Definition

In the Medical Assistance Administration, reports to a higher level Medical Assistance Program Manager and is responsible for medical assistance program analysis and evaluation, developing and writing policies and procedures, utilization review, preparing issue papers and reports, implementing policy changes and/or monitoring and administering provider contracts.  Provides consultative services to clients, medical providers, and other professionals in the community and/or department regarding program administration.

Typical Work

Develops and writes formal eligibility and authorization procedures for statewide administration and implementation of medical assistance programs; 

Coordinates implementation of policies with regional and office staff from other divisions; 

Develops, interprets and implements medical program policy; promulgates administrative and procedural regulations for program implementation; 

Confers with federal, state and department staff in the development and implementation of program and procedural changes to assure compliance with federal/state eligibility requirements; 

Takes lead responsibility in conducting in-depth analyses of medical assistance issues and programs; prepares project plans, conducts or leads data-gathering operations, analyzes data, reports specific findings, develops recommendations, and prepares project reports for written and/or oral presentation; 

Provides technical and consultative assistance to legislative staff, other state officials, providers, recipients, state and local groups and legal aid professionals regarding the medical assistance programs; 

Administers the Title XLX State Plan, including revisions and maintenance; 

Analyzes and evaluates proposed legislation and program and policy changes to ascertain administrative feasibility; 

Coordinates, develops and implements training programs with regional training coordinators; assists in the presentation of training; 

Monitors program policies and procedures for adequacy and consistency and makes recommendations in order to improve effectiveness of program delivery; 

Provides liaison and coordination with other bureaus and divisions of DSHS on programs having cross-bureau or cross-divisional impact; 

Participates in the decision-making process and coordinates implementation of program policy changes from project recommendations; 

Coordinates/consults with division, department, other state agency and federal administrative staff regarding implementation, monitoring, and follow-up on project recommendations; 

Prepares correspondence to federal, state, provider, community and other agencies regarding inquiries; 

Performs other work as required.

Knowledge and Abilities

Knowledge of:  state and federal policies and regulations related to medical assistance programs; principles and practices of program planning and evaluation; current trends and economic problems relating to medical providers and clients; health care organizations and industry; the legislative process. 

Ability to:  develop and evaluate programs; work effectively with program staff, providers, and other affected parties; analyze and resolve complex problems related to medical assistance programs; communicate clearly and effectively both verbally and in written form.

Legal Requirement(s)

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.

Desirable Qualifications

A Master's degree with major study in public health, public administration, business administration, social work, or closely related field and one year of consultative or supervisory experience in health services, social services, or medicaid programs. 

Two additional years of qualifying experience will substitute for the Master's degree provided a Bachelor's degree has been achieved. 

OR 

A Bachelor's degree and one year of experience as a Financial Services Specialist 5.

Class Specification History

New class: 4-13-84
Revised definition: 3-3-86 (Special Board Meeting)
Revised definition: 6-13-86 (emergency basis; permanent basis 8-15-86)
Revised definition and minimum qualifications: 5-14-93
Revised new class code: (formerly 52300) effective July 1, 2007
Change title, formerly Medical Assistance Program Manager 1; adopted February 9, 2012, effective February 10, 2012.  Final adoption effective May 11, 2012.