State of West Virginia · 2 days ago
Health and Human Resources Specialist, Senior - Human Services BMS - Kanawha Co.
Charleston, WV
Full-time
Onsite
Mid, Senior Level
4+ years expThe State of West Virginia is seeking a Senior Health and Human Resources Specialist to oversee the Medicaid managed care program, Mountain Health Trust. This role involves providing policy and contract interpretation, acting as a liaison for compliance, and overseeing daily operations of managed care contracts.
Government Administration
Responsibilities
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
Qualification
Required
Bachelor's Degree from a regionally accredited four-year college or university
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
Company
State of West Virginia
Wild & Wonderful West Virginia is a U.S. state located in the Appalachian region of the Southern United States.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Danielle Cox
Chief Information Security Officer
Recent News
Government Technology US
2025-08-29
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