terms.

• Actively participates in weekly and bi-weekly meetings with the rebate vendor and reports on outstanding balances and open issues that require action and/or clarification. Reviews contractor prepared audit report findings, dispute resolutions, and other documentation for presentation to drug manufacturers for accuracy prior to dispute resolution submission to manufacturers.

• Monitors contractor’s follow-up on corrective action plans to assure drug manufacturers comply with federal and state policies, rules and regulations.

• Ensures that working files are maintained for each drug manufacturer, for all drug entities included in the federal rebate system.

• Ensures manufacturer rebate files contain all documentation and correspondence between the contractor and the manufacturer.

• Confers with administrators, private and governmental auditors, including Louisiana Legislative Auditors (LLA), over 600 pharmacy manufacturers, pharmacy providers and others regarding audit findings and settlement/payment agreements. Answers correspondence regarding audit findings and results with the contractor, LLA and the Office of Inspector General (OIG). Initiates and confirms corrective action by correspondence or other follow-up procedures to ensure drug manufacturers’ compliance with federal and state policies, rules and regulations.

Mediates, as required, pharmacy rebate meetings with CMS and the drug manufacturers to resolve disputes. Confers with staff auditors and manufacturers to document findings to obtain

• Negotiate State Supplemental Rebates with manufacturers;

• Prepare therapeutic class monographs for Pharmaceutical and Therapeutics Committee deliberations;

• Present clinical and costing data to the Pharmaceutical and Therapeutics Committee;

• Maintain PDL; and

• Prepare clinical and cost data for performance indicators for Performance Based Budgeting.

• Gainwell (formerly DXC), the Medicaid Fiscal Intermediary

• Provides technology equipment purchase/installation (with ULM) to support the program;

• Creates application modifications to the current Medicaid Management Information System (MMIS);

• Designs and implements a Wide Area Network (WAN) for ULM;

• Supports of web-based pharmacy prior authorization (PA) software;

• Implements data research applications as needed;

• Supports data warehouse;

• Performs Statistical Analysis System (SAS) training for ULM research analysts;

• Trains and updates LDH and ULM staff on Pharmacy PA System;

• Trains prescribers and providers on the PA process; and

• Maintains and supports PDL/PA and supplemental rebate systems and operations.

• University of Louisiana at Monroe (ULM), School of Pharmacy

• Provides space, staff, and computers;

• Operates pharmacist-staffed PA desk;

• Receives and processes all FFS prior authorization requests;

• Creates prior authorization approval/denial for a specific drug for a specific recipient for a specific period of time. In accordance with state and federal statutes, requests must be addressed within twenty-four (24) hours. Provisions are in place whereby an emergency override is allowed for a minimum of a seventy-two (72) hour supply of medicine;

• Provides physician consultations;

• Serves as consultants on the Preferred Drug List and Prior Authorization program; and

• Performs departmental directed data analysis and outcome studies.

The incumbent in this position is responsible for assisting in the management the Rebate program and the contractor who supports the Rebate program related to the LMPBM section under the administrative direction of the Pharmacist 8 and Medicaid Program Manager 2. The incumbent is responsible for managing the accounting and system functions of the Rebate program. Work activity in this position requires frequent interaction with LDH and Rebate contractor staff, drug manufacturers, federal representatives of the Centers for Medicare and Medicaid Services (CMS), Office of Inspector General (OIG), Legislative Auditors, Health Economics staff, Bureau of Health Services Financing staff and the Fiscal Intermediary.

Duties include but are not limited to the following:

Program Administration

• Provides oversight of the non-clinical functions of the Pharmacy Rebate Program.

• additional information to answer questions, to resolve problems and to represent the agency as necessary in defending audit findings at hearings and informal discussions.

• Oversees quarterly report documentation to meet requirements for federal (CMS 64) and state (Division of Administration) rebate reporting, including verifying validity and accuracy of reports.

• Identifies, verifies, analyzes, and manages the expenditure patterns of the Pharmacy Benefits Management program. Monitors closely and promptly identifies existing or potential fiscal problems.

• Coordinates and participates in reviews of assigned program areas with Centers for Medicare and Medicaid Services (CMS), Office of the Inspector General, Legislative Auditors, LDH Legal, and Medicaid Management Information Systems (MMIS), Health Economics Division staff, Bureau of Health Services Financing staff and Fiscal Intermediary regarding the Pharmacy Benefits Management program. Prepares responses to findings of such reviews, and develops and implements a corrective action plan for identified deficiencies or areas of non-compliance. Directs professional staff in assignments related to these areas.

• Coordinates the preparation of the Administrative Budget Request, Revenue Collection, and Contract monitoring for Pharmacy Benefits Management. This entails working closely with the BHSF Medicaid Director and Deputy Directors, and the Financial Management and Operations sections to develop, prioritize, and implement the short and long-term objectives to be achieved during the state fiscal and federal fiscal years.

• Identifies, verifies and analyzes the expenditure patterns of the Pharmacy Benefits Management program. Monitors closely and promptly identifies existing or potential fiscal problems.

• Prepares monthly financial operation reports for Financial Management Operation – monthly contract submissions, monthly summary of expenditures, monthly administrative reports, salaries, etc.

• Responds in person, in writing, electronically, and by telephone to requests for statistical information on pharmacy services or rebate collections from within LDH, Division of Administration, Legislative Fiscal Office, members of the legislature, the press, the general public, CMS and other entities requesting information on pharmacy services/medical drug claims/rebates.

Other

• Designs and executes special reports as requested by Pharmacist 8 or Program Manager 2, Department officials, congressional delegation, state legislative staff, the State Attorney General’s office, federal and state regulatory agencies and all other approved requests relating to the pharmacy program.

• Develops new reports and/or analyzes existing reports and synthesizes data to support decision-making, policy formulation, program evaluation and financial management. Plans and develops methods of meeting state and federal reporting requirements and legislative and audit requests.

• Works in conjunction with pharmacy team to oversee the contractor’s use of the federal Health Resources and Services Administration (HRSA)’s file to identify covered entities not eligible for rebate invoicing. This is essential to assure manufacturers are not invoiced twice for the same units of drugs when the drug was purchased by the provider enrolled in the 340B program.

• Incumbent performs other duties as assigned to assist with the management and operations of the Pharmacy section.

Louisiana State Government represents a wide variety of career options and offers an outstanding opportunity tomake a differencethrough public service. With an array of career opportunities in every major metropolitan center and in many rural areas, state employment provides an outstanding option to begin or continue your career.

As a state employee, you will earn competitive pay, choose from a variety of benefits, and have access to a great professional development program:

Insurance Coverage More information can be found at https://info.groupbenefits.org/

Parental Leave– Up to six weeks paid parental leave

More information can be found athttps://www.civilservice.louisiana.gov/Parental-Leave/Default.aspx

Holidays and Leave – State employees receive the following paid holidays each year:

• New Year's Day

• Martin Luther King, Jr. Day,

• Mardi Gras,

• Good Friday,

• Memorial Day,

• Independence Day,

• Labor Day,

• Veteran's Day,

• Thanksgiving Day and Christmas Day.

* Additional holidays may be proclaimed by the Governor

State employees earn sick and annual leave which can be accumulated and saved for future use. Your accrual rate increases as your years of service increase.

Retirement – State of Louisiana employees are eligible to participate in various retirement systems (based on the type of appointment and agency for which an employee works). These retirement systems provide retirement allowances and other benefits for state officers and employees and their beneficiaries. State retirement systems may include (but are not limited to):

• Louisiana State Employees Retirement System (www.lasersonline.org). LASERS has provided this video (https://lasersonline.org/wp-content/uploads/2016/07/Your_Retirement_System.mp4) to give you more detailed information about their system

• Teacher's Retirement System of Louisiana (www.trsl.org),

• Louisiana School Employees Retirement System (www.lsers.net), among others

  01

  This position will be filled as a Job appointment only. Job appointments may last up to 48 months. Acknowledge by checking “Yes” that you understand this is a temporary position.

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  Required Question

Employer

State of Louisiana

Address

For agency contact information, please refer to

the supplemental information above.

Louisiana State Civil Service, Louisiana, 70802

Phone

(866) 783-5462

Website

http://agency.governmentjobs.com/louisiana/default.cfm

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