Full Job Description
Medicaid and CHIP Services’ (MCS) mission is to deliver quality, cost effective services to Texans. Core values of the program include encouraging teamwork to achieve excellence. The Vendor Drug Program (VDP) team is critical to the MCS mission and embraces these values. The VDP Director III fulfills program goals by ensuring member have timely access to the prescription drug services they need and optimizing resources to ensure a sustainable Medicaid program.
The Director III leads VDP in MCS, and performs advanced management and oversight functions relating to Medicaid and CHIP prescription drug services delivered through managed care and fee-for-service models, and relevant programs, policies, and initiatives. In addition, the Director provides oversight of functions relating to the Medicaid Electronic Health Record (EHR) Incentive/Promoting Interoperability Program which provides financial incentives to eligible Medicaid professionals and hospitals for the adoption and meaningful use of certified EHR technology.
The Director reports to the Deputy Associate Commissioner for Medicaid and CHIP Operations. The Director participates in strategic planning related to the management of VDP. The Director leads the strategic planning, program development, and establishing goals for health information exchange, pharmacy resolutions, formulary pricing and management, contract compliance, and drug utilization review in support of the overall objectives of VDP. Develops goals, strategies, and initiatives that align Medicaid and CHIP with the HHSC strategic plan and evaluates progress in meeting these goals. This includes overseeing the development of guidelines and policies and reviewing the federal and state regulations that impact the MCS programs and operations.
The Director meets with and coordinates strategy with other HHS Divisions, specifically IT, Actuarial Analysis, and Budget. Meets with fiscal and budget staff to assess the monetary impact regulations may have on HHSC.
The Director is responsible for managing information and communication provided to legislators, stakeholders, consumer advocacy groups, other state agencies, the Office of the Inspector General, and other entities. Responds to legislative information requests ensuring coordination with appropriate staff for accurate and timely responses.
The Director represents the agency at business meetings, hearings, trials, legislative sessions, conferences, and seminars or on boards, panels, and committees.
The Director works under minimal supervision with extensive latitude for the use of initiative and independent judgment Performs other duties as assigned and required.
Essential Job Functions:
(30%) Provides planning, direction, guidance, and oversight of day-to-day management activities. Establishes the strategic plan, goals, and objectives for the office. Ensures that Medicaid and CHIP Vendor Drug programs are delivered efficiently and effectively and are in compliance with federal and state laws, regulations, and policies. Develops program goals, strategies, and initiatives to align with HHSC and MCS strategic plan. Works closely with staff from other MCS program areas and agencies that manage daily operations of Medicaid and CHIP programs and financing to effectively manage the program. Provides effective direction and leadership to professional and technical program staff within program areas and supporting them to achieve performance expectations, stated program goals, and legislative mandates. Serves as the liaison to Centers for Medicare and Medicaid Services (CMS) and other federal, state, pharmacy, and health information exchange stakeholders.
(25%) Provides leadership and oversight for areas of responsibility. Directs program area(s) and activities. Develops and implements techniques for evaluating program activities. Plans, develops, and approves schedules, priorities, and standards for achieving goals; and directs evaluation activities. Reviews and approves requests for design changes and/or programming requirements for the Vendor Drug programs systems including the electronic claims adjudication system to ensure maximum system performance and service level for pharmacy providers.
(15%) Develops executive briefings documents, issue papers, and memorandums for executive decision-making and delivers executive level briefings, as appropriate. Reviews and approves management, productivity, and financial reports and studies. Reviews guidelines, procedures, rules, and regulations; and monitors compliance. Reviews results of special investigations, internal audits, research studies, forecasts, and modeling exercises to provide direction and guidance. Responds to legislative information requests ensuring coordination with appropriate staff for accurate and timely responses.
(15%) Develops and reviews budgets, procurement and contracting activities and provides final approval. Develops HHSC legislative appropriations requests to ensure adequate and appropriate support and funding for program services. Develops and manages departmental budget and HHSC resources efficiently and effectively.
(15%) Represents the agency at pharmacy and health information technology meetings, hearings, trials, legislative sessions, conferences, and seminars or on boards, panels, and committees.
Knowledge Skills Abilities:
Knowledge of the role of federal and state laws, regulations, policies, and procedures in management of publicly funded health care services.
Knowledge of the role of the State of Texas legislative process.
Knowledge of Medicaid administrative policies, regulations, and laws as they apply to the Vendor Drug program.
Knowledge of pharmacy laws and regulations.
Extensive knowledge of information technology systems necessary to operate the Vendor Drug Program.
Knowledge of rate methodologies, appropriations, financial arrangements, and reimbursement methods.
Ability to develop and implement strategic plans, goals, objectives, and evaluation tools to monitor progress and ensure accountability·
Ability to effectively manage employees; recruit, hire, develop, manage performance, ensure accountability, and motivate to build morale.
Ability to routinely identify and effectively mitigate risk management strategies. Skill in developing and managing a departmental budget.
The ability to communicate effectively, build and maintain effective working relationships, negotiate with individuals and groups internally and externally, develop professional networks with other organizations, and to identify the internal and external dynamics that impact the work of the organization.
Registration or Licensure Requirements:
Initial Selection Criteria:
Ten years of experience working in or oversight of complex programs.
Preferred: Knowledge of Medicaid administrative policies, regulations, and laws. Governmental or non-governmental experience with public health programs.
There are no direct military occupation(s) that relate to the responsibilities, and registration or licensure requirements for this position. All active duty, reservists, guardsmen, and veterans are encouraged to apply if they meet the qualifications for this position.
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
I-9 Form - Click here to download the I-9 form.
In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.