Medical Benefits Policy Manager

Job Description :

The Medical Benefits Policy Manager reports to the Director of Medical and Dental Benefits Policy (MDBP) in the Office of Policy and Program.

This position performs highly advanced (senior level) managerial work administering daily operations and activities related to the development of clinical policy for Texas Medicaid medical benefits.

The work conducted and overseen by this position is complex, very technical, requires high-level analytical skills, strong interpersonal skills, and involves effective facilitation and negotiation within MDBP, with other areas, and within the Division, HHS, as well as with the claims administrator contractor, and vendors.

The position must be able to synthesize evidence based clinical information from a variety of sources (current practice, other states, and federal guidance and peer-review scholarly journals) when providing direction to staff and must have outstanding interpersonal and communication skills for cultivating a positive and productive work culture with staff and co-workers.

The Manager V works under the general direction of the Medical Benefits Policy Director with extensive latitude for the use of initiative and independent judgment and performs other duties as assigned.

Essential Job Functions :

30%) Plans, assigns, and supervises the work of staff in the development of Texas Medicaid medical benefits. Provides direction to staff for the development of medical policy to ensure staff performs assigned tasks using established, evidence-based resources, using established processes and within established time frames.

Reviews and approves all work product. Organizes and develops materials such as papers, presentations, and reports in response to requests for program and clinical information from providers, stakeholders, legislative or executive staff, and others.

30%) Facilitates communication within the Office of Policy and Program, Office of Medical Director, and other areas within HHS and other agencies.

Assists with negotiations and problem-solving to ensure quality of work and that work is performed within time frames. Identifies areas of needed change and makes recommendations to improve operations.

Informs the Director of activities and emerging issues and proposes remedies.

20%) Ensures staff is trained to complete assigned work, and expectations of staff are clearly and respectfully communicated.

Motivates staff through positive and constructive feedback, fostering professional development, collaboration among and between teams, and promoting constructive interpersonal communication within their team.

Communicates with staff regarding work performance and expectations. Assists staff in constructively and productively dealing with change, as appropriate.

Establishes goals and standards for the team and develops measurement tools for determining progress for meeting goals / standards, such as performance evaluations, progress plans, spreadsheet tracking, and other task or time management methods.

Performs human resource requirements including approval of time and leave, recruiting potential staff, interviewing, hiring, and advising staff.

15%) Leads or participates in agency workgroups as necessary for successful implementation of projects, policies, and initiatives.

Works with and speaks to community and professional groups, other HHSC programs, other state agencies, legislative staff, and public stakeholders, to provide information, technical assistance, identify needs, cultivate professional relationships, and resolve issues.

Makes presentations with recommendations to executive staff and other leaders. Approves staff responses to legislative, provider, and stakeholder requests for information.

5%) Performs other duties as assigned to support the agency.

Knowledge Skills Abilities :

The candidate must have knowledge of the Medicaid and CHIP programs as well as other public health services programs; knowledge of public administration and management techniques;

and knowledge of analysis processes and program planning and implementation.

• The candidates must have skill in researching clinical, scholarly, academic, and peer-reviewed literature; assembling and analyzing facts to devise solutions to problems;
• written and oral communication, including the ability to make public presentations, write technical information in an understandable format, and produce sophisticated research reports;

and in developing and evaluating policies and procedures.

The candidate must have skills in managing competing priorities and establishing and maintaining effective working relationships.

Candidates must have skill using personal computer application software such as Microsoft Word, Power Point, Excel, Microsoft Project, or similar programs.

Candidates must be able to communicate effectively; lead and motivate staff; lead project teams; and work with multiple stakeholders, setting clear and collaborative goals and expectations with their staff and co-workers.

Candidate must have effective interpersonal communication skills and ability to collaborate across a variety of business areas and with staff at multiple levels of experience and expertise.

Healthy work-relationship building is a must.

Candidate must be able to apply a coaching management style to include active listening, asking questions, providing constructive / collaborative feedback, building trust, and setting SMART goals.

Candidate’s managerial skills must encompass the ability to engage with staff effectively, addressing staff’s communication, individual styles, and work products in real-time, while maintaining efficiency using a supportive and even-handed approach.

Candidates must be able to identify problems, evaluate alternatives, and propose effective solutions; effectively plan, assign, and supervise the work of others;

work cooperatively as a team member in a rapid-paced, deadline-oriented environment; and organize resources to achieve desired outcomes.

Candidates must have the ability to manage multiple staff at multiple levels of experience, backgrounds, and expertise; the ability to exercise judgment and work independently with minimum supervision;

and the ability to organize and develop work plans and adhere to strict deadlines.