Quality Assurance & Appeals Manager pay range

What the state says the job is

This class includes positions that manage the Recipient Hearings & Appeals Section in DHHS or the DHHS Hearings Office. The Recipient Hearings and Appeals Section processes appeal requests arising from applicant/recipients having a right to appeal a County Department of Social Services decision that grants, denies, terminates, or modifies assistance; or the failure of the County to act in a reasonable time. The DHHS Hearings and Appeals Section conducts impartial informal appeals by Medicaid and Health Choice providers regarding adverse determinations, holds hearings for long-term care residents who are being transferred or discharged from an adult care home or nursing facility, holds hearings for individuals who appeal a preadmission screening and resident review; and conducts second level reviews for Health Choice recipients who have a denial, reduction, suspension or termination of he ...

Knowledge, skills and abilities

Thorough knowledge of the regulations, rules and laws governing hearing subjects. Considerable knowledge of quasi-judicial procedures; administrative law principles and procedures. Working knowledge of medical terminology. Ability to interpret and apply complex department policies, administrative rules, general statutes, and both Federal and State regulations to include Privacy and HIPAA laws and ability to manage a comprehensive and diverse docket.. Ability to listen to and evaluate testimony using reasoning and logic to conceptualize legal judgments and ability to engage in legal research. Ability to communicate clearly, concisely, effectively, and professionally, both orally and in writin ...

Minimum qualifications

Bachelor's degree from an appropriately accredited institution and five (5) years of experience as a hearings officer, claims adjudicator, or manager of a business or government program; or an equivalent combination of education and experience. <h2