ASSISTANT DIRECTOR, NURSING & WAIVER SERVICES (PROGRAM MANAGER IV)

Maryland; Baltimore (MD); Hybrid; USD 120,000 - 160,000; Full time

Benefits offered by this job

Excellent Health Benefits Package

Flexible Spending Accounts (Reduced)

Generous Leave Benefits

Retirement

Paid Parental Leave Flexible Work Sche

Free Mass Transit

Job summary

Maryland Department of Health in Baltimore seeks an Assistant Director for Waiver and Nursing Services within the Office of Long-Term Services and Supports. You will plan and direct operations for the four LTSS divisions and oversee FMCS contract implementation and monitoring.

The role requires leading division chiefs, ensuring timely execution, and coordinating with CMS and stakeholders on quality and compliance. Hybrid telework is supported, with office days and remote work each week.

Qualifications

• Bachelor's degree from an accredited college or university.
• 6 years of professional health or human services experience.
• 2+ years of Medicaid program experience.
• 3+ years of supervisory or managerial experience.
• Additional professional level health or human services experience can substitute for the bachelor's degree at 30 credit hours for 1 year of experience for up to 4 years.

Responsibilities

• Plan and direct operations for multiple LTSS divisions.
• Oversee FMCS contract implementation and monitoring.
• Supervise four division chiefs and ensure compliance with timeframes.
• Coordinate with CMS and stakeholders on quality and compliance.
• Oversee planning for long-term care reform.

Skills

Leadership experience

Regulatory knowledge

Strategic initiatives

Policy development

Education

Bachelor's degree

Job description

GRADE

STD0022

LOCATION OF POSITION

MDH, Office of Long-Term Services and Supports, Baltimore, MD

Main Purpose of Job

This position serves as the Assistant Director for Waiver and Nursing Services directorate within the Office of Long-Term Services and Supports (\"OLTSS\"). The Assistant Director plans and directs the functional operations and processes for the following divisions: Division of Provider Integrity, Claims, and Compliance; Division of Clinical Support; Division of Participant Enrollment and Service Review; and the Division of Nursing Services. Additionally, the incumbent is responsible for the Financial Management and Counseling Services (FMCS) contract implementation, oversight, and monitoring. The Assistant Director manages the case management hierarchy and oversees the coordination of services for dually-enrolled Medicaid participants.

The Division of Provider Integrity, Claims, and Compliance, Division of Clinical Support, and the Division of Participant Enrollment and Service review are responsible for the operations of the Community First Choice (CFC), Community Personal Assistance Services (CPAS), Increased Community Services (ICS), and Home and Community-Based Options Waiver (\"Community Options\") programs. In addition to operating these programs, this triad is responsible for maintaining the federal authorities associated with each program, engaging with stakeholders, drafting and implementing regulatory and subregulatory guidance, and performing quantitative and qualitative analyses to inform decisions related to program operations. Each division is responsible for certain functions as noted below.

The Division of Provider Integrity, Claims, and Compliance is responsible for monitoring provider compliance with the home and community-based services (HCBS) settings rule – specifically, ensuring that individuals with disabilities receiving HCBS have the same opportunities as individuals without disabilities and are fully integrated in their communities. As such, division staff conduct onsite visits and desk reviews to ascertain provider compliance, provide technical assistance, and initiate disenrollment for non-compliance providers. Additionally, division staff process manual claim adjustments, assist providers with billing concerns, and provide technical assistance to providers interested in becoming a Medicaid-enrolled provider.

The Division of Clinical Support is comprised of clinical and non-clinical staff. The clinical staff conduct utilization review on medically complex plans of service for applicants and participants in the CFC, CPAS, ICs, and Community Options programs. Additionally, the clinicians serve as expert witnesses in appeal hearings to defend the Department’s decisions. Both non-clinical and clinical staff investigate reportable events and make referrals to other agencies as appropriate. This division provides oversight of the nurse monitoring program, completion of the interRAI assessment, and completion of the Pre-admission Screening and Resident Review (PASRR) Level II performed by the Local Health Departments (LHD) across the State.

The Division of Participant Enrollment and Service Review has three units – Plan of Service, Registry, and Enrollment. This team conducts utilization review for plans of service for applicants and participants in the CFC, CPAS, ICs, and Community Options programs. The registry team manages the Community Options registry and completes the monthly wave to invite individuals from the registry to apply for the program. The enrollment team reviews technical eligibility for the four aforementioned programs and processes the authorizations to participate in the programs. This division is responsible for management and oversight of the Competitive Solicitation for Comprehensive Case Management.

The Division of Nursing Services (DONS) is responsible for four separate and distinct programs within Medicaid. These programs are home health services; home care for disabled children under a Model Waiver; medical day care for children; and early and periodic screening, diagnosis, and treatment (EPSDT) nursing services for individuals younger than 21 years old. This division is a multi-disciplinary team with staff who serve in medical and administrative roles.

This position directly supervises the four division chiefs for each of the aforementioned divisions. The Assistant Director is responsible for ensuring each division carries out its assigned responsibilities and tasks while adhering to mandatory timeframes. The Assistant Director is responsible for personnel tasks such as performance monitoring and onboarding and offboarding of staff.

The position actively participates in planning efforts regarding long term care reform, and works with the Centers for Medicare and Medicaid Services (CMS) regarding quality and compliance activities for federal home and community-based services programs. The position reports directly to the Deputy Director of OLTSS and may act for the Deputy Director in the Deputy Director’s absence or as assigned by the Deputy Director.

Program services for which the Assistant Director is responsible represent over $613 million in Medicaid expenditures annually, serving a large portion of the Medical Assistance population.

This position operates in a hybrid telework manner, with days in the office and remote days each week, as directed by the appointing authority.

MINIMUM QUALIFICATIONS

Qualified applicants must possess a bachelor's degree from an accredited college or university, 6 years of professional health or human services experience, 2 years or more of experience working with a Medicaid program and at least 3 years of supervisory or managerial experience. Additional professional level health or human services experience can be substituted for the bachelor's degree at the rate of 30 credit hours for 1 year of experience for up to 4 years.

DESIRED OR PREFERRED QUALIFICATIONS

Preferred candidates should possess the following:

• Experience leading or managing Medicaid long-term services and supports (LTSS), home and community-based services (HCBS), waiver programs, nursing services, or other complex healthcare programs.
• Knowledge of federal Medicaid requirements, including HCBS waiver authorities, the HCBS Settings Rule, CMS Ensuring Access Rule, quality reporting requirements, and Medicaid program integrity standards.
• Experience supervising managers and leading multidisciplinary teams responsible for policy development, program operations, clinical review, compliance, or provider oversight functions.
• Experience developing and implementing strategic initiatives, regulations, policies, State Plan Amendments, waiver amendments, or other federal and State programmatic requirements.
• Demonstrated ability to collaborate with executive leadership, federal partners, providers, advocates, legislators, and other stakeholders to resolve complex operational and policy issues.

SELECTION PROCESS

This is a Management Service position, and serves at the pleasure of the Appointing Authority. Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position.

Applicants may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

• Excellent Health Benefits Package, including Medical, Vision, Prescription and Dental
• Flexible Spending Accounts (Reduced Child and Health Care)
• Generous Leave Benefits (6 Personal Days, 12 Regular Holidays, Annual Leave, 15 Sick Days)
• Retirement
• Paid Parental Leave Flexible Work Schedules (where applicable)
• Free Mass Transit (Baltimore metro area)

EQUAL OPPORTUNITY & DIVERSITY STATEMENTS

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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