Director, Compliance MHT

Director, Contract Compliance MHT

Job Summary:

The MHT Director, Contract Compliance and Administration is responsible for the overall delivery of the WV Medicaid/WVCHIP Mountain Health Trust managed care contract with the WV Bureau for Medical Services (BMS). The Director meets as needed with BMS, legislators, other government bodies, community partners and other stakeholders, maintains a positive client relationship, provides timely and informed responses to operational and administrative inquiries, and ensures compliance with all MHT contractual deliverables, including standard reporting requirements.

• Bachelor's degree or higher;
• Prior experience with health insurance and contract oversight;
• Prior experience working with the public, specifically low-income individuals;
• Must be able to evaluate and analyze regulations;
• Must be able to interpret regulations and make policy recommendations to ensure compliance;
• Knowledge in Microsoft Office programs;
• Must be able to work on multiple projects concurrently;
• Must have excellent organizational and leadership skills, work independently and have the ability to interact well with others;
• Valid driver's license;
• Must be based in West Virginia, preferably Charleston.

• Knowledge in current policies and regulations related to Medicaid;
• Strong oral communication skills and the ability to write clearly and effectively;
• Knowledge of HEDIS measures and NCQA accreditation standards.

• Work with various teams to ensure contract deliverables are completed accurately and on time;
• Oversee and monitor subcontractors and vendors based upon agreed-upon contract terms and requirements with BMS contract and other applicable contracts;
• Coordinate the member appeal process;
• Review and research state and federal regulations;
• Review and analyze State Plan Amendments to determine impact on operational processes;
• Provide contract compliance support for EQRO and NCQA;
• Audit/monitor various activities/functions/reports for accuracy and contract compliance;
• Responsible for completion/updates of required contractual documents such as Member Handbook;
• Responsible for development and modifications to policies and procedures related to contract requirements and compliance;
• Assist SVP in implementing new lines of businesses related to Government Programs;
• Assist with efforts of Community Outreach Liaison(s);
• Assist with Member Advisory Committee and other ad hoc committees/meetings that actively inform the Department's community and stakeholder engagement goals;
• Pursue strategic initiatives or pilots and bring these to fruition by partnering with the Marketing, Clinical, Quality and/or Provider Delivery Services Departments;
• Cultivate relationships with key not-for-profit, academic and government/elected officials to proactively anticipate policy, legislative or regulatory changes impacting managed care organizations at the state and federal level;
• Collect information to contribute to strategic planning and design of Medicaid/WVCHIP value-adds or potential optional benefits of interest to members.

8:00am-5:00pm

Director

Full-time

Legal

Insurance