DSHS HCLA WCF Beneficiary Appeals Program Manager

Washington State Department of Social and Health Services; Olympia (WA); Hybrid; USD 85,000 - 105,000; Full time

Job summary

The Washington State Department of Social and Health Services is seeking a Beneficiary Appeals Program Manager to oversee the appeals process for the WA Cares Fund. This role involves policy development, collaboration with state agencies, and program management to ensure beneficiaries have a fair appeals process. Candidates should have extensive experience in long-term care settings and policy implementation, with a focus on legal appeals. The position offers flexible hybrid remote work within Washington State.

Qualifications

• 10 years of experience in long-term care policy or legal appeals.
• Experience in developing and implementing policies.

Responsibilities

• Create and maintain a statewide system for appeals.
• Coordinate with state agencies to manage the appeals process.
• Ensure compliance with laws and regulations.

Skills

Policy Development

Program Management

Collaboration

Education

Bachelor’s Degree in Legal Studies

Master’s Degree in Public Administration

Job description

The WA Cares Fund (WCF) is a first-in-the-nation, social insurance program, created by the Legislature to provide affordable long-term care insurance coverage to all working Washingtonians. This program is one of the latest examples of why Washington State is a national leader in long-term care policy. Our team is the first point of contact for the program, and we are responsible for helping Washingtonians understand this new benefit.

WCF is seeking a Beneficiary Appeals Program Manager to join our dynamic team in the Home and Community Living Administration (HCLA). At HCLA, we champion choice, independence, and safety for seniors and people with disabilities. We aim to partner with people to access support, care, and resources. Our vision is that people find human services to shape their own lives and WA Cares is leading the nation with this self-directed program.

This opportunity offers flexible hybrid remote work. You can work anywhere in Washington state. However, based on business needs, you may need to travel occasionally, and the official duty station is in Lacey, WA.

In this role, you will develop the framework of rules, policies, and procedures that allow beneficiaries to dispute determinations made by WCF, while also overseeing the implementation of a comprehensive statewide program for the appeals process. This is an essential aspect of our work, so we are seeking people with experience in crafting new policies and procedures, particularly within legal systems.

You will also support regional staff in establishing a consistent statewide standard for appeals while guiding long-range planning and development of our appeals program. You will work closely with WCF leadership and various stakeholders, including state agencies and partners, to ensure the appeals process follows all state standards and legal requirements and will serve as our subject matter expert for beneficiary appeals.

The Beneficiary Appeals Program Manager plays a vital role in ensuring that people receiving services from WCF have a fair and consistent process to challenge our decisions. It is essential that this system remain aligned with our appeals program for providers (those that provide healthcare services), making collaboration a key priority.

What You Will Do

• Create Rules and Procedures to Implement the WCF Appeals Program: You will create and maintain a statewide system for people to appeal decisions made by the WA Cares Fund. This involves:
  • Drafting and updating our rules, policies, and procedures;
  • Developing systems to ensure our appeals process is consistent across the state; and
  • Ensuring our system is consistent for beneficiaries as well as our registered providers.
• Coordination and Collaboration: You will work closely with other state agencies, such as the Health Care Authority, Employment Security Department, and the Office of Administrative Hearings, as well as external partners like the Area Agencies on Aging (AAA), to develop and manage the appeals process effectively.
• Program Management:You will establish and monitor required contracts and agreements and consult with the Attorney General and other subject matter experts to determine appropriate actions.
• Training and Support: You will provide training to regional staff, AAAs, and other stakeholders on how the appeals process works and ensure everyone involved understands their roles and responsibilities.
• Compliance: You will ensure our policies and procedures comply with laws and regulations. This includes monitoring and updating these policies to reflect changes or improvements.
• Record Retention: You will create and manage the system for creating, tracking, and storing appeal records.
• Data Analysis: You will recommend changes to the application systems required to maintain the statewide beneficiary appeals program. You will understand trends in appeals to identify areas for improvement and will create and provide reports to decision-makers.

Who Should Apply

• 10 years of professional experience working in a professional capacity within a long-term care setting developing and implementing policy or managing legal appeals.
• Or, a bachelor’s degree in legal studies, public administration, political science, social/human services, or related discipline; plus 6 years of experience working in a professional capacity within a long-term care setting developing and implementing policy or managing appeals.
• Or, master’s degree in legal studies, public administration, political science, or related discipline; plus 4 years of experience working in a professional capacity within a long-term care setting developing and implementing policy or managing appeals.

Preferred knowledge, skills, and abilities:

• Legal education towards completion of a law degree or Juris Doctorate, although a license to practice law is not necessary.
• Implementing a social service appeals program or significant knowledge of the requirements for appeals.
• Writing WAC or other state administrative codes; writing internal policies and procedures within legal systems.
• Proven experience in overseeing and managing complex programs, ensuring effective implementation, strategic alignment, and continuous improvement.
• Demonstrated ability to collaborate effectively across multiple business units to drive cohesive strategies and align processes.

This job is classified as a Washington Managment Services 2 (WMS2).

DSHS partners with people to access support, care, and resources.

Interested?Please list 3 professional references’ contact information on your application and include your current resume and a cover letter explaining how your knowledge, skills, and abilities qualify you for this role, including your work experience with legal appeal processes and large-scale program management.

The Department of Social and Health Services’ (DSHS) vision that people find human services to shape their own lives requires that we come together with a sense of belonging, common purpose, shared values, and meaningful work. It is crucial to our agency’s vision that you bring an equity, anti-racism, and social justice commitment to your work with DSHS. We strive to create greater access and affirming representation of the communities we serve, including Black, Indigenous, and People of Color, people with physical, behavioral health, and intellectual disabilities, elders, LGBTQIA+ individuals, immigrants and refugees, and families building financial security.

Questions?Please email Jenny [e-mail] or call 360-725-5848 and reference #03489. To learn more about DSHS, go towww.dshs.wa.gov.

Prior to a new hire, a background check including criminal record history may be conducted. Information from the background check will not necessarily preclude employment but will be considered in determining the applicant’s suitability and competence to perform in the job. This announcement may be used to fill multiple vacancies. Employees driving on state business must have a valid driver's license. Employees driving a privately owned vehicle on state business must have liability insurance on the privately owned vehicle.

Washington State Department of Social and Health Services is an equal opportunity employer and does not discriminate in any area of employment, its programs or services on the basis of age, sex, sexual orientation, gender, gender identity/expression, marital status, race, creed, color, national origin, religion or beliefs, political affiliation, military status, honorably discharged veteran, Vietnam Era, recently separated or other protected veteran status, the presence of any sensory, mental, physical disability or the use of a trained dog guide or service animal by a person with a disability, equal pay or genetic information. Persons requiring accommodation in the application process or this job announcement in an alternative format may contact the Recruiter at [phone]. Applicants who are deaf or hard of hearing may call through Washington Relay Service by dialing 7-1-1 or 1-800-833-6384.

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