Deputy Director of Rate Setting

Deputy Director of Rate Setting Augusta , Maine , United States Community & Social Services Full-time Apply by: April 18, 2024 Apply with Linkedin Apply Department of Health and Human Services (DHHS)Public Service Manager IIOpening Date: March 25, 2024 Closing Date: April 18, 2024Job Class Code: MA31 Grade: 31 Salary: $72,529.60 - $98,779.20/yearPosition Number: Location: Augusta Agency information: TheDepartment 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 oversees the implementation and operations of MaineCare'saward-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. These rate reform efforts also aim to help MaineCare maintain its goal of paying 40% of its total reimbursement to providers through Alternative Payment Models (APMs). For more information on MaineCare's rate reform efforts, please visit: Core Responsibilities: The Deputy Director 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 and MaineCare's rate determination efforts. Collaborate and manage relationships with a variety of partners, including provider groups, advocacy organizations, advisory groups, and other DHHS offices and State agencies. Develop and present analyses of and recommendations for rates and rate methodologies 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. This includes, but is not limited to, reviewing and making recommendations on methodologies for MaineCare's Accountable Communities and Primary Care Plus programs. 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 determinations projects. 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 three (3) years of that experience must be in a supervisory/managerial capacity. At least two (2) years of that experience must be in cost, budget, and financial analysis. 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 APMs. 4. Strong ability to communicate complex information through visual and verbal presentation and in writing to internal DHHS leadership and large external audiences. 5. An established record of managing complex fiscal issues with successful outcomes. Thinking about applying? Research shows that people from historically excluded communities tend to apply to jobs only when they check every box in the posting. If you're currently reading this and hesitating to apply for that reason, we encourage you to go for it. Let us know how your lived experience and passion set you apart. 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 . Benefits 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 employees receive personal leave. + Health Insurance Coverage - The State of Maine pays 85%-100% of employee-only premiums ($10,523.28-$12,380.40 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State. + Health Insurance Premium Credit - Participation decreases employee-only premiums by 5%. Visit the Office of Employee Health and Wellness for more information about program requirements . + Dental Insurance - The State of Maine pays 100% of employee-only dental premiums ($350.40 annual value). + Retirement Plan - The State of Maine contributes 18.21 % of pay to the Maine Public Employees Retirement System (MainePERS), on behalf of the employee. + Gym Membership Reimbursement - Improve overall health with regular exercise and receive up to $40 per month to offset this expense. + Health and Dependent Care Flexible Spending Accounts - Set aside money pre-tax to help pay for out-of-pocket health care expenses and/or daycare expenses. + Public Service Student Loan Forgiveness - The State of Maine is a qualified employer for this federal program. For more information, visit the Federal Student Aid office . + Living Resources Program - Navigate challenging work and life situations with our employee assistance program. + Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child-including fathers and adoptive parents-receivesix weeks of fully paid parental leave . Additional, unpaid leave may also be available, under the Family and Medical Leave Act . + Voluntary Deferred Compensation - Save additional pre-tax funds for retirement in a MaineSaves 457(b) account through payroll deductions. + Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness . There's a job and then there's purposeful, transformative work. Our aim is to create a workplace where you can learn, grow, and continuously refine your skills. Applicants demonstrate job requirements in differing ways, and we appreciate that many skills and backgrounds can make people successful in this role. As an Equal Opportunity employer, Maine State Government embraces a culture of respect and awareness. We are committed to creating a strong sense of belonging for all team members . click apply for full job details