DIRECTOR OF MEDICAL ASSISTANCE-QUALITY REVIEW                                                                       3312

 

 

DISTINGUISHING FEATURES OF THE CLASS

Under general supervision, an employee in this class directs the activities of a bureau consisting of diverse units engaged in the scheduling, evaluation control and case management of health care.  The incumbent provides administrative direction and supervision for a staff of health care professionals, who review the quality of care received under the Medical Assistance Program.  It is the responsibility of the unit to ensure that the medical care received by program recipients conforms to professional standards, as well as Federal, State and department guidelines.  The emphasis of the work of this position is on the organization of the unit structure and workflow, the formulation of unit goals, policies and procedures, and the supervision of data collection and information retrieval systems.  The incumbent is expected to use considerable independent judgment and initiative in the direction and formulation of program policies within the framework of Federal, State and local rules and regulations.  Performance is reviewed by the Medical Assistance Administrator through consultation, periodic conferences and written reports.  Does related work as required.

 

TYPICAL WORK ACTIVITIES

          Directs the activities of health care professionals who review requests for authorization for medical services provided to Medical Assistance recipients;

          Supervises the coordination of health care services available to Medical Assistance recipients, such as the Child Health Assurance Program and Family Planning;

          Formulates goals for the unit in improving the quality, effectiveness and accessibility of health care received under Medical Assistance;

          Establishes policies and procedures to be followed by staff in implementing Federal, State and departmental regulations governing the program; formulates and directs ongoing in-service training programs;

          Designs record-keeping and information retrieval systems to facilitate analysis of recipient utilization of program services;

          Prepares periodic reports to departmental administrators and New York State on the operation of the unit;

          Develops and maintains contacts with health care providers and organiza­tions to encourage participation in the service delivery aspect of the program;

          Prepares the annual budget for the unit;

          Establishes CASA (Community Alternatives Systems Agency,) policies and procedures, and assures the quality and effectiveness of CASA services.

 

FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS

Thorough knowledge of the operations, principles and procedures of medical care delivery systems; thorough knowledge of the principles and practices of office management and supervision; good knowledge of current developments, literature and sources of information pertaining to the field of medical care administration; good knowledge of the operations of Federal, State and local social services and public assistance programs; ability to develop and implement administrative and case management procedures and to evaluate their efficiency and effectiveness; ability to analyze and evaluate complex data, prepare comprehensive reports and make practical recommendations concerning the solu­tions of medical care problems; ability to plan, direct and review the work of subordinate employees in a manner conducive to full performance and high morale; ability to establish and maintain effective working relationships with health care providers, professional organizations, other public officials and the general public; ability to express oneself clearly and concisely, both orally and in writing; physical condition commensurate with the demands of the position.

 

MINIMUM QUALIFICATIONS

          OPEN COMPETITIVE

          Graduation from a New York State or Regionally accredited college or university with a Master's Degree in Social Work or Public Health and seven (7) years of experience in a health or social service agency, five (5) years of which must have been in an administrative capacity with responsibility for program planning, direction and coordination.

 

 

 

R4/18/84

SUFFOLK COUNTY

Competitive

RR1/24/03