Eligibility Program Manager 1

Grade 27

New York State has approximately 12 positions* in this title statewide. You may view a breakdown of positions by county. This position exists in Health, Department of. View links to all New York State agencies including agencies that have this title. For more information, New York State employees can contact the Career Mobility Office at (518) 485-6199 or (800) 553-1322. If you are not a current New York State employee, you can use the Department of Civil Service Web site to explore possible employment opportunities.

*The number of positions is approximate and represents the number of positions established (both filled and vacant); it is not an indication or reference to position type or duration, or intent to be filled. If you are viewing a trainee title, please note this number reflects the number of positions established at the journey level. Agencies may fill at the trainee level(s) or at the journey level based on employee qualifications. GOT-IT does not provide information on any job postings or job availability. For information on current job postings, please visit State Jobs NY. You may also visit specific New York State Agency websites for information about an agency and its job opportunities.

Career Ladder

A listing of titles that are most commonly used as steps for upward mobility for this title series. The salary schedule for this career ladder is also available.

  1. Eligibility Program Manager 1

    Grade 27

  2. Eligibility Program Manager 2

    Grade 29

  3. Eligibility Program Manager 3

    Grade 64

Summary of Job Description

Positions in this title series administer and oversee bureaus and larger units within the Office of Health Insurance Programs and the New York State of Health that manage the New York State Medicaid Program, Child Health Plus Program, Qualified Health Plan coverage, and other public health insurance programs.  Incumbents direct, administer, and oversee all aspects of eligibility and enrollment for public health insurance programs.  Levels in the title series are distinguished by the scope of the program area or multiple programs managed, and the quantity and allocation of staff supervised.  

These positions are classified at the Department of Health (DOH), Office of Health Insurance Programs (OHIP).

Coordinates, manages, and oversees a unit or multiple units of subordinate staff engaged in the overall determination of eligibility and enrollment in a limited or small public health insurance program:

Provides supervision, guidance, and oversight to subordinate staff; intervenes and resolves problems as necessary.  

Determines and oversees staff assignments and reassignments; evaluates performance; monitors time and attendance; and approves leaves and the use of overtime.  

Directs staff in responding to intra and inter-agency correspondence, letters, telephone calls, and emails from the public, clients, stakeholders, oversight agencies, federal staff, members of the legislature, and health care provider community.  

Identifies training needs and arranges for the provision of training.  

Manages and directs program activities by setting priorities and deadlines.  

Assists in the development and implementation of program policies, procedures, and guidelines for the determination of eligibility in a public health insurance program.

Develops, refines, establishes, and implements program procedures and the activities necessary to determine eligibility and target eligible participants for public health insurance programs.

Evaluates public health insurance program data, including service levels, potential eligibles, target populations, public health trends, and program accountability.

Prepares and reviews reports of program activities.  

Implements and ensures adherence to federal eligibility regulations and State requirements.  

Provides clarification of federal eligibility regulations and State requirements to other Department of Health units, Fiscal Management, other State agencies, local program agencies, and other requesting entities.  

Represents the Department of Health and its public health insurance programs on various workgroups, cross-functional teams, and intra and inter-agency task forces concerned with public health insurance program eligibility and enrollment issues.  

Interprets federal and State laws, rules, and regulations to develop instructions, eligibility policy statements, directives, analyses, and other materials:  

Interprets guidelines and instructions related to eligibility issues; performs analysis for bureau and division-level staff; and makes recommendations for improvement.

Writes analytical reports and papers as required.

Collaborates with technical business systems and requirements analyst staff to develop automated systems programs and solutions.  

Reviews and updates prepared material used to train local program staff and entities engaged in the determination of eligibility and enrollment.  

Provides information for and direction to health care provider staff and recipients of public health insurance programs.  

May serve as contact or liaison with federal Centers for Medicare and Medicaid Services (CMS) staff and auditors.  

Oversees program review and management evaluation processes:

Develops and approves annual review schedules, final review reports, and corrective action submissions.

Analyzes and evaluates findings for trends and repetition, and recommends training topics from review findings.  

Analyzes and communicates to staff the impact of a variety of federal and State laws, rules, and regulations related to eligibility for public health insurance programs.  

Oversees program implementation and participation:

Develops policies and procedures, and communicates them to staff, local program agencies, and other entities engaged in the determination of eligibility for public health insurance programs.  

Develops and monitors plans for training and evaluation of program components and systems for documentation and reporting to meet federal and State requirements.  

Measures program growth and reduction by geographic region to ensure optimum participation levels.  

Implements efficiency measures based on cost-benefit analysis.

Directs outreach activities to ensure target populations are served.  

Directs evaluations activities designed to recognize program deficiencies in service levels or categories.  

May serve as an assistant bureau director in a larger program, or over multiple programs.

View the classification standard for this title, on the Classification and Compensation webpage.

The NYS Title and Salary Plan provides additional information regarding other titles. If there is a classification standard available there will be a link under the column labeled STD. NO. If no link is available there is no classification standard available at this time for that title.

Summary of Minimum Qualifications

Please note: qualifications for this position may be subject to change. If substitutions for education and/or experience are allowed, this information would be available on the announcement.

You must take and pass a Civil Service examination to be considered for this position.

A bachelors degree and four years of professional experience, two years of which must have included second-level supervision of staff, performing one or more of the following seven activities* in a program with one or more of the following functions: provides reimbursements for health care services; works with social services program areas; determines eligibility for a consumer assisted program in a hospital or other health care facility; provides health care regulatory oversight; or performs quality assurance and interpretation/application of standards of health care.  


1. Overseeing and directing staff in determining eligibility for a health insurance program or consumer assisted program in which financial eligibility criteria must be met.

2. Overseeing and directing staff in performing utilization review, including pre-payment or post-payment review of requested health care services, prior approval or authorization activities, adjudication or pricing of claims for payment, or analysis of patterns of health care.  

3. Overseeing and directing staff in developing mechanisms for the reimbursement and financing of health care services, including rate-setting or approval, capitation reimbursement methodologies, fee schedule development, coding constructs for medical goods and services, or application and processing of reimbursement methodologies.

4. Administering and overseeing staff responsible for day to day program operations for budgeting, staffing, or program planning.

5. Overseeing and directing staff in inspecting, assessing, or monitoring health insurance programs or health care facilities for certification, licensure, or adherence to laws, rules, regulations, and policies.

6. Overseeing and directing staff in planning, designing, developing, researching, or evaluating proposals to establish or refine health related programs, with responsibility for interpreting legislation or regulations, defining and describing target populations and local demographics, grant and proposal writing, or developing, reviewing, and evaluating contracts.

7. Administering and overseeing staff responsible for performing quality assurance activities such as ensuring compliance with laws, rules, regulations, and policies, as it pertains to activities 1 through 6.

For informational purposes only, click on the examination number(s) listed below to see the current or previous examination(s) that are used to fill this title.


How to Apply

When this examination is scheduled to be held, the announcement can be found on the Department of Civil Service, Examination Announcements web page. If you do not see an examination currently scheduled please check back on a monthly basis or sign up for announcement notification by email so that you will automatically be notified when new examinations are being offered.

Career Mobility

Career mobility is not just limited to the titles in the Career Ladder, above. Additional movement may be achieved through other examinations, additional education and/or work experience or transfer opportunities. For additional information or clarification of transfer determinations, current State employees should contact the Career Mobility Office. Visit ELMS Online to view established open-competitive, promotion, and transition eligible lists. If you are not a current New York State employee, see Employment Opportunities with New York State and find out how to become a New York State employee.

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