The Health Plan (THP) · 12 hours ago
Director, Contract Compliance MHT
Charleston, WV
Full-time, Contract
Onsite
Mid Level
3+ years expThe Health Plan (THP) 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 oversees compliance with contractual deliverables and maintains relationships with stakeholders to ensure operational and administrative effectiveness.
Health CareInsuranceNon ProfitWellness
Responsibilities
Work with various teams in ensuring 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 on 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 for required contractual documents such as Member Handbook
Responsible for development and modifications to policies and procedures related to contract requirements/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
Qualification
Required
The Administrator must possess professional experience in health care, managed care, or health services administration and meet the following requirements: Bachelor's degree with a minimum of four (4) years' professional experience and two (2) years' experience in health care contracting; or Master's degree with a minimum of three (3) years' professional experience and one (1) year experience in health care contracting
Experience working with Medicaid and/or CHIP populations
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, works independently and has the ability to interact well with others
Valid driver's license
Must be based in West Virginia, preferably Charleston
Preferred
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
Company
The Health Plan (THP)
The Health Plan is a clinically-driven, technology-enhanced, and customer-focused health maintenance organization that manages and improves the health and well-being of its members.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Ryan J. Ralston
Chief Financial Officer
Bob Roset
Senior Vice President, Information Systems (CIO)
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