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

Description

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.

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.).

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.

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.

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.

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