What are the responsibilities and job description for the Health and Human Resources Office Director 2 - Bureau for Medical Services - Kanawha Co. position at West Virginia?
Department of Human Services (DHS)/ Bureau for Medical Services (BMS)/ Kanawha Co - Under limited supervision, this position serves as the Chief of Quality (COQ) under the general direction of the Deputy Commissioner. They provide administration, guidance, oversight, and planning for BMS for the continuous improvement of Medicaid and WVCHIP Quality is defined as the degree to which provided services for members and populations increase the likelihood of desired outcomes; the identification and removal of barriers to equity so that all members may attain their optimal health regardless of their demographic circumstances; ensuring optimal EDS development, operations, and compliance. These responsibilities span the entirety of BMS programming including Medicaid and WCHIP, both managed care and fee-for-service environments, representing over $5.2 billion in program costs and providing services to more than 650,000 members (around 36% of West Virginia residents). The COQ directs the Center for Quality, consisting of the Office of Quality Management and the Office of EDS Operations This position will review and approve submission of key CMS reporting, approve policy changes and MMIS configuration changes, reviews and approves policies and policy amendments, and development of office policies and procedures. They will Influencing others outside of BMS, such as our MCOs, hospitals and other providers, on difficult, high-stakes and controversial issues, such as health disparities, needed health quality interventions, billing practices, inappropriate clinical practices or shortcuts and eliciting the desired change. Standing up to/challenging executives and lobbyists of very large vendors in heated contract enforcement matters, such as calling out areas of lagging performance and making the (often costly) demands necessary to mitigate the issue. The position will also advises and oversee a complex ecosystem of quality-and-performance-based initiatives designed to leverage partnerships with the federal government, plans, providers and contractors. These include defined payment programs (DPP), which leverage federal matching dollars to provide millions in supplemental funding to hospital systems based upon attainment of annual. performance targets; the managed care capitation quality withhold measurement programs, which reserve a portion of plan premium payments and condition payment upon attainment of certain predefined targets: the quality rating system (ORS), which ranks plans in a variety of areas on a 5-star system and provided to members to support their plan selection decisions, forcing plans to complete on a quality basis; advanced planning projects which provide enhanced federal matching typically 90% and involve reporting and robust accountability requirements, the numerous Medicaid waiver programs and demonstration projects, all of which require various performance based requirements and accountability to federal oversight agencies, and a variety of value-based care models and contract service level agreements impacting healthcare quality, equity and data quality and completeness requiring performance bases. Performs other duties as assigned.
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.
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.
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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.
***DETAILS OF RELATED EXPERIENCE MUST BE SHOWN IN THE WORK EXPERIENCE SECTION OF YOUR ONLINE APPLICATION***
Salary : $49,642 - $91,837
