MEDICAL / HEALTH CARE PROG ANALYST - SES - 64055877

Medical / Health Care Prog Analyst - Ses - 64055877

The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website.

This position spends most of the time engaged in supervisory responsibilities. This includes communicating with, motivating, training, and evaluating employees in addition to planning and directing employees' work. The incumbent has the authority to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline subordinate employees or effectively recommend such action. The incumbent will also be required to develop performance expectations, meet with staff regularly to discuss performance, complete performance reviews, maintain vacation and work schedules, ensuring proper coverage, and complete timesheets.

This is a highly responsible supervisory position within the Patient Care Unit in the HIV / AIDS section. The incumbent functions under the supervision of the Patient Care Director. This position oversees the coordination of insurance benefits for ADAP clients to ensure maximum access, quality and customer service and works closely with the Patient Care Director and with other offices in the HIV / AIDS section and county health department staff, to ensure operations, planning and program goals are coordinated and do not conflict with or duplicate those of other offices.

Supervises direct reports including motivating, training, providing guidance, and direction. Develops expectations and meets with staff regularly to discuss performance, complete performance reviews, and disciplinary action, if needed. Maintains vacation and work schedules to ensure proper coverage and completes timesheets. Ensures all staff complete required training and are offered additional training.

Responsible for the implementation of the program by playing a major role in assisting with the planning, development, and implementation of the ADAP in accordance with the state's Integrated HIV Prevention and Care Plan to maximize resources, data analysis, data distribution, and data utilization.

Ensures that staff are appropriately trained and cross-trained. Develops and maintains written office procedures, including process maps, for all functions related to insurance coordination.

Responsible for overseeing the contract management function for ADAP insurance. Ensure the timely and accurate contract development, processing of invoices, payment of invoices, contract monitoring and full allocation of contract funds. Ensures that all program requirements, technical assistance guidelines, professional standards, and contract deliverables, including but not limited to the Pharmacy Benefits Management and the premium payments contracts, are met and in compliance with department standards.

Responsible for the review process of insurance policies and prescription benefits, to ensure that the annual aggregate cost of maintaining health insurance coverage for an ADAP clients : including premiums, co-payments, deductibles; does not exceed the annual cost of maintaining the same clients in the traditional ADAP, which provides direct drug dispensing.

Responsible for overseeing the pursuit of any excess premium tax credit received by a client for which the program has purchased a qualified health plan.

Responsible for overseeing the tracking, reporting, and billing processes for the collection of pharmaceutical rebates and the processing of returned checks resulting from premium or prescription claim adjustments.

Responsible for overseeing the development and implementation of training materials for ADAP staff and communication for ADAP clients and stakeholders regarding ADAP insurance coordination. Ensures that any information and technical assistance provided to the field is consistent and in alignment with the program's policy and procedures.

Participates in the development of budget planning, grant proposals and periodic reports for the HIV / AIDS program. Regularly reviews and analyzes program to identify trends, gaps, and opportunities for improvement. Document findings and make recommendations to the Patient Care Director for planning, implementation, and quality improvement. Provides weekly and monthly reports as required. Prepares routine and ad hoc reports of results for the Department and for the HRSA.

Participates in the development of tools, coordinating data and other information needed to represent the ADAP on-site visits to county health departments either as a member of the section's QI team, to provide technical assistance or training regarding insurance coordination. Provides follow-up reports from the QI visits, makes quality improvement recommendations, tracks, and conducts follow-ups-verbal or in written and creates, implements, and monitors any corrective actions as required. Participates in the ADAP's quality management and improvement initiative.

Monitors insurance client surveys, feedback, and suggestions and continuously improves the insurance program to meet client needs and acts as first point of contact for client grievances on insurance services.

Performs other duties as assigned.

Ability to make decisions and solve problems. Knowledge of developing objectives and strategies. Ability to listening skills : social perceptiveness : time management : multi-tasking : critical thinking : identifying downstream consequences : Identification of key cause. Ability to communicate with persons outside organization. Ability to analyze data or information. Ability to monitor and control resources; implementing ideas or initiatives; guiding, directing, and motivating subordinates : team development and building : updating and using job-relevant knowledge : law, government, and jurisprudence; customer and personal service.

Minimum - Six years' experience managing insurance benefits and insurance coordination in a healthcare setting.

Preferred - BS in Healthcare Administration, Public Health, or related field.

Mission : To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.

Vision : To be the Healthiest State in the Nation.

Values : Innovation : We search for creative solutions and manage resources wisely. Collaboration : We use teamwork to achieve common goals & solve problems. Accountability : We perform with integrity & respect. Responsiveness : We achieve our mission by serving our customers & engaging our partners. Excellence : We promote quality outcomes through learning & continuous performance improvement.

Tallahassee, FL

Working for the State of Florida is more than a paycheck. The State's total compensation package for employees features a highly competitive set of employee benefits including :

• Annual and sick leave benefits;
• Nine paid holidays and one personal holiday each year;
• State group insurance coverage options, including health, life, dental, vision, and other supplemental insurance options;
• Retirement plan options, including employer contributions

For more information, please click www.myfrs.com. Flexible spending accounts; Tuition waivers; And more!

For a more complete list of benefits, including monthly costs, visit www.mybenefits.myflorida.com.

Your responses to qualifying questions for this position must be verifiable by documentation provided through the electronic application process. This position requires a security background check and / or drug screening and participation in direct deposit. Any misrepresentations or omissions will disqualify you from employment consideration. Note : You will be required to provide your Social Security Number (SSN) in order to conduct this background check. Successful completion of a drug test is a condition of employment for safety-sensitive positions. Male applicants born on or after October 1, 1962, will not be eligible for hire or promotion unless they are registered with the Selective Services System (SSS) before their 26th birthday, or have a Letter of Registration Exemption from the SSS.

If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be canceled, suspended or deemed ineligible depending upon the date of your retirement. The successful candidate will be required to complete the Form I-9 and that information will be verified using the E-Verify system. E-Verify is operated by the Department of Homeland Security in partnership with the Social Security Administration to verify employment eligibility. Incumbents may be required to perform emergency duty before, during, and / or beyond normal work hours or days.

All Florida Department of Health positions require the incumbent to be able to learn and communicate effectively, orally and in writing, in English. Applicants who do not meet this requirement will not be considered. The State of Florida is an Equal Opportunity Employer / Affirmative Action Employer and does not tolerate discrimination or violence in the workplace. Applicants requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and / or People First Service Center (1-877-562-7287). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation. The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act. Florida has the third largest population of veterans in the nation with more than 1.5 million service men and women. The Florida Department of Health (department) is committed to serving members of the United States Armed Forces, veterans and their families by encouraging them to apply for vacancies that fit their area of knowledge and / or expertise. Through the Department's VALOR program, which expedites licensing for military veterans, the Department also waives initial licensing and application fees for military veterans who apply for a health care professional license within 60 months of