Job Information
HEALTH AND HUMAN SERVICES COMMISSION Physician II in Austin, Texas
Job/Position DescriptionPhysician II - Medical Director for Waiver EligibilityThe Medical Director for Waiver Eligibility for the Medicaid and CHIP Services Department (MCS) serves as a senior-level clinical staff in the Office of the Medical Director (OMD) that is focused on eligibility determinations for certain Medicaid waiver programs. MCS is driven by its mission to deliver quality, cost-effective services to Texans. OMD provides clinical consultation and guidance to other areas within MCS, throughout the Agency, and to external stakeholder organizations. It works to provide a clinical vision for improving the health of Texans by aligning MCS programs with state public health priorities. OMD also leads the utilization review team of MCS which is charged with ensuring that individuals receive medically necessary, cost-effective services.This position reports to the Senior Associate Medical Director for MCS. The work involved is highly advanced (senior-level) clinical, consultative, and managerial work. Work includes review of clinical assessments completed by the staff of Medicaid managed care organizations (MCOs) for determination of waiver eligibility. Work also includes integrating knowledge of the Medicaid/CHIP programs with up-to-date healthcare practices and evidence-based clinical guidelines. This position may plan, assign, and/or supervise the work of others to include clinical/professional-level staff. Work also involves consultation with HHSC staff within MCS, but also across areas to include other HHSC areas as well as the Texas Department of State Health Services (DSHS). Work may also include directing clinically related training and the provision of technical assistance to HHSC staff and stakeholders as well as provide clinical guidance and interpretation of HHSC policy. The position interfaces with a variety of stakeholders and stakeholder organizations to include providers, advocates, Advisory Committees, legislators, and other policymakers. This position frequently interfaces with medical directors from other state agencies (e.g., Department of State Health Services), vendors, and Medicaid Managed Care Organizations (MCOs). This position works under minimal supervision with extensive latitude for the use of initiative and independent judgment. This critical work helps to shape policies and the delivery of comprehensive healthcare to children and adults served by HHSC. This position may serve as Acting Chief Medical Director for MCS when the Chief Medical Director and/or the Senior Associate Medical Director are unavailable.The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy.Essential Job Functions60% Performs review of assessments and associated documentation for determination of waiver eligibility. Interprets complex state and federal laws, regulations, and rules related to the program. Guides staff in the interpretation of medical policy. Provides day to day clinical guidance, support and leadership for review activities and decisions. Advises nurses and leaders in the clinical decision-making activities.20% Represents unit at fair hearings and administrative reviews as needed. Reviews documentation generated internally and submitted from external sources as part of the proceedings. https://jobshrportal.hhsc.state.tx.us/ENG/CareerPortal/job_profile.cfm?szOrderID=597762 Copy the URL in the preceding sentence to an Internet Explorer browser to apply to the job directly through the Texas Health and Human Services Career Portal.