New York State Department of Health
OHIP Chief Medical Officer (Public Health Physician 3)- 88004
The Public Health Physician 3 will serve as the Director of the Division of Medical and Dental Director, managing a division of over 60 staff members. The role involves overseeing medical director reviews, leading stakeholder engagement, supporting healthcare transformation initiatives, reviewing claims, and providing medical and dental policy direction across Medicaid programs.
Key Responsibilities
- • Management of a division consisting of over 60 staff members, including Medical Directors, Dental Directors, and program staff
- • Overseeing medical director reviews of prior approval requests and denials related to durable medical equipment, medical supplies, private duty nursing, and hearing aids
- • Leading divisional stakeholder engagement activities, promoting health equity policies, supporting healthcare transformation initiatives, and advancing service delivery reforms
- • Reviewing pended claims and recommending payment or denial
- • Reviewing requests for enhanced reimbursement for Out-of-State Hospital services
- • Participating in the review of Out-of-State Skilled Nursing Facility placements
- • Supporting cross division program management and policy development for complex populations and other medical programs managed by the Office of Health Insurance Programs
- • Actively participating in various committees including the Drug Utilization Review Board, Provider Enrollment Appeals Committee, Evidence-Based Benefit Review Advisory Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, Medical Coding Review and Coverage Decisions Committee
- • Providing medical and dental policy direction across all aspects of Medicaid, including managed care, fee-for-service, and waiver programs
Required
- • Current license and registration to practice medicine in New York State
- • Board-eligible or board-certified in a medical specialty
- • Either a master’s degree in public health or two years of experience in a public health program
Preferred
- • Direct experience in Medicaid or Managed Care, including managed long-term care, primary care, and geriatric care
- • Demonstrated commitment to promoting health equity and addressing social determinants of health
- • Familiarity with relevant regulations, policies, and procedures related to Medicaid programs and healthcare reimbursement
- • Strong problem-solving skills, with the ability to navigate complex situations related to medical or dental policy, stakeholder engagement, or service delivery reforms within the Medicaid program
- • Experience in participating on multiple committees and ensuring that contributions are valuable and impactful in a fast-paced, dynamic environment
- • Demonstrated ability to engage with stakeholders, advocate for health equity policies, and lead initiatives promoting service delivery reforms within the healthcare industry
- • Expertise in medical and dental policy direction across various aspects of Medicaid programs, including managed care, fee-for-service, and waiver programs
Benefits & Perks
- • 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
Description
Duties Description
The Public Health Physician 3 will function as the Director of the Division of Medical and Dental Director, reporting directly to the Medicaid Director. The duties for this position include, but are not be limited to: Management of a division consisting of over 60 staff members, including Medical Directors, Dental Directors, and program staff; Overseeing medical director reviews of prior approval requests and denials related to durable medical equipment, medical supplies, private duty nursing, and hearing aids; Leading divisional stakeholder engagement activities, promoting health equity policies, supporting healthcare transformation initiatives, and advancing service delivery reforms; Reviewing pended claims and recommending payment or denial, as well as review requests for enhanced reimbursement for Out-of-State Hospital services and participating in the review of Out-of-State Skilled Nursing Facility placements; Supporting cross division program management and policy development for complex populations and other medical programs managed by the Office of Health Insurance Programs; Actively participating in various committees, including the Drug Utilization Review Board, Provider Enrollment Appeals Committee, Evidence-Based Benefit Review Advisory Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, Medical Coding Review and Coverage Decisions Committee, among others; Providing medical and dental policy direction across all aspects of Medicaid, including managed care, fee-for-service, and waiver programs.
Qualifications
Minimum Qualifications
Current license and registration to practice medicine in New York State, AND board-eligible or board-certified in a medical specialty AND either a master’s degree in public health or two years of experience in a public health program.
Preferred Qualifications: Direct experience in Medicaid or Managed Care, including managed long-term care, primary care, and geriatric care. Demonstrated commitment to promoting health equity and addressing social determinants of health; Familiarity with relevant regulations, policies, and procedures related to Medicaid programs and healthcare reimbursement; Strong problem-solving skills, with the ability to navigate complex situations related to medical or dental policy, stakeholder engagement, or service delivery reforms within the Medicaid program; Experience in participating on multiple committees and ensuring that contributions are valuable and impactful in a fast-paced, dynamic environment. Demonstrated ability to engage with stakeholders, advocate for health equity policies, and lead initiatives promoting service delivery reforms within the healthcare industry; Expertise in medical and dental policy direction across various aspects of Medicaid programs, including managed care, fee-for-service, and waiver programs.
Additional Comments
This position may require travel throughout New York State including overnights to areas not served by public transportation.
We offer a work-life balance and a generous benefits package, worth 65% of salary, including:
If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.reasonable.accommodation@health.ny.gov to make a request.
NYS Department of Health does not participate in E-Verify and does not sponsor visa applications.
For new State employees appointed to graded positions, the annual salary is the hiring rate (beginning of the Salary Range) of the position. Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations and negotiated union contracts.
Duties Description
The Public Health Physician 3 will function as the Director of the Division of Medical and Dental Director, reporting directly to the Medicaid Director. The duties for this position include, but are not be limited to: Management of a division consisting of over 60 staff members, including Medical Directors, Dental Directors, and program staff; Overseeing medical director reviews of prior approval requests and denials related to durable medical equipment, medical supplies, private duty nursing, and hearing aids; Leading divisional stakeholder engagement activities, promoting health equity policies, supporting healthcare transformation initiatives, and advancing service delivery reforms; Reviewing pended claims and recommending payment or denial, as well as review requests for enhanced reimbursement for Out-of-State Hospital services and participating in the review of Out-of-State Skilled Nursing Facility placements; Supporting cross division program management and policy development for complex populations and other medical programs managed by the Office of Health Insurance Programs; Actively participating in various committees, including the Drug Utilization Review Board, Provider Enrollment Appeals Committee, Evidence-Based Benefit Review Advisory Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, Medical Coding Review and Coverage Decisions Committee, among others; Providing medical and dental policy direction across all aspects of Medicaid, including managed care, fee-for-service, and waiver programs.
Qualifications
Minimum Qualifications
Current license and registration to practice medicine in New York State, AND board-eligible or board-certified in a medical specialty AND either a master’s degree in public health or two years of experience in a public health program.
Preferred Qualifications: Direct experience in Medicaid or Managed Care, including managed long-term care, primary care, and geriatric care. Demonstrated commitment to promoting health equity and addressing social determinants of health; Familiarity with relevant regulations, policies, and procedures related to Medicaid programs and healthcare reimbursement; Strong problem-solving skills, with the ability to navigate complex situations related to medical or dental policy, stakeholder engagement, or service delivery reforms within the Medicaid program; Experience in participating on multiple committees and ensuring that contributions are valuable and impactful in a fast-paced, dynamic environment. Demonstrated ability to engage with stakeholders, advocate for health equity policies, and lead initiatives promoting service delivery reforms within the healthcare industry; Expertise in medical and dental policy direction across various aspects of Medicaid programs, including managed care, fee-for-service, and waiver programs.
Additional Comments
This position may require travel throughout New York State including overnights to areas not served by public transportation.
We offer a work-life balance and a generous benefits package, worth 65% of salary, including:
- 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...
If you require reasonable accommodation to complete a job application, a job interview or to otherwise participate in the hiring process, please contact by phone 518-486-1812 or email doh.sm.reasonable.accommodation@health.ny.gov to make a request.
NYS Department of Health does not participate in E-Verify and does not sponsor visa applications.
For new State employees appointed to graded positions, the annual salary is the hiring rate (beginning of the Salary Range) of the position. Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations and negotiated union contracts.
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