Senior Manager of Reimbursement and Fiscal Management

Department of Health and Human Services (DHHS)
Public Service Manager II
Opening Date:

November 12, 2024
Closing Date: November 25, 2024
Job Class Code:

MA31 Grade:

31

Salary:

$74,713. 59 - $105,809. 60 per year
Position Number:

02000-4101
Location : Augusta

Core Responsibilities:

The Senior Manager of Rate Setting supports the ongoing implementation and operations of a comprehensive, streamlined, and coherent system to set reimbursement rates for MaineCare services and programs. This role will be responsible for working with MaineCare's Senior Management Team and the Delivery System Reform Unit to set the strategic direction of MaineCare reimbursement reform and leading the Rate Setting team to execute that vision.
This role's responsibilities will include:
• Provide leadership, oversight, and support for the rate setting team.
• Collaborate and manage relationships with a variety of partners, including provider groups, advocacy organizations, advisory groups, vendors, and other DHHS offices and State agencies.
• Develop and present analyses of and recommendations for rates and reimbursement methodologies, including alternative payment models, to a variety of internal DHHS and external partners.
• Analyze DHHS program fiscal performance and provide advice on opportunities for improvement and efficiencies to program/financial managers.
• Provide primary methodological and analytic oversight for several MaineCare value-based programs including, but not limited to, MaineCare's Accountable Care Organization (ACO) program, Accountable Communities (AC), a multi-pronged initiative aimed at reducing costs while improving quality and outcomes for MaineCare members.
• Evaluate financial policies and procedures and implement appropriate modifications to improve efficiency and cost effectiveness, ensure compliance with applicable rules and regulations, and promote sound financial management practices.
• Oversee procurement, contracting, and contract management processes. Secure and manage outside vendors working on rate setting projects, actuarial analysis and/or financial management analysis.
• Calculate payment amounts and generate invoices for supplemental payments to providers and determine appropriate allocations of state and federal matching funds.
• Oversee the generation and submission of reporting required by the Centers for Medicare & Medicaid Services (CMS), including Upper Payment Limit (UPL) demonstrations and supplemental payment reporting.

Minimum Qualifications:

To qualify, you must have a minimum of an eight (8) year combination of education and/or experience. At least one (1) years of that experience must be in a supervisory/managerial capacity. At least two (2) years of that experience must be in cost, budget, financial analysis, or payment reform.

Preferred experience includes:
• A Master's Degree in Business Administration, Non-Profit Administration, Finance, Public Policy, Health Care Administration or a closely related field.
• 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.
The background of well-qualified candidates will demonstrate the following competencies:

1. Knowledge of the Governmental Accounting Standards Board's Generally Accepted Accounting Principles (GASB/GAAP) or extensive knowledge related to financial analytics.
2. Experience effectively leading a team of individuals with different roles, backgrounds, and perspectives to work toward achieving the organization's goals, including contracted vendors.
3. Experience with healthcare payment reform and the use of payment models and payment incentives to drive outcomes.
4. Strong ability to communicate complex information through visual and verbal presentation and in writing to senior leadership and large external audiences, including the ability to translate complex information to a lay audience.
5. An established record of managing complex fiscal issues with successful outcomes.

Thinking about applying?

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Agency information:

The Department of Health and Human Services (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers.

The Office of MaineCare Services (OMS) within DHHS administers the state's Medicaid program, which provides free or low-cost health insurance coverage for low-income Mainers so they can access the health care services they need to work, care for family, go to school, and participate in the community. OMS works collaboratively with other State agencies, the Legislature, the Office of the Governor, MaineCare members, health care providers, and other health care purchasers on statewide healthcare improvement initiatives. OMS is committed to advancing health equity efforts to improve access to care and positive health outcomes for all low-income Mainers. OMS provides benefit coverage and support services in alignment with Department goals, federal requirements, and State statutes. OMS also provides oversight necessary to ensure accountability and efficient and effective administration of the state's Medicaid program.

The Rate Setting unit is located within the OMS Data Analytics team. Rate Setting is a major contributor to the implementation and operations of MaineCare's award-winning rate system reform efforts and other key DHHS reimbursement initiatives. Rate Setting objectives are to streamline, rationalize, and improve MaineCare's reimbursement system to ensure rates are equitable and adequate to provide all MaineCare members with access to needed, high value healthcare services. For more information on MaineCare's rate reform efforts, please visit: mainecare. gov/rate-reform.

Application Information:

For questions, please contact David Jorgenson at ***.

Please submit all documents or files in PDF format.

To request a paper application, please contact Mandy. L. Harman@Maine. gov

Benefits of working for the State of Maine:

No matter where you work across Maine state government, you find employees who embody our state motto-"Dirigo" or "I lead"-as they provide essential services to Mainers every day. We believe in supporting our workforce's health and wellbeing with a valuable total compensation package, including:
Work-Life Fit - Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt emp.