Health Program Manager

Full job description Description and Functions Open Until Filled GENERAL DESCRIPTION:


Manages and oversees benefit management and provider management for Wyoming's statewide Medicaid program, including oversight of all designated provider policy, reimbursement methodology, claims payment and provider services monitoring, expenditure management, and communication for a program that comprehensively pays over $500 million annually. Coordination will require ongoing collaboration between the Division of Healthcare Financing and the Centers for Medicare and Medicaid (CMS) and ensure ongoing compliance.



Human Resource Contact: ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function which may be performed at the job level.

Independently directs and oversees agency rules and regulations governing the program administration and operations of the delegated provider oversight areas for Community Mental Health Centers, Substance Abuse Treatment Centers, Psychiatrists, Clinical Psychologists, Neuropsychologists, Advanced Practice of Registered Nurses (APRNs), Licensed Mental Health Providers (LMHPs), Provisional LMHPs, Certified Addictions Practitioner (CAPs), Certified Social Worker (CSWs), Registered Nurse (RNs), Licensed Practical Nurse (LPNs), Community Health Workers, Case Management, Peer Specialists, Board Certified Behavior Analyst- Doctoral (BCBA-Ds), Board Certified Behavior Analyst (BCBAs), Board Certified Assistant Behavior Analyst (BCBAs), Registered Behavior Technician (RBTs), Child Development Centers, Clubhouse services, and Psychiatric Residential Treatment Facilities (PRTFs). Specific activities include: Manages and monitors Behavioral Health and PRTF programs. Research current federal regulations and national trends to update policy as required and analyze the impacts of federal and state legislation. Establish and direct goals, objectives, policies, and procedures that govern the participation and reimbursement of the service providers. Designs, develops, and manages policy which includes identifying coverage and limitations for current and proposed services. Manage billing methodology for program fee schedule establishment. Create and evaluate draft rules for compliance, integrity, and reasonableness. Establish provider guidance and expertise to various State agencies in matters of compliance with program policies and procedures. Prepare State Plan Amendments (SPAs) and respond to federal agency inquiries regarding SPAs. Develops, implements, and promulgation process of final rules to reflect legislative changes or federal policy changes. Follow legal requirements and procedures relating to agency rule promulgation and policy development. Skills in: Interpersonal relations, team building, and consensus building. Goal setting, performance evaluation, and individual motivation. Research and analysis of complex problems as well as identification of options and solutions; decision making and evaluation of results. Public speaking, oral and written communication at a variety of levels and with multiple audiences. General Medicaid waiver program opportunities - purpose, development, and ongoing maintenance requirements to include in required federal reporting. Ability to: Coordinate and motivate individuals and teams to undertake complex projects and achieve specific goals. Balance numerous demands on time and resources when assigning projects or delegating responsibilities to employees or team members. Quickly identify problems, prioritize needs, research solutions, and make decisions. Design and implement policies and processes in a timely, responsive, and cost-effective manner. Comprehend complex budgets, federal fiscal matches, and applications to programs. Coordinate complex integration of unique program and system interfaces. Research, analyze, and resolve issues. Understand technology as it relates to healthcare. Make decisions in the absence of the Provider and Benefits Management Unit Manager. Communicate state plan amendments and negotiate with regional and national representatives from the Centers for Medicare and Medicaid Services (CMS) regarding coverage, provider qualifications, and reimbursement methodologies. Maintain qualification for the federal definition of a "skilled professional medical personnel" per 42 CFR 432.50 by keeping the clinical knowledge base up-to-date regarding the research base for efficacy criteria for indicated treatments and programming. Qualifications PREFERENCES:


Background in working mental health and substance abuse programs is a plus



KNOWLEDGE: Knowledge of State and Federal Government functions, procedures, concepts; principles and practices of professional healthcare administration; policies and procedures established for the work system; Medicaid programs, law and regulatory structure. The ability to comprehend Federal regulations, state statutes, program rules, and policy. Able to interpret and integrate the foregoing into legislation, statute, and policy. Medicaid law and regulatory structure including State and federal Medicaid statutes, regulations, and policies. Contract procurement, negotiation, and administration. Accounting and budgeting in Wyoming government. Administrative fair hearing process; citation and interpretation of complex legislation. National coding and documentation requirements per CMS and each professional discipline for various clinical and community practice settings. Current principles of child development in screening assessing, and treating children with emotional disturbance; best practices related to children with serious emotional disturbance. National Accreditation requirements, national standards, and state statutes regarding ethical and safe practices for each provider group. National and regional resources regarding usual and customary rate development, Medicare reimbursement, and methodologies. Knowledge of the Medicaid Benefit Management System and its application to the Medicaid programs. Ability to examine data and reports for completeness, accuracy, and conformance to regulations. Oral and written communication skills to communicate with a broad range of audiences, including clients, administrators, legislators, contractors, and staff. Ability to communicate Medicaid program information and policy to public and private entities
MINIMUM QUALIFICATIONS:
Education: Bachelor's Degree (typically in Healthcare)
Experience: 1-2 years of progressive work experience (typically in Health Programs) with acquired knowledge at the level of a Health Program Specialist
OR Education & Experience Substitution: 4-6 years of progressive work experience (typically in Health Programs) with acquired knowledge at the level of a Health Program Specialist
Certificates, Licenses, Registrations: None


Necessary Special Requirements PHYSICAL WORKING CONDITIONS: Typically, the employee may sit comfortably to perform the work; however, there may be some walking, standing, bending, carrying light items, driving an automobile, etc. Special physical demands are not required to perform the work. NOTES: FLSA: Exempt The Wyoming Department of Health is an E-Verify employer. Supplemental Information
048-Wyoming Department of Health - Division of Healthcare Financing


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The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.

Class Specifications are subject to change, please refer to the A & I HRD Website to ensure that you have the most recent version.
Working for the State of Wyoming provides employees with a range of valuable benefits and offers a fulfilling career path. Employees enjoy comprehensive healthcare coverage, including medical, dental, and vision plans, ensuring their well-being and that of their families. Additionally, the state offers multiple retirement plans, which provide financial security and stability for employees once their career in public services comes to an end. the state recognizes the importance of personal time and offers generous paid time off and flexible arrangements, allowing employees to recharge, take care of personal matters, and maintain a healthy work-life integration.


There are many benefits to living and working in Wyoming. Beautiful country with wide-open spaces, clean air, great recreational activities, and no State income tax to mention a few!


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