Rate Setting ManagerAugusta , Maine , United States | Community & Social Services | Full-time Apply by: Aug. 2, 2024 Apply with Linkedin ApplyDepartment of Health and Human Services (DHHS)Public Service Manager IIOpening Date: July 19, 2024 Closing Date: August 2, 2024Job Class Code: MA30Grade: 30Salary: $71,843.20 - $101,587.20/yearPosition Number: 02022-8072Location: AugustaThis is only open to those with promotional status in the Department of Health and Human ServicesAgency information: TheDepartment of Health and Human Services (https://www.maine.gov/dhhs/) (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’s award-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. For more information on MaineCare’s rate reform efforts, please visit: www.mainecare.gov/rate-reform. Core Responsibilities:The Rate Setting Manager supports the ongoing implementation and operations of a comprehensive, streamlined, and coherent system of reimbursement for MaineCare services and programs. This role will provide leadership to the Rate Setting team, working to maintain and improve processes and procedures. This role’s responsibilities will include: · Supervise and provide guidance to unit staff members who administer rate setting processes for MaineCare’s claims processing system, MIHMS.· Be responsible for ensuring that rates established for MaineCare programs and services are properly entered into MIHMS.· Provide cost analyses and subject matter expertise for services contracted by the Department, which will be used to determine reimbursement rates and methods.· Provide fiscal analyses of departmental costs associated with reimbursement for MaineCare and other DHHS programs.· Review proposed legislation and prepare fiscal estimates related to this legislation. Implement adopted legislation or regulations.· Provide contractual oversight for vendors performing the rate system evaluation, rate assessments, and actuarial analysis of rates and savings payments within specific initiatives.Minimum Qualifications:To qualify, you must have an eight (8) year combination of education and/or experience comprised of a Master’s Degree in Business Administration, Public Policy, or closely related field AND two (2) years of responsible experience in quantitative analysis. Directly related professional experience may be substituted for education on a year-for-year basis. Preferred experience includes:
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
Experience as a direct supervisor
The background of well-qualified candidates will demonstrate the following competencies:
Extensive knowledge of Medicaid programs, policies, and operations
Experience effectively leading a team of individuals with different roles, backgrounds, and perspectives to work toward achieving the organization’s goals, including contracted vendors.
A proven ability to analyze complex quantitative data and translate analyses into concise and understandable reports and recommendations.
Experience managing contracts and working effectively with vendors.
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:Please submit all documents or files in PDF format.For questions, please contact David Jorgenson at 207-624-6928To request a paper application, please contactAshley.Smith@Maine.gov (Ashley.Vigue@Maine.gov) .Benefits of working for the State of Maine: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 ($11,196.96 - $13,172.88 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.
Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($358.08 annual value).
Retirement Plan – The State contributes the equivalent of 18.09% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS).
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 .
State employees are eligible for an extensive and highly competitive benefits package (https://www.maine.gov/bhr/state-jobs/compensation-benefits) , covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness (https://www.maine.gov/bhr/oeh/) .
Note: Benefits may vary somewhat according to specific collective bargaining agreements and are prorated for anything less than full-time.
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, and our process ensures an inclusive environment to applicants of all backgrounds including diverse race, color, sex, sexual orientation or gender identity, physical or mental disability, religion, age, ancestry, national origin, familial status or genetics. If you’re looking for a great next step, and want to feel good about what you do, we’d love to hear from you. Please note reasonable accommodations are provided to qualified individuals with disabilities upon request.
Full-time