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Medicaid Program Manager 2

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Medicaid Program Manager 2

Salary

$5,477.00 - $10,740.00 Monthly

Location

Baton Rouge, LA

Job Type

Classified

Job Number

MVA/SP/198901

Department

LDH-Medical Vendor Administration

Opening Date

08/19/2024

Closing Date

9/18/2024 11:59 PM Central

• Description

• Benefits

Supplemental Information

The Louisiana Department of Health is dedicated to fulfilling its mission through direct provision of quality services, the development and stimulation of services of others, and the utilization of available resources in the most effective manner.

LDH serves as a model employer for individuals with disabilities.

This position is located within the Louisiana Department of Health / Medical Vendor Administration / Director's Office/Executive Management Team / East Baton Rouge Parish

Announcement Number: MVA/SP/198901

Cost Center: 3052010100

Position Number: 50335882

This vacancy is being announced as a Classified position and may be filled as a Probationary appointment, Promotional appointment or Detail to Special Duty.

No Civil Service test scoreis required in order to be considered for this vacancy.

Occupational Summary

The mission of the Louisiana Department of Health (LDH) is to protect and promote health and to ensure access to medical, preventive and rehabilitative services for all citizens of the State of Louisiana. LDH is dedicated to fulfilling its mission through direct provision of quality services, the development and stimulation of services of others, and the utilization of available resources in the most effective manner.

This position is in the Bureau of Health Services Financing (BHSF), Louisiana's single state Medicaid agency within the Louisiana Department of Health (LDH). The program is a state of federal partnership financed with a combination of state and federal funds and governed by a complex body of state and federal laws, policies, regulations, and guidelines.

This is a highly complex, responsible management position located in the Bureau of Health Services Financing, Louisiana Medicaid Pharmacy Benefits Management (LMPBM) Program Section. This position reports directly to the Pharmacist 8 (Pharmacy Director) who reports to the Medicaid Deputy Director of Medicaid Pharmacy. The LMPBM Section is responsible for the development, implementation and administration of the Medicaid pharmacy Program within the Bureau of Health Services Financing (BHSF). Additionally, the LMPBM Section is responsible for the daily operational activities of pharmacy prescription services. The pharmacy program covers all Food and Drug Administrative (FDA) approved legend drugs that meet the OBRA '90 and OBRA '93 criteria with a few exceptions. The drug file contains over 120, 000 drug products (brand, generic and some over-the-counter). The LMPBM Section determines the reimbursement methodology for both the drug ingredient cost and the dispensing fee for covered drugs.

The LBPBM Section consists of the following components which the incumbent directs: policy, program development and implementation, the PDL vendor, the federal and state supplemental rebate program vendor, pharmacy help desk, request for proposals and request for information, pharmacy vendor contracts and amendments, legislative reports, legislative auditor requests and corrective action plans, MCO reporting, public record request, and LDH pharmacy budget.

Staff in this Section provides regulatory supervision regarding the discharge of their contractual requirements to five (5) contractors including the fiscal intermediary for activities related to the pharmacy program. These five contracts include the following functions essential to the administration of the LMPBM program: Fiscal Intermediary Contract- performs pharmacy-related services, Preferred Drug List (PDL) Vendor Contract- supplemental Drug Rebate Program, University of Louisiana-Monroe, College of Pharmacy- participates as a consultant resource, and Myers and Stauffer, LLC- design and develop procedures to revise the reimbursement methodology for multi-source drugs, survey pharmacy providers to establish reasonable reimbursement rates and evaluate the effects of the reimbursement on pharmacy providers.

This position will serve as a Program Manager 2, supporting the administration of the LMPBM program.

Duties include but are not limited to:

Plans, manages and directs the operations of the vendor responsible for administering the PBM's Federal Rebate and State Supplemental Rebate Operations within federal and state laws and regulations. Monitors the contractor responsible for negotiation, preparation tracking and monitoring of as many as 400 individual contracts and amendments with pharmaceutical manufacturers participating in the State Supplemental Rebate Program. Directs and supervises the vendor who performs support functions to the PBM with its rebate operations.

Directs the non-clinical functions delegated to the Prior Authorization and State Supplemental Rebate Unit of the statewide Medicaid PBM Section.

Develop administrative and operational plans, policies and procedures to ensure the operation is consistent with the objectives and state and federal laws and regulations. Provides regulatory supervision to the PDL and State Supplemental Rebate contractor and monitors staff performance. Delegates administrative, management, and other responsibilities to appropriate staff. Plans and organizes staff assignments, adjusts assignments to meet program priorities and adhere to agency changes regarding budget deficits, policy changes and other strategies as warranted.

Manages the Pharmaceutical and Therapeutics (P&T) Committee. The P&T committee recommends changes to the Single Preferred Drug List ensuring preferred drugs are clinically and financially appropriate. These management duties include working the Governor’s Boards and Commissions staff and Medicaid Director to replace a vacancy on the P&T committee, coordinate with P&T chairman to schedule meeting dates, disseminate clinical packets to P&T committee members prior to each meeting, and organize day-of meeting activities.

Coordinates and directs all aspects of legislative mandates, performance based budgeting in the PBM section, including the strategic plan, operational plan and performance indicators.

Develops, directs development, and monitors of Unit's contracts and interagency agreements with other state agencies. Manages or directs Requests for Proposals (RFP) for competitively bid contracts in the program, including negotiating or directing negotiation of contracts with successful proposers.

Assist with the direction of the PBM Unit and supervision of other PBM Program functions as delegated by the Pharmacist 8.

Reviews and interprets current and proposed state and federal laws and regulations related to the PBM Program. Develops, modifies and implements changes in policy, procedures and/or system functions to ensure effectiveness and compliance of the pharmacy services with all applicable federal and state laws and regulations.

Represents the Department or BHSF at various federal, state and local bearings, conferences and functions including giving testimony to legislative committees or individuals and conducting public hearings on the Pharmacy Benefits Management Program.

Selects, trains, supervises, monitors and evaluates subordinate staff regarding work planning, goal setting and performance. Conducts staff conferences with unit staff to discuss status of projects or program changes. Prioritizes and schedules works assignments and directs/monitors work of professional subordinated in unit or as assigned. Makes recommendations on the appointment, promotion, discipline or dismissal of subordinate staff in accordance with agency rules for personnel administration.

Manages subordinate staff of the pharmacy helpdesk which is staffed by University of New Orleans (UNO). This includes onboarding new staff, staff training, staff scheduling, conduct staff meetings and staff performance evaluations. Facilitates, coordinates and completes the process for pharmacy related Request for Proposals (RFP), Request for Information (RFI), and contracts. This also includes reviewing and amending existing vendor contracts with pharmacy related components.

Direct and manage subordinate staff in the preparation of Federal Rebate and State Supplemental Rebate quarterly invoices to manufacturers and reports to meet the requirements for federal and state (Division of Administration) reporting, including verifying validity and accuracy of reports.

Manages activities of the program through subordinate professional staff. Supervises and directs the work of staff, establishes performance goals, objectives, and evaluation criteria for employee performance. Schedules and participates in periodic performance reviews and planning conferences and completes formal performance appraisal.

Develops, directs and monitors the State Supplemental Rebate contract that provides technical support for the PDL development and maintenance, State Supplemental Rebate manufacturer contract negotiations, and other support functions associated with the State Supplemental Rebate System and PDL. Ensures contract deliverables are timely and accurate. Makes recommendations to Pharmacy Director regarding payment of contract invoice.

Plan, coordinate and implement various components of P & T Committee Meetings comprised of fifteen (15) members, including physicians and pharmacists responsible for developing the Preferred Drug List (PDL) in conjunction with the PA process.

Participates in meetings and conferences with state and federal officials, providers, professional groups, other LDH staff, contractors' staffs, and other interested parties as directed by the Pharmacy Director.

Develops or supervises development of management reports and federally mandated reports in collaboration with Pharmacy Director and other Sections, Bureau and LDH staff. Reviews and analyzes reports to ensure continuing accuracy and responsiveness to management needs. Secures changes to the design and reporting requirements of the reports to reflect program changes and controls the interface between administrative requirements and implementation of changes to meet such requirements.

Designs reporting methods and reports to support fiscal planning and control program evaluation, decision-making and provider/recipient profiling. Detects areas of program/systems needing enhancements or correction, makes recommendations to Pharmacy Director and directs implementation upon approval.

Responds in person, in writing and by telephone to requests for programmatic and statistical information on the pharmacy program from LDH, Division of Administration, Legislative Fiscal Office, Legislative Auditor's Office, members of the legislature and Congress, the press, the general public, CMS and entities.

Conducts and directs studies and special projects pertaining to the PBM Program Section. Prepares special reports as requested.

Corresponds and meets with the federal Centers for Medicare and Medicaid Services staff on federal regulations, interpretations and issues relating to the management of the Pharmacy Program. Coordinates or participates in federal reviews of service areas and prepares responses to findings of such reviews and develops and implements a corrective action plan for identified deficiencies or areas of non-compliance. Directs staff in assignments related to these areas. Interacts with Department's legal staff regarding issues of law.

Responds, on behalf of the Secretary and/or Medicaid Director, to correspondence and inquiries from congressional and legislative delegation members as well as Professional organizations

Meets with providers individually and through committees for input into policy and procedures.

Provides consultative services to providers, recipients, legislators and other state staff regarding Pharmacy program coverage and reimbursement.

Performs other duties as assigned.

Required skills:

Strong Technical Skills (Typing, Word, Excel, Power Point Strong analytical and problem-solving skills Attention to detail and strong organizational skills Ability to work in a fast-paced, deadline-driven, team environment

Preferred skills

Legal experience such as paralegal or attorney

To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.

Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.

A resume upload willNOTpopulate your information into your application. Work experience left off your electronic application or only included in an attached resume is not eligible to receive credit

For further information about this vacancy contact:

Shambrielle Pooler

Shambrielle.Pooler@la.gov

LDH/HUMAN RESOURCES

BATON ROUGE, LA 70821

This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.

Minimum Qualifications

MINIMUM QUALIFICATIONS:A baccalaureate degree plus four years of professional experience in administrative services, economics, public health, public relations, statistical analysis, social services, or health services.

SUBSTITUTIONS:Six years of full-time work experience in any field may be substituted for the required baccalaureate degree.Candidates without a baccalaureate degree may combine work experience and college credit to substitute for the baccalaureate degree as follows:

A maximum of 120 semester hours may be combined with experience to substitute for the baccalaureate degree.

30 to 59 semester hours credit will substitute for one year of experience towards the baccalaureate degree.

60 to 89 semester hours credit will substitute for two years of experience towards the baccalaureate degree.

90 to 119 semester hours credit will substitute for three years of experience towards the baccalaureate degree.

120 or more semester hours credit will substitute for four years of experience towards the baccalaureate degree.

College credit earned without obtaining a baccalaureate degree may be substituted for a maximum of four years full-time work experience towards the baccalaureate degree. Candidates with 120 or more semester hours of credit, but without a degree, must also have at least two years of full-time work experience to substitute for the baccalaureate degree.

Graduate training with eighteen semester hours in one or any combination of the following fields will substitute for a maximum of one year of the required experience on the basis of thirty semester hours for one year of experience: public health; public relations; counseling; social work; psychology; rehabilitation services; economics; statistics; experimental/applied statistics; business, public, or health administration.

A master's degree in the above fields will substitute for one year of the required experience.

A Juris Doctorate will substitute for one year of the required experience.

Graduate training with less than a Ph.D. will substitute for a maximum of one year of the required experience.

A Ph.D. in the above fields will substitute for two years of the required experience.

Advanced degrees will substitute for a maximum of two years of the required experience.

NOTE:

Any college hours or degree must be from an accredited college or university.

Job Concepts

Function of Work:

To administer medium size and moderately complex statewide Medicaid program(s).

Level of Work:

Manager.

Supervision Received:

Broad from a higher-level administrator/executive.

Supervision Exercised:

Supervision over lower level positions in accordance with the Civil Service Allocation Criteria Memo.

Location of Work:

Department of Health and Hospitals.

Job Distinctions:

Differs from Medicaid Program Manager 1-A and Program Manager 1-B by administering medium size or moderately complex statewide program(s) and supervision exercised.

Differs from Medicaid Program Manager 3 by absence of responsibility for administering large and/or very complex Medicaid program(s) and supervision exercised.

Examples of Work

Administers and manages enrollment of Medicaid providers for all Medicaid programs statewide; directs overall goals and objectives.

Plans, coordinates, and controls a medium size or moderately complex statewide program.

Plans, develops, implements and monitors comprehensive Medicaid program policies.

Conducts and directs studies and special projects pertaining to the programs assigned.

Analyzes the impact of federal, state, and local legislation; advises agency officials; prepares position statements; presents testimony at hearings; writes legislation.

Reviews and analyzes complex data and system reports to ensure compliance with program regulations.

Administers the day-to-day operational functions of the Medicaid fee for service programs. Assures that program policy and procedures are properly applies in accordance with federal and state laws and regulations.

Develops and writes agency rules and regulations governing the administration of all supervised Medicaid programs and submit them for publishing in the official state publication in accordance with the requirements of the Administrative Procedures Act.

Implements Medicaid regulations directing provider participation standards and recipient benefits. Analyzes multi-mullion dollar Medicaid claim data and project the fiscal impact for budget forecasting.

Identifies, verifies and analyzes the various revenue sources for the program. Determines and/or confirms match requirements. Monitors availability of revenue sources and promptly identifies existing or potential financing problems.

Louisiana State Government represents a wide variety of career options and offers an outstanding opportunity tomake a differencethrough public service. With an array of career opportunities in every major metropolitan center and in many rural areas, state employment provides an outstanding option to begin or continue your career.

As a state employee, you will earn competitive pay, choose from a variety of benefits, and have access to a great professional development program:

Insurance Coverage More information can be found at https://info.groupbenefits.org/

Parental Leave– Up to six weeks paid parental leave

More information can be found athttps://www.civilservice.louisiana.gov/Parental-Leave/Default.aspx

Holidays and Leave – State employees receive the following paid holidays each year:

• New Year's Day

• Martin Luther King, Jr. Day,

• Mardi Gras,

• Good Friday,

• Memorial Day,

• Independence Day,

• Labor Day,

• Veteran's Day,

• Thanksgiving Day and Christmas Day.

* Additional holidays may be proclaimed by the Governor

State employees earn sick and annual leave which can be accumulated and saved for future use. Your accrual rate increases as your years of service increase.

Retirement – State of Louisiana employees are eligible to participate in various retirement systems (based on the type of appointment and agency for which an employee works). These retirement systems provide retirement allowances and other benefits for state officers and employees and their beneficiaries. State retirement systems may include (but are not limited to):

• Louisiana State Employees Retirement System (www.lasersonline.org). LASERS has provided this video (https://lasersonline.org/wp-content/uploads/2016/07/Your_Retirement_System.mp4) to give you more detailed information about their system

• Teacher's Retirement System of Louisiana (www.trsl.org),

• Louisiana School Employees Retirement System (www.lsers.net), among others

Agency

State of Louisiana

Address

For agency contact information, please refer to

the supplemental information above.

Louisiana State Civil Service, Louisiana, 70802

Phone

(866) 783-5462

Website

http://agency.governmentjobs.com/louisiana/default.cfm

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