DEPUTY DIRECTOR, OFFICE OF ELIGIBILITY SERVICES ((Program Manager Senior II))

GRADE

STD0024

LOCATION OF POSITION

MDH, Office of Eligibility Services, Baltimore MD

Main Purpose of Job

This position serves as the sole Deputy Director of the Office of Eligibility Services (OES). The Deputy Director plans, directs, supervises, administers, and evaluates operations of the three main sub-directorates within OES: Eligibility Determination; Eligibility Policy & Operations; and Systems Reconciliation, Program Integrity, Information Analysis & Monitoring. This includes providing quality oversight for the financial eligibility determinations of Medicaid’s 1915(c) Home and Community-Based Services (HCBS) waiver programs to ensure all operations align with federal and State requirements. Additionally, the position directs the statewide framework for Medicaid eligibility policy, training, and beneficiary enrollment while leading strategic efforts in program integrity and the reconciliation of eligibility IT systems. These sub-directorates support eligibility policy and operations for MAGI and non-MAGI Marylanders. The Deputy Director establishes overall policies and procedures for the programs, oversees their implementation, evaluates their effectiveness and approves major revisions; establishes overall program goals, standards and controls to meet program objectives and oversees their achievement; oversees and manages the personnel and financial resources of the programs; plans, coordinates, supervises and evaluates the work of subordinate managers; develops, implements and manages short and long-range plans for program operations and resources; determines organizational structure and staffing needs of the programs; prescribes and oversees development and training of program staff; and represents the agency before federal, State and local officials, legislative committees and senior managers and executives of other agencies concerning program activities. The position actively participates in planning and readiness efforts regarding Medicaid eligibility reform and works with the Centers for Medicare and Medicaid Services (CMS) and the Maryland Health Benefit Exchange (MHBE) regarding eligibility related compliance and program integrity activities. The position reports directly to the Director of OES and may act for the Director in the Director’s absence or as assigned by the Director. The position supervises several individuals, including the three Assistant Directors for the three sub-directorates of OES, a Senior Advisor, Special Assistant, HR Liaison, and Administrative Assistant. This position operates in a hybrid manner, meaning job duties will be performed both remotely and on-site unless otherwise directed by the Appointing Authority.

POSITION DUTIES

This position is responsible for three sub-directorates:

Eligibility Determination

The Eligibility Determination sub-directorate includes one Assistant Director, one Trainer, and three divisions: 1) Non-MAGI Medicaid; 2) MAGI Medicaid; and 3) Quality, Compliance, and Systems. The central function of this sub-directorate is the training and management of a team of case workers responsible for reviewing complex financial documentation to render eligibility determinations for HCBS waiver applications and redeterminations. This unit also manages its own specialized call center, an internal training center, and administrative appeals cases. The sub-directorate works closely with the Systems Reconciliation, Program Integrity, Information Analysis and Monitoring sub-directorate and IT teams within the Maryland Department of Health (MDH) and across sister agencies to ensure technical alignment for eligibility and enrollment case worker platforms.

Eligibility Policy and Operations

The Eligibility Policy and Operations sub-directorate includes one Assistant Director and four divisions: 1) Medicaid Eligibility Policy; 2) Beneficiary Enrollment and Call Center; 3) Eligibility Training; and 4) Recipient Eligibility Programs. Medicaid Eligibility Policy: This division develops and maintains eligibility regulations and policies for all new and existing program populations, disseminating critical information through the Maryland Medical Assistance Manual and HCBS waiver manuals. It serves as the single point of contact for the MAGI and Non MAGI Medicaid programs as well as the Maryland Children’s Health Program (MCHP) and CHIP coverage groups. Beneficiary Enrollment and Call Center: This unit is responsible for the oversight of the HealthChoice program, linking eligible recipients with Managed Care Organizations (MCOs). The call center serves as a point of entry for MCO enrollment including, Long Term Care disenrollment, capitation requests, and enrollment assistance for various MAGI and Non-MAGI Medicaid programs. This unit has frequent contact with the MCOs and the Healthchoice eligible recipients. Eligibility Training: Training staff provide Medical Assistance eligibility training for caseworkers throughout the state, as well as specialized waiver training for sister agencies including the Maryland Department of Aging and the Department of Human Services. Recipient Eligibility Programs: This division ensures that the Medicaid Management Information System (MMIS) Recipient Eligibility File and related sub-files are updated accurately and timely. Key responsibilities include managing the Medicare Part A and Part B Buy-in Programs and ensuring data reconciliation across eligibility interfaces.

Systems Reconciliation, Program Integrity, Information Analysis and Monitoring

This sub-directorate focuses on the technical integrity and audit compliance of OES operations. Systems Support and Liaison: This unit supports and oversees system enhancements for eligibility systems. It serves as a primary liaison on behalf of EDD the Department to oversee and improve the IT systems used by eligibility case workers. Division of Program Integrity: This division coordinates all federal and state audits, such as the Payment Error Rate Measurement (PERM), Medicaid Eligibility Quality Control (MEQC) and Single State Audits. It monitors determinations to ensure compliance with federal and state regulations, developing and reviewing Corrective Action Plans (CAPs) in response to audit findings. Information Analysis and Monitoring: This unit conducts analysis and evaluates the operational procedures impacting Medicaid eligibility and data systems. It tracks and measures the timeliness and completion of applications and renewals to meet federal reporting requirements for CMS.

MINIMUM QUALIFICATIONS

Qualified candidates must possess a Bachelor's degree from an accredited college or university and six years of health or human services administrative or professional experience, including three years at a supervisory or managerial level. A Master's degree from an accredited college or university will substitute for one year of the general experience and a Doctorate will substitute for two years of the general experience. Additional experience will substitute on a year-for-year basis for the college degree.

SELECTIVE QUALIFICATIONS

The selected candidate must possess at least three years of executive-level management experience overseeing a layered, matrixed organizational structure. This must include managing a large organization through subordinate managers and supervisors who directly oversee their own operational teams and staff (rather than sole oversight of direct reports).

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should possess professional experience in the administration, management, or oversight of Medicaid eligibility programs. This experience must include responsibility for at least one of the following: Medicaid eligibility policy development or implementation; eligibility determination operations; federal or State regulatory compliance; or, the management of programs responsible for Medicaid eligibility determinations.

People with disabilities and bilingual candidates are encouraged to apply.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.

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