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Medicaid Policy Writer

 
 

Description

 The Georgia Department of Human Services (DHS) provides a wide range of human services designed to promote self-sufficiency, safety, and well-being for all Georgians. The department is one of the largest agencies in state government with an annual budget of $1.8 billion and nearly 9,000 employees. DHS is comprised of three Divisions: The Division of Aging Services, the Division of Child Support Services, and the Division of Family and Children Services and 14 Administrative Support Offices.

The Georgia Division of Family and Children Services (DFCS), a division of the Georgia Department of Human Services, investigates reports of child abuse; finds foster and adoptive homes for abused and neglected children; issues SNAP, Medicaid, TANF and childcare assistance to low-income families; helps out-of-work parents get back on their feet; and provides numerous support services and innovative programs to help families in need. 


The Office of Family Independence is seeking a Medicaid Policy Writer for the State Office Medicaid Unit. The Policy Writer will research, interpretation, development, and implementation of Medicaid policy. Also be responsible for answering inquiries related to Medicaid policy from various stakeholders, maintaining eligibility policy manuals, and ensuring accurate eligibility determinations. This position requires critical thinking and problem-solving skills, the ability to understand and clearly communicate complex policy and procedures and establish and maintain positive working relationships with a wide variety of internal and external stakeholders.

Job Description

The Medicaid Policy Writer reports directly to the Medicaid Unit Manager and will work remote and in a location at 2 Peachtree Street in downtown Atlanta, Georgia.
 
Pay Grade: L

Under broad supervision, performs complex administrative duties and statistical, financial, or operational data analysis and reporting in support of management decision making in functional area. Identifies trends, discrepancies, and variances to improve the efficiency and effectiveness of operations. May partner with other departments, divisions, outside agencies, and vendors to address business issues. Exercises various latitudes of  independent judgment. May administer or provide high level support for various projects, grants, contracts, implementation of procedures, and/or any specialized functions. Assists with orientation, training, or providing task guidance of junior team members. Provides strategic analysis.


Role and Responsibilities:

 
 

  • Researches, interprets, develops, revises, and disseminates Medicaid Policy, regulations, and procedures via manual transmittals and emails.
  • Provides technical assistance to the Field Program Specialist, Medicaid Eligibility Specialist, and Supervisors/Administrators.
  • Responds to customer inquiries, drafts correspondence to legislators and the general public. 
  • Participates in computer system change request definition and user acceptance testing.
  • Develops and disseminates any training that the field requests.
  • Represents Medicaid Policy at agency and partner meetings/events.
  • Performs other professional responsibilities as assigned by supervisor.
  • Maintains good working knowledge of the Gateway eligibility system.

Minimum Qualifications

  • Bachelor’s degree in business or related field from an accredited college or university AND Four (4) years of experience related to area of assignment.

Note: An equivalent combination of education and job specific experience that provided the knowledge, experience and competencies required to successfully perform the job at the level listed may be substituted on a year-over-year basis.

Preferred Skills/Qualifications:

 
Preference will be given to candidates who, in addition to meeting the minimum qualifications, demonstrate some or all the following education/skills/experience: 
 

  • Master of Science degree in a related field from an accredited college or university AND Two (2) years of related experience, One (1) year of which as a supervisor or lead worker.
  • Bachelor’s degree in a related field from an accredited college or university AND Four (4) years of related experience.
  • Two (2) years of experience at the lower-level Business Support Analyst 2 or position equivalent.
  • Data analysis experience. 
  • Excellent oral, written, analytical, presentation and interpersonal communication skills.
  • Strong proficiency in the use of Microsoft Office Suite and/or standard software applications typically used in a corporate office environment. 
  • Knowledge of Medicaid policies and procedures.
  • Work experience in Medicaid program.

Additional Information

Employment Information
Current State employees are subject to State Personnel Board rules regarding salary.

The Georgia Department of Human Services (DHS) accepts educational credential recognized by the Council for Higher Education Accreditation (CHEA) and/or the US Department of Education (DOE) will be considered. DHS will contact educational institutions to verify degree, diploma, licensure, etc.

Criminal Background Checks/Applicant Privacy Rights
All applicants may be subject to a drug screen, a motor vehicle report check and may be required to submit fingerprints to check for the existence of criminal history information
through the Georgia Bureau of Investigation and the Federal Bureau of Investigation.  Applicants have the right to challenge the contents of any criminal history record obtained for the purpose of employment with DHS. For an explanation of these rights, please read, “Applicant Privacy Rights” at: http://gbi.georgia.gov/sites/gbi.georgia.gov/files/related_files/document/ApplicantPrivacyRights.pdf
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NON-CRIMINAL JUSTICE APPLICANT’S PRIVACY RIGHTS
gbi.georgia.gov

NON-CRIMINAL JUSTICE APPLICANT’S PRIVACY RIGHTS As an applicant that is the subject of a Georgia only or a Georgia and Federal Bureau of Investigation


As an employee of DHS, in the event of an identified emergency you may be required, as a term and condition of employment, to assist in meeting the emergency responsibilities of the department.


DHS is an Equal Opportunity Employer

It is the policy of DHS to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law.

Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail. All qualified applicants will be considered but may not necessarily receive an interview. Selected applicants will be contacted by the hiring agency for next steps in the selection process. Applicants who are not selected will not receive notification.


This position is subject to close at any time once a satisfactory applicant pool has been identified.

In addition to a competitive salary, DHS offers a generous benefits package, which includes employee retirement plan; paid holidays annually; vacation and sick leave; health, dental, vision, legal, disability, accidental death and dismemberment, health and child care spending account. Visit http://team.georgia.gov/ for more information.
 

Insurance

Health, dental, vision, legal, disability, accidental death and dismemberment, healthcare and childcare spending accounts, and life insurance plans are available.

Health Benefits: 1-800-610-1863   State Health Benefit Plan

Flexible Benefits:  1-877-342-7339    GA Breeze Portal

Retirement

State employees participate in the Employee’s Retirement System. Contributions are based on a percentage of salary and service date entry

Employee Retirement System: 1-800-805-4609   ERS Website

Deferred Compensation

Tax shelter plans are available that enable employees to provide for greater retirement security. Fund programs are available in both 457(k) and 401(k) plans. 

Peach State Reserves: 1-877-342-7339 ERS / Peach State Reserves

Credit Union

Employees are eligible to become members of the Atlanta Postal Credit Union and  Georgia United Credit Union

  
 

01

The answers you provide to the supplemental questions will be used to determine if you meet the minimum qualifications for this position. Your responses pertaining to specific work experience and education must be clearly shown in the areas for work history and education on your application. Your application must be completed in full before it is submitted. We do not accept additional information after your application has been received by the Office of Human Resources. Do you accept these conditions?

  • Yes
  • No

02

Are you aware this position will be located at 2 Peachtree Street in downtown Atlanta, Georgia and remote?

  • Yes
  • No

03

What is your highest level of education completed?

  • Doctorate Degree
  • Master’s Degree
  • Bachelor’s Degree
  • Associate’s Degree
  • Some College/Tech
  • High School Diploma
  • GED
  • None of the Above

04

How proficient are you in working with established database programs and generating reports?

  • None
  • Beginner
  • Intermediate
  • Advanced
  • Expert

05

Do you have experience developing and writing program policy?

  • Yes
  • No

06

How many years of experience do you have working with the Georgia Gateway System?

  • None
  • Less than 1 Year
  • 1+ Years
  • 2+ Years
  • 3+ Years

07

How many years of experience do you have working with the Medicaid Program ?

  • None
  • 1 – 2 Years
  • 3 – 4 Years
  • 4 or more Years

08

How many years of Experience do you have regarding oral, written and interpersonal communication within an office setting?

  • None
  • 1 – 3 years
  • 4 or more years

09

Are you a current or former State of Georgia employee?

  • Yes
  • No

10

If yes, please provide your employee ID number

Required Question

 
 

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We’ve updated our Privacy Policy and Terms of Use. Please, read and accept changes.

Effective date: June 29, 2021

GOVERNMENTJOBS.COM, INC. PRIVACY POLICY

Contents

  • 1.Introduction
  • 2.About this Policy
  • 3.Information We Collect About You
  • 4.Our Use of Your Information
  • 5.Information We Disclose
  • 6.Your Data Rights
  • 7.Retention and Removal
  • 8.Cookies and similar Tracking Technologies; “Do Not Track”
  • 9.Information Security and Integrity
  • 10.Information on Children
  • 11.Your California Privacy Rights
  • 12.Your Nevada Privacy Rights
  • 13.Your Rights and Control under EU GDPR
  • 14.Right to Revise
  • 15.Contact Details
  • 16.Privacy Contacts

Introduction.

Governmentjobs.com, Inc. (DBA “NEOGOV” and referred to herein as “we”, or “us”) is committed providing transparency regarding use of your information. We collect personal information by lawful and fair means with your knowledge and where appropriate, your consent. We consider information privacy throughout our product lifecycle – from inception, to production, and ongoing support.

The principal purpose of this Privacy Policy (the “Policy”) is to describe how we collect, use, protect, and disclose personal information online and offline but excluding services that state that they are offered under a different privacy policy.

About this Policy.

By using any part of the Services you agree that your information will be processed as described in this Policy and you have read and agree to be bound by this Policy. Please note, this Privacy Policy does not apply to information collected by our partners, sites that link to or are accessible from our Services, and employers that utilize our Services (our “Customers”) that have their own privacy policies you may be subject to.

This Privacy Policy is incorporated into the Governmentjobs.com Terms of Use. Definitions not explicitly defined herein shall retain the meaning as prescribed in the Terms of Use. Any dispute related to privacy is subject to the Terms of Use and this Policy, including limitations on liability. If you disagree with this Policy or NEOGOV’s Terms of Use, please do not use our Services.

Information We Collect About You.

We require certain personal information in order to provide you Services, automatically collect information during your usage, and collect other information about you from other sources. The information we collect depends on the context – who “you” are in a given interaction and how you are using our services. In this Section we set out general categories of personal information and data we may collect and process.

Information Provided by You

We collect information from you directly when you visit our Services from either your computer, mobile phone, or other device. For example, certain information we collect is necessary to provide the Services to you or our Customers, such as the information collected with you create an account, submit a job application, or information used to interact with you regarding support or inquiries about our Services. We also collect information from you to register for text message or email communications, or when communicate through the Services. The categories of information we collect include the following:

Inquiry and Contact Data. We process information contained in or relating to any inquiry and contact information you submit to us regarding the Services, support, in response to a survey, or interaction with our sales team, including: name; email; phone number; address and related contact data. If you are a Customer or one of our partners, we collect Contact Data of primary users or designated contacts to administer the relationship or for other specified purposes.

Account Data. We may process your account data which may include your account credentials, email address, and account activity or other security related information.

Job Application and Profile Data. We may process personal information within the job applications you send to employers who use our Services, as well as information processed on our Services throughout the relationship you maintain with that employer. Typical personal information found in a job application or within a user Profile may include name, address, e-mail, telephone number, resume, driver’s license, work experience and performance data, education history, age, gender, race, information related to your health or financial information, marital status, military or veteran status, your signature, or and any other supplemental information added at your discretion or requested by an employer.

Transaction and Billing Data. We allow payment processing companies to process information relating to transactions, including purchases of Services, that you enter on the Services or payment processor website, or to facilitate processing of payroll and tax services. If you make an online payment to us through a payment processing company, we require you to provide your billing details, a name, address, email address and financial information corresponding to your selected method of payment (e.g. a credit card number and expiration date or a bank account number).

Voice Data. With your permission we collect voice recordings when you interact with our support teams to diagnose issues, our product teams to improve our services, our implementation teams during implementation of our Services, and our sales teams while providing demos of our Services.

Biometric Data. We collect fingerprints to identify who you are when you punch in and out on our timeclocks, for example, when you place or your finger or hand on the timeclock’s scanner. If our Customer uses biometric scanning on a timeclock, we may create data using a mathematical algorithm based off your fingerprint and store that Biometric Data. For more information regarding our use of Biometric data, please see our Biometric Data Notice.

Publication Data. We may process information that you post for publication on our website or through our Services (e.g., feedback comments, information you provide to our support teams, videos, photographs, images).

Contests and Survey Data. When you complete any forms, respond to a survey or questionnaire, or participate in a contest, we collect the personal data you provide.

Resume Data. We collect information to evaluate you for a job opening with us, including your name, employment and education history, and references.

You may voluntarily submit other information to us through our Services that we do not request, and, in such instances, you are solely responsible for such information.

Information Collected Automatically

With the help of our Service Providers, we also automatically collect information about you and your device and how you interact with our Services. Categories of information collected automatically include the following:

Usage Data. We may process data about your use of our Services. This information may include webpages visited, what you click on, features you use, how often and when you use features, e-mails you view, and the Services you purchase.

Location Data. We collect data about your device’s location by tracking the IP address or data that indicates a country, state, city or postal code. Where a Customer utilizes our time clocks, we collect precise location data (latitude/longitude) of the timeclock you use to punch in and out of your work shifts.

Device Data. We may process information about your device or how you access our Services. Device Data may include Internet protocol (IP) address, browser type, device type, software and hardware attributes, your operating system, system and performance information, cookie date/time stamp, and search terms entered on the site.

Tracking Data. We use tracking services that employ logs, cookies, pixel tags, and embedded scripts to collect user statistics and usage about visitors of our Services and receipt of communications.

Log Data. Our servers maintain log files that document events that occur during interaction with our Services and servers. Logs include information about the nature of each access, IP address, ISP, files viewed, content changes in certain cases, operating systems, device type and timestamps.

Cookie Data. We use cookies to improve your online experience and tailor content to you. For more information on Cookies see the “Cookies” section below.

Pixel Tags. We use pixel tags (aka “web beacons”) in combination with cookies that are embedded in our emails and webpages. Pixel tags send information about your use to our servers.

Embedded Scripts. We use embedded scripts to collect information about how you interact with our Services.

Information from Other Sources

We also receive information about you from other sources. For example, we receive information about the status of background checks you participate in, updates from payment processors regarding your purchases, receipts and analytics for text communications you send and receive, and information you provide to, or automatically collected by, our hosting providers. 

Categories of information collected from other sources include the following:

Partners. We collect and use information collected by integrators and from partners for joint product and marketing opportunities. This information may include Account, Transaction, Billing, Profile, and Tracking Data. Integrations may include payment processing companies, background check and online assessment providers, communication providers, performance or analytics providers, or HR related services employers choose to integrate with our Services.

Public sources. We collect information from publicly accessible websites and government sources.

Data brokers. We purchase additional contact data to supplement and correct the Contact Data we collect.

Our Use of Your Information.

We collect and process information in order to fulfill our contractual responsibility to deliver the Services, fulfill your requests, pursue our legitimate interests and our business and commercial purposes. Your information will only be collected and used for purposes stated herein, where you provide additional consent, or as required by law or regulation – including national security or law enforcement requirements. Our purposes for using your information, including over the past year, consist of the following:

  • to process and manage our Services including to facilitate your use of such Services, maintain your user preferences, to help others find your profile and make your profile viewable by potential employers, transfer your job applications to potential employers (NEOGOV’s Customers), post for publication on the Services, and facilitate HR processes
  • to communicate with you and send you information as part of the Services regarding your requests for information, contests you entered into, newsletters and surveys, technical notices, security alerts, support and administrative messages, significant updates to the Services or policies, as well as relevant notifications regarding your account or job application, job suggestions, or the status of your background check or assessment (to learn how to manage these communications, see “Your Data Rights” below)
  • allow our Customers, their personnel, and job applicants to communicate with one another
  • marketing our products and features (for as long as you do not opt-out), measure the performance of email messaging and promotional campaigns, learn how to improve email deliverability and open rates, and improve our business activities
  • to provide support, troubleshoot and diagnose problems with our Services or servers, fix bugs, ensure the security of our Services, maintain back-ups of our databases, optimize the Services for particular devices and browsers, and ensure the Services are accessible
  • make improvements, enhancements, or modifications to the Services through data analysis and research of usage trends, feedback sessions, and analysis of enhancements contained in or relating to any communication you send us
  • make payments through the Services, bill you for use of our Services (if applicable), send notices regarding status of payments, forward payroll and tax information to partners to facilitate processing, and to ensure the Services you pay for those you have access to
  • track your preferences and behavior to identify and understand trends in the various interactions with our services and internal system administration, determine country of origin, identify clickstreams that led you to our Services, and make personalized recommendations of relevant job opportunities, features, and other content
  • ensure you can use our Services in conjunction with other services and facilitate your use of integrations
  • to verify your identity or confirm your location
  • to conduct research on social, economic and public sector hiring trends
  • fulfill other business activities at your direction
  • to respond to legal requests or prevent fraud, enforce our legal agreements where applicable, prevent potentially illegal activities, and screen for and prevent undesirable or abusive activity

We also use your information with your consent, including the following:

  • make personalized recommendations of content and features
  • to help others find your profile and make your profile viewable by potential employers and transfer your job applications to employers
  • communicate with you and send you information as part of the Services regarding your requests for information, contests you entered into, newsletters and surveys, significant updates to the Services or policies, as well as relevant notifications regarding your account or job application, or the status of your background check or assessment. Please note, you cannot opt-out of receiving service messages from us, including security and legal notices.

We use your data to derive data that does not identify you in order to provide Customers with useful and relevant insights, build features, improve our Services and to develop de-identified data services. For instance, we combine information about you from your use of the Services with other information to make inferences about your job opportunities or Customer HR processes. We may produce the insights with the help of independent sources and processors. This Privacy Policy does not apply to non-personal information or instances where we aggregate or de-identify personal information.

Information We Disclose.

We share information with other parties for the purposes stated herein or as required by law. The following categories are the entities we’ve shared information with, including over the past year.

Employers

We disclose information to employers that utilize our services. For instance, when a job seeker makes their profile information searchable within our Services or responds to a job posting, we will share information with employers in order to facilitate the job search and hiring process. If your current or former employer uses one of our Services, information you input into the Services is accessible by that employer’s end users – subject to the security and access controls set up by the employer.

Please note: Job applications and other information submitted to employers are generally controlled and managed by the employer. In those instances NEOGOV is processing that information on behalf of the employer – our Customer. Our legal obligations as a processor are set out in our Customer contracts and policies. If you apply to a job, make your profile viewable to employers, provide information to show interest in a job, or reply to a message from an employer using our Services, you consent to disclosing your information to that employer for their personnel to complete recruitment and hiring processes, contact you for current or future job opportunities, and respond to your support, product, and transaction inquiries. This Policy does not describe the processing of your information by our Customers, and we encourage you to visit the applicable Customer’s privacy policy for information about their privacy practices. Any questions you may have relating to the information processing by our Customers and your rights related to that processing should be directed to the agency you applied to or your employer that utilizes NEOGOV services.

Affiliates

We disclose information to our affiliates with our Customer’s consent in order to facilitate any Service transition or implementation services.

Service Providers

We share information with services providers hired to provide services on our behalf. For instance, we use service providers to facilitate our support services, data security, email, web hosting, credit card payments, deliver and help us track our marketing and advertising content, deliver payroll processing and disbursements, coordinate our customer conferences, and manage our sales and customer relations. We share information with analytics and advertising companies that may act as our processor and a controller in other instances. We work with other entities to perform research, under controls that are designed to protect your privacy. We publish or allow others to publish insights, presented as aggregated, de-identified, or non-personal data. Where we share information with a party that is not our service provider, such sharing is either at your direction or the direction of our Customers. For example, we share information if you or a Customer chooses to use an integration in conjunction with our Services, to the extent necessary to facilitate that use. Integrations may include payment processing companies, background check and online assessment providers, communication providers, or other independent services Customer chooses to utilize our open API with.

We may share non-personal information with affiliated partners and use machine learning techniques on tracking and metadata in order to provide Customers with useful insights from the data they collected using Services, to build or enhance features, improve Services, and improve infrastructure and security.

We do not sell information in the traditional sense; however, should an activity we undertake constitute a “sale” under the expanded definition of “sale” within the California Consumer Privacy Act, California consumers have the right to opt-out of the sale of your personal information. Please see “Your Data Rights” and “Your California Privacy Rights” for more information on how to exercise your right to optout.

Other parties when you give your consent

We may also share personal information where you provide your consent or post your information publicly. Where required by law, additional consent is obtained before personal information is transferred to us or forwarded to other parties. For example, we share information with background check providers if a job applicant consents and we are instructed to do so by our Customers.

During your use of the Services you may have the opportunity to visit or link to other websites, including websites by third parties unaffiliated with us. We have no relationship or control over unaffiliated websites. These websites might collect personal information about you, and you should review the privacy policies of such other websites to see how they treat your personal information. Use of such websites are at your own risk.

Mergers, Acquisitions, Dissolutions

We may transfer or disclose information to another entity who acquires or may acquire any or all of our business units, whether such acquisition is by way of merger, consolidation or purchase of all or a substantial portion of our assets, or bankruptcy.

Other third parties where required by law

We also share personal information or data in order to: meet any applicable law, regulation, legal process or enforceable governmental request; enforce applicable policies, including investigation of potential violations; detect, prevent, or otherwise address fraud, security or technical issues; protect against harm to the rights, property or safety of our users, the public or to NEOGOV and/or as required or permitted by law; protect your vital interests or the vital interests of another natural person; and where disclosure is necessary for establishment, exercise or defense of legal claims or where there is reasonable belief that disclosure is required by law or regulations

Your Data Rights.

You can review and enforce your personal information rights through your account, communications you receive from us, third party mechanisms, or with the assistance of our support team. 

Our Services incorporate privacy controls which allow you to specify and limit how we process your information, as well as update and remove information we retain about you.

For instance, to place limits on which Customers can preview your profile, log into your account on https://www.governmentjobs.com and go to your account settings. Job seekers can utilize similar privacy controls on a per Customer basis in each Career Page account created.

In certain circumstances you have the right to have inaccurate personal information about you rectified. You can modify or delete personal information within your account at any time by logging in to your applicable account and following the prompts to either “update my profile” or “delete my profile.”

You can change your email preferences to control notifications you receive from us and Customers or unsubscribe from a notification by following instructions contained within the notification itself, your account settings, or using your email provider preferences. SMS text messages will be sent to you strictly in accordance with your preferences, and only after you have explicitly opted in. If you change your mind at any time, and no longer wish to receive SMS text messages, reply to a message with the word “OPTOUT” in all capital letters. Afterwards, should you choose to begin receiving messages again, reply with the word “OPTIN” in all capital letters. Job seekers may also control their receipt of SMS text messages through their job seeker Account preferences, by contacting the Customer the text message pertains to, or by notifying support at support@GovernmentJobs.com.

You can restrict cookies by using your cookie manager settings.

You may have the right to confirmation as to whether or not we process your personal information and, where we do, access to the personal information. To see whether information on you is retained on our servers, please click here. Certain users are entitled to request copies of their personal information held by us. You can print a copy of your Profile information using your web browser and download your attachments at any time by logging into your account and following the download process.

For inquiries related to resetting your account, or if you believe someone else has gained access to your account or provided us your contact information, please contact support at: support@GovernmentJobs.com. If you have a valid data subject request, including a request to restrict or limit our use of your information, you may either contact support at privacy@governmentjobs.com or fill out a Data Subject Request Form if available.

To the extent the basis for our processing of your personal information is consent, you have the right to withdraw that consent at any time by using the privacy controls in your settings, within certain contacts you receive, by deleting personal information within your Profile, or by deleting your account. If you revoke your consent by deleting your account, your Profile will be removed from our job seeker server; however, revoking your consent will not remove applications you previously submit to employers or our aggregated, de-identified, or non-personal data.

Your data rights for information you submit to our Customers

Upon submission of a job application or making your information available to an employer (our Customer) , your information is controlled by that employer. In this regard, we are a data processor for personal information employers’ maintain in our servers, and we maintain limited rights to such data as permitted by our Customers’, to process as necessary to deliver the Services or support to Customers’, ensure safety and security of our Services, where necessary to protect our interests or the public interest, or as required by law.

For these reasons, we are not in a position to directly handle data requests for data controlled by Customers. Customers may store personal information they receive from you on our servers or their own storage facilities. Customers control the types of personal information requested from you, how it’s used, who can access it, and how long they retain this personal information. Your data rights are subject to Customer internal policies and applicable law. You should contact the Customer regarding personal information they may hold about you and to exercise any data rights you may have. We will cooperate with such inquiry to the extent it is permitted under our confidentiality and privacy obligations.

Retention and Removal.

We retain your personal information for as long as your account is considered active, to provide you or our Customers our services, meet regulatory requirements, resolve disputes, investigate security incidents, prevent fraud and abuse, protect your vital interests or the vital interests of another natural person, enforce our contractual agreements, or fulfill your request to “unsubscribe” from messages or exercise your data rights

Our retention policies and procedures are designed to help ensure our compliance with legal obligations and allow Customers to comply with their own record retention requirements. We implement retention controls within the Services that Customers utilize to control their data retention periods. The Customer determines when the purpose of personal data about their employees has been fulfilled. The Customer has the means to permanently destroy personal data about their employees.

For personal information we determine the purposes for and means by which it is processed, such information will not be kept for longer than necessary for the purpose, when no longer relevant, or upon permissible request, and will be appropriately disposed in a manner designed to ensure it cannot be reconstructed or read.

Upon deletion of a job seeker account or any data point within the job seeker account, it will be removed from our job seeker database; however, your data may persist elsewhere, such as applications you previously submit to Customers will persist until Customer disposal. Job seekers should contact the Customer they sent the application to if they seek enforcement of eligible data rights in that application. We may retain de-identified information after your account has been closed.

 

Cookies and similar Tracking Technologies; “Do Not Track”

A cookie is a file containing an identifier (a string of letters and numbers) that is sent by a web server to a web browser and is stored by the browser and device you use to access our Services. The identifier is then sent back to the server each time the browser requests a page from the server.

Cookies may be either “persistent” cookies or “session” cookies. A persistent cookie will be stored by a web browser and will remain valid until its set expiry date, unless deleted by the user before the expiry date; a session cookie, on the other hand, will expire at the end of the user session, when the web browser is closed.
We and our partners use cookies on our Services. Insofar as those cookies are not necessary for the provision of our Services, or the legitimate interests of delivering and optimizing our Services, we receive your consent to use of cookies when you first visit our Services. When your browser or device allows it, we use both session cookies and persistent cookies for the following purposes:

  • Authentication to identify you when you visit our Services, as you navigate our Services, to confirm whether you are currently logged in, and determine if an occurrence affects you.
  • Metrics to determine how you use the Services, what features you utilize and how often, how much time you spend on the Services and features, and other details about the hiring and HR process. This data is aggregated and anonymized.
  • Personalization to store information about your preferences and personalize our Services to you, including to supply Customers with details about their hiring processes, and provide job recommendations to job seekers and Customers based on their past interest.
  • Security to protect user accounts, including preventing fraudulent use of login credentials and to protect our Services generally.
  • Advertising and feedback to determine whether our advertising and feedback inquiries are received, opened, if the content or campaign is effective, and to provide you more specific content about Services we or our partners offer.
  • Analysis to help us analyze the use and performance of our Services, and display different versions of features or content, all of which helps us determine what parts of our Services need improvement and which ones you enjoy most (which may include marketing content).
  • Google Analytics and Adsense to analyze the use of our Services and publish advertisements. Google’s use of advertising cookies enables it and its partners to serve ads to your users based on their visit to your sites and/or other sites on the Internet. You may opt out of personalized advertising by visiting Ads Settings.
  • You can opt out of vendor use of cookies for personalized advertising by visiting www.aboutads.info. In addition, most browsers allow you to refuse to accept or delete cookies. The methods for doing so vary from browser to browser. Please refer to your browser instructions on how to manage your cookies. Blocking all or some cookies may have a negative impact upon the usability of the Services, and there is no industry consensus as to what site operators should do with regard to these signals. Accordingly, unless and until the law is interpreted to require us to do so, we do not respond to the browser “Do Not Track” signal if enabled by the end user in their web browser. When other parties we integrate with set or read their own cookies, they may or may not respond to the DNT signal.

Other data gathering mechanisms, such as web beacons, HTML Storage Objects, and web tags, are used by us and our service providers to gather more specific information on your use. A web beacon (also called a web bug or clear GIF) is a graphic on a webpage or in an email message that is designed to monitor who is reading the page or message. Web beacons are often invisible because they are typically only 1-by-1 pixel in size. Web beacons are often used alongside cookies to track activity. Web beacons may be used to add information to a profile about a site visited, provide an independent accounting of how many people have visited a website, gather statistics about usage, among other things. HTML Storage Objects are program code that collects information about your activity on our Services. The HTML is temporarily downloaded onto your device while you are connected to our Online Services.

Data Security and Integrity.

We implement physical, technical, and administrative safeguards designed to maintain data accuracy, integrity, and security, prevent unauthorized access, and facilitate correct use of personal information. These safeguards include limiting access to data, storing personal information on secure servers and computers, encrypting personal information at rest and in transit, periodically testing our security technology, and training our employees in information security.

In addition, we seek to maintain contractual data security, confidentiality, and privacy obligations with our partners and vendors, and our employees that have access to personal information are subject to access, use, and confidentiality policies. Only authorized employees with a reasonable need related to their job duties have access to Customer and job seeker personal information. Employees who violate our policies are subject to disciplinary action, up to and including termination.

Although we maintain the controls listed herein, transmission of data is not without risk and we complete security of your information cannot be guaranteed. Please note, you are responsible for keeping your username and password secret at all times.

In the event we believe the security of your personal information in our possession or control may be compromised, we may seek to notify you by e-mail and you consent to our use of e-mail as a means of such notification.

Information on Children.

These Services are not directed at children under the age of thirteen (13) and we do not knowingly collect personal information from children under the age of thirteen (13). If we become aware that we have inadvertently received personal information from a person under the age of thirteen (13), we will delete the information from our records. If you believe that we have collected personal information from a child under 13 without parental consent, you may report this to us at privacy@governmentjobs.com.

If you are a California resident under 18 years old, you have the right to remove information you have posted to our Services. Please contact us at privacy@governmentjobs.com and describe what information you’ve posted that you now want removed. We will use reasonable efforts to remove such information in compliance with the law and our other obligations stated herein. We do not sell the personal information of consumers we actually know are less than 16 years of age, unless we receive affirmative authorization from either the consumer who is at least 13 but not yet 16 years of age, or the parent or guardian of a consumer less than 13 years of age.

 

Your California Privacy Rights.

If you are a California resident, you have additional data rights including:

  • Right to notice of collection

We’ve provided details on what information is collected about you in Section 4 “Information We Collect About You”. However, to ensure compliance with CCPA, the following categories of information as defined by the CCPA have been collected over the past year:

  • Direct identifiers such as your name, User ID, and email.
  • Commercial information such as your transactions and purchases.
  • Employment and education history information including when you submit a job application through our services or apply to a job at NEOGOV.
  • Demographic data including your race, ethnicity, gender, marital status and any other demographic information requested by our Customers.
  • Internet or other electronic network activity including your search history on our job board, analytics regarding your use, and device identifiers for location and security.
  • Audio and electronic data including your signature and voice recordings collected with your consent while speaking to our support, sales, or product teams.
  • Information inferred and derived from other categories to determine your preferences and trends.
  • Right to notice of your data rights
  • Right to opt out of sale (“Do Not Sell My Information”)

NEOGOV allows select companies to place tracking technologies like cookies on our sites, which allow those companies to receive information about your activity on our Services. The companies may use that data to serve you more relevant ads on our sites or others. Sharing data for online advertising like this may be considered a “sale” of information. California consumers have a right to opt-out of these sales. You have control over whether these technologies work on your devices. You can disable them using browser Do Not Track features or Cookie Settings provided by us.

  • Right to know the categories of personal information collected about you and the business or commercial purpose of collection, the categories of collection methods and sources, categories of entities your information is sold or disclosed for a business purpose or disclosed to third parties for a business purpose – as well as the purpose of such disclosure (provided in the preceding sections of this Privacy Policy)
  • Right to access certain specific data fields stored about you and the right to delete such data
  • Right to non-discrimination by us for the exercise of any of your rights. on price or our Services based on your exercise of data rights
  • Right to have an authorized agent exercise your rights on your behalf. Note that we will require written proof of the agent’s permission to do so and will verify your identity directly.

To exercise these rights, you can either contact our support team at privacy@governmentjobs.com. If you exercise your rights through emailing our support teams, please title the email “California Privacy Rights Request”, and within the body of the email specify what right you seek to invoke. Please note, if we cannot verify your identity we may deny certain data right requests.

You can designate an authorized agent to submit requests on your behalf, but we require written proof of the agent’s permission and verify your identity directly.

California Civil Code Section 1798.83 permits our visitors who are California customers to request certain information regarding our disclosure of personal information to third parties for the third parties’ direct marketing purposes. To make such a request please send a letter to: Governmentjobs.com, Inc., 300 Continental Blvd. Suite 565, El Segundo, CA 90245 Attn: Privacy Department. Requests must include “California Privacy Rights Request” in the first line of the description and include your name, street address, city, state, and ZIP code. Please note Governmentjobs is not required to respond to requests made by means other than through the provided mail address.

Your Nevada Privacy Rights

A sale under Nevada law is the exchange of personal information for monetary consideration. We do not currently sell personal information as defined under Nevada law. If you want to submit a request relating to our compliance with Nevada law, please contact us as at privacy@governmentjobs.com and include the words “Nevada Rights” in the subject line.

Your Rights and Control under EU GDPR.

Data Controllers and Processors

Our Customers use our Services to post job opportunities, evaluate job applicants, manage their human resource activities, and train their workforce. In conducting these activities, the Customer maintains control over what information is collected, how it is used, how long it is retained, and who it is disclosed to. For purposes of the EU GDPR, the Customer is considered a data controller in these respects and NEOGOV is a data processor. In other instances, such as when NEOGOV uses cookies or sends you Contact about our Services, NEOGOV will determine the means and purpose of processing.

Lawful Basis for Processing.

For personal information subject to GDPR, we rely on multiple legal bases for processing, including:

  • Consent (which can be revoked by utilizing privacy controls, deleting Profile or Account Data, or contacting support).
  • When processing is necessary to perform a contract (e.g. delivering you the Services).
  • Legitimate business interests such as developing the Services, marketing new features or products, proper administration of our website and business, ensuring safety and security.
  • Where necessary to protect vital or public interests.
  • As required by law.

EU Data Subject Rights

Data subjects in Europe whose information we receive through appropriate safeguards have legal rights to determine whether we hold personal data about them, to access personal data we hold about them, and to obtain its correction, update, amendment, or deletion in appropriate circumstances. In particular, your rights may include:

  • Data Access Rights
  • Right to Restrict Processing
  • Right of Rectification
  • Right to be Forgotten
  • Right to Object to Processing
  • Right to Withdraw Consent; and
  • Data Portability Rights

Some of these rights may be subject to exception and limitation. In any case, we will respond to your request to exercise these rights within a reasonable time but no later than within 30 days of receiving a request. To request to exercise your rights, you may contact us at privacy@governmentjobs.com. Some of the rights are complex, and you should read the relevant laws and guidance from the regulatory authorities for a full explanation of these rights. You may also have the right to make a GDPR complaint to the relevant Supervisory Authority. A list of Supervisory Authorities is available here: https://edpb.europa.eu/about-edpb/board/members_en

If you visited our website and you want to exercise any of the above rights please contact our support team or privacy team at the contacts listed herein. If your request is for the right to be forgotten as it relates to our use of cookies, you can achieve this by clearing the cookies in your browser settings.

International Transfers

For personal data transferred from the European Union, the United Kingdom, or Switzerland, we will provide appropriate safeguards, such as through use of standard contractual clauses.

Governmentjobs.com, Inc complies with the EU-U.S. Privacy Shield Framework and the Swiss-U.S. Privacy Shield Framework as set forth by the U.S. Department of Commerce regarding the collection, use, and retention of personal data from European Union member countries, the United Kingdom, and Switzerland transferred to the United States pursuant to Privacy Shield. Governmentjobs.com, Inc has certified that it adheres to the Privacy Shield Principles with respect to such personal data. If there is any conflict between the policies in this privacy policy and data subject rights under the Privacy Shield Principles, the Privacy Shield Principles shall govern personal data processed in reliance on Privacy Shield. To learn more about the Privacy Shield program, and to view our certification page, please visit https://www.privacyshield.gov/. Governmentjobs.com, Inc. will use appropriate safeguards to comply with the judgement issued by the Court of Justice of the European Union on July 16, 2020 declaring the EU-U.S. Privacy Shield Framework as invalid.

We will provide an individual opt-out choice, or opt-in for sensitive data, before we share your sensitive data with third parties other than our agents, or before we use it for a purpose other than which it was originally collected or subsequently authorized. To request to limit the use and disclosure of your personal data, please submit a written request to privacy@governmentjobs.com.

In certain situations, we may be required to disclose personal data in response to lawful requests by public authorities, including to meet national security or law enforcement requirements.

Where Governmentjobs.com, Inc. relies on Privacy Shield Principles for onward transfers of personal data from the EU, the United Kingdom, and Switzerland, including the onward transfer liability provisions, Governmentjobs.com, Inc. remains responsible under the Privacy Shield Principles for third-party agents processing personal data on its behalf.

Where Governmentjobs.com, Inc. receives personal data under the Privacy Shield and then transfers it to a service provider acting as agent, Governmentjobs.com, Inc. has certain liability under the Privacy Shield if both (i) the agent processes the personal data in a manner inconsistent with the Governmentjobs.com, Inc. and (ii) Governmentjobs.com, Inc. is responsible for the event giving rise to the damage. With respect to personal data received or transferred pursuant to the Privacy Shield Framework, Governmentjobs.com, Inc. is subject to the investigatory and enforcement powers of the U.S. Federal Trade Commission.

Governmentjobs.com’s accountability for personal data that it receives in the United States under the Privacy Shield and subsequently transfers to another party is described in the Privacy Shield Principles. In particular, where where Governmentjobs.com transfers personal data in reliance on Privacy Shield, Governtmentjobs.com, Inc. remains responsible and liable under the Privacy Shield Principles if any agents that it engages to process personal data on its behalf do so in a manner inconsistent with the Principles, unless Governmentjobs.com proves that it is not responsible for the event giving rise to the damage.

In compliance with the Privacy Shield Principles, Governmentjobs.com, Inc commits to resolve complaints about your privacy and our collection or use of your personal data transferred in reliance on Privacy Shield to the United States pursuant to Privacy Shield. European Union and Swiss individuals with Privacy Shield inquiries or complaints should first contact Governmentjobs.com by email at privacy@governmentjobs.com.

Governmentjobs.com, Inc. has further committed to refer unresolved privacy complaints regarding personal data transferred in reliance on Privacy Shield Principles to an independent dispute resolution mechanism, the BBB EU PRIVACY SHIELD. If you do not receive timely acknowledgment of your complaint, or if your complaint is not satisfactorily addressed, please visit https://bbbprograms.org/privacy-shield-complaints for more information and to file a complaint. This service is provided free of charge to you.

Governmentjobs.com, Inc. has further committed to cooperate with the panel established by the EU data protection authorities (DPAs) and the Swiss Federal Data Protection and Information Commissioner (FDPIC) with regard to unresolved Privacy Shield complaints concerning human resources data transferred from the EU, the United Kingdom, and Switzerland in reliance on Privacy Shield and in the context of the employment relationship.

If your Privacy Shield complaint cannot be resolved through the above channels, under certain conditions, you may invoke binding arbitration for some residual claims not resolved by other redress mechanisms. See Privacy Shield Annex 1 at https://www.privacyshield.gov/article?id=ANNEX-I-introduction.

Right to Revise.

We reserve the right to revise our Privacy Policy to reflect changes in our online information practices or to comply with the law by publishing a new version on our website. In circumstances where we materially change the way in which we collect or use personal information, we materially change the terms of this Privacy Policy, or where personal information is no longer used consistently with a previously named purpose, we will provide notice and publish the new version on our website.

You should periodically check this page to remind yourself of the rights herein.

Contact Details.

This website is owned and operated by Governmentjobs.com, Inc. (DBA “NEOGOV”). Our principal place of business is at 300 Continental Blvd., El Segundo, CA 90245. You can contact us by email, telephone, or regular mail using the contact information listed herein.

Privacy Contacts.

If at any time you have questions or concerns about this Privacy Policy, please feel free to e-mail us at the appropriate contact relative your jurisdiction:

United States:

privacy@governmentjobs.com

(310) 426-6304

European Union:

Data Protection Manager at dpo@governmentjobs.com

Users who have a visual disability may be able to use a screen reader or other text-to-speech tool to review the contents of this Privacy Policy. If you experience any difficulties assessing the information here or you wish to obtain a copy of this Privacy Policy, please contact us using the details above.

Clipped from: https://www.governmentjobs.com/careers/dhsgeorgia/jobs/3149428/ofi-medicaid-policy-writer-bus-sup-anal-3-00179395?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Posted on

Nurse Utilization Management l – InPatient Medicaid in , Tennessee

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time


 

Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.  It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

 
 

This is an exceptional opportunity to do innovative work that means more to you and those we serve. 

 
 

RN Nurse Utilization Management l (Inpatient) (PS54543)

 
 

Location: Residence in the state of Tennessee preferred, or within driving distance to the Memphis, TN area required if residence not in Tennessee. This is a work@home position but qualified candidates must reside within a reasonable commute to an Anthem office for training and technical needs.

 
 

The Nurse Medical Management l for the Tennessee Health Plan is a member of the UM
In-Patient Team and is responsible for collaboration with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources for more complex medical issues. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient  admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately  interpreting benefits and managed care products, and steering members to appropriate providers, programs or community   resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment.  May also manage appeals for services denied.

 
 

Primary duties may include, but are not limited to:

  • Conducts review of initial concurrent authorization requests for skilled nursing, acute in-patient rehabilitation, long term acute care reviews, and acute in-patient to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
  • Collaborates with providers to assess member’s needs for early identification of and proactive planning for discharge planning.
  • Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.
  • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

 
 

Qualifications

  • Requires current active unrestricted RN license to practice as a health professional in state of residence and 2 years acute care clinical experience or case management, utilization management or managed care experience, which would provide an equivalent background.

 
 

  • Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products.
  • Prior managed care experience preferred.
  • Strong computer skills

 
 

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

 
 

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes.  To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.  Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

Clipped from: https://anthemcareers.ttcportals.com/jobs/7157367-nurse-utilization-management-l-inpatient-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Posted on

Medicaid Claims Manager Priority Health

 
 

CURRENT SPECTRUM HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Spectrum Health team members only.


Job Summary


Job Description


Provide leadership and direction to the Medicaid Claim Processing teams to ensure that the goals and standards of the department and Priority Health are being met. Facilitate the development of the team within the Claims department. Participate in ongoing development of new products and technologies.
DIRECTION EXERCISED: Manage the Medicaid Claims Team Leaders.


Directly supervises above mentioned employees in accordance with Priority Health’s policies and applicable Federal and State Laws. Responsibilities include but are not limited to effectively interviewing, hiring and training employees; planning, assigning and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems.


Essential Functions

  • CAREER DEVELOPMENT OF STAFF:

  • Ensure that all team members are treated with respect and fairness
  • Facilitate the development of the Medicaid team within the Claim Services department.
  • Serve as coach, facilitator and motivator to the teams, removing operational roadblocks that result in teams not achieving the operational objectives.
  • Ensure that individual team meetings are routinely scheduled to discuss performance results, operational issues, and provide all team members the opportunity to explore alternative approaches to exceed the current performance levels.
  • Identify training requirements for individual team members and overall training needs for the entire team to further develop the performance of the teams within the Claims teams.
  • Coordinate with the Learning and Development Team all necessary refresher training and new product training required.
  • Provide opportunities for and encourage professional growth of individual team members.
  • Work with team to set goals.
  • Effectively educate team on an ongoing basis relative to day to day changes, company initiatives and communications (internal or external) that may directly effect their interpretations of policy changes or benefit clarification to members, participants, providers, employers and the Priority Health staff.
  • MONITORING TEAM PRODUCTION AND QUALITY

  • Develop and implement performance tracking and trending tools to allow for daily monitoring of the team’s performance level for all functions to ensure that departmental standards are met.
  • Review the performance of assigned team members on at least a quarterly basis. Identify successes and areas of improvement. Implement appropriate counseling and performance improvement action plans according to Human Resource regulations and guidelines. Termination of employment, when necessary, would be coordinated with Human Resources and Manager’s direct report.
  • Ensure consistency exists with the application of operational policies and procedures within the various teams.
  • Ensure all benefit language, policies and procedures are interpreted accurately within the teams.
  • Monitor team operational and financial performance and initiate corrective actions when required.
  • PROCESSING AND PRODUCTION:

  • Auditing and reporting of claims.
  • Investigation and resolution of inter/intradepartmental inquiries regarding claims status, benefit issues and adjudication errors.
  • PROJECT MANAGEMENT:

  • Participate in Process Improvement Planning (PIP)
  • Effectively develop, prioritize and implement project plans as assigned by management.
  • Communicate project progress in a clear and timely manner.
  • SERVICE TO CUSTOMERS:

  • Represent department in various meetings and committees
  • Implement activities to meet customer requirements based on internal feedback and customer survey results.
  • OTHER ESSENTIAL FUNCTIONS

  • Monitor any delays or issues with cycle times and develop corrective action plans. Ensure trend reporting is developed and distributed to key personnel.
  • Maintain knowledge of operational functions and software.
  • Maintain general knowledge of other functional areas of the system and Priority Health business to better assess the impacts of the Operational functions.
  • Facilitate continuing improvement of business processes in Claims.
  • Provide technical analysis and recommendations as requested by management or staff regarding a variety of issues or problems.
  • Identify ways to re-engineer the operational procedures to gain efficiency in operational processes.
  • Exercise fiscal responsibility in managing team budgets.
  • Participate in ongoing development of new products and technologies. Ensure that Claim Services can administer new and existing products effectively and efficiently.
  • Assist in handling members with potential grievances in an effort to achieve an acceptable outcome.
  • Create, develop, and design any forms or spreadsheets needed within the department to use for collecting and/or reporting data.
  • Other duties as deemed appropriate by Sr. Manager of Claims and/or Chief Operating Officer (COO) of Enterprise Operations.
  • Represent department in audit related activities at group, state and/or federal levels to ensure compliance requirements are maintained.


     

Qualifications

  • Required Bachelor’s Degree

 
 

  • 3 years of experience typically gained through skills/knowledge/abilities managed care experience and/or training; or equivalent combination of education and experience Required
  • 3 years of experience typically gained through skills/knowledge/abilities management experience in a managed care or health care environment Required
  • Excellent working knowledge of managed care concepts and HMO operations Required
  • Government programs operational experience Preferred
  • Knowledge or experience related to TQM, Process Improvement or Reengineering Methodologies


     

Primary Location

SITE – Priority Health – 1239 E Beltline – Grand Rapids


Department Name


PH – Claims Administration


Employment Type


Full time


Shift


Day (United States of America)


Weekly Scheduled Hours


40


Hours of Work


8 a.m. to 5 p.m.


Days Worked


Monday to Friday


Weekend Frequency


Variable weekends

Accommodation Notice: If you are a qualified individual with a disability, you may request a reasonable accommodation in Spectrum Health’s application process. Contact us at 616-486-SHHR (7447).


Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected


category. See more here .

 
 

Clipped from: https://www.linkedin.com/jobs/view/2637882854/

Posted on

Director, Medicaid and SNP Product & Strategy

 
 

Description

This position is responsible for assigned Medicaid and SNP product portfolio development and management. The Director will design, implement, maintain, document and analyze current Medicaid and SNP plans, as well as identify, prioritize and develop strategy for product expansion to continuously improve Medica’s Medicaid and SNP market position while working to align products and program offerings with state procurement cycles.

This role will work closely with Medicaid and SNP segment leadership, actuarial, network, sales, operations, marketing, and physician & health services to develop and communicate product intent, and ensure accurate and complete understanding and administration both internally, in the marketplace and with state and federal regulators.

Incumbent must have a proven track record with Medicaid and SNP products and understand the operational, clinical and financial implications of plan designs. Director is subject matter expert on Medicaid and SNP plan performance including membership, income, and operating margin. Position will also implement and manage strategic partnerships, alternative payment arrangements and external vendors.

Qualifications:

  • Bachelor’s degree or equivalent combination of education and experience required
  • 10+ years Medicaid, Medicare or SNP experience with a track record of successfully leading growth initiatives
  • 5+ years leadership experience required
  • Medicaid and SNP Products plan benefit design, bid development and operational implementation

Specific types of experience or skills required:

  • Product performance monitoring, establishing metrics to measure product success
  • CMS and DHS compliance and understanding of MCO regulatory environment
  • Health plan operations understanding
  • Analytical ability in business planning and financial management
  • Demonstrated leadership and influencing skills with the ability to lead and drive change
  • Strong communication and presentation skills
  • Strong strategic planning skills
  • Financial performance measurement skills, accountable for results
  • Ability to articulate vision and strategy
  • Passionate about member experience and recognized as a positive change agent who can work effectively in creating direction and influence to effective results
  • Team player with strong relationship building skills at all levels of the organization and externally
  • Creative problem solving skills using innovative approaches
  • Ability to handle multiple complex projects with a high degree of engagement
  • Strong drive for results and accountability
  • Expertise in project development and implementation management

 
 

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

 

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

Equal Opportunity Employer including Veterans and Disabled Individuals

Clipped from: https://www.minnesotajobnetwork.com/job/detail/57068216/Director-Medicaid-and-SNP-Product-Strategy?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Booz Allen Hamilton Medicare and Medicaid Program Evaluator Job in Columbia, MD

 
 

Key Role:

Serve as a healthcare consultant focused on supporting our government client. Support business development and federal client delivery in the evaluation space. Lead capture efforts for the design and execution of formative and outcomes evaluations for client programs, including Center for Medicare & Medicaid Innovation (CMMI) models. Manage across teams and client delivery for evaluation projects.

This position is open to remote delivery anywhere within the U.S., to include the District of Columbia.

Basic Qualifications:

  • 7+ years of experience with program evaluation design, implementation, and management
  • Experience with developing data collection tools and templates
  • Experience with the federal procurement process, including business development and proposal development leadership
  • Experience with client management
  • Experience with developing evaluation reports and peer-reviewed publications
  • Ability to manage a mid-sized team and manage budgets
  • MA or MS degree

Additional Qualifications:

  • Experience with CMMI Alternative Payment Models
  • Experience with payment calculations
  • Experience with oncology / radiation oncology programs
  • Ph.D.

We’re an EOE that empowers our people—no matter their race, color, religion, sex, gender identity, sexual orientation, national origin, disability, veteran status, or other protected characteristic—to fearlessly drive change.

Clipped from: https://www.glassdoor.com/job-listing/medicare-and-medicaid-program-evaluator-booz-allen-hamilton-JV_IC1153546_KO0,39_KE40,59.htm?jl=4084315776&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Supervisory Health Insurance Specialist – US Centers For Medicare & Medicaid Services Woodlawn

 
 

Welcome to the Latest Job Vacancies Site 2021 and at this time we would like to inform you of the Latest Job Vacancies from the US Centers For Medicare & Medicaid Services with the position of Supervisory Health Insurance Specialist – US Centers For Medicare & Medicaid Services which was opened this.

If this job matches your qualifications, please send your application directly through our latest Job site. Indeed, every job is not easy to apply because it must meet several qualifications and requirements that we must meet in accordance with the standard criteria of the Company who are looking for potential candidates to work. Good job information Supervisory Health Insurance Specialist – US Centers For Medicare & Medicaid Services Woodlawn below matches your qualifications. Good Luck: D

Collaborating with state or national stakeholders to assess and to address technical needs to ensure successful Medicaid and CHIP enrollment…

  • Company Name : US Centers For Medicare & Medicaid Services
  • Open Position : Supervisory Health Insurance Specialist – US Centers For Medicare & Medicaid Services Woodlawn
  • Location Job : Woodlawn, MD
  • Country Job : US

How to Submit an Application:

After reading and knowing the criteria and minimum requirements for qualifications that have been explained from the Supervisory Health Insurance Specialist – US Centers For Medicare & Medicaid Services job info – US Centers For Medicare & Medicaid Services Woodlawn, MD above, thus jobseekers who feel they have not met the requirements including education, age, etc. and really feel interested in the latest job vacancies Supervisory Health Insurance Specialist – US Centers For Medicare & Medicaid Services job info – US Centers For Medicare & Medicaid Services Woodlawn, MD in 05-06-2021 above, should as soon as possible complete and compile a job application file such as a job application letter, CV or curriculum vitae, FC diploma and transcripts and other supplements as described above, in order to register and take part in the admission selection for new employees in the company referred to, sent via the Next Page link below.

US Centers For Medicare & Medicaid Services | Woodlawn, MD Woodlawn, MD MD US 07-07-2021

 
 

Clipped from: https://idblogo.com/job/e4215f1619ac442b/supervisory-health-insurance-specialist-us-centers-for-medicare-medicaid-services.html?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Posted on

Amerihealth Provider Network Account Executive II | Washington, DC

 
 

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

The AE II is responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers. Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations. AE II maintains in depth understanding of Plan’s contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues. Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the Plan’s territory in keeping w/ State and Federal contact mandates for all products. Identifies, contacts and actively solicits qualified providers to participate in Plan at new and existing service areas and products, assuring financial integrity of the Plan is maintained and contract management requirements are adhered to, including language, terms and reimbursement requirements. Maintains complete understanding of Plan reports and metrics and uses them to evaluate the performance of assigned providers/practices/facilities, determining, communicating and implementing plans for providers to improve performance and measuring ongoing performance. Uses data to develop and implement methods to improve relationship. Assists in corrective actions required up to and including termination, following Plan policies and procedures. Supports the Quality Management department with the credentialing and re-credentialing processes, investigation of member complains and any potential quality issues. Maintains a functional working knowledge of Facets, including the provider database and routinely relays information about additions, deletions or corrections to the Provider Maintenance Department. Maintains and delivers accurate, timely activity and metric reports as required. Identifies and maintains strong partnerships with appropriate internal resources and stakeholders.

 
 

Education/ Experience:

  • Bachelor’s Degree.
  • 1 to 3 years previous Account Executive experinces in the manage care space.
  • Required Medicaid experience along with 3 to 5 years experience in a Provider Services position working with providers
  • 5 ot 10 years experience in the managed care/health insurance industry with demonstrated strengths in:

 
 

  • Plan policies and procedures related to provider contracting, provider credentialing, provider billing and payment, provider incentive programs.
  • State and Federal regulatory requirements related to providers, claim adjudication systems, provider file database requirements and relevant software applications.
  • Substantive Account Executive experience with high impact, high dollar, extremely visible and critical provider groups.
  • Working independently and managing complex projects and programs both as an independent owner and team leader, training and mentoring skills, interacting at an executive level internally and externally.

 
 

Note: Presently all of our AmeriHealth Caritas Family of Companies associates are working remotely due to the Pandemic. This role/department will be transitioning to the District of Columbia site when it is safe to return to the office.

Clipped from: https://www.glassdoor.com/job-listing/provider-network-account-executive-ii-medicaid-amerihealth-caritas-JV_IC1138213_KO0,46_KE47,66.htm?jl=4108001985&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Director, Medicaid Initiatives Job at Families USA Foundation in Washington, District of Columbia

 
 

Who we are

Since 1981, Families USA Foundation has been a leading national voice for health care consumers. Through our long-standing relationships of consumer leaders, advocates, and partner organizations across all 50 states and the District of Columbia, we have remained steadfast in our mission – Dedicated to the achievement of high-quality, affordable healthcare and improved health for all. We advance our mission through public policy analysis, advocacy, and collaboration with partners to promote a patient-and community-centered health system.

Your Role

We are looking for a Director of Medicaid Initiatives providing strategic leadership and support for Families USA’s Medicaid policy and advocacy projects. Central job responsibilities include providing expert Medicaid policy analysis and strategy and developing Medicaid policy recommendations for the organization related to the Health Policy team’s areas of focus and projects. Collaborate with other departments to develop and implement strategies and tactics to advance Medicaid policy recommendations in these areas, including development efforts. This person will work in close collaboration with the senior leadership team and will also serve as a spokesperson for the organization around Medicaid work.

Main job responsibilities:

  • Direct and develop effective organizational strategies related to Medicaid.
  • Conduct or direct the completion of activities necessary to execute Medicaid related strategies, including anticipating next steps from Congress or target states.
  • Respond to changing political dynamics and maintain focus on the Medicaid program and the organization’s efforts to sustain a strong Medicaid program at the federal and state levels.
  • Evaluate the likely impact of changes on Medicaid enrollees’ health care access and assess the organization’s position and appropriate response.
  • Stay abreast of, track, and analyze Medicaid related news reports, scholarly studies, articles, and state and federal program changes, legislation, bills, and regulations.
  • Collaborate with Strategic Partnerships, Federal Relations, and Communications teams on a broad range of written products and research, including proposals, blogs, research studies, issue briefs, and regulatory comments to implement organizational strategy.
  • Establish thought leadership in broader health policy community.
  • Maintain positive relationships with funders and external stakeholders and confer with internal and external colleagues about events to refine our position and determine our best response.
  • Represent Families USA at external meetings and conferences.
  • Serve as a reviewer of draft documents and ensure that written products are of high quality before reaching the Senior Director and Executive Review process.
  • Supervise staff including assigning and supervising work, providing feedback, helping staff set long-term goals and monitoring progress, facilitating weekly check-ins, providing opportunities for enrichment through external opportunities and internal meeting participation, and providing mentorship and professional development.

Your Experience

Undergraduate degree in public health, public policy or related field. 5 to 10 years’ experience with high-level content knowledge, knowledge of and experience with federal and state-level policy-making processes (both legislative and administrative). Demonstrated understanding of public programs and the health system, with a focus on Medicaid. Experience representing an organization with media, federal and state regulators, state and national partners, funders, including ability to speak in public. Capacity to handle multiple competing priorities – including developing and executing project plans. Highly motivated team player who contributes to an atmosphere in which people collaborate enthusiastically and effectively to produce results.

Our Workplace

We offer a dynamic, empowering, and collaborative work environment that allows staff to reach their full potential. We offer an extremely attractive total compensation package, including competitive salary, medical, dental, vision, disability and life, 403(b), 3+ weeks’ vacation, nine (9) Federal holidays and our offices are closed between Christmas Eve and New Year’s Day and many more exciting benefit programs.

 
 

Clipped from: https://www.politicaljobhunt.com/jobs/71335667-director-medicaid-initiatives-at-families-usa-foundation?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Pharmacist Program Manager/WNY Medicaid Plan

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time


 

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. 

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortune Top 50 Company.

Pharmacist Program Manager

*Open to other locations however, the individual is preferred to live in an Eastern Time Zone area. 

The Pharmacist Program Manager is responsible for serving as the primary contact for the BCBS WNY Medicaid pharmacy program.

Primary duties include but are not limited to:

  • Represent BCBS WNY Medicaid pharmacy program for the region, externally;

 
 

  • Face of plan to Government Relations, NYS DOH
  • Attend state meetings, respond to email inquiries
  • Represent BCBS WNY Medicaid pharmacy program within the health plan and with PBM vendor
  • Maintain, enhance and modify components of the pharmacy program as needed to align with health plan goals and pharmacy program national Medicaid best practice 
  • Prepare and present routine pharmacy program updates within various forums, including but not limited to: quarterly business reviews, regulatory meetings, quality meetings to support accreditation, biweekly trend meetings
  • On occasion solve claims issues and complaints with the support of Pharmacy Operations team or Medicaid Account Management team
  • Perform routine benefit surveillance to assure benefits are working correcting, optimal penetration of preferred products, low claim reject volumes
  • Assure successful implementation of program changes including: state mandates and programs to improve the member and provider experience, contain costs and improve quality of service
  • Present and report on Enterprise quality programs that impact the market

 
 

  • Advocate for plan needs
  • Identify, develop, and/or advocate for quality programs that will drive more favorable withhold measures (local, enterprise)
  • Report on the productivity and outcomes of clinical quality programs
  • Assure appropriate access for health plan staff to RX tools
  • Assure all necessary client/vendor accountability reporting is complete, accurate an on time.
  • Develop and implement communications to pharmacies, prescribers and members as necessary to improve member and provider experience and reduce cost

Qualifications

Qualifications 

  • Requires a registered pharmacist; 2 years of managed care pharmacy experience including knowledge of current health care and managed care pharmacy practices; or any combination of education and experience, which would provide an equivalent background. 
  • Current state license to practice pharmacy as a RPH required. 
  • Minimum 2 years of managed care pharmacy experience that is NOT RETAIL PHARMACY related preferred
  • Proficiency in MS Excel, Power Point, Outlook
  • Program Management experience in managed care or other related field
  • Must demonstrate proficiency as a key participant in program development, where the program seeks to satisfy regulatory requirements, improve clinical outcomes, quality, cost or other measure.
  • Must demonstrate proficiency in clinical/technical communication to business leaders, an ability to communicate messages pertaining to programs and systems using data and other details in a way business leaders can understand
  • Professional designation preferred
  • Day travel and occasional overnight travel may be required
  • Experience with government programs (Medicare/Medicaid) strongly preferred

 
 

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/6985076-pharmacist-program-manager-slash-wny-medicaid-plan?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Manager, Medicaid Claims | AbbVie

 
 

About AbbVie


AbbVie’s mission is to discover and deliver innovative medicines that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people’s lives across several key therapeutic areas: immunology, oncology, neuroscience, eye care, virology, women’s health and gastroenterology, in addition to products and services across its Allergan Aesthetics portfolio. For more information about AbbVie, please visit us at www.abbvie.com. Follow @abbvie on Twitter, Facebook, Instagram, YouTube and LinkedIn.


Primary Job Function


The US federal and state governments are significant customers of AbbVie ensuring patients covered under their numerous healthcare programs have access to our medicines. Medicaid is one of the largest of these programs. AbbVie contributes to the success of this program by providing discounted prices on our products. The incumbent will manage the analysis, payments, and disputes of a large volume of quarterly rebate claims within required timelines.


Core Job Responsibilities

  • Manage and develop three or more direct reports in the payment of rebate claims.
  • Offer guidance on the analysis of payments for reasonableness as well as on dispute guidelines.
  • Act as a liaison between AbbVie and government customers to drive the team to the settlement of disputes.
  • Perform ad hoc legal, management, and customer requests.
  • Maintain procedural documentation as required by changes in legislation and business practices.
  • Assist various projects related to government system upgrades and/or enhancements.
  • Perform other duties as assigned.

 
 

Position Accountability And Scope

Ability to manage a team and perform duties independently or with a low level of supervision. The incumbent is responsible for the accurate and timely payment of Medicaid rebates totaling $3 billion annually to state Medicaid agencies, including providing adequate review and approval of payments as they are processed by team members. Must have the aptitude to understand and analyze payment trends and ensure team members have accurately depicted and explained payment variances from prior periods, including managing and forecasting the right level of balance sheet reserves. Must support corporate cash flow management activities by ensuring payment releases as close to the due date as possible and provide Corporate Treasury weekly payment forecasts during heavy processing periods. Incumbent will ensure team members are current with resolving invoice disputes to keep balances within reasonable levels, including ensuring periodic payment reconciliations with the states as required. Must build strong product knowledge in order to perform the necessary units per script and reimbursement test validations to ensure payment accuracy for key products. Must have a strong technical background to support the various Excel reports and tools required to manage the business, including quickly learning the Medicaid modules in the Model N Revenue Management System. A background in SQL/VBA programming is preferred. Must have the ability to manage multiple priorities, ad-hoc projects, and react to a rapidly changing dynamic work environment. He/she is expected to identify opportunities for productivity and process improvements.

Minimum Education

Qualifications

BA/BS required;

5+ years business experience, preferably with a concentration in contracting, Medicaid related activities or financial analysis

Minimum Experience/Training Required

Incumbent must have the ability to manage a productive team tasked with demands that require responding to a high volume of work that requires absolute accuracy and rapid turnaround time. Must have excellent oral and written communication skills as job responsibilities include communicating with various levels of management within AbbVie as well as with external customers. The job can be demanding at times due to the dynamic nature of the rebate function and the evolving legislative and legal environment. Therefore, it requires ability to respond to change and to continually reprioritize to satisfy demands of a rapidly changing environment. Problem solving and integrity are key competencies of this position. Must be able to drive the process and ensure sound judgment in determining appropriate payments. Extremely strong organizational skills along with a high degree of follow through are requirements. Must have intermediate or higher-level skills with the Microsoft Office Suite, especially Excel. Previous experience with Revenue Management software (i.e., Model N, Revitas, etc.) and SQL/VBA is helpful.

Significant Work Activities
Continuous sitting for prolonged periods (more than 2 consecutive hours in an 8 hour day)
Travel
Yes, 5 % of the Time
Job Type
Experienced
Schedule
Full-time
Job Level Code
M

Clipped from: https://www.linkedin.com/jobs/view/manager-medicaid-claims-at-abbvie-2638105148/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic