Clipped from: https://www.indeed.com/viewjob?jk=25c7dde67926c145&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Overview

About Public Consulting Group

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, technology, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG employs approximately 2,000 professionals worldwide—all committed to delivering solutions that change lives for the better. The firm has extensive experience in all 50 states, Canada, and a growing practice in Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com.

Responsibilities

The Medicaid marketplace is changing, and PCG is at the forefront. We are looking for an experienced Medicaid Consultant to join our team and help lead our growth efforts. Deep Medicaid experience is critical, as well as experience working with the Centers for Medicare and Medicaid Services (CMS) and the new streamlined modular certification (SMC) and outcomes-based certification (OBC). Our ideal Medicaid Consultant will provide oversight and direction for scope, schedule, , quality, , communications, risk, and , stakeholder management activities, all while adding deep Medicaid and Medicaid Enterprise Systems (MES) experience and thought leadership

Specific Responsibilities:

• Demonstrated understanding and knowledge of Medicaid, CMS, SMC/OBC, and MES
  
• Conduct Medicaid System Assessments
  
• Help states plan for and execute SMC/OBC activities
  
• Help lead and provide expert level guidance on various projects
  
• Ensure planned results are achieved on time
  
• Work with clients, vendors, team members to establish and achieve project goals
  
• Address problems through risk management and contingency planning
  
• Plan, organize, execute, and monitor and control project activities
  
• Perform project assessments and report on project progress
  
• Facilitate meetings and present project information
  
• Identify, document, and/or escalate issues to appropriate levels
  

Qualifications

Required Skills/Experience:

• Bachelor’s degree or equivalent university degree
  
• 5+ years experience performing project oversight and assessments for a large enterprise grade information technology initiative
  
• 4+ years experience performing performance metrics measurements and reporting to management and executive level staff.
  
• Demonstrated experience working with SMC/OBC
  
• Demonstrated written and verbal communications skills
  
• Ability to influence internal and external stakeholders
  
• Ability to lead/manage others in a matrixed environment
  
• Proficiency in Microsoft applications (Outlook, Word, Excel, PowerPoint, Visio, Project) and project management tools
  

#LI-AH1

#D-PCG

#LI-remote

Compensation

Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, PCG provides the following reasonable range of compensation for this role: $110,000-$140,000

EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

Job Type: Full-time

Pay: $110,000.00 – $140,000.00 per year

Work Location: Remote

Clipped from: https://jobs.centene.com/us/en/job/1401919/Manager-Cost-Reporting-Medicaid-Remote?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose:
Responsible for managing and coordinating people and processes involved with filing of cost/expense reports for lines of business across the enterprise. Organizes and directs resources, removes barriers and solves problems in team settings to ensure that the filing process is successful. Cost/expense reports entail categorizing utilization, medical expense, premium, and administrative expenses across types of service, lines of business, and rate cohorts.

An ideal candidate would have …
– Basic knowledge of health care industry and government health plans such as Medicaid etc.
– Basic knowledge of accounting/financial statements and accounting processes etc.
– Basic knowledge of actuarial concepts such as reserving and rate setting etc.
– Basic knowledge of health economics concepts such as MLR, cost and utilization metrics etc.

In this Manager, Cost Reporting role, you will:
•        Manages and coordinates team activities to ensure all regulatory cost reports, supplemental reports, and cost report audits (where applicable) are accurate, in compliance with applicable regulations, have appropriate sign off, and are submitted on time.
•        Collaborates with business leaders across the markets and within finance department (i.e. Accounting, Actuarial, and HealthCare Analytics) to understand and gather the financial data required to produce the required regulatory reports.
•        Utilizes subject matter expertise and provides leadership to interpret evolving cost reporting guidance and to prepare recommendations and solutions to issues in a clear, logical and comprehensive manner. •        Ensures all regulatory cost reports are reconciled to the general ledger, encounter data, and/or audited financial statements.
•        Provides training and coaching to staff on general health care knowledge as well as on specifics of cost/expense reports processes
•        Uses tools to develop processes and implement procedures for gathering, categorizing, and allocating claim and financial data.  Tools include data warehouse tables, EDW data, actuarial data, access databases, and Excel spreadsheets.
•        Manages the implementation of new programs, strategies, and process improvements.
•        Performs ad-hoc reconciliations and work on special projects, as required.

Important Note: 
This position is fully remote.  However, due to the needs of the business, candidate must be available to work a Eastern Standard Time (EST) schedule.

Education/Experience:
– Bachelor’s degree in Finance, Accounting, Economics, Actuarial Science, Mathematics, Statistics, or related field. Master’s degree preferred.

– 5+ years of financial/cost reporting or related experience. Knowledge of generally accepted accounting principles, GASB and FASB statements and standards.

Preferred Experience/Knowledge:

– Basic knowledge of health care industry and government health plans such as Medicaid etc.

– Basic knowledge of accounting/financial statements and accounting processes etc.

– Basic knowledge of actuarial concepts such as reserving and rate setting etc.

– Basic knowledge of health economics concepts such as MLR, cost and utilization metrics etc.

License/Certification:
– CPA/ASA preferred

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Clipped from: https://jobs.wjtv.com/jobs/director-encounters-medicaid-remote-new-york/898990519-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Under the general direction the SVP, Integration & Innovations is responsible for the strategy, design, and management of the team that will implement companywide initiatives impacting:
Encounters Accuracy & Completeness (ie Encounter Production, Audit, Production Vendor Oversight) for all lines of business.
Responsible for centralizing all corec encounter submission processes including identification of any vendor or system support requirement for most effective and accurate processing. Assessment of resources across the organization for purposes of centralization and establishing an Encounters Center of Excellence
Assume all (Encounter) submissions currently sitting in Risk Adjustment to ensure standardization, completeness and accuracy of submissions
Develop and implement all montoring reporting needed for optimized outcomes and reduce/eliminate financial penalties.
Responsible for increasing volume of encounters received from providers, improve completeness of encounter data with states, CMS, HHS to reconcile data.
Implemented processes to monitor rejected encounters to correct and resubmit where applicable
Improve submission accuracy for frequent occurring error codes and create systemic imporvements
Standardize State/LOB reporting increasing visibility into accuracy & completeness
Centralize and automate standardized resources, requirements and encounter tranformation
Encounter submissions, rejection management & resolution for all lines of business including internal strategic partnerships supporting the production of encounters including but not limited to the Corporate Recovery Team, Corporate Claims Compliance Team, Support Services, Enrollment and Billing, Encounters Team as well as providing overall organizational leadership aimed at managing overall healthcare costs.
Hires, coordinates training and manages staff involved in creating controls, documents and tools within the Encounter process in order to manage work in any of the assigned resources.
Identifies, develops and trains appropriate staff and implements processes to standardize the overall ends-to-end processing, management and accuracy of encounters, as well as working with partner departments to implement process improvements impacting quality and timeliness of encounters processing and accuracy.
Ongoing monitoring and management rhgouth resolution any potential penalities related to accuracy and timliness of encounters submissions.
Initiates staff and coordinates needed projects around various systems enhancements, conversions and upgrades. These projects improve QNXT Claims MASS Adjudication results, enhances the Corporate Operations claims quality and reduces unit claims costs by reducing rework (both underpayments and overpayments) for all lines of business.
Identifies projects/initiatives that reduce administrative costs for Molina and/or providers as well as identifies opportunities to ensure accurate encounters are occurring to assist in the management of the organizational health care costs for all lines of business and directly impacting Risk Revenue and Quality Compliance. Convenes work groups, develops implementation plans with identified tasks, timelines and assigned parties. Executes and measures success.
Participates with others in the Corporate Operational Leadership Team along with IT to analyze the root cause of information of variations to the encounters, to find/propose ways to improve
upon performance results, to identify potential risks to the organization and to lead the needed changes within the encounters process to support the organizational needs in all lines of business.
Collaborate with leadership, peers, and business partners to establish encounters improvement objectives and execute business priorities based on strategic goals in the operational plan.
Works with the Training Team in preparing needed documentation around training of new/existing staff while also assisting in preparing needed Guidelines to assist in the timely and accurate processing of encounters for all lines of business.
Manages direct Molina staff as well as oversees vendors involved in any of the areas reporting to the VP, Core Operations – Encounters to enable the organization to produce operational results at the lowest possible cost, the most consistent and compliant service levels and the highest level of quality for all lines of business.
Ensures all state, federal and Molina regulations, Policies/Procedures and SOPs are implemented and followed on a consistent basis to ensure the highest compliance possible within the Corporate Operations areas.
Sets and manages overall costs to meet/exceed annual budgets and finds ways to improve productivity and automation wherever possible to reduce unit costs and overall G&A for the organization.
Design and implement systematic approach to improve member and provider experiences through increased operational efficiency and effectiveness.
Responsible for reporting potential liabilities for financial tracking and accruals to senior leadership.
Excellent verbal and written communication skills.
Ability to influence and drive change among peers and others within the Molina organization.
Skill to envision, craft proposals, obtain consensus around approving and implementing future state processes and systems needed to support strategic direction set by organization.
Ability to abide by Molinas policies.
Ability to maintain attendance to support required quality and quantity of work.
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
Other duties as assigned.

Clipped from: https://www.linkedin.com/jobs/view/test-engineer-healthcare-medicaid-testing-at-gainwell-technologies-3455166540/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.


Summary


Your role in our mission


Essential Job Functions

• Performs testing, troubleshooting and analysis tasks on various phase(s) of network systems development including integration, systems testing, interoperability testing, field test plans and customer acceptance plans to maintain the credibility/viability of the system.
  
• Provides support for monitoring the initial configuration and parameters of equipment for system credibility. Assists in the investigation and resolution of matters of significance in conjunction with other engineering and technical support to ensure cost effective and efficient resolution of problems.
  
• Designs, develops, implements and maintains test processes and diagnostic programs for assigned projects. Works closely with team lead towards the completion of specifications and procedures for new products.
  
• Participates in writing test plans for assigned projects. Maintains record of test progress, documents test results, prepares reports and may present results as appropriate.
  
• Defines test cases and creates integration and system test scripts and configuration test questionnaires from functional requirement documents. Maintains defect reports and updates reports following regression testing efforts.
  
• Adheres to and advocates use of established quality methodology and escalates issues as appropriate.
  
• May work with clients to determine systems requirements. Assists lead engineer/management in writing proposals to recommend process/program and follows through on implementation.
  
   
  

Basic Qualifications

• Bachelor’s degree or equivalent combination of education and experience
  
• Bachelor’s degree in computer science or engineering or related field preferred
  
• Three or more years of network testing experience
  
• Experience working with computer systems and their uses
  
• Experience working with telecommunications systems and their corresponding principles
  
• Experience working with network management and protocol system testing
  
• Experience working with scripting languages such as TCL, PERL, HP, etc
  
• Experience working with data transmission protocols such as TCP/IP, etc.
  
• Experience working with operating systems
  
• Experience working with protocols and technologies such as HTTP, SSL, FTP, SMTP, POP3, etc
  
• Experience working with network equipment: switches, routers, firewalls, intrusion detection systems, etc.
  
   
  

Other Qualifications

• Good analytical and problem solving skills
  
• Good organization and time management skills
  
• Interpersonal skills to interact with customers and team members
  
• Communication skills
  
• Ability to work independently and as part of a team
  
• Willingness to travel
  
  
   
  

Work Environment

• Office environment
  
• May require shift or weekend work
  
  
   
  

What we’re looking for


What you should expect in this role


Competency1


Competency2


Competency3


Competency4


Competency5


The pay range for this position is [[$63,130]] – [[$78,957]] per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.


We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.


Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

Clipped from: https://www.indeed.com/viewjob?jk=45f0de9a09b28376&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Benefits

Pulled from the full job description

Health insurance

Loan forgiveness

Comagine Health is looking for a remote Clinical Reviewer RN to support Alaska Medicaid and private contracts. In this role, you will work with a variety of patient populations across the organization, providing utilization management and care planning as needed. You will perform utilization management using evidence-based clinical criteria and guidelines to determine the safest and most appropriate medical services for patient populations. While working remotely, you will need to picture yourself at the hospital or bedside to successfully perform this work. You’ll be a part of a remote team working across the country that prides themselves on their collaboration and communication. If this sounds like a role you’d be interested in, we encourage you to read on and apply!

 
 

Who is the Comagine Health?

Comagine Health is a non-profit consulting firm that seeks to improve health and to increase the effectiveness and quality of health care. As a recognized Quality Improvement Organization (QIO), we support providers, plans, purchasers, and consumers, and offer services to state and federal agencies and others to help them better manage health care under the existing system and to assess, plan for and implement broader system transformation. We collaborate with academic, government, and nonprofit partners on initiatives funded by NIH, CDC, AHRQ, BJA, SAMHSA, and others. In short, we are changing healthcare at a fundamental level.

 
 

What you’ll be doing for us:

• Participate in a multi-disciplinary team to improve the quality of healthcare for individuals and populations.
  
• Apply nationally-recognized clinical criteria and guidelines to determine the medical necessity of inpatient admissions, outpatient procedures, and other healthcare services.
  
• Consult with physicians or refer cases to others, when indicated.
  

 
 

Required Competencies:

• Professional curiosity and lifelong learner mindset-we cover many contracts with this team and there is always something new!
  
• Excellent written communication.
  
• Ability to document critical thinking and develop questions for providers regarding decision-making and plan of care.
  

 
 

Required Qualifications:

• A degree or diploma in Nursing.
  
• Current, active, unrestricted RN licensure in good standing.
  
• 3+ years of clinical (direct patient care) work experience that includes critical care, ED, and/or intensive care.
  

 
 

Desired Qualifications:

• 1+ years of utilization review (or other medical management experience) preferred.
  

 
 

Salary Range: $69,000 – $95,000

The salary range posted reflects the range that Comagine is willing to pay for this position. Salary is determined by many factors, including but not limited to geographic location of where the employee will perform their job duties in addition to their knowledge, skills, education, and relevant work experience.

 
 

We offer competitive pay and benefits. Additionally, employment with Comagine Health qualifies if you apply for the Public Service Loan Forgiveness (PSLF) Program!

 
 

Comagine Health’s mission is to work together with our partners to improve health and create a better health care system so that people and communities will flourish. As part of our mission and values, we recognize the importance of having our employees vaccinated against COVID-19- both as a protection for our larger community and to keep our employees and their families safe.

 
 

As a federal contractor, and in compliance with Executive Order 14042, Comagine Health requires its employees and contractors to be fully vaccinated against COVID-19 (including any booster shots if required), unless they are approved for a reasonable accommodation based on medical condition or religious belief that prevents them from being vaccinated. Being fully vaccinated against COVID-19 is a condition of employment at Comagine Health.

• If you are fully vaccinated, you will be required to provide proof of your completed COVID-19 vaccination prior to the first day of your employment. Failure to provide timely proof of your COVID-19 vaccination status may result in your offer of employment being rescinded or your start being delayed.
  
• If you are unable to be fully vaccinated due to medical condition or religious belief, you will be required to request an exemption upon acceptance of the offer of employment. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an exemption is not approved, then your offer of employment may be rescinded.
  

Required Skills

Required Experience

Clipped from: https://www.glassdoor.com/job-listing/senior-business-analyst-medicaid-gainwell-technologies-JV_KO0,32_KE33,54.htm?jl=1008445206818&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As a Senior Business Analyst – Medicaid at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Your role in our mission

Take charge and focus on how we can meet critical needs to help clients deliver better health and human services outcomes.

• Coordinate workstreams and teams on IT projects to align solutions with client business priorities
  
• Demonstrate your knowledge as SME and liaison for clients and internally between technical and non-technical workers to transform requirements into real results
  
• Delegate work across teams, and coach and monitor project team members to plan, design and improve complex business processes and modifications
  
• Streamline workflows across clients and technical personnel to determine, document and oversee carrying out system requirements
  
• Support quality control as you approve and validate test results to verify that all requirements have been met
  

What we’re looking for

• 5+ more years of experience working as a business analyst or ‘requirements translator’ between technical and non-technical personnel, with 3 or more years of Medicaid and Medicare experience preferred
  
• Knowledge of Microsoft Excel advanced features such as macros and/or relational database software
  
• Ability to clearly and concisely translate technical requirements to a non-technical audience
  
• Skills working with business processes and re-engineering
  
• Curiosity to solve complex problems and strong interpersonal skills to interact with and influence clients and team members
  
• A caring team leader who motivates and coaches less experienced resources
  

What you should expect in this role

• Fully remote, only US location options will be considered
  
• Client is in Central time zone
  
• #LI-HC1
  

The pay range for this position is $63,100.00 – $90,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

Clipped from: https://www.azstatejobs.gov/jobs/special-projects-advisor-housing-phoenix-arizona-united-states?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

AHCCCS

Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.

AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

The Division of Health Care Management

Special Projects Advisor – Housing

Job Location:

Address: 801 East Jefferson Street. Phoenix, Arizona 85034 

Posting Details:

Open Until Filled

Salary: $68,000 – $77,000

Grade: 23  

Job Summary:

The Division of Health Care Management is seeking a Special Projects Advisor. Under the direction of the Integrated Care Administrator, this position will serve as the primary contact and operational/programmatic subject matter expert for housing and homelessness related supportive services for Transition Aged Youth (TAY) aged 16-26 who are homeless or at risk of homelessness, including runaway minors, abandoned youth or youth who were expelled from their homes, youth who have aged out of child foster care or who been released from juvenile detention facilities. This position will oversee the managed care organizations service delivery and monitoring of the community based Coordinated Entry process and Homeless Management Information System (HMIS), to ensure members are connected to supportive service providers. This position will participate in community-wide efforts to address homelessness and related factors for the TAY population, facilitate regular meetings with MCOs and community stakeholders, and oversee operational and programmatic compliance for related deliverables. This position will also be responsible for participating in case conferencing with internal and external partners and providing support and technical assistance to MCOs in implementing initiatives related to H2O supportive services.

Knowledge, Skills & Abilities (KSAs):

Knowledge of:
* Clinical expertise in the delivery of behavioral health services and programs, including but not limited to; evidence based practice for permanent supportive housing, homelessness, Child and Family Team Practice, First Episode Psychosis, human trafficking, Substance Use Disorder, etc.
* Arizona Public Behavioral Health system, including AHCCCS/Administrative policies and procedures
* Principles and practices of program planning; assessment skills; Person Centered Planning and mechanisms of managed (prepaid) health care systems; preventative health practices; organization of health care systems and current trends that affect the systems; and research methodology and process
* Medicaid regulations
* Health care delivery systems, complex populations and unique applications in rural as well as urban areas.
* The roles and responsibilities of state agencies that serve AHCCCS members.
* The basic principles and practices of medical management/case management
* In depth knowledge of problem solving and technical writing
* Clinical knowledge of conducting case reviews/member case staffing
Ability to:
* Interpreting existing and new rules, laws and agency policy pertaining to the delivery of behavioral health services
* Monitoring policies and procedures that result in integrated behavioral health services with physical health care services, and/or enhance existing processes to achieve better outcomes
* Organizational skills that result in prioritization of multiple tasks
* Providing effective guidance and technical assistance regarding health care issues and the administration of AHCCCS behavioral health and integrated care programs.
Ability to:
* Produce effective written communication
* Multi-task in a fast-paced environment
* Produce work products with limited supervision
* Understand and communicate data/health analytics
* Improve processes/systems
* Collaboratively develop and implement new concepts
* Analyze barriers or problems and make recommendations for improvements
* Analytically review and evaluate program activities
* Establish and maintain effective working relationships, especially in a changing health care environment
* Communicate effectively with all levels of health care professionals and community partners/stakeholders

Qualifications:

Minimum:
Five years clinical and/or programmatic experience in behavioral health service delivery systems including experience in a
public managed care environment;

Preferred:
A licensed clinical social worker (LCSW); a Registered Nurse or Nurse Practitioner with Psychiatric-Mental Health specialty
or a Master’s or higher degree in a behavioral health or health related field

Pre-Employment Requirements:

• Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
• Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
• Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.

Benefits:

Among the many benefits of a career with the State of Arizona, there are:
• 10 paid holidays per year
• Paid Vacation and Sick time off (13 and 12 days per year respectively) – start earning it your 1st day (prorated for part-time employees)
• A top-ranked retirement program with lifetime pension benefits
• A robust and affordable insurance plan, including medical, dental, life, and disability insurance
• Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
• RideShare and Public Transit Subsidy
• A variety of learning and career development opportunities
• Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office)

By providing the option of a full-time or part-time virtual/remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement:

Lifetime Pension Benefit Program
• Administered through the Arizona State Retirement System (ASRS)
• Defined benefit plan that provides for life-long income upon retirement.
• Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
• Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program

• Voluntary participation.
• Program administered through Nationwide.
• Tax-deferred retirement investments through payroll deductions.

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing ca*****@******cs.gov.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

Clipped from: https://careers.lilly.com/us/en/job/R-43009/Associate-Director-Contract-Administration-Medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

At Lilly, we unite caring with discovery to make life better for people around the world. We are a global healthcare leader headquartered in Indianapolis, Indiana. Our 35,000 employees around the world work to discover and bring life-changing medicines to those who need them, improve the understanding and management of disease, and give back to our communities through philanthropy and volunteerism. We give our best effort to our work, and we put people first. We’re looking for people who are determined to make life better for people around the world.

Overview

The overarching goal of this position is to ensure quality, speed, and consistency in the delivery and execution of Lilly USA, LLC’s contractual obligations by uncovering insights and driving business results. A varied set of capabilities, including technology-first forward thinking, operational excellence, and disciplined execution, will help Contract Management & Analytics (CMA) drive innovation and growth to lead within the dynamic nature of customers and technology.

The Contract Administration (CA) Associate Director role aids in minimizing the financial and legal risks associated with sales reductions by ensuring all contract payments are appropriately administered, analyzed, documented, controlled, and reported on a consistent and timely basis. Responsibilities include, but are not limited to, oversight of day-to-day payment operations, supervision of area teams and prioritization of their activities, implementation of performance management, and coordination of Lilly Value and Access systems priorities/issues. This position serves on the staff of the CMA Associate Vice President. This position will also be involved in internal and external audits.

Primary Responsibilities

The Contract Administration (CA) Associate Director acts as the controller for Lilly Value and Access contract administration activities, balancing valid customer needs and obligations with appropriate financial controls with the Medicaid and Co-Pay segments. The CA Associate Director is responsible for ensuring operational efficiencies and consistency across customer segments, as well as payment system ownership. The CA Associate Director will clearly define expectations and instill a sense of ownership, responsibility, and accountability within the team. The Associate Director will also lead CA’s newly created Center of Excellence (CoE) which will drive special projects to conclusion utilizing SME’s across CA and IDS.

Key Objectives

• Staff Development/Supervision – Lead, coach, and develop a team of direct reports. Responsibilities include a) developing a high performing team that effectively responds to an evolving business environment and exceeds business needs; b) driving industry leading service and operations through exceptional leadership; c) fostering an inclusive environment which builds trust, coaches, develops, and empowers team members; d) ensuring all training is complete; e) executing Performance Management.
  
• Implementation of CMA Leadership Initiatives – as a member of the CMA Leadership Team, has shared responsibility for attaining alignment across functional boundaries and achieving CMA business goals and strategic objectives.
  
• Contract Administration Operations – responsible for establishing processes to validate both contract proposals and payments, ensuring that Lilly is not exposed to unnecessary risk. As necessary, provide input on new contracting possibilities, patient affordability programs, and help resolve escalated payment disputes.
  
• Authorization of Customer Payments/Contractual Commitments – responsible for accurate, timely, and compliant rebate payments across Medicaid and CoPay segments. Optimize payment and administration business practices as well as monitor compliance with established metrics. Evaluate and address potential impact to internal operations resulting from updates to the Medicaid Drug Rebate Program (MDRP) and Lilly’s patient affordability programs.
  
• CoE Lead & Special Projects – Facilitate the analysis and implementation of various special projects. Establish processes for prioritization, communication, and escalation between CA and Information & Digital Solutions (IDS). Other potential projects may include revenue leakage activities, participation in industry trade group initiatives, implementation of governmental regulations, organizational efficiency improvements, etc.
  

Basic Qualifications

• Bachelor’s Degree with a concentration in Accounting, Finance, Economics, Information Technology, Marketing, or relevant field of study that includes quantitative analysis
  
• 5+ years of relevant contracting, accounting, finance or similar experience
  
• Qualified candidates must be legally authorized to be employed in the United States. Lilly does not anticipate providing sponsorship for employment visa status (e.g., H-1B or TN status) for this employment position.
  

Additional Skills/Preferences

• High learning agility
  
• Demonstrated business acumen and analytical skills
  
• Strong communication, interpersonal, and leadership skills
  
• Ability to engage and motivate team members with a focus on inclusion
  
• Demonstrated ability to translate organizational goals into specific actions
  
• Demonstrated ability to deliver projects/tasks on-time and within budget
  
• Controllership experience
  
• Negotiation/Conflict resolution
  
• Previous direct and/or indirect supervisory experience
  
• Knowledge of Model N or Flex Medicaid revenue system (or other comparable system)
  
• Experience leveraging technology in business operations
  
• Internal or external audit experience
  
• Financial and/or IT Certification (e.g., CPA, CMA, CIA, CISA)
  
• Previous experience with customers in pharmacy distribution channel or payer environment (Wholesalers, PBMs, Payer Customers, Pharmacies, CoPay Vendors)
  
• Experience with and understanding of Sarbanes-Oxley requirements
  

Location: LTC-South

Travel Percentage: 0-10%

Additional Information

Lilly is an EEO/Affirmative Action Employer and does not discriminate on the basis of age, race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, protected veteran status, disability or any other legally protected status.

Qualified candidates must be legally authorized to be employed in the United States. Lilly does not anticipate providing sponsorship for employment visa status (e.g., H-1B or TN status) for this employment position.

Eli Lilly and Company, Lilly USA, LLC and our wholly owned subsidiaries (collectively “Lilly”) are committed to help individuals with disabilities to participate in the workforce and ensure equal opportunity to compete for jobs. If you require an accommodation to submit a resume for positions at Lilly, please email Lilly Human Resources ( Li*************************@*********ly.com ) for further assistance. Please note This email address is intended for use only to request an accommodation as part of the application process. Any other correspondence will not receive a response.

Lilly is an EEO/Affirmative Action Employer and does not discriminate on the basis of age, race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, protected veteran status, disability or any other legally protected status.

Our employee resource groups (ERGs) offer strong support networks for their members and help our company develop talented individuals for future leadership roles. Our current groups include: Africa, Middle East, Central Asia Network, African American Network, Chinese Culture Network, Early Career Professionals, Japanese International Leadership Network (JILN), Lilly India Network, Organization of Latinos at Lilly, PRIDE (LGBTQ + Allies), Veterans Leadership Network, Women’s Network, Working and Living with Disabilities. Learn more about all of our groups.

As a condition of employment with Eli Lilly and Company and its subsidiaries in the United States and Puerto Rico, you must be fully COVID-19 vaccinated and provide proof of vaccination satisfactory to the company (subject to applicable law). 

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