A class incumbent is responsible for directing Department-wide activities related to the highly complex areas of health care cost containment which involves managing the financial analysis, development, and implementation of significant and comprehensive planning, evaluation and service delivery projects.
Nature and Scope
The class incumbent reports to the Director, Planning, Research and Evaluation. The work requires specialized skills, training, and perspective in order to manage the total planning process. The complexities confronted in the area of health care cost containment involve such functions as policy development, alternative delivery systems, health care financial management and facility management and operations. Assignments typically require the development of new reimbursement methodologies which ultimately alters current health care delivery systems. In the management of projects, the incumbent supervises and coordinates the work of high level staff from throughout the Department including administrators, facility directors, and agency heads. Further, the incumbent is responsible for selecting and monitoring the work of private health care and cost containment consultants. General objectives of assignments are given and selective priority of projects are fixed. The incumbent subsequently plans and executes work, reports progress to supervisor, and receives guidance only on unusual technical problems. Completed work is reviewed for overall conceptual accuracy. The incumbent represents the Department in discussions with representatives from statewide public and private provider groups, hospitals, nursing homes, task forces and health care agencies. A significant aspect of the work involves functioning as the State's technical expert in the field of health care cost containment.
Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.
Serves as Department's technical expert in the highly complex areas of health care cost containment.
Manages, directs and/or performs specialized studies which result in alternative health care delivery systems and methodologies. Supervises staff as needed when directing any project.
Provides technical expertise to other Divisions, within the Department, in the areas of policy development, research and evaluation, reimbursement methodologies and health care cost containment initiative.
Collects and analyzes varied and complex data used in support of report, project and funding development purposes.
Serves on or coordinates special committees, task forces, and working groups involved in strategic planning, policy development, service delivery and cost containment projects for the Department.
Analyzes reports and documents from federal, state and the department and recommends cost containment policy changes.
Prepares annual legislative Health Care Cost Containment Report which outlines the Department activities in this area.
Keeps abreast of legislative and technical developments and change related to the area.
Works with other state, local or private agencies that are affected by cost containment policy changes
Knowledge, Skills and Abilities
The intent of the listed knowledge, skills and abilities is to give a general indication of the core requirements for all positions in the class series; therefore, the KSA’s listed are not exhaustive or necessarily inclusive of the requirements of every position in the class.
Knowledge of health care economics financing and administration.
Knowledge of health care policy issues, on a national and local level.
Knowledge of all types of health care delivery systems.
Knowledge of federal, state and community health planning principles.
Knowledge of health care facility management; such as hospitals, nursing homes, HMO, etc.
Skill in health care policy analysis and development.
Skill in complex data gathering, analysis and formulation.
Ability to identify problems and conceptualize solutions from complex data.
Ability to analyze state and federal legislation.
JOB REQUIREMENTS for Health Care Cost Containment Specialist
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:
Three years experience in health care cost containment such as analyzing health care costs and recommending delivery systems and reimbursement procedures.
Six months experience in developing policies and procedures.
Six months experience in interpreting health care laws, rules, regulations, standards, policies and procedures.
Six months experience in health or human services program administration such as overseeing and directing the development, implementation and evaluation of health or human services programs and services; planning and establishing short and long range program goals and objectives. Providing advice to other agency organizational units through consultation.
Knowledge of managing budgets, grants or contracts.
Knowledge of staff supervision acquired through course work, academic training, training provided through an employer, or performing as a lead worker overseeing the work of others; OR supervising staff which may include planning, assigning, reviewing, and evaluating the work of others; OR supervising through subordinate supervisors a group of professional, technical, and clerical employees.