WV Departments of Health, Health Facilities, and Human Services · 20 hours ago
Health and Human Resources Specialist, Senior - Human Services BMS - Kanawha Co.
Kanawha County, WV
Full-time
Onsite
Mid, Senior Level
4+ years expWV Departments of Health, Health Facilities, and Human Services is seeking a Senior Health and Human Resources Specialist to provide oversight and direction of the Medicaid managed care program. The role involves ensuring contract compliance, policy interpretation, and acting as a liaison for problem resolution while overseeing various managed care aspects.
GovernmentHealth CareInformation ServicesMedical
Responsibilities
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
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
Qualification
Required
Bachelor's Degree from a regionally accredited four-year college or university
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
Company
WV Departments of Health, Health Facilities, and Human Services
The mission of the West Virginia Departments of Health, Health Facilities, and Human Services is to collaborate with stakeholders to promote, protect, manage, and provide appropriate health and human services for our residents to improve their health, well-being and quality of life.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Jessica Hudson
Chief Operating Officer
Angie Jacobs-Ferris, SHRM-SCP
Chief Human Resources Officer
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