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Health and Human Resources Specialist, Senior - Bureau for Medical Services - Kanawha County

  • ... West Virginia
  • ... Kanawha, West virginia, United States
  • ... Full time
  • ... Salary: 66589 per month
  • Posted on: May 26, 2024

Health and Human Resources Specialist, Senior - Bureau for Medical Services - Kanawha County   

JOB TITLE:

Health and Human Resources Specialist, Senior - Bureau for Medical Services - Kanawha County

JOB TYPE:

Full-time

JOB LOCATION:

Kanawha West virginia United States

No

JOB DESCRIPTION:


Department of Human Services (DoHS)/ Bureau for Medical Services (BMS)/ Kanawha Co -
This position is to assume coordination and administration, through a vendor contract of the claims processing system managing the pharmacy benefit according to West Virginia Medicaid policy. The position would be responsible for overseeing, with the vendor, system capability with regard to provider enrollment, member eligibility, drug file review, pricing accuracy, and coordination across the MMIS components. This major program is the most highly utilized benefit within the Medicaid program and requires complex problem solving and decision-making skills in addition to diplomacy and leadership in managing pharmacy services for 350,000 beneficiaries and 700 pharmacy providers, with expenditures in excess of $355 million. This person will act as a liaison with the Medicaid fiscal agent to configure pharmacy policies and evaluate system performance. Will also act as a liaison with the Medicaid fiscal agent and other vendors to facilitate transfer of data and managing deliverables as required under contractual agreements. Direct monitoring activities to ensure that existing Medicaid policies are enforced and mandated services are accessible to Medicaid and state supported program beneficiaries. Provide leadership and training to other pharmacy and support staff relating to the claims processing system. Ensure that all approved pharmacy benefit policies are accurately configured and enforced through the automated pharmacy claims processing system in order to meet existing and respond to future federal and state regulatory requirements. Perform other duties as assigned.

Job Location: Kanawha County
*****************************************************************************

Click The APPLY Link To Apply Online .

IMPORTANT: Your eligible score will be based on information provided in your application; therefore, make sure your application is detailed and complete. You MUST complete ALL parts of the application, including the Work Experience section.

ATTENTION: Applicant must verify post high school education by submitting an official transcript or diploma, training or licensure earned pertaining to this position by the closing date of the posting, if not previously verified . If you are claiming Veterans preference, please submit \"MEMBER 4\" form and/or your VA Letter. Protecting your personal information is our highest priority. If your official transcript, training/licensure, or Veterans documentation contains your Social Security Number and/or birthdate, please redact that information before submitting it to the Division of Personnel.


Please attach documents to the online application before submitting it. Or, you may email it to: applicantservices@wv.gov or by mail to: WV Division of Personnel, 1900 Kanawha Blvd. E., Building 3, Suite 500, Charleston, WV 25305.


This announcement is for one (1) or more specific vacancies and only applies to the location(s) indicated. Your application will remain active for this job for one-hundred eighty (180) days or until the job is filled. Application for this job does not automatically qualify you for other positions. Be sure to submit your application for each position of interest. To receive an email notice anytime jobs in this or other categories are posted, you may choose to complete a Job Interest Card from the slide-out menu located at the top left of our Job Opportunities page.

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.

***DETAILS OF RELATED EXPERIENCE MUST BE SHOWN IN THE WORK EXPERIENCE SECTION OF YOUR ONLINE APPLICATION***



Position Details

POSTED:

May 26, 2024

EMPLOYMENT:

Full-time

SALARY:

66589 per month

SNAPRECRUIT ID:

S-1717186997-dbba74e848193ae8c95bf4b21981c9b7

LOCATION:

West virginia United States

CITY:

Kanawha

Job Origin:

jpick2

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Department of Human Services (DoHS)/ Bureau for Medical Services (BMS)/ Kanawha Co -
This position is to assume coordination and administration, through a vendor contract of the claims processing system managing the pharmacy benefit according to West Virginia Medicaid policy. The position would be responsible for overseeing, with the vendor, system capability with regard to provider enrollment, member eligibility, drug file review, pricing accuracy, and coordination across the MMIS components. This major program is the most highly utilized benefit within the Medicaid program and requires complex problem solving and decision-making skills in addition to diplomacy and leadership in managing pharmacy services for 350,000 beneficiaries and 700 pharmacy providers, with expenditures in excess of $355 million. This person will act as a liaison with the Medicaid fiscal agent to configure pharmacy policies and evaluate system performance. Will also act as a liaison with the Medicaid fiscal agent and other vendors to facilitate transfer of data and managing deliverables as required under contractual agreements. Direct monitoring activities to ensure that existing Medicaid policies are enforced and mandated services are accessible to Medicaid and state supported program beneficiaries. Provide leadership and training to other pharmacy and support staff relating to the claims processing system. Ensure that all approved pharmacy benefit policies are accurately configured and enforced through the automated pharmacy claims processing system in order to meet existing and respond to future federal and state regulatory requirements. Perform other duties as assigned.

Job Location: Kanawha County
*****************************************************************************

Click The APPLY Link To Apply Online .

IMPORTANT: Your eligible score will be based on information provided in your application; therefore, make sure your application is detailed and complete. You MUST complete ALL parts of the application, including the Work Experience section.

ATTENTION: Applicant must verify post high school education by submitting an official transcript or diploma, training or licensure earned pertaining to this position by the closing date of the posting, if not previously verified . If you are claiming Veterans preference, please submit \"MEMBER 4\" form and/or your VA Letter. Protecting your personal information is our highest priority. If your official transcript, training/licensure, or Veterans documentation contains your Social Security Number and/or birthdate, please redact that information before submitting it to the Division of Personnel.


Please attach documents to the online application before submitting it. Or, you may email it to: applicantservices@wv.gov or by mail to: WV Division of Personnel, 1900 Kanawha Blvd. E., Building 3, Suite 500, Charleston, WV 25305.


This announcement is for one (1) or more specific vacancies and only applies to the location(s) indicated. Your application will remain active for this job for one-hundred eighty (180) days or until the job is filled. Application for this job does not automatically qualify you for other positions. Be sure to submit your application for each position of interest. To receive an email notice anytime jobs in this or other categories are posted, you may choose to complete a Job Interest Card from the slide-out menu located at the top left of our Job Opportunities page.

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.

***DETAILS OF RELATED EXPERIENCE MUST BE SHOWN IN THE WORK EXPERIENCE SECTION OF YOUR ONLINE APPLICATION***



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