68064831 - MANAGEMENT REVIEW SPECIALIST - SES

Requisition No: 852479 

Agency: Agency for Health Care Administration

Working Title: 68064831 - MANAGEMENT REVIEW SPECIALIST - SES

 Pay Plan: SES

Position Number: 68064831 

Salary:  $1,794.92 Biweekly 

Posting Closing Date: 05/20/2025 

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This is a full-time Selected Exempt Service (SES) management position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5 p.m. 

This Management Review Specialist-SES is anticipated to be filled at a rate of $1,794.92 bi-weekly and is non-negotiable. 

This position may involve travel related activities from 1-25%. 

Successful completion of a criminal background investigation is a condition of employment.

The Florida Medicaid program is one of the five largest in the country with an estimated $38 billion annual budget. 

Each month Florida Medicaid covers medical services for over 5 million recipients. 

To effectively serve this large patient population, one of the Agency goals is to ensure fewer budgeted dollars are lost to fraud, abuse, and waste. 

The Bureau of Medicaid Program Integrity (MPI) does this specifically through audits and investigations of Medicaid providers, including managed care plans. 

MPI also imposes administrative sanctions for program violations and refers suspected fraud or other criminal violations to appropriate law enforcement agencies for further investigation.

MPI operates with dynamic and fast-paced units that work closely together to serve the overall bureau mission. 

MPI units are responsible for developing novel methods and innovative solutions necessary to address the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program. 

These highly collaborative units rely on teams with diverse educational and experience backgrounds.

The selected candidate will be responsible for the effective management of team members within the Operations Unit. 

This supervisor is responsible for recruiting, hiring, and evaluating the performance of program staff and OPS personnel, as well as motivating, training, planning, and directing employees’ work assignments. 

This will include communication, motivation, training and evaluating employees; planning, and coordinating the work initiatives of staff to ensure the timely and efficient performance of assigned duties.  

The selected candidate will be responsible for effectively overseeing bankruptcy notices, certified out of business notifications, potential overpayments, change of ownership, denial of payments for new admissions, record requests, litigation holds, and explanation of Medicaid Benefits letters, surplus, along with handling and delivering daily mail for the bureau, and oversees the main office telephone line.   

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. 

Benefits of Working for the State of Florida:

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!

For a more complete list of benefits, please visit https://www.mybenefits.myflorida.com/.

For more information on MPI, please visit MPI at: http://ahca.myflorida.com/MCHQ/MPI/index.shtml. 

KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge, skills and abilities, including utilization of equipment, required for the position: MPI supervisors should have knowledge pertaining to:

•Knowledge of contract and purchasing administration.

•Knowledge of basic principles of personnel administration.

•Ability to collect, evaluate, analyze, and disseminate data relating to purchasing and personnel functions.

•Ability to assess budgetary needs and formulate budget requests.

•Ability to demonstrate efficiency with software programs such as Word, Excel, PowerPoint, Outlook, SharePoint, and Vizio.

•Ability to understand and apply applicable rules, regulations, policies, and procedures relating to operational and management analysis activities.

•Ability to plan, organize and coordinate work assignments.

•Ability to establish and maintain effective working relationships with others.

•Ability to travel with or without accommodation.

MINIMUM QUALIFICATIONS REQUIREMENTS

•Two years of professional work experience managing personnel or other demonstrated leadership and personnel management capability.

•Two years’ professional work experience in a position with duties related to procurement, contract, budget, and/or personnel administration.

•Preference is given to candidates with a bachelor’s degree from an accredited college or university in one of the following disciplines: health law; health sciences; health services administration; business administration; public administration; political science/government relations; or a substantially similar discipline, such as criminology or criminal justice.

•Professional or nonprofessional experience, beyond three years, can substitute on a year-for-year basis for the preferred education.

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

N/A

CONTACT: HELEN GUNN 850-412-4626

BACKGROUND SCREENING

It is the policy of the Florida Agency for Health Care Administration that any applicant being considered for employment must successfully complete a State and National criminal history check as a condition of employment before beginning employment, and, if applicable, also be screened in accordance with the requirements of Chapter 435, F.S., and Chapter 408, F.S.  No applicant may begin employment until the background screening results are received, reviewed for any disqualifying offenses, and approved by the Agency.  Background screening shall include, but not be limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) and may include local criminal history checks through local law enforcement agencies.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.