Summary

This senior role involves overseeing West Virginia's Medicaid managed care program, called Mountain Health Trust, by monitoring contractors, ensuring compliance with rules, and resolving issues for smooth operations.

It includes acting as a key coordinator for special programs like newborn assignments and behavioral health services, while providing guidance to staff and agencies.

A good fit would be someone with experience in healthcare administration or policy who enjoys problem-solving, attending meetings, and improving program efficiency.

Key Requirements

Bachelor's degree from a regionally accredited four-year college or university (or equivalent experience substitution on a year-for-year basis)
Four years of full-time (or equivalent part-time paid/volunteer) experience in a technical or program area related to health or human services
Strong knowledge of federal, state, and local regulations, laws, policies, and procedures governing Medicaid programs
Experience in contract management, oversight, and compliance, including working with vendors and enrollment brokers
Ability to interpret and communicate policies and contracts to staff, supervisors, and external stakeholders
Skills in problem resolution, report monitoring, and participation in RFP development and meetings
Potential supervisory or lead worker responsibilities for professional staff

Full Job Description

County of Posting: Kanawha

Number of Vacancies: 1

This HHR Specialist Senior position provides oversight and direction of the Medicaid managed care program, Mountain Health Trust, which includes oversight of the enrollment broker contractor by attending meetings, ensuring contract compliance and technical assistance to the vendor when needed. This position provides policy and contract interpretation to staff, supervisors, and other state agencies. Agency objectives are enforced through written policy, telephonic requests, and attendance at various meetings and participation on advisory boards.

Acts as liaison to facilitate problem resolution and assure compliance with federal, state, and local regulations, laws, policies, and procedures governing the program or technical area.

May consult on highly complex individual situations that potentially have significant impact on systems or involve sensitive legal issues.

Key staff of the managed care Quality Strategy development and oversight

Key staff to oversee newborn assignment issues and fiscal agent point of contact

Dual-Eligible Special Needs Plan (DSNP) Coordinator

Key staff for Behavioral Health services under managed care

May supervise or act as lead worker for other professional staff.

Respond to, interpret, and communicate policy and contract clarification to all managed care organizations.

Work directly with contracted vendors enrollment broker, managed care administration Contract Manager, and oversee the daily operations of each contract as it pertains to the managed care aspects of the Mountain Health Trust program.

Verify system setup is correct for all programs to ensure proper payment to providers involved in each program.

Attend and conduct meetings concerning policy making and agency objectives and provide solutions to issues arising from meetings.

Monitor reports generated from each program to look for ways to improve the program and offer cost savings suggestions to administration.

Participate in the development of request for proposals (RFP) related to all programs. Follow the RFP process from beginning to end including but not limited to writing contract renewals, extensions, and request or change orders.

Respond to written and telephonic requests for information and complaints from providers of service, members, public officials, and other state agencies.

Other duties as assigned.

Click The APPLY Link To Apply Online.

Qualifications

Training: Bachelor's Degree from a regionally accredited four-year college or university.

Substitution: Additional experience as described below may be substituted for the required training on a year-for-year basis.

Experience: Four years full-time, equivalent part-time paid or volunteer experience in a technical or program area that is related to the area of employment.

Substitution: Post-graduate education in a field related to the technical or program area may be substituted for the required experience on the basis of fifteen semester hours for one year of experience.

✓ Fresh Listing

Health and Human Resources Specialist, Senior - Human Services BMS - Kanawha Co.

Job Description

Summary

Key Requirements

Full Job Description

Qualifications

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