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Departmental Manager 14 - HS Claims Review Unit

Job Description

The MDHHS mission is to provide opportunities, services, and programs that promote a healthy, safe, and stable environment for residents to be self-sufficient. We are committed to ensuring a diverse workforce and a work environment whereby all employees are treated with dignity, respect and fairness. For more information, please visit our MDHHS Diversity, Equity, and Inclusion Plan (Download PDF reader).

This position manages staff responsible for the review of suspended ambulatory and institutional medical claims for practitioners that participate in the Medicaid program and is responsible for maintaining and approving complex resolution instructions for payment, pricing and/or denial of these claims consistent with program policies. This position resolves complex problems, ensures that any policy changes are tested and instituted correctly and confers with Information Technology programmers, analysts, and managers to resolve any problems in implementing changes. This position is responsible for monitoring the review of claims and ensuring that procedures are in place to efficiently and accurately resolve claims.

Position Description

Job Specification (Download PDF reader)

To be considered for this position you must:

apply for this position online via NEOGOV; click on "Apply" in the job posting for instructions on submitting your electronic application. Hard copy applications are not accepted.
relevant experience and/or education referred to in the supplemental questions must be documented in the resume, transcript and/or application to allow for accurate screening.
attach a resume identifying specific experience and dates of employment. Dates of employment should include month and year and hours per week.
attach a cover letter.
If applicable, attach a copy of an official transcript(s). We accept scanned copies of official transcripts. We do not accept web-based, internet, or copies of unofficial transcripts. Official transcripts provide the name of the institution, confirmation that a degree was awarded and on what date, and the registrar's signature. Please review Civil Service's guidelines regarding Official Transcripts: Official Transcripts (michigan.gov)

Failure to complete any of the above may result in your application being screened out as incomplete. See instructions for attaching files here: Instructions (Download PDF reader)

Required Education and Experience

Education
Possession of a bachelor's degree in any major.

Experience
Four years of professional experience, including two years equivalent to the experienced (P11) level or one year equivalent to the advanced (12) level.

Alternate Education and Experience

Alternate Education and Experience Requirements applicable to internal State of MI employees ONLY

The following alternate education and experience must be gained in any of the following areas to qualify for the posting classification and level: Health Services Administration, the former Medical Services Administration, Policy, Planning & Operational Support Administration, Legislative Services Administration; the former Behavioral Health & Developmental Disabilities; the former Aging & Adult Services Agency, Financial Operations Administration; or the Director's Office)

A bachelor's degree in any major and at least two (2) years of experience as a Departmental Supervisor 11;
OR
A bachelor's degree in any major and at least one (1) year of experience as a Departmental Supervisor 12, 13, or 14;
OR
Education level typically acquired through the completion of high school and at least four (4) years of experience as a Departmental Supervisor 11;
OR
Education level typically acquired through the completion of high school and at least three (3) years of experience as a Departmental Supervisor 12, 13, or 14

Additional Requirements and Information

The use of artificial intelligence (AI) software of any kind is prohibited in all areas of the selection process; including, but not limited to, responses to application questions, and responses to interview questions or exercises.

If you previously held status in this classification and departed within the last three (3) years, please contact Human Resources regarding your interest in a potential reinstatement. Reinstatement is not guaranteed or required.

Your application for any position does not guarantee you will be contacted by the Department/Agency for further consideration. Only those applicants interviewed will be notified of the results.

Position Location/Remote Office: The physical location of this position is 400 S. Pine St. Lansing, MI. Based on operational needs and within established limits, remote work and alternate or hybrid work schedule requests for this position may be considered.

Selected candidates who have been approved to work remotely or a hybrid schedule must complete that work within Michigan. Candidates should confirm work location and schedule at the time of interview.
Employees will be provided computers to perform state work. Phones may also be provided for necessary communications. If working remotely, employees will be responsible for providing other components of a remote office at their own expense, including:

A secure work location that allows privacy and prevents distractions.
A high-speed internet connection of at least 25 Mbps download and 5 Mbps upload.
Suitable lighting, furniture, and utilities.

As a Condition of Employment: this position requires successful completion of a background investigation and a criminal records check.

The Department of Health and Human Services reserves the right to close this posting prior to its original end date once a sufficient number of applications have been received.

For information about this specific position, please email MDHHSVacancies@michigan.gov. Please reference the job posting number in subject line.

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MDHHS is proud to be a Michigan Veteran's Affairs Agency (MVAA) Gold Level Veteran-Friendly Employer.

Accommodations
If you require a reasonable accommodation to participate in the application or selection processes, please contact the ADA coordinator (Download PDF reader) for the agency that posted this position vacancy.

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