DISTINGUISHING FEATURES OF THE CLASS: Depending upon the examining unit workload and the organizational structure of the agency, the incumbent may supervise a group of examiners or senior examiners responsible for determining financial eligibility for the various programs administered by the local social services district. The incumbent may also work independently implementing and monitoring the Medicaid Managed Care Program in Genesee County. This involves negotiating and developing agreements with Health Maintenance Organizations providing Medicaid Managed Care in Genesee County. This is an important position involving responsibility for planning, coordinating, supervising, managing the performance and activities of a group of employees, and working cooperatively with line and supervisory staff in the various work units within the agency. Duties are similar to those of a senior social welfare examiner, however they are broader in scale, and involve a greater variety of related functions and the exercise of supervision over a greater number of subordinates. Work is performed under the general supervision of the Director of Financial Services. Does related work, as required.
TYPICAL WORK ACTIVITIES:
Participates in the negotiation of managed care contracts with designated HMO’s;
Works closely with State Department of Social Services and State Department of Health officials on issues pertaining to managed care programs;
Works closely with HMO’s to market and enroll clients in the managed care program;
Monitors client grievance process, quality assurance procedures and HMO’s for compliance with existing contracts;
Coordinates the activities of various units within the department in their delivery of the managed care program;
Provides direction to those who oversee direct services to clients;
Acts as spokesperson for the Managed Care Program to clients, medical providers, private/public agencies and organizations;
Assists in the formulation of policies and procedures which relate to financial eligibility;
Interprets federal, state and local policies and programs as they relate to financial eligibility;
Plans, coordinates, supervises and manages the activities within assigned area of responsibility;
Establishes necessary controls for determining staff performance and makes necessary performance evaluations;
Reviews recommendations made by lower level examiners and approves or disapproves them;
Approves referral of clients to social service section for services;
Maintains cooperative relationships with other units and sections of the agency, through administrative channels;
Maintains contact with community groups and other agencies in area of responsibility;
Uses a statistical model to review cases of experienced Social Welfare Examiners (Case Supervisory Review).
The above examples of duties are intended only as illustrations of the various types of work performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.
FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND/OR PERSONAL CHARACTERISTICS: Thorough knowledge of federal, state and local social services laws and programs; thorough knowledge of the agency's overall programs, policies and procedures; thorough knowledge of laws and programs which may affect enrollment in managed care; good knowledge of modern principles of supervision; good knowledge of other pertinent laws and programs which may affect eligibility, such as, Workmen's Compensation, Social Security and Unemployment Insurance; ability to communicate and deal effectively with others; ability to plan, coordinate, manage and supervise the work of others and evaluate their performance; ability to prepare complex reports; ability to make sound judgments; initiative and resourcefulness; tact; judgment; leadership; emotional maturity.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit, use hands to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee is required to walk, talk and hear.
The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually quiet.
MINIMUM QUALIFICATIONS: Graduation from high school or possession of an appropriate equivalency diploma recognized by the NYS Department of Education, AND:
Four years experience in examining, investigating or evaluating claims for assistance, veterans or unemployment benefits, insurance or a similar program operating under established criteria for eligibility, two years of which has been in a supervisory capacity.
NOTE: Study in a regionally accredited college or university or one registered by New York State or business college registered by New York State may be substituted for the experience as noted above but may not be substituted for the supervisory experience on a year for year basis.