Job Description

The Medical Assistance Program (MAP) administers Medicaid and related public health insurance programs, for the City of New York. Applying individuals and families are approved for eligibility against applicable Federal and State guidelines. Those found to be eligible can use coverage provided to access doctors, medication and other health care services at little or no cost.

The Medical Assistance Program (MAP), is recruiting for one (1) Administrative Manager NM-III, to function as the Executive Director, of the Office of Mail Renewal, Managed Care Program (MCP), and Third-Party Health Insurance, who will:

Under the executive direction of the MAP Assistant Deputy Commissioner (ADC) of NHED, MCP and OMR with wide latitude for independent initiative, decision making, and judgement, the Executive Director (ED) is responsible for the administration of three (3) Medical Assistance Program (MAP) divisions: the Office of Mail Renewal (OMR), the Managed Care Program (MCP), and Third-Party Health Insurance. Ensuring that the three divisions keep pace with changes relating to health care reform and anticipated program growth without causing delays or interruptions to its service delivery. The ED collaborates with the ADC in service planning, service evaluation, and policy formation, and is responsible for resolving complex service issues in the respected areas.

The Office of Mail Renewal (OMR) is primarily responsible for reviewing and processing renewal applications received from consumers for continued medical coverage. Consumers are renewed on an annual basis. Vanguard Direct, is contracted to both mail and receive renewal applications which they scan and forward to OMR electronically via EDITS (Eligibility Data and Image Transfer System) Renewal. Most consumers return their renewals by mail, but they also have the option to hand deliver the renewal applications to the Out-stationed Eligibility Division (OED) offices located in each NYC borough. Beginning in March 2020, renewals are being extended for twelve months by SDOH and the Department of Social Services Information Technology Services (DSS ITS) pursuant to the COVID-19 easements. OMR is responsible for manually extending renewals that are exception from the SDOH and DSS ITS processes. It is anticipated that monthly renewals will be extended through May 2021.

The OMR division receives approximately 30, 000 renewals monthly.

The Managed Care Program (MCP), interfaces with managed care delivery systems comprised of Managed Care Organizations (MCOs) and case management providers through which eligible Medicaid clients access behavioral and health care services. MCP is comprised of three program areas: Managed Care Client Services (MCCS), Recipient Restriction Program (RRP), and Comprehensive Medicaid Case Management (CMCM). These areas work with the New York State Department of Health (SDOH), MCOs, the Office of Medicaid Inspector General (OMIG), provider organizations (hospitals, physician groups and pharmacies), city agencies, client advocates, and MAXIMUS (the state managed care enrollment broker for the managed care program) to ensure the operational integrity of MAP’s managed care program.

The Third-Party Health Insurance (TPHI), which includes the Reimbursement Division, is responsible for determining consumer eligibility for Medicaid reimbursements of out-of-pocket medical expenditures and for the payment of third-party health insurance premiums. The division also assists consumers with accurate notation of third-party health insurance information in case records, primarily through eMedNY, and administers the premium payment portion of the AIDS Health Insurance Program (AHIP). Lastly, although the administration of the Medicaid Transportation program transitioned in 2015 to the NYSDOH-contracted transportation broker, the division continues to direct consumers seeking transportation reimbursement.

• Administratively responsible for planning, administering, and coordinating the operational activities of OMR, MCP, and TPHI. Ensure adherence to all local, state and federal mandated timetables, cost parameters, eligibility determination procedures, sanctioned error rates, and other agency objectives.

• Provide administrative leadership, consultation, and technical guidance to OMR, MCP, and TPHI senior and supervisory staff. Interpret policy and procedural changes to staff, and establish standards and criteria to improve the performance, quality and productivity of the staff’s responsibility areas.

• Identify areas of vulnerability for committing fraud, and program changes through the monthly statistics and changing demographics. Ensure that the divisions keep pace with these changes to ensure continued services to its consumers. Also review progress and performance reports submitted by the senior and supervisory staff for the purpose of increasing efficiency and to better meet the needs of the public.

• Make recommendations affecting OMR, MCP, and TPHI organizational structure, major program and automated systems operations to ensure the optimum effectiveness of the divisions. Based on the operational needs of each division, initiate personnel actions necessary to accomplish the mission of each division efficiently and effectively.

• Make recommendations to the ADC and participate in the formulation and implementation of agency program policies and procedures and evaluate proposals for policy changes impacting the operations of each division. Effectively implement policy changes ascertaining proper integration and compliance of local, state, federal, and Agency regulations.

• Oversee the coordination of the review, redesign and/or establishment of new programs and procedures in the determination of OMR, MCP, and TPHI eligibility aimed at reducing the level of eligibility decision errors, avoiding financial/billing discrepancies to MCOs, easing administrative backlogs and deficiencies that slow down vital services to an at-risk population, and identifying possible vulnerabilities that would allow fraud.

Recommend corrective actions including procedural changes to the ADC in order to achieve greater cost savings and productivity.

• Oversee special projects and studies, including quality control activities, to identify and develop approaches to resolve OMR, MCP, and TPHI program issues in the areas of personnel resources allocation, financial management and control, and management systems development and a design with a goal of ensuring quantitative and qualitative performances.

• Maintain liaison with other agencies such as the NY State Department of Health (SDOH), NY Medicaid CHOICE/MAXIMUS, Managed Care Organizations (MCOs), the Office of Medicaid Inspector General (OMIG), other MAP and HRA officials, and other governmental and private agencies/parties who are concerns with matters involving the delivery of essential services to Medicaid eligible consumers. Also responds to their inquiries and concerns related to the provision of Medicaid benefits and payments.

• Represent the divisions at committee meetings and hearings to resolve critical issues and major problems related to service delivery. Also represent each division’s interests and concerns before legislative bodies and in discussions with local, state and federal agencies.

• Responsible for the integration of divisional functions and activities with operations of other organizational components in MAP, HRA, other city departments, SDOH, and other governmental and private social services, including the implementation of medical assistance related rules and regulations.

Salary Range $81,659 to $122,432

Work Location: 470 Vanderbilt Avenue, Brooklyn, NY, 11238

Hours/Schedule: 9 am – 5 pm

Qualifications

1. A baccalaureate degree from an accredited college and four years of satisfactory, full-time progressively responsible clerical/administrative experience requiring independent decision-making concerning program management or planning, allocation for resources and the scheduling and assignment of work, 18 months of which must have been in an administrative, managerial, executive or supervisory capacity. The supervisory work must have been in the supervision of staff performing clerical/administrative work of more than moderate difficulty; or

2. An associate degree or 60 semester credits from an accredited college and five years of satisfactory, full-time progressively responsible experience as described in "1" above, 18 months of which must have been in an administrative, managerial, executive or supervisory capacity. The supervisory work must have been in the supervision of staff performing clerical/administrative work of more than moderate difficulty; or

3. A four-year high school diploma or its educational equivalent and six years of

satisfactory, full-time progressively responsible experience as described in "1"

above, 18 months of which must have been in an administrative, managerial,

executive or supervisory capacity. The supervisory work must have been in the

supervision of staff performing clerical/administrative work of more than

moderate difficulty; or

4. Education and/or experience equivalent to "1", "2" or "3" above. However, all

candidates must possess the 18 months of administrative, managerial, executive or supervisory experience as described in "1", "2" or "3" above. Education above

the high school level may be substituted for the general clerical/administrative

experience (but not for the administrative, managerial, executive or supervisory

experience described in "1", "2" or "3" above) at a rate of 30 semester credits

from an accredited college for 6 months of experience up to a maximum of 3½

years.

Additional Information

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.