Utilization Control Manager

Main Purpose of Job

The main purpose of this position is to research, develop, and implement high-priority initiatives for the Office of Long Term Services and Supports (OLTSS) with a focus on utilization control and technical leadership for information technology solutions. This position serves as contract monitor for the Department’s Utilization Control Agent (UCA) that supports the Acute Care Administration and OLTSS and is the expert consultant and technical advisor on utilization control.

The UCA Manager is responsible for ensuring robust utilization control that ensures the best use of Medicaid resources for optimal health outcomes for participants through the evaluation of medical necessity, appropriateness, and efficiency of services. The UCA Manager completes all procurement tasks, ensures compliance with terms of the contract, evaluates performance metrics, and assesses financial penalties as permitted in the contract. This position is responsible for facilitating provider training and developing and revising standard operating procedures (SOPs) to instruct the UCA on its work. Additionally, this position develops and implements regulatory and sub regulatory guidance, in collaboration with program staff, to instruct Medicaid-enrolled providers on utilization review activities.

This position operates in a hybrid manner, meaning job duties will be performed both remotely and on-site unless otherwise directed by the appointing authority.

MINIMUM QUALIFICATIONS

Education: Graduation from an accredited high school or possession of a high school equivalency certificate.

Experience: Six years of administrative staff or professional work.

DESIRED OR PREFERRED QUALIFICATIONS

• Contract monitoring and technical writing experience
• Experience facilitating stakeholder engagements
• Experience conducting or overseeing utilization review activities to ensure cost-effective, medically necessary services to improve health outcomes

LICENSES, REGISTRATIONS AND CERTIFICATIONS

Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator's license valid in the State of Maryland.

SELECTION PROCESS

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview).

Complete applications must be submitted by the closing date. Information submitted after this date will not be added.

Incorrect application forms will not be accepted. Resumes will not be accepted in lieu of a completed application.

Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

STATE OF MARYLAND BENEFITS

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201. Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

If additional information is required, the preferred method is to upload. If you are unable to upload, please fax the requested information to 410-333-5689. Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.

For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410-767-1251.

If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 or [email protected].

Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258.

We thank our Veterans for their service to our country.

People with disabilities and bilingual candidates are encouraged to apply.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.