Rate Development Director

DHRM; Richmond (VA); On-site; USD 165,000 - 176,000; Full time

Job summary

Department of Medical Assistance Services (DMAS) seeks a Rate Development Director to lead the Provider Rate Development Division. You will oversee reimbursement methodologies and fee schedules, coordinating with actuaries and staff to determine payment structures.

You will manage supplemental payments, provider tax assessments and cost settlements, reporting to the Deputy Director of Finance/CFO. You will guide policy interpretation and implementation for Medicaid reimbursement, chairing work

Qualifications

• Experience with Medicaid rate setting for managed care, fee-for-service, and cost settlements.
• Experience developing financial analysis processes and measuring fiscal impact of policy changes.
• Experience leading complex projects from inception to completion.
• Experience creating and implementing financial and healthcare programs and policies.
• Advanced Excel skills including PowerQuery, PowerPivot and pivot tables.
• Experience in supervisory and human resource management.

Responsibilities

• Provide leadership across Managed Care Rate Setting, Provider Rate Setting, Supplemental Payments and Cost Settlement units.
• Design, implement and oversight of reimbursement methodologies and fee schedules.
• Collaborate with internal and external actuaries to review capitation structures.
• Manage payments via supplemental and state-directed payments and oversee provider tax assessments.
• Oversee settlement and auditing of institutional providers’ cost reports and price payments.
• Chairs work groups with provider associations and briefs executives; coordinate fiscal impact statements during legislative sessions.

Skills

Medicaid rate setting

Data analysis

Project management

Stakeholder communication

Supervisory experience

Excel advanced formulas

Tools

Excel

PowerQuery

PowerPivot

Job description

Title: Rate Development Director

State Role Title:Gen Admin Manager III

Hiring Range: $164,705 - $175,529

Pay Band: 7

Agency: Dept of Med Assistance Svcs

Location:Dept of Medical Asst Services

Agency Website:www.dmas.virginia.gov

Recruitment Type: General Public - G

Job Duties The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Rate Development Director in the Provider Rate Development Division. Job responsibilities will include, but are not limited to: Provides leadership across the following units within the Provider Reimbursement division: Managed Care Rate Setting, Provider Rate Setting, Supplemental Payments and Cost Settlement and Audit. This position leads the design, implementation and oversight of reimbursement methodologies and fee schedules for healthcare providers and partners with internal and external actuaries to review capitation rate structures. The position manages the determination of payments through supplemental payment and state-directed payments and manages the provider tax assessments. The position also manages the settlement and auditing of institutional providers’ cost reports and utilizing both regulatory and market information to determine appropriate and allowable payments. This position reports directly to the Deputy Director of Finance / Chief Finance Officer (CFO) and provides management and strategic planning for all provider reimbursement programs for the Department of Medical Assistance Services, in accordance with state and federal laws and established policies and procedures. This position requires a deep understanding of state and federal Medicaid policies, payments systems and healthcare reimbursement principles to ensure compliance with requirements on payment limits and rate adequacy. This position develops, interprets and implements policy related to Medicaid reimbursement methodologies. This position directs the analysis used to establish provider rates, serves as a liaison and chairs various work groups with provider associations and provides executive-level briefings. During the annual General Assembly session, ensures accurate and timely responses on fiscal impact statements and coordinates with the Budget Division Director. The business needs for this position have in office requirements to include but are not limited to attending in-person meetings and training, external meetings and occasional conferences and travel. Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org/ The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high-quality health care coverage. DMAS wants talented individuals who can align their experience with the mission of the agency and its core values – service, collaboration, trust, problem solving and adaptability. At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.

Minimum Qualifications Competitive candidates will meet these minimum qualifications: Considerable experience with Medicaid rate setting for managed care programs; fee-for-service programs; supplemental payments; cost settlements; program planning; and health care programs, including Medicaid. Extensive experience developing processes and procedures for complex financial analysis; calculating fiscal impact of policy changes; analyzing complex data to draw conclusions; using data to make recommendations; and applying statistical and quantitative methods. Extensive experience leading complex projects, from inception to completion. Considerable experience in developing, creating, and implementing financial and health care programs and policies. Considerable experience as power user of Excel, including utilizing advanced formulas and aggregating data using PowerQuery, PowerPivot as well as pivot tables. Considerable knowledge of state and federal regulatory processes and applying regulations, law, and policy to financial model development. Considerable experience in meeting deadlines. Considerable experience communicating with internal and external stakeholders. Considerable experience in developing, creating, and implementing financial and health care programs and policies. Considerable experience in supervisory and human resource management. Considerable experience in program management and directing direct multiple, diverse operations.

Additional Considerations There are no additional considerations for this position.

Special Instructions You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position. The Virginia Department of Medical Assistance Services (DMAS) does not offer employment-based Sponsorship. Selected candidates will have their work authorization completed using the E‐Verify Program. The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth’s Department of Human Resource Management Policy 1.61 Teleworking. This position could be expected to work in the office as driven by business needs. Telework arrangements are a privilege and may be rescinded at any time based on performance and/or business need. The agency reserves the right to modify or terminate a telework arrangement, provided that reasonable notice is given to the employee. This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references. This position requires the submission of a Statement of Economic Interest (financial disclosure). If you wish to apply for a job with the Department of Medical Assistance Services, an application and/or resume for employment must be submitted electronically through this website. Mailed, faxed, emailed, or hand-delivered applications/resumes will not be accepted. Consideration for an interview is based solely on the relevant information presented in the state application and/or resume submitted before the closing date. Applications and/or resumes should include relevant work history which indicates your qualifications for this position. The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce. In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly called a Certificate of Disability) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans may also apply via the AHP if they also provide an AHP Letter. To request an AHP Letter, use this link: https://www.dars.virginia.gov/drs/cpid/PWContact.aspx or call DARS at 800-552-5019, or DBVI at 800-622-2155 From July 1, 2026, through January 21, 2029, applicants who were involuntarily separated from employment with the Federal Government on or after January 1, 2025, due to a reduction in force, budget reduction, or workforce restructuring initiative may be eligible for HB494 Federal Employee Priority Consideration. Applicants seeking HB494 Federal Employee Priority Consideration must identify themselves within the state application process and provide supporting documentation, including a Standard Form 50 (SF-50), verifying their eligibility. The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.

Contact Information Name: DMAS Talent Acquisition Phone: 804 - 225 - 4407 Email: [e-mail]

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.

Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.

Advertised: 03 Sep 2026 Eastern Daylight Time Applications close: 01 Oct 2026 Eastern Daylight Time