Review Vacancy
TitleEligibility Program Manager 1 (NY HELPS) - 79006
Occupational CategoryOther Professional Careers
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $106898 to $131665 Annually
Appointment Type Contingent Permanent
Street Address Division of Eligibility and Marketplace Integration /Bureau of Long Term Care/SSI-Related Populations
99 Washington Avenue
Duties Description The Eligibility Program Manager 1 will serve as a unit manager of the Long-Term Care/SSI-related Medicaid Policy and Initiatives Unit located within the Bureau of Long-Term Care and SSI-Related Populations. The unit manager will be responsible for development, administration, oversight and implementation of complex Medicaid Program eligibility policy for the aged, blind and disabled population and oversight of subordinate staff.
The unit manager will provide policy guidance, support and oversight for the implementation of key Medicaid eligibility budget initiatives and federal requirements, including but not limited to supporting the transition of the non-MAGI eligibility group (the aged, blind and disabled Medicaid population) to a new State-based eligibility system, including integration of the eligibility rules for the aged, blind and disabled; and the implementation of federal Medicaid eligibility rule changes. The unit manager will also assist in implementing and administering Medicaid public health emergency COVID-19 “Unwind” and Medicaid renewal operations as required by the Centers for Medicare and Medicaid Services.
Duties of this EPM 1 position include, but are not limited to:
•Coordinate, manage and oversee a sub-unit of subordinate staff responsible for the development and implementation of program policies, procedures, and guidelines for the determination of Medicaid eligibility for specific populations;
•Assist in development and approval of policies, procedures and guidelines for statewide administration of current and newly identified Medicaid eligibility initiatives related to Medicaid eligibility rules for the aged, blind and disabled;
•Oversee the development of projects required to implement cost saving and other key initiatives; assist with state centralization of Medicaid eligibility determinations for the aged, blind and disabled Medicaid population; and provide policy guidance needed for improvements and updates of electronic Medicaid eligibility systems.
•Direct staff in responding to various intra- and inter-agency emails, correspondence and phone calls from department colleagues, local social services districts, stakeholders, oversight agencies, federal staff and members of the Legislature;
•Provide policy guidance expertise needed to assist system staff in the development and ongoing maintenance of applicable automated Medicaid eligibility systems;
•Participate in meetings with various stakeholders and Commissioners of Local Social Services Districts on new eligibility policies to provide guidance, ensure input and address concerns, as appropriate;
•Provide programmatic policy guidance, requirements and oversight to ensure adherence to federal and State regulations and requirements; interpret federal and State laws, rules and regulations to develop policy directives, analyses and other materials;
•Review litigation and assist legal staff in handling of litigation as it relates to areas of Medicaid eligibility responsibility;
•Coordinate response to various audits in areas of Medicaid eligibility responsibility, including overseeing assessment of local social services district actions subject to audit;
•Serve as a liaison with other Divisions and executive level staff on special projects as needed.
Minimum Qualifications Reassignment: Current NYS Department of Health employee with permanent or contingent permanent status as an 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 experience in New York Medicaid program eligibility and enrollment policies and operations and with related data systems such as eMedNY, NY State of Health and WMS; have experience developing and/or interpreting policies, procedures, statutes and regulations; work well both independently and as part of a team and under pressure to meet deadlines; possess excellent oral and written communication skills and excellent organizational and interpersonal skills; have strong research and analytical skills; and experience supervising staff and determining priorities.
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 Corning Tower, Empire State Plaza, Room 2217
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/EPM1/79006 included in the subject line or by mail to Human Resources Management Group, SCD/EPM1/79006, 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.