Occ. Code 0227100
MEDICAID REDESIGN ANALSYT 1, GRADE 18
MEDICAID REDESIGN ANALYST 2, GRADE 23
MEDICAID REDESIGN ANALSYT 3, GRADE 27
MEDICAID REDESIGN ANALSYT 4, GRADE 29
New York State Department of Civil Service
BRIEF DESCRIPTION OF CLASS SERIES
Medicaid Redesign Analysts (MRA) address reform of public health care delivery and payment systems and public health care programs by reviewing the Medicaid services and delivery systems used by health care providers or managed care entities, and propose and implement changes to address specific goals.
Incumbents perform a broad range of programmatic, project, and financial/rate setting-related activities in the Delivery System Reform Incentive Payment (DSRIP) Program, the Value Based Payment (VBP) Program, and other Medicaid Redesign (MR) and Medicaid Innovation (MI) related initiatives designed to achieve measurable improvement in health outcomes, sustainable cost control, and a more efficient administrative structure. DSRIP seeks to restructure the health care delivery system by reinvesting in the Medicaid program with the goal of reducing avoidable hospital use. VBP is focused on payment reform to improve the quality of care and shift spending to keep individuals healthy and integrated in their community.
Medicaid Redesign Analysts are found only in the Department of Health.
MEDICAID REDESIGN ANALYST 1: full performance level. Under the supervision of a higher level MRA or program manager, conducts research, analysis, design, development, implementation, and/or financial/rate setting activities for the provision of health care services and benefits provided through Medicaid.
MEDICAID REDESIGN ANALYST 2: advanced performance level; may supervise subordinate MRA, paraprofessional, or office support staff. The MRA 2 recommends policy, program development, and/or financial/rate setting evaluation methodologies related to DSRIP and VBP initiatives; and handles issues with no clear precedents.
MEDICAID REDESIGN ANALYST 3: supervisory level; has responsibility for a Medicaid or public health care program impacted by DSRIP or VBP initiatives and directs one or more units, and/or may function as the second-in-command of a bureau. Assignments are varied and often include issues with no clear precedents or established guidelines for service development.
MEDICAID REDESIGN ANALYST 4: managerial level; serves as the head of a bureau typically containing 15 or more professional staff, or as an assistant director in a large bureau. Under the direction of the Bureau or Division Director, the MRA 4 provides guidance in the development, implementation, management, administration, oversight, and/or monitoring of health care programs related to DSRIP and VBP, as well as development of financial/rate setting and/or programmatic policies related to streamlining and improving access to health care services and supports, and the administration of Medicaid and other public health insurance programs.
Eligibility Program Managers administer and oversee the New York State Medicaid Program, Child Health Plus Program, Qualified Health Plan coverage, and other public health insurance programs; and direct, administer, and oversee all aspects of eligibility and enrollment for public health insurance programs.
Health Care Management Systems Analysts conduct health services research, and work with outside groups to develop policy options and recommendations to implement health care delivery systems, including managed care and health care insurance programs which contain costs while protecting access to quality health care; implement new or refined systems; and perform evaluations of health care financing systems.
Medicaid Eligibility Examiners assist in or determine eligibility for Medicaid or public health insurance programs and provide technical assistance and guidance to local social services districts, other Department of Health (DOH) programs, other State agencies, consumers, health care providers, professional organizations, insurance companies, and advocacy groups.
MEDICAID REDESIGN ANALYST 1
Duties are related to comprehensive Medicaid payment reform under DSRIP and VPB, and may include, but are not limited to:
· Provide information to health care providers, health plans, health care associations, control agencies, health care advocates, and other DOH programs.
· Aid in developing responses to inquiries on programmatic issues, gathering information on existing and new projects.
· Assist in the resolution of service provider issues by interpreting program guidelines.
· Review internal documents for quality control compliance.
· Conduct research on health care services provided in other states to advance New Yorks programmatic goals related to Medicaid Redesign (MR) implementation, DSRIP, and VBP.
· Conduct research of laws, rules, regulations, federal requirements, and program procedures and prepare draft changes.
· Assist in drafting regulations pertaining to health regulatory/surveillance systems and their standards, health insurance programs, or health care service delivery.
· Support the development and implementation of health care policies, programs, projects, and evaluation methodologies for the provision of health care services in various delivery models, with special emphasis on alternative systems that reward performance consistent with DSRIP objectives and measures.
· Support the development and implementation of new health care service initiatives that encourage practices consistent with DSRIP and VBP objectives.
· Assist in developing reimbursement rates for providers/health plans.
· Prepare narrative reports and draft correspondence concerning health regulatory/surveillance systems and policies surrounding the provision of health care services.
· Collect, analyze, and summarize process and outcome data for descriptive and inferential statistical purposes. Data can be numerical (discrete or continuous), categorical or ordinal, and may encompass areas such as financial, encounter, consumer, provider or demographical information and associated metrics, including those detailing process and outcome efficiency and effectiveness related to MRT, DSRIP and VBP initiatives and their commensurate financial impacts and savings.
· Report on the progress of programs, service needs met or unmet, number of cases, applications, complaints, incidents, etc. to supervisors and other managers.
MEDICAID REDESIGN ANALYST 2
May perform the same duties and functions as a Medicaid Redesign Analyst 1, but more independently, and may supervise professional, paraprofessional, and office support staff in the administration of program activities. In addition, duties may include:
· Provide programmatic and project coordination oversight either directly or through contractual services.
· Develop regulations resulting from legislative or administrative actions that require new or modified regulations for program development, implementation, or monitoring.
· Conduct research and develop policy options and recommendations for the provision of health care services including managed care products to encourage practices consistent with DSRIP and VBP objectives and metrics.
· Prepare, analyze, and interpret data from a range of sources in support of OHIPs efforts with DSRIP and VBP reform initiatives and other efforts to improve program management and evaluation.
· Make recommendations for health care reform that align NYS efforts with the goals of the U.S. Department of Health and Human Services on value based purchasing and alternative payment models.
· Develop standards, processes, and protocols to develop and improve procedures.
· Administer health care surveillance/regulatory systems and health care service delivery programs.
· Develop financial data analytics models and reimbursement rates for providers and health plans.
· Conduct health care surveillance and implement corrective actions to enhance the quality of health care. Surveillance activities document the impact of program, track progress towards specified goals, and monitor and clarify the nature of public health insurance issues to allow priorities to be set and to inform health care policy and strategies.
· Participate in best practice, program oversight, and/or certification visits to providers and health plans.
· Recommend policies and procedures regarding the licensure and certification of providers.
· Manage complaint and reporting processes.
· Develop, implement and administer the ongoing operation of health care programs, projects, health insurance, or other initiatives related to DSRIP and VBP.
· Assist in developing and implementing new health care initiatives including those carried out through memoranda of understanding and letters of agreement with other State and local agencies to advance programmatic goals.
· Participate in the design and management of health care and health insurance programs related to DSRIP and VBP.
· Act as liaison with other units in the Department and external entities on issues related to MR implementation, DSRIP, and VBP reforms.
· Draft reports, correspondence, and other documents related to the program functions impacted by DSRIP and VBP.
· Determine and oversee staff assignments.
MEDICAID REDESIGN ANALYST 3
May perform the same duties and functions as a Medicaid Redesign Analyst 2, and supervises units headed by professional staff and oversees other staff engaged in programmatic activities. Duties may include:
· Manage and direct program activities by setting priorities and deadlines.
· Manage development, change processes, projects, or specific emergent issues on health care initiatives impacted by the implementation of DSRIP and VBP initiatives.
· Provide policy direction on legislative, regulatory, and monitoring activities affecting Department programs to encourage practices consistent with DSRIP and VBP objectives.
· Coordinate DSRIP and VPB activities with those of other programs, bureaus, divisions, and agencies.
· Research federal initiatives, analyze impact on State programs related to DSRIP and VBP, and develop recommendations.
· Manage financial data analytics activities and staff in connection with financial rate setting.
· Prepare, analyze, and interpret data from a range of sources in support of OHIPs efforts with DSRIP and VBP initiatives and other efforts to improve program management and evaluation.
· Ensure compliance with program policies and regulations.
· Supervise staff in the development of health policy and implementation of new health care and health initiatives; including service programs, health insurance, surveillance systems, and new health care initiatives.
· Assist in developing, planning, and implementing new or refined systems that address the health care delivery system in the State.
· Collaborate with legal staff, State and federal control agencies, and local entities in developing legislative reforms.
MEDICAID REDESIGN ANALYST 4
May perform the same duties and functions as a Medicaid Redesign Analyst 3. In addition duties may include:
· Oversee a bureau or program by guiding the development, modification, and implementation of existing or new health care programs impacted by DSRIP and VBP.
· Provide policy interpretation and ensure uniform implementation of policy impacting MR, DSRIP, and VBP related issues.
· Develop and implement standards for program evaluation and strategies for DSRIP and VBP initiatives and other efforts to improve program management and evaluation.
· Serve as program expert in meetings, interdisciplinary teams, work groups, and in conferences related to MR implementation, DSRIP, or VBP issues.
· Assist in the evaluation of health care related legislation and programs.
· Develop and coordinate a variety of policy, regulations, projects, and procedures to facilitate program implementation and operations supporting practices consistent with DSRIP and VBP objectives.
· Administer and direct Medicaid and other public health care services programs and project activities.
· Respond to critical and high-profile DSRIP and VBP-related issues and requests for information.
· Collaborate with other units, programs, agencies, providers, health plans, and advocacy groups to develop, implement, design or redesign service or insurance programs.
· Participate in and collaborate with various inter-agency and intra-agency work groups.
· Serve a leadership role in the development of finance related policies and oversight of activities.
· Oversee staff data analysis activities to support objectives/goals.
· Assume leadership responsibilities in the absence of higher level management.
· Coordinate the resources of the bureau in support of specified objectives related to MR implementation, DSRIP, and VBP.
· Oversee staff to ensure effective response to the established priorities related to MR implementation, DSRIP, and VBP.
· Participate in public speaking activities, educational workshops/seminars, dialogue groups, and inter- and intra-agency workgroups.
MEDICAID REDESIGN ANALYST 1
Open Competitive: six years of specialized professional experience working for an organization whose primary function is one or more of the following: oversight of or provision of health care services; analysis of the provision of health care services; health care financing or data analysis; health care quality assurance and/or interpretation; and/or application of standards of health care.
MEDICAID REDESIGN ANALYST 2
Open Competitive: seven years of the specialized professional experience required for Medicaid Analyst 1.
Promotion: one year of service as a Medicaid Redesign Analyst 1.
MEDICAID REDESIGN ANALYST 3
Open Competitive: nine years of the specialized professional experience required for Medicaid Analyst 1. Two years of the experience must have been at a supervisory level.
Promotion: one year of service as a Medicaid Redesign Analyst 2.
MEDICAID REDESIGN ANALYST 4
Open Competitive: ten years of the specialized professional experience required for Medicaid Analyst 1. Three years of the experience must have been at a supervisory level, or one year of the experience must have been at a managerial level.
Promotion: one year of service as a Medicaid Redesign Analyst 3.
Substitutions: At each level, an associates degree may be substituted for two years of the required experience; a bachelors degree may be substituted for four years of the required experience; and a masters degree may substitute for an additional year of required experience. Education may not substitute for requirements of supervisory or managerial experience.
NOTE: Classification Standards illustrate the nature, extent, and scope of duties and responsibilities of the classes they describe. Standards cannot and do not include all of the work that might be appropriately performed by a class. The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written. Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.