See Health Care Program Consultant.

Serves as the program manager responsible for developing and administering a statewide health care program. Positions at this level are responsible for the full-range of program management functions, including: developing, implementing, administering, and evaluating statewide health care programs; developing program goals and objectives; developing time tables and work plans; developing policies and procedures; managing program budgets and expenditures; controlling allocation of program resources; administering, managing, and monitoring contracts; setting and adjusting program priorities; evaluating program quality and effectiveness; and managing appropriate outreach, training, and stakeholder management.

Serves as a statewide policy expert in a specific component of a large statewide program, statewide health care initiative, or long-term health care improvement projects and strategies to ensure patient access to quality care. Directly responsible for policy development, implementation, and compliance across statewide health care technology and/or health care delivery systems.

This is the supervisory and/or expert level of the series. Positions at this level serve as the supervisor of a unit of health care program staff and/or are responsible for the full range of program management functions for a health care program OR are policy experts in a specific component of a large statewide program (e.g. Medicaid), statewide health care initiative, or long-term health care improvement projects and strategies. Positions report directly to a unit supervisor or section manager and provide policy expertise regarding health care programs to top levels of management and to affected state, local, and federal governments, and private sector stakeholders.

Creates, develops, and implements new statewide medical and/or behavioral health programs within state and federal requirements; sets and adjusts program goals, objectives, and priorities;

Develops, implements, and manages existing medical and/or behavioral health programs to ensure optimal operation and fiscal compliance;

Develops work plans and devises methods to achieve program goals;

Develops, implements, and maintains new and revised program policies, rules, communications, and procedures;

Monitors, evaluates, and audits program compliance within state and federal requirements.
Evaluates program effectiveness through federal financial reviews, state audits, and in-house monitoring;

Conducts follow-up action and implements associated program changes resulting from audit findings from external oversight agencies, including Centers for Medicare and Medicaid Services, the Office of the Inspector General, and the Office of the State Auditor;

Prepares fiscal analysis and modeling of legislative provisos; completes rate setting functions; and prepares bi-annual forecasting steps based on programmatic and rate setting updates;

Develops, designs, implements, and administers contracts; monitors contract compliance;

Provides support, direction, guidance, and monitoring to groups such as Managed Care Organizations, Accountable Communities of Health, Behavioral Health Administrative Service Organizations, providers, payers, public and school employers, boards, commissions, and other grant funded or legislatively mandated bodies, and other external stakeholders;

Analyzes state and federal laws; uses analysis to modify or implement policies to ensure accuracy across delivery and technical systems;

Resolves the most complex inquiries from constituents, advocates, lawyers, community organizations, providers, public and school employers, MCOs, BH-ASOs, contractors, and other external stakeholders and partners;

Provides Medicaid business requirements for health care eligibility system changes to ensure alignment with new policy requirements and policy changes;

Researches, develops, and implements training, program materials, and other resource guides, including new and revised provider billing guides and program communications, for external stakeholders on program compliance and claims submissions;

Leads and manages the most complex rule promulgation of new, revised, and/or highly complex Washington Administrative Codes and provider guide projects that impact multiple statewide health care programs, ensuring compliance with the Administrative Procedures Act (RCW 34.05);

Analyzes and evaluates proposed legislation and program policy changes; provides expert advice to agency leadership regarding administrative feasibility, potential impacts, and professional recommendations;

Manages and directs the development of statewide health care initiatives or long-term health care improvement projects and strategies (i.e. Medicaid Transformation, IE&E, value-based purchasing, health care cost transparency, etc.) to ensure patient access to quality care;

May perform functions of a Health Care Program Consultant or Health Care Program Specialist, as necessary;

Performs other work as required.

Knowledge of: state and federal rules, policies, and regulations related to health care programs and rule promulgation; principles and practices of program planning, development, and evaluation; current trends and economic problems relating to health care providers and clients, health care organizations, and the health care industry; the legislative process; principles of individual and group behavior, social behavior, social and economic conditions, and their effects upon individuals; management principles and supervisory skills; office procedures and practices; the state contracting process; contract management, monitoring, and administration; the Health Insurance Portability and Accountability Act.

Ability to: develop and evaluate programs; work effectively with program staff, providers, clients, members of the community, external organizations, and state and federal partners; manage complex, multifaceted projects with multiple stakeholder groups; analyze and resolve complex fiscal and policy problems related to health care programs; appropriately interpret and apply complex state and federal regulations; write and develop statewide policies; communicate clearly and effectively both orally and in writing; make legally defensible independent decisions; analyze information and identify modifications to improve program performance.

A master’s degree with major study in public health, behavioral health, public administration, business administration, social work, or closely related field.

Three years consultative or supervisory experience in health services, social services, Medicaid, behavioral health, or other health care programs;


One year as a Health Care Program Specialist.

Additional qualifying experience may substitute, year for year, for education.

Equivalent education/experience.