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10/29/2026 (11:59 PM ET)
req82014
Human Srvs Prog Branch Manager
Pay Grade17
Salary
$77,637.84 - $87,990.00 Annually
Employment Type
EXECUTIVE BRANCH | FULL TIME | INELIGIBLE FOR OVERTIME PAY | 18A | 37.5 HR/WK
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Hiring Agency
Cabinet for Health & Family Services | Department for Medicaid Services
Location
275 East Main Street
Frankfort, KY 40621 USA
The agency may authorize the selected candidate to telecommute as a Hybrid. The agency may terminate or modifythe telecommuting arrangements at any time. This position is located in Frankfort, KY and is required to come to theoffice three days per week.
Description
Do you thrive in a fast-paced work environment?Do you enjoy working collaboratively with a dedicated team?If you answered yes to both questions, we may have an opportunity for you!The Department for Medicaid Services, Division of Health Plan Oversight, is seeking a qualified and motivatedprofessional to serve as the Appeals and Complaints Branch Manager.
In this role, the Human Services Program Branch Manager will provide leadership and oversight for the Appealsand Complaints Branch, including the management and coordination of External Independent Third-Party Review(EITPR) and administrative and state fair hearings. The position will be responsible for ensuring that appeals,and hearing-related activities are managed effectively, timely, consistently, and in accordance withapplicable federal and state requirements, Medicaid policies, and agency procedures.
Responsibilities and Duties:
- Provide leadership, direction, and oversight for the Appeals and Complaints Branch.
- Manage and coordinate EITPRs and administrative hearing activities.
- Ensure EITPR's and hearing-related matters are processed accurately and within established federal andstate timeframes.
- Supervise, coach, and develop branch staff while promoting a collaborative and accountable workenvironment.
- Monitor workload, performance measures, case status, and deadlines to ensure timely resolution ofmatters.
- Review complex or sensitive cases and provide guidance and direction to staff.
- Coordinate with internal DMS divisions, legal representatives, program staff, health plans, providers,beneficiaries, and other stakeholders as appropriate.
- Identify recurring issues and trends and make recommendations for process improvements.
- Ensure branch operations comply with applicable laws, regulations, Medicaid requirements, policies, andprocedures.
- Develop and implement procedures that promote consistency, efficiency, quality, and appropriatedocumentation.
- Prepare and review reports, correspondence, and other materials related to EITPRs, and administrativehearings.
- Represent the branch in meetings and workgroups and communicate program requirements and operationalneeds to leadership.
- Support the development and implementation of training and quality assurance activities.
- Perform other duties as assigned.
Skills and Expectations include but are not limited to the following:
- Medicaid programs, policies, eligibility requirements, and managed care operations.
- Federal and state laws, regulations, and requirements governing Medicaid appeals, complaints, andadministrative hearings.
- Principles and practices of case management, quality assurance, and regulatory compliance.
- Kentucky Medicaid programs and the health care delivery system.
- State and federal requirements related to beneficiary rights and access to health care services.
- Data collection, analysis, reporting, and performance monitoring.
- Supervisory and management principles, including staff development, workload management, performancemanagement, and team building.
- Conflict resolution, problem-solving, and effective communication with internal and externalstakeholders.
- Process improvement principles and methods for improving efficiency, consistency, and quality.
- Records management, confidentiality, and appropriate handling of sensitive information.
Minimum Requirements
EDUCATION:Graduate of a college or university with a bachelor's degree.
EXPERIENCE, TRAINING, OR SKILLS:Five years of professional experience in the administration of human services programs, emergency management services, emergency medical technician, paramedic, or related field.
Substitute EDUCATION for EXPERIENCE:A master's degree in social work, health administration, labor relations, public or business administration or related field will substitute for one year of the required experience.
Substitute EXPERIENCE for EDUCATION:Administrative or business experience, or professional, subprofessional, or clerical work in a human services area, emergency management services, emergency medical technician, paramedic, or related field will substitute for the required education on a year- for-year basis.
SPECIAL REQUIREMENTS (AGE, LICENSURE, REGULATION, ETC.):NONE
Working Conditions
Incumbents working in this job title typically perform duties in an office setting.
Probationary Period
This job has an initial and promotional probationary period of 6 months, except as provided in KRS 18A.111.
If you have questions about this advertisement, please contact Whitley Walker at Whitley.Walker [redacted].gov or [redacted].
