Deputy Director, Member Operations - Durham, United States - State of North Carolina

Description

Salary: $90, $130,803.00 Annually

Location : Durham County, NC

Job Type: Permanent Full-Time

Remote Employment: Flexible/Hybrid

Job Number: DHB

Department: Dept of Health and Human Services

Division: HEALTH BENEFITS

Opening Date: 05/28/2024

Closing Date: 6/10/2024 5:00 PM Eastern

Job Class Title: Health & Human Services Senior Planner

Position Number:

Section: Health Benefits

Work Location: Durham, Durham County

Salary Grade: Flat-Rated

Recruitment Range: $90,000 to $130,803

Description of Work

**This position is exempt from the State Human Resources Act**

This posting is for a pending vacancy, anticipated September 2024.

TELEWORK AVAILABILITY: We trust our employees to be self-motivated and successful in hybrid/remote roles; NC Department of Health and Human Services offers work from home options and variable work schedule flexibility for this position.

Division of Health Benefits employees with an approved hybrid telework schedule are currently expected to work onsite at their assigned duty station at least 4 working days per month or more as needed for business operations. Telework options are subject to change at the discretion of management. More information on this arrangement may be obtained at the time of interview.

This position's duty station is assigned to RTP Campus in Durham, North Carolina. This position is expected to travel in and out of the state for conferences and engagement with key stakeholders. More information on this arrangement may be obtained at the time of interview.

Position Summary

The Deputy Director of Member Operations reports to the Chief Operating Officer (COO). The primary purpose of this position is to manage the Member Operations unit within the Operations section. This role provides strategic Member Operations leadership and management, including implementation and communication of eligibility policy, NCFAST coordination, Enrollment Broker management, and Customer Service oversight. This position oversees the entire Member Operations team.

Member Operations manages the policy development process for eligible recipients and enrollment of beneficiaries for Medicaid; business requirement development and the beneficiary and county experience improvement strategy for NC FAST, our beneficiary eligibility and enrollment technology platform. Member Operations staff serve as the business leads for new capability development, business requirements, trainings, and communications to the Divisions and external stakeholders; the relationship with the NC Department of Social Services (NC DSS), local county Departments of Social Services (DSSs), and the field staff team that oversees the county level enrollment process to foster compliance and quality in eligibility determinations and redeterminations; policy expertise, design, and implementation of eligibility changes required for the transition to Medicaid managed care, including Standard Plans, Tribal Option, Tailored Plans, and Foster Care plans, and eventually the transition of our LTSS and dually eligible populations; oversight and implementation of NC Medicaid's contract with the Enrollment Broker vendor to provide choice counseling to beneficiaries enrolling in Medicaid managed care; oversight and monitoring of the NC Contact Center, which oversees NC Medicaid's internal call center, oversees vendor call centers, and supports the NC Medicaid Help Center.

Job Specific Responsibilities

• Provide overall strategy for policy development and execution.
• Lead and manage staff who research, update, and develop eligibility and enrollment policy.
• Research federal, State, and CMS regulations with the NC State Plan and submit amendments for changes that may impact eligibility and enrollment services for Medicaid.
• Provide policy expertise, design input, and implementation oversight of all eligibility changes required for the transition to Medicaid managed care, including Standard Plans, Tribal Option, Tailored Plans, Foster Care plans, and transition of our LTSS and dually eligible populations.
• Provide oversight and implementation of NC Medicaid's contract with the Enrollment Broker vendor to provide choice counseling to beneficiaries enrolling in Medicaid managed care.
• Develop Medicaid eligibility policy based on State and federal mandates, guidance from CMS, State Plan changes and rules.
• Meet and collaborate with other NC Medicaid and DHHS parties that are impacted by the policy (e.g. clinical, technology systems, vendors, DSS, etc.) to ensure that the policy is developed in alignment with all stakeholders.
• Communicate policy to county DSSs, provide trainings, and support on implementation.
• Partner and engage with NC FAST and NC Tracks, serve as business lead for platform development requirements and lead beneficiary and county experience improvement strategy.
• Provide strategic direction to the field staff team to ensure county level compliance for Medicaid beneficiary eligibility and enrollment functions.
• Establish effective relationships with county DSS leaders to routinely assess enrollment processes for accuracy, consistency, and organization.
• Engage in personnel administration to include but not limited to recruiting, coaching, selecting, managing employees, and disciplinary and termination actions as needed; delegating to staff members; encouraging and fostering professional development; establishing effective professional goals and work plan objectives.

Knowledge, Skills and Abilities / Competencies

To receive credit for all of your work history and credentials, you must list the information on the application form. Any information listed under the text resume section or on an attachment will not be considered for qualifying credit. Qualified applicants must document on the application that they possess all of the following:

• Experience establishing relationships and communicating effectively with internal and external stakeholders.
• Demonstrated experience in strategic program planning, implementation and management skills.
• Strong critical thinking skills with the ability to manage complex situations, recognize and respond appropriately to various issues and highly sensitive and high-profile situations.
• Demonstrated ability to effectively prioritize and organize work, set clear objectives, and break large-scale projects down to milestone deliverables or outcomes.
• Demonstrated data analysis and transaction processing experience, preferably in a managed care or Medicaid environment.
• Previous experience researching and implementing federal and/or state laws and regulations.

Management Preferences:

• Previous and proven work experience at Division of Health Benefits/NC Medicaid.
• Familiarity with relevant and current NC Medicaid operations and eligibility policies.
• Previous progressively responsible supervisory or managerial experience in Medicaid or Medicare administration.
• Proven leadership experience at a NC county DSS office, preferably overseeing a Medicaid or closely related program.
• Previous healthcare industry experience with leadership responsibility for one or more operational functional areas (enrollment, billing, claims, etc.).

Minimum Education and Experience Requirements

Some state job postings say you can qualify by an "equivalent combination of education and experience." If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both. See for details.

Master's degree in a discipline directly related to the agency's program, business administration or public administration from an appropriately accredited institution and five years of program experience in the public or private sectors involving significant decision-making authority in the planning, organizing, and directing of operations in an area related to the assigned program(s), including four years in a supervisory capacity;

or

Bachelor's degree as indicated above from an appropriately accredited institution in an area related to the assigned program(s) and seven years of program experience in the public or private sectors involving significant decision-making authority in the planning, organizing, and directing of operations in an area related to the assigned program(s), including four years in a supervisory capacity;

or

Associate's degree as indicated above from an appropriately accredited institution in an area related to the assigned program(s) and nine years of program experience in the public or private sectors involving significant decision-making authority in the planning, organizing, and directing of operations in an area related to the assigned program(s), including four years in a supervisory capacity;

or

If no degree, eleven years of program experience in the public or private sectors involving significant decision-making authority in the planning, organizing, and directing of operations in an area related to the assigned program(s), including four years in a supervisory capacity.

Degrees must be from appropriately accredited colleges or universities.

Supplemental and Contact Information

The North Carolina Department of Health and Human Services is an Equal Opportunity Employer.

Pre-employment criminal background checks are required for all positions with the Division of Health Benefits (DHB).

About NC Medicaid (Division of Health Benefits)

The North Carolina Department of Health and Human Services (NCDHHS) works closely with beneficiaries, health care professionals, community leaders and advocacy groups; local, state and federal entities; and other community partners vested to improve the health and safety of all North Carolinians by providing essential human services. NCDHHS is one of the largest, most complex agencies in the state, with about 17,000 employees.

The Division of Health Benefits (DHB) within NCDHHS is committed to advancing innovative solutions that improve health, promote well-being and foster independence for all North Carolinians. DHB manages and oversees North Carolina Medicaid, NC Medicaid Managed Care and other programs that provide access to services and supports for parents, children, seniors, people with intellectual / developmental disabilities, and behavioral health, substance use and traumatic brain injury disorders. With a budget over $21 billion in state and federal funds per fiscal year, DHB ensures that more than 96,000 enrolled providers are reimbursed for delivering covered services to 2.9 million beneficiaries.

Realizing the strength of DHB lies in its employees, DHB remains dedicated in its efforts to create and maintain a diverse, equitable and inclusive workplace environment.

Application Process

Applicants are encouraged to apply for positions of interest, regardless of their current grade level and job classification. A pay increase may or may not result. Salary decisions are based on relevant education and experience, budget, and internal equity.

To be under consideration for this vacancy, all applicants must complete an online application using this link: If multiple applications are submitted to an individual posting, only the most recent application received prior to the posting close date will be evaluated for consideration.

Due to the volume of applications received, we are unable to provide information regarding the status of your application. To check the status of your application, please log in to your account. You will either receive a call or email to schedule an interview or an email notifying you when the job has been filled. For technical issues with your application, please call the NeoGov Help Line at If there are any questions about this posting other than your application status, please contact us at

NOTE: For temporary, contract or other supplemental staffing appointments:
There are no paid leave, retirement or other benefits associated with these appointment types.

For permanent and time-limited appointments:
Eligible employees have benefits that include employee health insurance options, standard and supplemental retirement plans, NC Flex (a variety of high-quality, low-cost benefits on a pre-tax basis), and paid vacation, sick, and community service leave, to name a few. Paid parental leave is available for eligible employees. Some benefits require 30 + hours work/week for participation.

01

I UNDERSTAND that DHHS requires a complete descriptive work history with all employment experience detailed to be considered for employment. Answers to supplemental questions are not a substitute for providing all relevant information within the body of your application. In order to receive credit for the supplemental questions in which you answered yes, you must provide supporting information within the body of the application, to support your answer. Your application should also reflect all education and all professional work experience acquired including high school and all degrees. It is critical to our screening and salary determination process that applications contain comprehensive candidate information. (NOTE: AN ATTACHED RESUME NOR "SEE RESUME" DOES NOT SATISFY THE REQUIREMENT OF COMPLETING THE APPLICATION. If you haven't completed the application requirements, please return to your application to finish it before submitting your application.)

• Yes, I understand and have fully completed all requirements.

02

Which of the following best describes your current employment status?

• DHB Permanent or DHB Time-Limited employee
• DHB Temporary or DHB Contractor staff
• Other

03

I understand that the budgeted salary for this position is limited to $130,803. The posted recruitment range for this position is $90,000 to $130,803. If selected for this position, the salary offered will be within that range and based on your related education and experience on your application as well as internal equity. Would a salary within the posted recruitment range be acceptable to you?

• Yes, if offered, I would accept a salary offer within the posted recruitment range.
• No, if offered, I would not accept a salary offer within the posted recruitment range.

04

I understand that this position is based in North Carolina. Division of Health Benefits employees with an approved hybrid telework schedule are currently expected to work onsite at their assigned duty station at least 4 working days per month or more as needed for business operations. Telework options are subject to change at the discretion of management.

• I understand and can comply with this working arrangement.
• I am unable or unwilling to comply with this working arrangement.

05

This position's duty station is assigned to RTP Campus in Durham, North Carolina. This position is expected to travel in and out of the state for conferences and engagement with key stakeholders. If selected for this position, are you able and willing to comply with this travel expectation?

• Yes, I understand and can comply with this travel expectation.
• No, I am unable or unwilling to comply with this travel expectation.

06

How many years of experience do you have in a supervisory capacity in a human services, health administration, public administration, public policy, or a related field? This experience must also be sufficiently documented in the work experience section of your application to receive credit.

• No experience
• Less than 4 years
• 4 to 6 years
• 6 to 8 years
• More than 8 years

07

Please select the option that best describes your experience with data analysis and transaction processing in a managed care or Medicaid environment. This experience must also be sufficiently documented in the work experience section of your application to receive credit.

• No experience
• Basic
• Intermediate
• Advanced

08

Please provide a brief overview of your strategic program planning, implementation and management skills. Writing "see resume," "see cover letter," or "see application" will be considered disqualifying answers. This information must also be sufficiently documented on your application to receive credit. If you do not have these skills, please write "N/A" as your response.

09

Have you ever been convicted of an offense against the law other than a minor traffic violation? (A conviction does not mean you cannot be hired. The offense and how recently you were convicted will be evaluated in relation to the position for which you are applying.)

• Yes
• No

10

If you answer "yes" that you have been convicted of an offense against the law other than a minor traffic violation, please explain the nature of the conviction and the offense. If you answered "no" to the conviction question, please enter N/A as your response.

11

Where did you learn about DHHS or this opportunity?

• Company or OSHR Website
• Employee Referral
• Conference / Career Fair
• Email campaign
• Professional Association or Industry-specific job board
• Indeed
• LinkedIn
• NC Nursing Board email
• Google
• Other General Job Boards
• Other Search Engines
• Other Social Media
• Internet Advertisement
• TV / Radio

12

Please give additional detail where you learned of DHHS or this opportunity. (e.g., APA Annual Meeting in NYC in May 2021, Facebook, LinkedIn, Doximity, NC Substance Abuse Professional Practice Board, etc.))

Required Question