Review Vacancy
TitleProgram Research Specialist 4 (Health Care Finance) (NY HELPS) - 63299
Occupational CategoryHealth Care, Human/Social Services
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $106898 to $131665 Annually
Street Address OHIP/Division of Finance & Rate Setting/Bureau of Managed Long Term Care Rate Setting
99 Washington Avenue
Duties Description The Incumbent will perform research, evaluation, and analytical studies relating to the Partial Capitation, Medicaid Advantage Plus and Program of All-inclusive Care for the Elderly Managed Long Term Care Programs. Tasks include the direction and supervision of reimbursement mechanisms including capitation rate setting, directed payments and payment reconciliations, quality awards, and enhanced FMAP funding. Funding methodologies will be developed, implemented and reviewed that incorporate specified price and utilization metrics, fee-for-service rate schedules, health plan encounter data and community health assessment data as well as plan cost report and data surveys in accordance with State and Federal statutory regulations and actuarial principles. With this knowledge the incumbent will review and report on rate schedules prepared by the contracted actuary for actuarial soundness and generally accepted accounting principles. The incumbent will act as the subject matter resource for the bureau on the use of various data analytics software programs, including newly adopted tools, to develop actionable analtyical reports to support data-driven decision making. Additionally, the incumbent will conduct programmatic discussions and research with OHIP contract staff and DOB examiners and provide written directives outlining long term care objectives including integrated care, personal care utilization cost containment, worker wage compliance and Medicaid standards of eligibility for access to Managed Long Term Care. This will include analytics of budget scorecard proposals followed by presenting budget briefings to the Division of Budget/Chamber. The incumbent will lead studies and review compliance with objectives and coordinate with stakeholders such as the State’s certifying actuary, home care provider associations, health plan associations. other State agencies such as OMH and OASAS as well as work closely with the Centers for Medicare and Medicaid Services at the Federal level to insure finance and regulatory compliance.
Minimum Qualifications Reassignment: Current NYS Department of Health (DOH) employee with permanent or contingent permanent status as a Program Research Specialist 4 Health Care Finance, G-27.
Permanent Transfer Candidates:
Current NYS employee with one year of permanent or contingent permanent competitive service in a title eligible for transfer under Section 52.6 of the Civil Service Law.
The transfer cannot be a second consecutive transfer resulting in an advancement of more than two salary grades.
NY HELPS Non-Competitive Minimum Qualifications:
Twelve semester credit hours in statistics, biostatistics, economics, econometrics, research methods, mathematics, data analysis, or data modeling AND five years of professional research experience in the collection and evaluation of quantitative data directed toward review and analysis of healthcare reimbursement mechanisms, funding methodology, health economics, healthcare financing, cost containment, or patient classification systems. Two years of the experience must have involved supervision of professional staff engaged in the below functions.
Preferred Qualifications: Knowledge of NYS Medicaid program in the Managed Long Term Care (MLTC) environment including program and financial structure of the Partial Capitation, PACE, and MAP programs. An understanding of MLTC financing and rate-setting methodologies, including knowledge of minimum wage and other health worker wage adjustments utilized in rate setting, shifting MLTC reimbursement mechanisms, as well as service utilization dynamics in NYS Medicaid, Managed Care Organization (MCO) tax structure and financial reporting structure, directed payments, quality incentives awards and withholds and their related data sources. Knowledge of actuarial financing principles and standards of practice, federal managed care rate setting regulations, as well an understanding of the financial and rate impact of population acuity and the managed care risk adjustment process.
Additional Comments When reviewing qualifications, omissions and vagueness cannot be interpreted in the candidate’s favor. Candidates are responsible for providing accurate and clear descriptions of their experience demonstrating how they meet the minimum qualifications.
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, SCD/PRS4HCF/63299
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/PRS4HCF/63299 included in the subject line or by mail to Human Resources Management Group, SCD/PRS4HCF/63299, 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.