Under general supervision, this specialist performs medical/dental/pharmacy claims review and analysis working in coordination and collaboration as part of the management team of BMS servicing approximately 38k children annually in WVCHIP and 550k members in WV Medicaid. This position will be in the key coordinating role, working with the BMS team, third-party administrators and managed care organizations, to make annual revisions to the BMS benefits/policies and reviewing member or provider appeals for claims payments or utilization management determinations in coordination with the BMS medical director and recommending actions, as well as representing BMS at various meetings and conferences.
Click The APPLY Link To Apply Online.
IMPORTANT: Your eligibility 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: Baccalaureate degree in nursing from an accredited four-year college or university and two years of full-time or equivalent part-time paid experience as a registered professional nurse.
ORSuccessful completion of an associate degree in nursing from an accredited college or university or a diploma nursing program and three years of experience as a registered professional nurse.
ORProfessional certification from a recognized national nursing certifying organization as a nurse or nurse practitioner in the area of assignment plus two years of full-time or equivalent part-time paid experience as a registered professional nurse.
ORSuccessful completion of an associate degree in nursing from an accredited college or university or a diploma nursing program; plus baccalaureate degree in the health sciences or behavioral sciences and two years of full-time or equivalent part-time paid experience in nursing.
ORMaster's degree in nursing from an accredited four-year college or university.
Special Requirement: Current West Virginia license or temporary permit to practice as a registered professional nurse.
***The Division of Personnel uses your complete work history to qualify you for positions. Please be as detailed as possible and list all of your past employment.***
