The position reports to the Health Care Agency Deputy Director and is responsible for all regulatory compliance for Ventura County Health Care Plan (VCHCP) and Knox Keene licensed HMO. Further, this position is responsible for the following: Department of Managed Health Care (DMHC) and Centers for Medicaid Services (CMS) reporting requirements, audits of delegates, internal audits, thorough research of new and existing law as relates to VCHCP's licensor, and coordination of all regulatory required surveys. In addition, this position is responsible for the Brown Act compliance, Fraud and Abuse training and compliance and Cultural Linguistics training and compliance and will act as the DMHC and CMS liaison.
EDUCATIONAL/BILINGUAL INCENTIVE: Incumbents may be eligible for an educational incentive of 2.5%, 3.5%, or 5% based on completion of an Associate's, Bachelor's, or Master's degree that is not required for the classification. Incumbents may also be eligible for bilingual incentive depending upon operational need and certification of skill.
Program Administrator III
The Program Administrator III is a management classification and is not eligible for overtime compensation. Incumbents in this classification are eligible for benefits at the MB4 level.
The eligible list established from this recruitment may be used to fill current and future Regular (including Temporary, Fixed-Term) for this position or similar positions only. There is currently one (1) Regular vacancy within the Ventura County Health Care Plan.
OPENING DATE: January 18, 2023
CLOSING DATE: February 01, 2023
Examples Of Duties
Duties may include, but are not limited to the following:
Plans, organizes, coordinates, and directs the activities of regulatory compliance with Department of Managed Health Care (DMHC) regulatory and operational requirements;
Responds to DMHC all plan letters (APLs) and all DMHC inquiries and responsible for more than 45 cyclical DMHC filings required for licensor;
Coordinates all regulatory required ongoing and annual updates to operational policies and procedures;
Confers with other managers on policy matters and work problems; interprets laws, policies and procedures and explains their application within the context of the assigned program field;
Designs operational systems and ensures conformance in daily operation; designs tools and implements methods to monitor program performance;
Represents the County in contacts with other governmental or community agencies and/or the public;
Prepares required reports; compiles and analyzes narrative operational information and statistical data to improve operations, identifies program needs and/or change service delivery methods;
Monitors operational processes and procedures to ensure compliance with all legal and ethical standards;
Coordinates all DMHC audits including Medical Surveys, financial and regulatory compliance, Behavioral Health and more;
Oversees the regulatory required training specific to VCHCP including Cultural Linguistics, Fraud and Abuse training;
Investigates DMHC Technical Assistant Guides (TAGs) as they relate to audits and compliance and performs HIPAA breach investigations;
Manages the bi-annual Fraud and Abuse meetings/reporting;
Responsible for Standing Committee membership renewals in compliance with the Brown Act Participation in DMHC round table, California Association of Health Plans (CAHP) and Healthcare Industry Collaborative Effort (HICE); and
Performs other related duties as required.
These are entrance requirements to the exam process and assure neither continuance in the process nor placement on an eligible list.
EDUCATION, TRAINING, and EXPERIENCE
Any combination of education, training and experience which has provided considerable administrative support experience demonstrating possession of the knowledge, skills and abilities.
An example of qualifying experience can also be obtained by a Bachelor's degree in a related field and two (2) years of experience with audits and regulatory compliance.
Associate's degree in a related field and four (4) years of experience with audits and regulatory compliance.
Experience preparing administrative and technical reports
Experience working in a licensed HMO in a regulatory capacity
In depth understanding of Knox Keene and Department of Managed Health Care regulatory requirements
Possession of, or ability to obtain and maintain thereafter, a valid California driver license
Excellent written communication skills must be demonstrated in the application and responses to the supplemental questions
Willing and able to work overtime as necessary
Knowledge, Skills, and Abilities:
Working knowledge of:
regulatory compliance of Department of Managed Health Care (DMHC), Knox Keene and operational requirements
internal and external audits
public relations, and personnel administration as applicable to Ventura County Health Care Plan
principal techniques and methods applicable to Cultural Linguistics, Fraud and Abuse training
DMHC Technical Assistant Guides (TAGs) and All Plan Letters (APLs)
Brown Act Participation, California Association of Health Plans (CAHP), Healthcare Industry Collaborative Effort (HICE)
analyze administrative and fiscal problems
prepare a variety of reports and recommendations
speak effectively in public, and plan, organize
interpret laws, policies and procedures
FINAL FILING DATE: Applications must be received by County of Ventura Human Resources no later than 5:00 p.m. on Wednesday, February 01, 2023.
To apply on-line, please refer to our web site at www.ventura.org/jobs. If you prefer to fill out a paper application form, please call (805) 654-5129 for application materials and submit them to County of Ventura Human Resources, 800 South Victoria Avenue, L-1970, Ventura, CA 93009.
Note to Applicants: It is essential that you complete all sections of your application and supplemental questionnaire thoroughly and accurately to demonstrate your qualifications. A resume and/or other related documents may be attached to supplement the information in your application and supplemental questionnaire; however, it/they may not be submitted in lieu of the application.
NOTE: If presently permanently employed in another "merit" or "civil service" public agency/entity in the same or substantively similar position as is advertised, and if appointed to that position by successful performance in a "merit" or "civil service" style examination, then appointment by "Lateral Transfer" may be possible. If interested, please click here (Download PDF reader) (Download PDF reader) for additional information.
SUPPLEMENTAL QUESTIONNAIRE - qualifying
All applicants are required to complete and submit the questionnaire for this examination at the time of filing. The supplemental questionnaire may be used throughout the examination process to assist in determining each applicant's qualifications and acceptability for the position. Failure to complete and submit the questionnaire may result in the application being removed from consideration.
APPLICATION EVALUATION - qualifying
All applications will be reviewed to determine whether or not the stated requirements are met. Those individuals meeting the stated requirements will be invited to continue to the next step in the examination process.
TRAINING & EXPERIENCE EVALUATION: A Training and Experience Evaluation (T&E) is a structured evaluation of the job application materials submitted by a candidate, including the written responses to the supplemental questionnaire. The T&E is NOT a determination of whether the candidate meets the stated requirements; rather, the T&E is one method for determining who are the better qualified among those who have shown that they meet the stated requirements. In a T&E, applications are either scored or rank ordered according to criteria that most closely meet the business needs of the department. Candidates are typically scored/ranked in relation to one another; consequently, when the pool of candidates is exceptionally strong, many qualified candidates may receive a score or rank which is moderate or even low resulting in them not being advanced in the process.
NOTE: The selection process will likely consist of an Oral Exam, which may be preceded by or replaced with the score from a Training and Experience Evaluation (T&E), contingent upon the size and quality of the candidate pool. In a typical T&E, your training and experience are evaluated in relation to the background, experience and factors identified for successful job performance during a job analysis. For this reason, it is recommended that your application materials clearly show your relevant background and specialized knowledge, skills, and abilities. It is also highly recommended that the supplemental questions within the application are completed with care and diligence. Responses such as "See Resume" or "Refer to Resume" are not acceptable and may disqualify an applicant from further evaluation.
ORAL EXAM – 100%: A job-related oral exam may be conducted to evaluate and compare participating applicants' knowledge, skills, and abilities in relation to those factors which job analysis has determined to be essential for successful performance of the job. Applicants must earn a score of seventy percent (70%) or higher to qualify for placement on the eligible list.
Note: If there are three (3) or fewer qualified applicants, an oral exam will not be conducted. Instead, a score of seventy percent (70%) will be assigned to each application, and each applicant will be placed on the eligible list.
Applicants successfully completing the examination process may be placed on an eligible list for a period of one (1) year.
BACKGROUND INVESTIGATION: A thorough post offer, pre-employment background investigation which may include inquiry into past employment, education, criminal background information, and driving record may be required for this position.
For further information regarding this recruitment, please, contact Liz Gonzalez by email at Liz.Gonzalez@ventura.org or by telephone at (805) 677-5153.