New York State Department of Health · 2 days ago
Eligibility Program Manager 1 (NY HELPS) - 79006
Albany, NY
Full-time
Hybrid
Senior Level, Lead/Staff
$107K/yr - $132K/yr
8+ years expThe New York State Department of Health is responsible for health policy and programs in New York. They are seeking an Eligibility Program Manager 1 to oversee Medicaid Program eligibility policy and manage subordinate staff within the Bureau of Long-Term Care and SSI-Related Populations.
Health Care
No H1B
Responsibilities
Coordinate, manage and oversee a sub-unit of subordinate staff responsible for the development and implementation of program policies, procedures, and guidelines for the determination of Medicaid eligibility for specific populations
Assist in development and approval of policies, procedures and guidelines for statewide administration of current and newly identified Medicaid eligibility initiatives related to Medicaid eligibility rules for the aged, blind and disabled
Oversee the development of projects required to implement cost saving and other key initiatives; assist with state centralization of Medicaid eligibility determinations for the aged, blind and disabled Medicaid population; and provide policy guidance needed for improvements and updates of electronic Medicaid eligibility systems
Direct staff in responding to various intra- and inter-agency emails, correspondence and phone calls from department colleagues, local social services districts, stakeholders, oversight agencies, federal staff and members of the Legislature
Provide policy guidance expertise needed to assist system staff in the development and ongoing maintenance of applicable automated Medicaid eligibility systems
Participate in meetings with various stakeholders and Commissioners of Local Social Services Districts on new eligibility policies to provide guidance, ensure input and address concerns, as appropriate
Provide programmatic policy guidance, requirements and oversight to ensure adherence to federal and State regulations and requirements; interpret federal and State laws, rules and regulations to develop policy directives, analyses and other materials
Review litigation and assist legal staff in handling of litigation as it relates to areas of Medicaid eligibility responsibility
Coordinate response to various audits in areas of Medicaid eligibility responsibility, including overseeing assessment of local social services district actions subject to audit
Serve as a liaison with other Divisions and executive level staff on special projects as needed
Qualification
Required
Current NYS Department of Health employee with permanent or contingent permanent status as an Eligibility Program Manager 1, G-27
New York State employee with one or more years of permanent or contingent-permanent service in title at Grade 25 or above, and eligible for transfer to Eligibility Program Manager 1, G-27, under section 70.1 or 52.6 of the Civil Service Law
Eight years of professional experience, two years of which must have included second-level supervision of staff, performing one or more of the following seven activities in a program with one or more of the following functions: provides reimbursements for health care services; works with social services program areas; determines eligibility for a consumer assisted program in a hospital or other health care facility; provides health care regulatory oversight; or performs quality assurance and interpretation/application of standards of health care
Overseeing and directing staff in determining eligibility for a health insurance program or consumer assisted program in which financial eligibility criteria must be met
Overseeing and directing staff in performing utilization review, including prepayment or post-payment review of requested health care services, prior approval or authorization activities, adjudication or pricing of claims for payment, or analysis of patterns of health care
Overseeing and directing staff in developing mechanisms for the reimbursement and financing of health care services, including rate-setting or approval, capitation reimbursement methodologies, fee schedule development, coding constructs for medical goods and services, or application and processing of reimbursement methodologies
Administering and overseeing staff responsible for day-to-day program operations for budgeting, staffing, or program planning
Overseeing and directing staff in inspecting, assessing, or monitoring health insurance programs or health care facilities for certification, licensure, or adherence to laws, rules, regulations, and policies
Overseeing and directing staff in planning, designing, developing, researching, or evaluating proposals to establish or refine health related programs, with responsibility for interpreting legislation or regulations, defining and describing target populations and local demographics, grant and proposal writing, or developing, reviewing, and evaluating contracts
Administering and overseeing staff responsible for performing quality assurance activities such as ensuring compliance with laws, rules, regulations, and policies, as it pertains to activities 1 through 6
A Bachelor's Degree can substitute for four years of experience; a Master's Degree can substitute for five years of experience
Preferred
Experience in New York Medicaid program eligibility and enrollment policies and operations and with related data systems such as eMedNY, NY State of Health and WMS
Experience developing and/or interpreting policies, procedures, statutes and regulations
Work well both independently and as part of a team and under pressure to meet deadlines
Possess excellent oral and written communication skills and excellent organizational and interpersonal skills
Have strong research and analytical skills
Experience supervising staff and determining priorities
Benefits
Holiday & Paid Time Off
Public Service Loan Forgiveness (PSLF)
Pension from New York State Employees’ Retirement System
Shift & Geographic pay differentials
Affordable Health Care options
Family dental and vision benefits at no additional cost
NYS Deferred Compensation plan
Access to NY 529 and NY ABLE College Savings Programs, and U.S. Savings Bonds
And many more...
Company
New York State Department of Health
To protect, improve and promote the health, productivity and well-being of all New Yorkers.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Amy Gildemeister
Associate Director of Nutrition Policy and Partnership
Lindsay Redmond
Administrative Assistant to Medicaid CFO
Recent News
Central New York Business Journal
2025-12-06
Central New York Business Journal
2025-09-26
Morningstar.com
2025-08-26
Company data provided by crunchbase