Duty Statement
|duty statement |
|Class Title |Position Number |
|Staff Services Manager III |805-200-4802-005 |
|COI Classification | |
|Yes |No |
|Unit |
|Section |
|Branch |
|Clinical Program Integrity Branch Chief |
|Division |
|Clinical Assurance Division, Assistant Division Chief |
|This position requires the incumbent to maintain consistent and regular attendance; communicate effectively, both orally and in writing as appropriate, in dealing |
|with the public and/or other employees; develop and maintain knowledge and skill related to specific tasks, methodologies, materials, tools, and equipment; complete |
|assignments in a timely and efficient manner; and, adhere to departmental policies and procedures regarding attendance, leave, and conduct. |
|Job Summary: This Staff Services Manager III (SSM III) position serves a dual role within the Clinical Assurance Division (CAD), as the Assistant Division Chief |
|(Assistant DC) and as the Clinical Program Integrity Branch (CPIB) Chief. In the role of Assistant DC, the SSM III is responsible for assisting the Division Chief in |
|carrying out CAD’s mission to provide quality clinical oversight that results in appropriate and cost effective care for Medi-Cal members. This includes assisting to |
|manage the entire Treatment Authorization Request (TAR) process, including TAR submission and adjudication, and developing the specific policies necessary for |
|consistent adjudication, statewide, as well as post-payment reviews. |
| |
|As the CPIB Chief, the SSM III will direct efforts to ensure that services provided to fee-for-service Medi-Cal members are medically necessary. The CPIB Chief |
|provides guidance and leadership related to program oversight and integrity to management and clinical staff within multiple Divisions across DHCS. |
|Supervision Received: General direction is provided by the CAD Chief, a Career Executive Assignment, Level B. |
|Supervision Exercised: Manages a Branch of multi-disciplinary staff of approximately 30 state staff positions, largely comprised of licensed professional clinical |
|staff. In the absence of the Division Chief, is responsible for managing all Branches within the Division. |
|Description of Duties: See below. |
| |
| |
|Percent of Time Essential Functions |
| |
|30% Serve as the Assistant Division Chief (Assistant DC), to assist the CAD Chief, with the development, implementation, and evaluation of methods utilized to manage |
|and control costs for medical and benefits based on utilization, including policies that address the processing of TARs to ensure consistent application in all field |
|offices. Including but not limited to: development of a systematic data collection, analysis, and monitoring method to identify discrepancies and inconsistencies in |
|TAR adjudication and implements training and other corrective strategies. Establish priorities and procedures for the compliance review and monitoring processes that |
|are designed to provide a thorough assessment of TARs and assists in developing policies that fully coordinate with other State departments; ensure identification and |
|appropriate implementation of state and federal policies which maximize effectiveness and the prudent expenditure of funds. |
| |
| |
| |
|30% Direct CAD’s CPIB to ensure that services provided to Medi-Cal members are medically necessary. Oversee analyses of patient |
|medical records, Designated Public Hospital TAR-free processes, hospital Diagnostic Related Group (DRG) coding practices, and provider claims to verify that |
|fee-for-service payments to providers match patients’ diagnoses and treatment. Consult and coordinate with other DHCS Divisions such as Safety Net Financing Division |
|and Audits and Investigations to provide program oversight, ensure program integrity, reduce inflated provider claims, and help decrease fraud. Supervises and directs|
|staff in the development, implementation, analysis and evaluation of medical utilization management and clinical assurance policies and procedures. Recommend |
|development, analysis and implementation of utilization standards, payment mechanisms, rules, regulations, and quality controls for covered medical services. |
| |
|15% Coordinate the activities and administrative needs of CAD with other departmental division chiefs; participate in the annual budgeting process, oversee the |
|development of budget change concepts and proposals, including presentations to various groups and the budget committees; provide general direction to branch managers;|
|review personnel needs; and evaluate managerial and supervisory staff performance. As needed, may represent the CAD Chief in meetings with DHCS executive staff, |
|high-level federal and state officials, committees, advocacy groups, and high-level officials of other state departments to build consensus and to discuss and |
|formulate State policies and implementation strategies; participate in sensitive negotiations to resolve differences in program interpretation and application of said |
|information. |
| |
|10% Consult, establish, and maintain liaison and cooperative relationships with the medical professionals, including statewide professional and provider |
|organizations, allied health groups, and other public/private agencies engaged in health and medical services. May represent DHCS before peer groups, other provider |
|groups, and community organizations to advise them on the medical aspects of the Medi-Cal program. May require occasional travel. |
| |
| Percent of Time Marginal Functions |
| |
|5% Recruitment, hiring, training, and evaluation of subordinate staff. Perform other related duties that are within the scope of this classification as required. |
| |
1
|Employee’s signature |Date |
|Supervisor’s signature |Date |
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