Job ID: 28295
Agency: Department of Social Services, Division of Medical Services
Location: Sioux Falls or Pierre
Salary: Depending on Experience
Pay Grade: GK
Closing Date: 10.16.24
This is a Full-Time position with the Department of Social Services. For more information on the Department of Social Services, please visit dss.sd.gov.
The South Dakota Department of Social Services, Division of Medical Services, also known as South Dakota Medicaid, plays a vital role in the healthcare of South Dakotans. The program is one of the largest healthcare insurers in South Dakota, covering approximately 138,000 individuals. South Dakota Medicaid provides health coverage for children, adults, pregnant women, seniors in nursing homes, and individuals with physical or developmental disabilities. Individuals generally qualify for Medicaid on the basis of income or a combination of income and available resources.
South Dakota Medicaid is seeking a highly motivated individual to lead our Care Management Programs. Medicaid has three care management programs: the Primary Care Provider program, the Health Home program, and the Pregnancy program for pregnant women. Most Medicaid recipients participate in one of the three programs. The programs contract with medical providers and clinics for the provider/clinic to provide a medical home for individuals for their primary care. Broad goals of the programs include helping reduce unnecessary healthcare expenditures through care coordination, improving quality of care, and helping recipients achieve better health outcomes.
The position directly administers the Health Home program and manages the staff administering the Primary Care Provider program and Pregnancy Program.
Primary duties of the position include:
- Administering the Health Home care management program, focusing on improving outcomes for individuals with chronic conditions. Tasks associated with this include recruiting providers, providing education and support to providers, overseeing annual quality incentive payments to providers, and working with a vendor to calculate annual program cost savings.
- Identifying strategic care management program improvements related to quality, efficiency, effectiveness, or cost savings.
- Overseeing implementation of care management program changes.
- Providing subject matter expertise regarding care management system programming changes.
- Managing care management team members and ensuring they and the programs they oversee are successful.
- Monitoring care management program performance and completing internal and external reports regarding the programs.
- Communicating with key stakeholders regarding the programs, including coordinating advisory groups and listening sessions with participating providers.
Key priorities for the position will include modernizing the Primary Care Provider program, enhancing the focus of the care management programs on value and quality, and overseeing the continued implementation of the Pregnancy Program that was newly implemented in 2024.
Licenses and Certifications:
Prefer a Bachelor’s or Master’s degree in health care administration, business, health information management, public health, or a similar degree and 3 or more years of experience in Medicaid, health care, health care administration, or a related field.
The Ideal Candidate Will Have:
- Experience managing care management programs or health-related programs that have achieved meaningful results.
- Experience with health care quality metrics and alternative payment methodologies associated with quality.
- Strong leadership skills and experience, including both interpersonal skills, team management, and project management.
- A demonstrated history of a high level of individual and team achievement.
- Strong logical reasoning, critical thinking, and problem-solving skills.
- Experience successfully developing collaborative working relationships with a broad variety of internal and external stakeholders.
- Dedication to helping and serving others.
Knowledge, Skills, and Abilities:
- Ability to help develop the strategic roadmap for the care management programs, develop goals, and develop associated action items to achieve the goals.
- Ability to lead change efforts, including evaluating options, developing cost/benefit analyses, obtaining stakeholder input, and making recommendations.
- Ability to plan, organize, direct, and manage the work of program staff.
- Ability to establish and maintain effective working relationships with key stakeholders.
- Ability to communicate information clearly and effectively, including conducting presentations, facilitating stakeholder discussions, and drafting written communications.
- Knowledge and skill to proficiently use the Microsoft Office suite.
Additional Requirements: To be considered, please attach your resume.
This position is exempt from the Civil Service Act. This position is eligible for Veterans' Preference per ARSD 55:10:02:08.
The State of South Dakota does not sponsor work visas for new or existing employees. All persons hired will be required to verify identity and eligibility to work in the United States and complete an Employment Eligibility Verification, Form I-9. The State of South Dakota as an employer will be using E-Verify to complete employment eligibility verification upon hire.
The State of South Dakota offers a $0 premium employee health insurance option plus eleven paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information at
bhr.sd.gov.
Must apply online:
Apply Here. You must apply online; emailed resumes or submissions will not be accepted.
South Dakota Bureau of Human Resources
Telephone: 605.773.3148
Email: careers@state.sd.us
Work for Us'An Equal Opportunity Employer'
#J-18808-Ljbffr
