Director of Medicaid & WVCHIP Eligibility Operations

Nature of Work - Under general direction, the office director will perform complex administrative and professional work at the advanced level in managing a major program component within an organizational unit within DOHS.

This position manages and coordinates the member eligibility division of the Medicaid and WVCHIP programs and provides direction regarding the eligibility and enrollment of over 500,000 Medicaid and WVCHIP members. The position also provides oversight of all aspects of member eligibility including member education, WVCHIP, long-term care, home and community-based waivers, medical review team, special pharmacy, undue Hardship committee, and program policy found in the WV income maintenance manual, acts as leader and adviser with expertise in policy, federal and state regulations, and best practice standards for all aspects of Medicaid and WVCHIP member eligibility; ensures state compliance with federal and state regulations governing Medicaid and chip member eligibility; provides direct supervision to HHR senior policy specialists and clerical staff.

Responsible for assigning, scheduling, organizing, coordinating, and directing their work. Assists senior policy specialists, program managers, and program directors in development of programs and policies.

• 1) Provide technical assistance and consultation to program policies to all levels of staff within DHHR, including BFA regional directors, community service managers, supervisors, and case workers, trainers, quality control reviewers, deputies, BMS commissioner, program directors and managers, and other officials inquiring about the Medicaid WVCHIP programs.
• 2) Establish strategies through planning activities to address compliance with federal and state regulations, legal mandates, agency policy, best practice, and provide oversight to ensure compliance.
• 3) Meet with BMS and BFA stakeholders for routine management meetings, attend state level meetings for various Work groups, program development, planning activities, regional and statewide family assistance supervisor meetings; meet with community stakeholders; attend technical assistance meetings with federal partners.
• 4) Review casework, confer and staff cases with regional attorneys, community service managers, state office and supervisory staff on legal issues, policy and procedural matters to solve complex situations, including client, provider and employee actions and grievances.
• 5) Complete special projects assigned by the Deputy Commissioner and Commissioner.
• 6) Meet with eligibility and enrollment system and Medicaid Management Information System staff to ensure system compliance with federal and state policy and procedures. Other duties/tasks as assigned.

Minimum Qualifications:

Training: Bachelor's degree from a regionally accredited college or university.

OR

Substitution: Additional experience as described below may substitute for the required training at a rate of one (1) year of experience for every thirty (30) semester hours of training.

AND

Experience: Five (5) years of full-time or equivalent part-time paid professional experience, two (2) years of which must have been in a program administration capacity.

OR

Substitution: Graduate course work from a regionally accredited college or university may substitute at the rate of fifteen (15) semester hours of training for one (1) year of experience.