MEDICAL DIRECTOR - MEDICAL ASSISTANCE PROGRAM 2443

DISTINGUISHING FEATURES OF THE CLASS

An employee in this class is responsible for the planning and coordination of the medical aspects of the Medical Assistance Program (Medicaid of Suffolk County) administered by the Department of Social Services. The employee confers with the Commissioner of Health and the Director of Medical Assistance to discuss problems and progress of the Medical Assistance Program. The incumbent advises the Commissioner on all aspects of medical services and acts as a technical advisor for other Divisions of the department regarding medical problems of clients and the interpretation of medical information, and as a consultant on the medical aspects of claims processing and payment. The Medical Director-Medical Assistance Program is responsible for assuring the medical necessity of services, and the provision of high quality care at a reasonable cost. Work is performed under the general direction of the Medical Assistance Administrator and is reviewed through conferences, consultations and the submission of required reports. Does related work as required.

TYPICAL WORK ACTIVITIES

Supervises the local medical plan in accordance with regulations of the State Department of Social Services;

Provides medical knowledge and experience in developing managed care programs and policies;

Utilizes the State's claims-paid system to review the quality and extent of care being provided to Medical Assistance recipients, and refers cases of suspected fraud and abuse for investigation;

Conducts Disability Reviews to determine eligibility of medical assistance applicants for Social Security disability;

Consults with the home care nursing staff regarding the medical necessity and appropriate hours of home care for disabled Medicaid clients;

Consults with personnel of the agency on medical or related problems of individual clients and interpretation of medical information;

Consults with attending physicians and other medical services providers on diagnosis, treatment and necessity of service;

Reviews hospital, nursing homes, ambulatory care, and practitioner's records of service in the Medical Assistance Program to assay their adequacy and cost benefit;

Attends professional courses or meetings to keep abreast of medical knowledge as this relates to the Medical Assistance Program;

Develops and maintains active communication with key officials of public and private organizations involved in medical care for Suffolk County Medicaid clients.

FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS

Thorough knowledge of the principles and practices of medicine; thorough knowledge of the Medical Assistance Program and its resources; thorough knowledge of the state and local public health laws and sanitary codes; ability to be effective as a medical advisor and consultant to the commissioner and the administrator in the planning and operation of the Medical Assistance Program; ability to establish and maintain effective working relationships with patients, public officials, physicians and other parties associated with the Medical Assistance Program; ability to express oneself clearly and concisely, both orally and in writing; good judgment; tact; courtesy; physical condition commensurate with the demands of the position.

MINIMUM QUALIFICATIONS

OPEN COMPETITIVE

Possession of a license to practice medicine in the State of New York and Board Certified or Board Eligible in a medical or public health specialty, and five (5) years of experience in the practice of medicine, public health or medical care administration which includes or is supplemented by two (2) years of experience in quality assurance in medical care.

R06/05/95

SUFFOLK COUNTY

Competitive