Health and Human Resources Specialist, Senior

State of West Virginia; Charleston (WV); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Benefits package

Job summary

The State of West Virginia's Office of Managed Care seeks an experienced professional to oversee Medicaid program communications and contract deliverables. Under general supervision, you will audit MCO materials for regulatory compliance and provide technical guidance statewide.

You will develop policy interpretations, build relationships with health care providers, and help drive quality outcomes for Medicaid members.

Qualifications

• Bachelor's degree from regionally accredited four-year college.
• Four years of full-time or equivalent experience in a technical or program area related to employment.

Responsibilities

• Audit MCO marketing materials for compliance.
• Provide statewide technical assistance to Medicaid programs.
• Manage stakeholder relations and drive quality improvement.
• Evaluate operational policies and recommend changes per CMS/DOHS guidance.
• Assist with provider and member issues requiring BMS intervention.

Skills

Policy interpretation

Auditing

Stakeholder management

Education

Bachelor's degree

Job description

Nature of Work

Under general supervision, this position performs advanced-level work within the Office of Managed Care to ensure critical health services are effectively provided to Medicaid members. This position will serve as a subject matter expert on policy interpretation, service delivery, and compliance with federal and state regulations.

This role is responsible for overseeing managed care contract deliverables, providing complex statewide technical assistance, managing stakeholder relations, and driving quality improvement across Medicaid programs. The primary function of this position is to audit and approve Managed Care Organizations' (MCOs) print, digital, social media, video, email, and website marketing materials to ensure strict compliance with federal and state regulations. This position will also provide highly technical, complex statewide technical assistance regarding Medicaid provider and member benefit claims. Assist with provider and member issues requiring Bureau for Medical Services (BMS) intervention. Evaluate operational policies and procedures to optimize service delivery, program performance, and member outcomes. Recommend operational changes aligned with CMS (Centers for Medicare & Medicaid Services) and DOHS guidance. Build and maintain positive, collaborative relationships with healthcare providers and key stakeholders who serve Medicaid members. Serve as a subject matter expert on relevant statutes, rules, and policy interpretations. Other duties and tasks as assigned.

Minimum 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.

Other Information

• Substitution: Three (3) years of full-time or equivalent part-time paid experience in the Health and Human Resources series may substitute for the required training and experience.

State employment offers a variety of benefits.