Director, Medicaid Benefits and Health Program Group Department of Health and Human Services

About the role

This position is located in the Center for Medicaid and CHIP Services (CMCS), Office of the Center Director, Disabled & Elderly Health Programs Group, Centers for Medicare and Medicaid Services (CMS).

Responsibilities

• Lead national Medicaid policy and operations for benefits, coverage, pharmacy programs, the Medicaid Drug Rebate Program, and long-term services and supports, including home and community-based services.
• Develops, monitors, and evaluates regulations, policies, procedures, and other guidelines for States in the design and implementation of their Medicaid programs in key program areas and provides technical assistance to support states.
• Develops and monitors Medicaid pharmacy policy, including the Medicaid Drug Rebate Program, classification of drugs, Federal Upper Limits, drug utilization review, prior authorization, Federal offsets/recapture, and preferred drug lists.
• Establishes, implements, and oversees the Medicaid program policy for the Health Homes, and Program for All Inclusive Care for the Elderly (PACE) programs.
• Reviews, and approves, benefits/coverage and State Plan Amendments, and 1915(c) waivers.
• Administers and monitors systems transformation grants, including Money Follows the Person. Assists the States in the design and implementation of their community-based long-term care support systems.
• Establishes policy regarding program monitoring, performance management, quality improvement, and consumer protections for programs and services administered by MBHPG.
• Led national Medicaid benefits and coverage policy, including behavioral health, long-term supports, home health, and clinical care.
• Provides national leadership on the development and management of Medicaid program policy related to benefits and coverage. To include mental health, substance use disorder services, long-term supports, home health, and clinical/facility care, ect.

Requirements

Subject to a 1-year supervisory probationary period (unless already completed).

To meet the minimum qualification requirements for this position, you must show that you possess the Executive Core Qualifications (ECQ) and Technical Qualifications (TQ) related to this position within your resume - NOT TO EXCEED 2 PAGES. Resumes over the 2-page limit, will not be reviewed beyond page 2 or may be disqualified. Your resume should include examples of experience, education, and accomplishments applicable to the qualification(s).

Technical Qualifications (TQs)

• Demonstrated tenured executive-level experience leading the development, implementation, and refinement of policies, strategies, and operational frameworks governing Medicaid benefits and coverage, such as benefit design; administration of the Medicaid pharmacy drug rebate program; oversight of integrated delivery system authorities; and oversight of long-term services and supports (LTSS) waivers and state plan services. Provides leadership in resolving complex programmatic, regulatory, and operational challenges to achieve effective oversight and performance outcomes.
• Demonstrated expertise in analyzing complex and evolving statutory and regulatory frameworks, often in the absence of clear or consistent precedent, to make authoritative determinations that guided organizational decision-making, informed resolution of related issues, and contributed to the development of Medicaid policy with a nationwide impact. Demonstrated executive-level experience designing, implementing, and overseeing organization-wide operations and processes for advising senior leadership/officials and external stakeholders on complex Medicaid matters.

Executive Core Qualifications (ECQs)

• Commitment to the Rule of Law and the Principles of the American Founding - This core qualification requires a demonstrated knowledge of the American system of government, commitment to uphold the Constitution and the rule of law, and commitment to serve the American people.
• Driving Efficiency - This core qualification involves the demonstrated ability to strategically and efficiently manage resources, budget effectively, cut wasteful spending, and pursue efficiency through process and technological upgrades.
• Merit and Competence - This core qualification involves the demonstrated knowledge, ability and technical competence to effectively and reliably produce work that is of exceptional quality.
• Leading People - This core qualification involves the demonstrated ability to lead and inspire a group toward meeting the organization's vision, mission, and goals, and to drive a high-performance, high-accountability culture. This includes, when necessary, the ability to lead people through change and to hold individuals accountable.
• Achieving Results - This core qualification involves the demonstrated ability to achieve both individual and organizational results, and to align results to stated goals from superiors.