Department

Executive Office of Health and Human Services

Division

Healthcare Health & Allied Professionals

Salary

$99,628.00 - $112,906.00

Job Profile

JC-02945500-77 - Chief Medical Care Specialist (RIASSE L580 DHS DCYF BHDDH DOC)

Scheduled Work Days & Work Hours

Monday - Friday, 8:30am - 4:00pm

35 Hours - Non-Standard

Job Requisition Number

JR103951 CHIEF MEDICAL CARE SPECIALIST (Open)

Pay Grade

C00A34 A

Classification

Chief Medical Care Specialist

Class Definition

GENERAL STATEMENT OF DUTIES: To be responsible for assisting the Medical Care Program Director in the planning and administration of a state-wide medical care program for eligible recipients of medical assistance; to assist the Medical Care Program Director by reviewing and reporting on new proposals; and to do related work as required.

SUPERVISION RECEIVED: Works under the administrative direction of the Medical Care Program Director (Public Assistance) with wide latitude for the exercise of initiative and independent judgement; work is reviewed in conference for conformance to department policy and objectives.

SUPERVISION EXERCISED: Plans, supervises and reviews the work of a professional and clerical staff.

ILLUSTRATIVE EXAMPLES OF WORK PERFORMED:

To be responsible for assisting the Director in the planning and administration of a state-wide medical care program for eligible recipients of medical assistance (under the provisions of Title XIX of the Federal Social Security Act and appropriate State Statues) by assisting in such activities as:

the development and revision of rules, regulations, procedures and fee and cost standards governing the procurement and payment of medical services and supplies; conferences with appropriate professional groups, representatives of state medical and dental societies, etc., and vendors of medical, dental and other supplies for the purpose of effecting common understanding and general acceptance thereon and to reconcile discrepancies and irregularities as well as continuous or aggravated violations involving charges, rules and regulations, standards or procedures of such medical care program; the preparation of manuals based on such rules, regulations, procedures and fee and cost standards for the benefit of members of the medical, dental and other professions as well as vendors of medical, dental or other supplies in order to assist them in preparing and submitting bills for payment to the State for such medical services and/or supplies; and reviewing and approving all requests for payment of medical services and supplies provided eligible recipients of medical assistance upon determination that the medical services and supplies provided and the amounts charged are allowable under the medical care program.

To participate in a program or orientation, information and consultation designed to acquaint social welfare staff, local directors of public welfare, professional consultants, advisory committees and other interested parties with the philosophy, objectives and operations of the public assistance medical care program.

To assist in the determinations of unmet needs in the medical care program and to make recommendations to establish a preliminary program to fulfill such unmet needs.

To assist the Medical Care Program Director in community activity in medical care and health planning.

To collect various statistical data relative to the medical care program and prepare reports on the various trends involving such medical care.

To relieve the Medical Care Program Director of administrative details relative to the operation of the medical care program.

To do related work as required.

REQUIRED QUALIFICATIONS FOR APPOINTMENT:

KNOWLEDGES, SKILLS AND CAPACITIES: A thorough knowledge of the State plan for medical assistance; a working knowledge of approved principles and practices of public health medical care administration and the ability to apply such knowledge by assisting a superior in the planning and administration of a state-wide medical care program; a familiarity with the practices and procedures of hospitals, nursing and convalescent homes and other institutions providing medical care and treatment; the ability to assist a superior by meeting with members of the medical and dental professions, social welfare staff and other interested parties for the purpose of explaining the philosophy, objectives and operations of the public assistance medical care program and to provide consultative services and advice as required; the ability to collect information relative to a medical care program and prepare various trend data for statistical purposes; the ability to relieve a superior of administrative details; the ability to assist in the planning, supervision and review of the work of a professional and clerical staff; the ability to establish and maintain effective working relationships with professional groups, community and other public and private agencies; and related capacities and abilities.

EDUCATION AND EXPERIENCE:

Education: Such as may have been gained through: graduation from a college of recognized standing and possession of a Master’s Degree from an accredited institution of higher education in the field of Medical Care Administration, Public Administration, Social Work, Public Health Administration, Business Administration.

Experience: Such as may have been gained through: employment as a Senior Medical Care Specialist, or in a responsible supervising position in the fields of Public Health, Medical Care Administration, Public Administration or Social Work.

Or, any combination of education and experience that shall be substantially equivalent to the above education and experience.

Supplemental Information

• Supervisory or lead experience in Medicaid, healthcare, eligibility, enrollment, claims, payment processing, or a related field.
• Strong working knowledge of RIBridges, MMIS, JIRA, and Microsoft products particularly Excel.
• Experience with Medicaid eligibility, managed care, enrollment, claims, or payment processes.
• Excellent oral and written communication skills with the ability to work effectively with providers, consumers, managed care plans, and staff.
• Strong investigative, analytical, and problem-solving skills.
• Exceptional attention to detail and meticulous record-keeping abilities.
• Ability to learn new systems, policies, and procedures quickly.
• Strong organizational, prioritization, and critical-thinking skills.
• Resourceful, proactive, productive, and focused.
• Ability to effectively supervise staff and manage competing priorities in a fast-paced, high-volume, dynamic agency environment.

https://www.everify.gov/sites/default/files/everify/posters/IER_RighttoWorkPoster.pdf

https://everify.uscis.gov/web/media/resourcesContents/EVerify_Participation_Poster_ES.pdf

The individual hired to fill this position will have access to Federal tax Information (FTI), as defined in IRS Publication 1075, and, as such, must undergo a national fingerprint background screening in accordance with the set forth in regulation 220-RICR-40-00-2 (IRS Publication 1075 – Background Check Process and Criteria available at https://rules.sos.ri.gov/regulations/part/220-40-00-2. Additionally, the individual is being hired to an E-Verify site which contains FTI and must have their employment eligibility validated through E-Verify.

Benefits

For information regarding the benefits available to State of Rhode Island employees, please visit the Office of Employee Benefits' website at http://www.employeebenefits.ri.gov/.
 

Also, be advised that a new provision in RI General Law 35-6-1 was enacted requiring direct deposit for all employees. Specific to new hires, the law requires that all employees hired after September 30, 2014 participate in direct deposit. Accordingly, any employee hired after this date will be required to participate in the direct deposit system. At the time the employee is hired, the employee shall identify a financial institution that will serve as a personal depository agency for the employee.