68019357 - AGENCY FOR HEALTH CARE ADMINISTRATOR-SES

Agency For Health Care Administrator-Ses

The Agency for Health Care Administration (AHCA) is Florida's chief health policy and planning entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities, and empowering consumers through health care transparency initiatives. Under the direction of the Agency Secretary, AHCA is focused on advancing Governor DeSantis' vision for Florida's health care system to be the most cost-effective, transparent, and high-quality health care system in the nation. The Medicaid program provides low-income families and individuals with access to health care. If you have a desire to use your talent and skills at an organization that provides critical services to millions of individuals and families across the state, AHCA invites you to apply to become an essential member of our team. As one of Florida's leading state agencies, AHCA's diverse workforce community of more than 1,400 employees is proud of its efforts to serve the people of Florida.

This is an exciting opportunity to help shape the quality of health care in Florida. We are seeking to hire an AHC Administrator - SES who desires to work to enhance the delivery of health care services through the Florida Medicaid Program. This position requires a candidate who is creative, flexible, innovative, and who will thrive in a fast-paced, team based work environment. This position is located in the Bureau of Medicaid Policy. Medicaid Policy is responsible for the development, coordination, and implementation of Florida Medicaid program policies, including : all Medicaid federal authorities (e.g. the Florida State Plan, 1115 waivers and home and community based waivers), administrative rules, coverage policies, managed care plan contracts, bill analyses, drug utilization review boards, preferred drug lists, supplemental rebate contracts, and KidCare / Title 21. This position is responsible for leading and overseeing the Pharmacy Policy Section.

This position includes, but is not limited to, coordinating activities that include planning, directing, coordinating and implementing policy and program development functions for the Pharmacy Policy Section including overseeing policy regarding pharmacy services and the Florida Medicaid preferred drug list. Responsibilities for this position include but are not limited to : coordinating work and supervising employees; maintaining up-to-date knowledge concerning the Florida Medicaid program, including pertinent Federal laws and regulations, state statutes and rules, the Florida Medicaid State Plan and its amendment processes, Medicaid Managed Care Waivers and Medicaid program manuals; leading, developing, coordinating, and / or executing strategic planning activities for Medicaid Pharmacy Policy and the Florida Medicaid Preferred Drug list in order to assist in implementing goals, objectives and priorities of the Medicaid program; planning, developing, and implementing policies and procedures related to Medicaid Pharmacy Policy and the Florida Medicaid Preferred Drug list, including handbook, rule and state plan amendment updates and changes; acting as the liaison between the Bureau of Fiscal Agent Operations to ensure that the claims processing system has the correct edits and audits in order to adjudicate claims correctly; assisting with the development of performance measures for the SMMC waivers, recommending program design modifications with regards to the SMMC program, policy language for the SMMC contracts and amendments, Dear Health Plan letters, policy transmittals, provider alerts, SMMC report guide; assisting in coordinating clinical and claim system changes with the pharmacy benefit manager, including approval of coding changes for preferred / non-preferred products; updates to claim edits; and system generated prior authorization criteria, based upon clinical practice guidelines and Food Drug Administration (FDA) indications; managing the Pharmaceutical and Therapeutics Committee (P&T) and the Drug Utilization Review (DUR) panel, including acquiring knowledge of specific products that will be presented to the P&T and DUR boards, and Assisting and attending the quarterly P&T and DUR board committee meetings, in addition to monitoring and assisting with administration of the federal and state supplemental rebate program; ensuring 340B providers are labeled as such in the pharmacy system and sustaining an audit processes with respect to 340B pharmacy providers; planning, organization, execution and coordination of program training and provision of technical assistance relating to Medicaid Pharmacy Policy and the Florida Medicaid Preferred Drug list, to ensure consistency in program operation and conformity with goals and objectives of the Agency and state and federal laws, rules, regulations and guidelines; directing the appropriate planning, organization, execution and coordination of program evaluation activities to evaluate the efficiency and effectiveness of Medicaid Pharmacy Policy and the Florida Medicaid Preferred Drug list, and assess the achievement of goals, objectives and priorities of the Medicaid program related to the Medicaid program; representing the Agency in local, state or national meetings, conferences, workshops and seminars related Medicaid Pharmacy Policy and the Florida Medicaid Preferred Drug list; this position is not a remote or telework position. A good attendance record is essential for any individual in this position as the work involved occurs daily and is time sensitive. The individual in this position is expected to report to work daily and on time.

Working for the State of Florida is more than a paycheck. The State's total compensation package for employees features a highly competitive set of employee benefits including : State Group Insurance Coverage Options, including health, life, dental, vision, and other supplemental insurance options; Flexible Spending Accounts; State of Florida retirement options, including employer contributions; Generous annual and sick leave benefits; 9 paid holidays a year and 1 Personal Holiday each year; Career advancement opportunities; Tuition waiver for courses offered by Florida's nationally ranked State University System; Training and professional development opportunities; And more!