Director, Center for Managed Care

Nature of Work

Under the general direction of the Deputy Commissioner, the Director, Center for Managed Care (CMC) provides leadership, administration, oversight, and strategic planning for the Bureau for Medical Services (BMS).

The CMC oversees highly complex state and federal programs and manages $1.3 billion in contractual agreements. The office consists of:

• One Director
• One Office of Child Welfare Program Manager
• One Office of Managed Care Program Manager
• Six staff overseeing operations
• Three on-site contractors

The CMC is responsible for directing and managing programs that coordinate and provide medical benefits to over 450,000 West Virginia Medicaid members, overseeing the delivery of 80% of BMS programs.

The Mountain Health Trust operates under 1915(b) waiver authority, requiring statutory compliance and federal oversight. The Director is directly responsible for:

• Planning and directing daily operations of CMC programs.
• Managing and evaluating staff performance, identifying training needs, and overseeing professional development.
• Negotiating and administering provider contracts and agreements.
• Ensuring compliance with federal and state regulations, including 1915(c) waiver deliverables.
• Reviewing and approving program policies, fiscal audits, and regulatory reports.
• Overseeing procurement processes for technical services through RFP/RFQ development and bid analysis.
• Directing fiscal oversight by verifying expenditures, actuarial services, and program budgets.

The Director serves as a primary liaison to the Centers for Medicare and Medicaid Services (CMS), state and national agencies, advocacy groups, service providers, and policymakers. The foster care and Children’s Health Insurance Program (CHIP) are also under the CMC, requiring significant stakeholder collaboration.

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.

Job Type: Full-time

Pay: $54,842.00 - $97,037.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Tuition reimbursement
• Vision insurance

Ability to Commute:

• Charleston, WV 25301 (Required)

Ability to Relocate:

• Charleston, WV 25301: Relocate before starting work (Required)

Work Location: In person

Salary : $54,842 - $97,037