Review Vacancy
TitleEligibility Program Manager 1 (NY HELPS) - 79342
Occupational CategoryOther Professional Careers
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $106898 to $131665 Annually
Street Address Division of Eligibility and Marketplace Integration / Bureau of Quality Management and Change Control
295 Main Street, Ellicott Square
Duties Description The Bureau of Quality Management and Change Control (QMCC) oversee NY State of Health contact center operations and manages the change control process with the contractor, working with other bureaus to assess the impact of proposed changes, identifying impacts across program areas, and tracking all change requests. The QMCC also monitors the quality of the contractor’s performance by conducting quality assurance (QA) reviews designed to identify trends and provide recommendations for improvement. Under the direct supervision of the Bureau Director, the EPM 1 will provide key management support, including oversight of Bureau staff located in the Buffalo office and execution of the Bureau’s objectives geared toward ensuring qualify customer service at the NY State of Health contact center. This includes oversight of staff responsible for the Bureau’s document change control activities, performing documentation reviews, editing procedure documents, providing feedback to change control team members, and assisting with the Bureau’s quality assurance review and reporting processes.
Minimum Qualifications Reassignment: Current NYS Department of Health employee with permanent or contingent permanent status as a Eligibility Program Manager 1, G-27).
Permanent Transfer Candidates:
New York State employee with one or more years of permanent or contingent-permanent service in title at Grade 25 or above, and eligible for transfer to Eligibility Program Manager 1, G-27, under section 70.1 or 52.6 of the Civil Service Law.
This title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS). HELPS Program titles may be filled via a noncompetitive
appointment. This means that you do not need to take an exam to qualify, but you do need to meet the minimum qualifications of the title.
NY HELPS Non-Competitive Minimum Qualifications
Eight years of professional experience*, two years of which must have included second-level supervision of staff, performing one or more of the following seven activities in a program with one or more of the following functions: provides reimbursements for health care services; works with social services program areas; determines eligibility for a consumer assisted program in a hospital or other health care facility; provides health care regulatory oversight; or performs quality assurance and interpretation/application of standards of health care.
Activities
1. Overseeing and directing staff in determining eligibility for a health insurance program or consumer assisted program in which financial eligibility criteria must be met.
2. Overseeing and directing staff in performing utilization review, including prepayment or post-payment review of requested health care services, prior approval or authorization activities, adjudication or pricing of claims for payment, or analysis of patterns of health care.
3. Overseeing and directing staff in developing mechanisms for the reimbursement and financing of health care services, including rate-setting or approval, capitation reimbursement methodologies, fee schedule development, coding constructs for medical goods and services, or application and processing of reimbursement methodologies.
4. Administering and overseeing staff responsible for day-to-day program operations for budgeting, staffing, or program planning.
5. Overseeing and directing staff in inspecting, assessing, or monitoring health insurance programs or health care facilities for certification, licensure, or adherence to laws, rules, regulations, and policies.
6. Overseeing and directing staff in planning, designing, developing, researching, or evaluating proposals to establish or refine health related programs, with responsibility for interpreting legislation or regulations, defining and describing target populations and local demographics, grant and proposal writing, or developing, reviewing, and evaluating contracts.
7. Administering and overseeing staff responsible for performing quality assurance activities such as ensuring compliance with laws, rules, regulations, and policies, as it pertains to activities 1 through 6.
*A Bachelor's Degree can substitute for four years of experience; a Master's Degree can substitute for five years of experience.
Preferred Qualifications: Preferred candidates will have professional experience in public health insurance programs, including New York’s Medicaid, and/or Child Health Plus. Preferred candidates will also have excellent verbal and written communication skills; strong analytical skills and attention to detail; strong organizational skills; proficiency in Microsoft Office (Word, Excel, Access); the ability to work well independently and as part of a team, and to manage multiple priorities in order to meet deadlines; experience using electronic data systems, such as eMedNY and NYSOH Back Office; and supervisory experience.
Additional Comments This position is part of the NYS HELPS program. No examination is required.
We offer a work-life balance and a generous benefits package, worth 65% of salary, including:
• Holiday & Paid Time Off
• Public Service Loan Forgiveness (PSLF)
• Pension from New York State Employees’ Retirement System
• Shift & Geographic pay differentials
• Affordable Health Care options
• Family dental and vision benefits at no additional cost
• NYS Deferred Compensation plan
• Access to NY 529 and NY ABLE College Savings Programs, and U.S. Savings Bonds
• And many more...
The NYS Department of Health is committed to making New York a safer, healthier, and more equitable place to live. Understanding health equity, social determinants of health and health disparities is critical to accomplish our goal of eliminating health disparities. For more information on the NYS Department of Health’s Mission, Vision, Values and Strategic Plan, please visit: https://health.ny.gov/commissioner/index.htm
If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.reasonable.accommodation@health.ny.gov to make a request.
NYS Department of Health does not participate in E-Verify and does not sponsor visa applications.
For new State employees appointed to graded positions, the annual salary is the hiring rate (beginning of the Salary Range) of the position. Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations and negotiated union contracts.
Some positions may require additional credentials or a background check to verify your identity.
Name Human Resources Management Group
Email Address resume@health.ny.gov
Address
Street Room 2217, Corning Tower Building, Empire State Plaza
Notes on ApplyingPlease submit your resume and cover letter as one (1) document, preferably in PDF format, by email to resume@health.ny.gov, with Reference SCD/EPM1/79342 included in the subject line or by mail to Human Resources Management Group, SCD/EPM1/79342, Rm 2217, Corning Tower Building, Empire State Plaza, Albany, NY 12237-0012, or by fax to (518) 473-3395. Failure to include the required information may result in your resume not being considered for this position.