Chief Health Insurance and Managed Care

Profile

Chief, Health Insurance and Managed Care
The candidate will provide leadership regarding health insurance and Health Maintenance Organization (HMO) related issues for the Division. Will assist the Associate Commissioner of Life and Health with the implementation of the Affordable Care Act (ACA) and provides guidance to staff on the impact of the ACA on policy form review. Oversee the management of the Life and Health Division's Health Review and the Managed Care Units, which are responsible for the review and approval of all health and managed care contracts in Maryland, including provider contracts. Assign Utilization Review Analysts new and renewal Private Review Agent (PRA) and Medical Director applications for review to determine compliance with Maryland laws and regulations, and evaluates the quality of review performed. Assist the Associate Commissioner of Life and Health with the analysis and interpretation of proposed state and federal legislation and regulations, and acts as the Associate Commissioner's designee, if needed, at meetings and by providing testimony during the legislative session. Integrate new legislation and regulations into the form review process and PRA and medical director certification process, and assisting with the drafting of any necessary regulations, bulletins, checklists, and training materials for staff. Advise the Associate Commissioner of Life and Health on numerous health insurance issues impacting consumers and insurance carriers, and answers technical questions from consumers, insurance carriers, and staff regarding filing requirements and other complex health insurance issues.

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