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

Nature of Work

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.

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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.

State employment offers a variety of benefits.  to visit the Division of Personnel's Benefits Page.