Category: Curator- Job Hunter

 
 

Job Description


Assists with the design and development of curriculum for Member Services and develops and delivers training sessions to a designated audience of learners. Collaborate with health plan leadership and national curricula design teams to ensure the successful development and transfer of learning from the classroom back to the job. Oversees the classroom environment for long-term and complex training situations, managing all aspects of student performance and feedback to management.
Job Responsibilities

• Perform performance analysis with business leaders to identify performance gaps, appropriate training interventions, and other variables required to improve business performance
• Actively engage with the local health plan leadership to collect and coordinate subject matter expertise, to collaborate on and influence the design and development of curriculum and to ensure that the right curriculum is developed using the appropriate learning medium
• Revise and customize curriculum to reflect unique geographic, product and/or audience variations
• Lead training sessions for designated audiences.
• Work with health plan leaders to align the performance variables required to transfer learning back to the job
• Assess the effectiveness of training programs during and at designated intervals after delivery
• Develop and conduct follow-up assessments to determine the effectiveness and, when appropriate, ROI of training programs
• Provide feedback from program participants and health plan leaders back to the Call Center Support team as appropriate and participate in the development effort to enhance the curricula based on that feedback
  
  

Required Qualifications

• Strong technical knowledge of the function being trained
• Excellent platform skills and the ability to interact effectively with people at all levels of the organization
• Previous training experience or proven platform skills desirable
• 3-5 years of experience in appropriate technical function
• Education in adult learning principles and best in practice learning techniques desirable
• Bachelor’s degree or equivalent work experience
  
  

Preferred Qualifications

• Proficient in Medicaid Member Services for Aetna Better Health
  
  

Education
Bachelor’s degree or equivalent experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-member-services-trainer-at-aetna-2499560729/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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 Mgr/VA Medicaid Health Plan

*This individual must be Virginia based and willing to travel to our Richmond health plan on as needed basis

Summary: Responsible for serving as the clinical pharmacy subject matter expert for Anthem affiliated Medicaid Health Plan in VA.

Primary duties may include, but are not limited to:
 

• Partners with pharmacy sales and account management to win and retain pharmacy business through clinical consultation and recommendations
• Acts as a support resource for the sales team regarding efforts to improve the performance of the pharmacy benefit for existing accounts
• Provides ongoing support to Anthem affiliated Medicaid Health Plan regarding pharmacy clinical programs and performance goals
• Provides expertise and guidance regarding drug utilization, spend and trend
• Manages both internal and external stakeholder communications for assigned area
• Shares insights with matrix partners during the creation and roll out of new pharmacy programs
• Ensures the proper reaction to and resolution of issues concerning the pharmacy benefit program

Qualifications

 

• Requires a current unrestricted VA state license to practice pharmacy as a registered pharmacist (RPh); minimum 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
• Minimum 2 years of pharmacy benefit management experience strongly preferred
• Professional designation preferred
• Excellent clinical skills, analytical ability, strategic planning, organizational, and leadership skills required
• Proficiency in Excel, PowerPoint required
• Strong verbal and written communication skills required

Clipped from: https://tarta.ai/j/Ikw-xXgBrJRKg1c1uOJ0-pharmacist-program-manager-va-medicaid-health-plan-in-not-specified-virginia-va-at-jobrxindex?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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 benefits companies and a Fortune Top 50 Company.

Title: Staff VP Encounters

Location: Virginia Beach, VA or within commutable distance to a local office

Travel: 25%

Responsible for the strategic, design and management of the Encounters e2e program and team that supports the day to day Encounter intake, analysis and submissions to federal and state partners, as well as the implementation of company-wide initiatives

Primary duties may include, but are not limited to:

• Oversees Encounters performance metrics ensuring timeliness, accuracy and completeness are met with state and federal partners for all lines of business
• Oversees Encounters submissions, rejection management & resolution for all lines of business including internal strategic partnerships supporting the production of encounters as well as providing overall organizational leadership aimed at managing overall healthcare costs
• Ongoing monitoring and management resolution for any potential penalties related to performance measurements of encounters submissions
• Engages with internal business partners and IT to analyze the root cause, identify potential risks, find ways to improve upon performance and lead the needed changes
• Develops and leads strategic innovative initiatives to deliver more value for state and federal partners. Consults and calibrates with senior leaders as well as vendors and outside organizations, being the face of Encounters for the Anthem enterprise
• Identifies, develops, hires, trains, coaches, counsels, and evaluates performance of direct reports

Qualifications

• Requires a BA/BS in business or related field; 15+ years of experience in Healthcare or Operations industry;
• Advanced strategic planning, organizational, managerial, and leadership skills; excellent verbal and written communication skills, experience drafting proposal, obtaining consensus for approving and implementing future state processes and systems need to support strategic direction or any combination of education and experience, which would provide an equivalent background.
• 5+ Medicare and Government Medicare, Medicaid
• 5+ Claims payment processing
• 5+ Financial management
• 5+ Regulatory and/or government experience

Preferred requirements:

• MA/MBA
• Vendor Management experience
• Claims and Encounters within Health Insurance
• Six Sigma, Agile Methodology and Design Thinking
  
  
  
  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/6579403-staff-vp-encounters-gbd-medicare-and-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Location: Long Island (Commack/Smithtown area)


Full time, Direct hire


Salary plus great benefits


Onsite, M-F, 8/8:30 to 5/5:30


Our client, a home health services company, is looking for a biller and denials representative with strong Medicaid expertise.


The successful candidate will be an Medicaid expert- 80% of their billing is directly to Medicaid. Duties will include billing, collections and denials.


Musts


Expertise in Medicaid


Prior Home Health Billing Experience Highly Preferred


Experience with either HHAeXchange or DSS


Knowledgeable with NY’s MLTC (Managed Long Term Care plan)

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-biller-at-tts-technologies-llc-2499626854/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Centene Corporation New Port Richey, FL

Position Purpose:

• Assist in financial analysis, pricing and risk assessment to estimate outcomes.
• Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes
• Assist with developing probability tables based on analysis of statistical data and other pertinent information
• Analyze and evaluate required premium rates
• Assess cash reserves and liabilities enable payment of future benefits
• Assist with determining the equitable basis for distributing money for insurance benefits
• Participate in merger and acquisition analysis

Education/Experience:

• Bachelor’s degree or equivalent experience.
• 0-3 years of actuarial experience.

License/Certification:

• Passed one actuarial exam.

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

Centene Corporation

 
 

Address

New Port Richey, FL

34655 USA

Industry

Finance and Insurance

 
 

Clipped from: https://www.ziprecruiter.com/c/Centene-Corporation/Job/Actuarial-Analyst-Medicaid/-in-New-Port-Richey,FL?jid=d1ab0efb846d5691&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Manage/retain/grow large key account business to achieve team and corporate goals through the development of strong multi layered client relationships. Continuously and effectively demonstrate Versant Health Value proposition. Serve as point of contact and SME to internal business partners for clients to determine needs and deliverables to support implementations, renewals and retention. Exhibit strong customer service focus to both our internal/external customers.

May supervise the Senior Client Manager and Client Manager team to include selection, training and development, coaching, counseling and performance management

Provide strategic leadership and solution based support to expand and maintain business relationships with existing Government Sponsored Health plans (ie Medicaid and/or Medicare), large, complex accounts encompassing $35,000,000 to $75,000,000 in revenue

Demonstrates individual ownership and accountability in the development of client, consultant and broker relationships for client retention, client satisfaction and achieving corporate strategic goals relative to book of business

Lead, coordinate implementation process with internal business partners for successful implementation of renewals and new sales. To include confirmation of benefits, rates, contract duration and network selection

Partner with Implementation Coordinators to determine client operational requirements including enrollment process, eligibility transfers, billing, claims processing, customer service, performance commitments and reporting

Determine client communication needs and expectations (ie pre/post enrollment materials, benefit/health fInstitutes, staff training, etc.) including periodic meeting schedules to ensure optimal plan performance. Keep Management informed of status through implementation process reporting

Lead collaboration on renewals with solution based recommendations for benefit changes and pricing with underwriting. Partner with underwriting for development of appropriate rates

Lead with solution based recommendations, the executive contract review with legal and executive team on successful timely contract execution

Reach out to multiple levels of management, tailoring the message accordingly for successful strategic client discussion to influence desired oCompanyomes

Gain understanding of client’s multifaceted needs and recommend appropriate products and benefit design accordingly

Partner with Management to cultivate existing client, consultant and producer relationships to create new business opportunities for Sales and/or Client Management

Actively support/participate in client meetings to add relative insight and expertise necessary to solve customer issues and/or plan to proactively meet and exceed client expectations, strong client loyalty and comprehension of Versant Health value proposition

Review and confirm client receives all requested reports, satisfaction results and performance guarantees within the timeframe requested

Make recommendations and independent decisions (as appropriate) to address escalated client issues and opportunities. Notify Team leader of potential growth opportunities as well as escalated client concerns, continued negative feedback or red flags’ within assigned book of business

Understand applicable internal systems and processes and their downstream impacts so as to appropriately direct client requests and set client expectations. Respond timely to inquiries from internal business partners

Inform Senior Management of market and client trends that affect the personal and team’s book of business and develop strategies to address trends

Communicate effectively, consistently and frequently with assigned client base. Continuously working to improve customer loyalty. Meet all assigned revenue, client retention and profitability goals

Maintain relevant industry knowledge and current events to facilitate a trusted advisor relationship with client and consultants

 
 

Clipped from: https://www.learn4good.com/jobs/denver/colorado/business/260597432/e/

 
 

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Your Talent. Our Vision. At Anthem Blue Cross, a proud member of the Anthem, Inc. family of companies, 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.

 
 

Program Manager (CA Medicaid)

 
 

Work Location – Must reside in the state of California (This position covers Alpine, Amador, Calaveras, Inyo, Mariposa, Mariposa, Mono and Tuolumne counties in California.  May consider working remotely.)

 
 

This is an exceptional opportunity to do innovative work that means more to you and those we serve. An exciting opportunity to drive the future of health care, Anthem Blue Cross is the place where exceptional talent meets exceptional opportunity to do innovative work that has a positive impact on the quality of life for the 1.2 million Medi-Cal Managed Care members we serve. Program Manager Responsible for the development and ongoing management of one or more multi-year external client facing programs within a business unit. Program managers typically support business strategies through an integrated portfolio of external client facing projects or initiatives. A program manager may have responsibility for a piece of a larger enterprise/regional external client facing program. Primary duties may include, but are not limited to:

 
 

Represent Health Plan on special projects and growth initiatives that result in performance improvements. – Enhance relationships with local elected officials and local stakeholders. – Serve as liaison with County Health and Human Services Agency and County Behavioral Health Departments – Facilitate Community Advisory Committee Meetings, County Public Health Memorandum of Understanding (MOU) meetings, County Behavioral Health MOU meetings and Regional Center MOU meetings. – Prepare and monitor reporting of activities for submission to Regulatory & Compliance departments. – Build and maintain provider relationships, support local and community health collaborative initiatives, and serve on managed care related committees. – Function as a resource in assigned program areas and help resolve non-routine questions, situations, and provider, member, and regulatory/compliance issues. – Support development and execution of key marketing strategies that help grow membership while complying with state and federal regulations. – Develop and implement initiatives/projects that streamline complex processes across multiple business and clinical functions in a highly matrix health care organization. – Develop and deliver highly engaging visual presentations on program performance and projects/initiatives to external and internal leaders. – Perform Market/Competitive Intelligence. – Compliance Focus: Regulatory and Contractual Requirements. – Develop and maintain relationships with the Local Health Plan.

 
 

Requires a BA/BS degree; 5-7 years of external client facing experience in program/project management; or any combination of education and experience, which would provide an equivalent background. – Medi-Cal Managed Care experience and/or Public Health, Community Health Center experience preferred.

 
 

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.

 
 

Clipped from: https://tarta.ai/j/sH2qongBrJRKg1c1YE8i-program-manager-ca-medicaid-in-sacramento-ca-at-anthem-career-site?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic
 

Director, Medicaid Market Access and Public Policy

Overview

Alnylam is the world’s leading RNA interference (RNAi) company.

Founded in 2002, Alnylam was built upon a bold vision of turning scientific possibility into reality by harnessing the power of RNAi for human health as an innovative new class of medicines. We are a growing biopharmaceutical company with three approved medicines and a robust pipeline of investigational medicines focused in four strategic therapeutic areas: genetic medicines, cardio-metabolic diseases, infectious diseases, and central nervous system (CNS) and ocular diseases, including several in late-stage development.

Headquartered in Cambridge, Mass., Alnylam employs over 1,500 people in 19 countries and is rapidly growing globally, with additional offices in Norton, Mass., Maidenhead, U.K., Zug, Switzerland, Amsterdam, Netherlands, and Tokyo, Japan. Alnylam is proud to have been recognized as one of The Boston Globe’s Top Places to Work six years in a row (2015-2020), a Great Place to Work in the U.K. and Switzerland two years in a row (2019-2020) and a Science Magazine’s Top Employer two years in a row (2019-2020). Please visit www.alnylam.com for more information.

The Director, Medicaid Market Access and Public Policy will focus on several key areas for Alnylam success: Access to Alnylam therapies in Medicaid programs; the creation and execution of state contracts, primarily value-based agreements; state governmental engagement; and monitoring and assessment of state policy issues.

Principal Responsibilities:

Medicaid Market Access

• Conduct outreach to and engage Medicaid agencies, managed care Medicaid organizations, and Medicaid pharmacy benefits managers (PBMs) in prioritized states.
• Organize meetings for clinical presentations for Alnylam programs, pipeline reviews and to discuss optimal patient access. Work with Medical Affairs (Medical Outcomes Science Liaisons (MOSL) or MSLs) to engage states on prior authorization or coverage policy requirements.
• Organize meetings with prioritized state Medicaid agencies to review options for value-based agreements and contracts.
• Lead the execution of value-based agreements by reviewing state Medicaid contract templates, editing templates to include program-specific amendments, and working with Alnylam’s Public Policy, Legal, and Commercial teams as well as outside counsel to finalize contract proposals.
• Lead the assessment of any state-requested supplemental rebates, analyze options for response, align internal teams and provide timely responses to states.
• Work with Medical Affairs, Commercial, Legal and Public Policy teams regarding approaches to ensure patient access to Alnylam programs in states with drug price cap or similar laws.
• Develop reporting materials for Alnylam colleagues regarding execution of Alnylam Medicaid strategy. Maintain Medicaid dashboard which provides real-time information about state meetings, coverage and access.
• Support the execution of Alnylam’s Medicaid strategy through engaging state governmental entities (governors’ offices, state administration, state legislatures) to introduce Alnylam therapies and Alnylam’s approach to patient access.
• Develop, as needed, educational materials (slide decks) for use in Medicaid meetings, in partnership with Commercial, Medical, and Legal teams.
• Lead cross-functional meetings with Medicaid and state policy consultants: set agendas, identify action items, send around post-meeting notes with deliverables and follow up items.
• Liaise and support Alnylam’s field reimbursement team regarding specific reimbursement or payment and access matters.

State Public Policy Analysis & Strategy

• Monitor and assess the state policy and regulatory landscape to ensure that Alnylam is aware and in front of emerging policy issues.
• In partnership with Global Public Policy and Government Relations team, analyze state public policy proposals, identify priorities, and develop slides or educational materials to present to Alnylam colleagues regarding risks and opportunities.
• Create strategies for engagement with state government officials, patients, and stakeholders to support achievements of public policy priorities and that address risks to Alnylam’s business and patient access.
• Engage and support trade associations (BIO, state biotechnology associations) to advance Alnylam’s policy positions and to support those organizations’ advocacy and policy engagement. Serves on BIO state policy and appropriate regional committees.
• Influence and actively participate in the development of state government legislation and regulations to ensure a favorable environment for Alnylam programs and patient access (e.g., step therapy limits, etc.).
• Work with Alnylam patient advocacy team to support engagement by disease advocacy groups on state policy matters.
• Find opportunities to create coalitions among companies interested in similar state-level issues.

Education & Background Qualifications

• Bachelor’s Degree. Graduate Degree preferred.
• 8-10 Years of work experience required, preferably in biotech, pharmaceuticals or healthcare.

Other qualifications: Skills and Attributes

• A record of success engaging state Medicaid agencies to achieve access for innovative products is required. Experience with rare disease products is desired.
• Familiarity with innovative contracting strategies in Medicaid, such as value-based agreements (VBAs).
• Significant experience with state government engagement across multiple states.
• Expertise in state public policy issues and analysis of impacts across various stakeholders and operational aspects.
• In-depth background in the analysis of state government processes, laws, and regulations.
• Demonstrated ability to work effectively in a cross-cutting role that interacts effectively across numerous expertise areas such as market access, legal, medical affairs, patient advocacy, and commercial.
• Ability to provide internal partners with timely, accurate and well written information to communicate opportunities, threats, and business interests at the state level.
• Desire and interest to be a “content creator” with strong writing and PowerPoint skills, and ability to simplify complex political or regulatory requirements in writing. Meticulous attention to detail and commitment to high quality and timely work product.
• A “roll your sleeves up” attitude and ability to manage and prioritize multiple issues and tasks and meet tight deadlines.
• Strong communications skills, an ability to present ideas and information, and ability to lead meetings with external or internal partners.
• Strong relationship management and interpersonal skills are essential.
• Excellent written and oral communication skills, including presentation skills.
• Travel 30% depending on meetings in states and state issues.

Alnylam Pharmaceuticals is an EEO employer committed to an exciting, diverse, and enriching work environment.

 
 

Clipped from: https://helponebillion.com/job/0abaf1eb416c08631a7a14d852b077a7/Director-Medicaid-Market-Access-Public-Policy?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Help at Home is still hiring in your community!

Help at Home is the nation’s leading provider of high-quality support, providing a gold standard of care to seniors and people with disabilities.

Right now, our clients need us more than ever.

We are still hiring compassionate caregivers, and we are taking every precaution to protect our communities.

We commit to being transparent and open in our hiring process to ensure your health and safety.

Our clients, caregivers and employees will always be our top priority.

Help at Home seeks an experienced Medicaid and MCO Coordinator.

In this role, the ideal candidate will be responsible for the administration of all Help at Home Medicaid revalidations and Manage Care Organization (MCO) credentialing functions.

The Medicaid and MCO Coordinator coordinates all aspects of Medicaid revalidations and MCO credentialing.

He/she will ensure all renewals are completed accurately and timely.

The Medicaid and MCO Coordinator will work closely with all key stakeholders within the Business Development department and with Regional Vice Presidents to ensure all Medicaid revalidations and credentialing are completed per state regulation.

Additionally, the candidate will have a solid understanding of Medicaid revalidation and MCO credentialing policies and procedures.

The ideal candidate will also be responsible for key reporting, managing key metrics, monitoring due dates, and developing presentations to provide business intelligence.

Responsibilities Ensures all Medicaid revalidation is maintained and renewed accurately and timely Ensures all MCO credentialing is maintained and renewed accurately and timely Continued communication with Regional Vice President’s and Medicaid/Managed Care plans for follow up on licensure, applications, (effective dates/terminations), demographic changes, etc.

Maintains positive and professional relationships with all providers, field questions and collect data from supervisors, managers, directors, outside vendors, Interact on a project/consistent basis with various departments Problem solving and troubleshooting as needed Stays abreast of provider recruitment and strategic partnership opportunities Maintains spreadsheet on current credentials including, user identification and passwords, NPI numbers, State, and expiration dates, effective dates for each Medicaid Provider ID and MCO credentialing period Maintains Medicaid revalidation and MCO credentialing trackers in smartsheet More responsibilities will be added per business needs Qualifications Bachelor’s degree in a related field Minimum of three (3) years of Medicaid Waiver enrollment/revalidation and/or MCO provider credentialing experience 15 % or occasional travel required (adjust as needed) Comprehensive knowledge of data sets and analytics Proficient in Microsoft Office Suite Experienced in smartsheet Exceptional presentation and reporting skills Strong research and analytical abilities Able to work independently, and efficiently with a minimal amount of oversight Excellent oral and written communication skills Experience in working within the non-medical home care or home health care sectors is strongly preferred Ability to work well within a diverse team and across departments Flexibility to adapt to a fast-paced and dynamic work environment Ability to multi-task, organize and meet deadlines Personal attributes include initiative, discretions, sound judgment, collaborator, positive behavior and performance

Clipped from: https://www.job.com/job/medicaid-and-mco-coordinator-in-chicago-il/47904349?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Health Care Service Corporation

Job Description

Job Opportunity Manager, Appeals and Grievances – Oklahoma Medicaid 4/2/21Full-Time RegularOK – Oklahoma City Refer Save Apply Job ID: EG-1041263 Description: JOB PURPOSE: This position is responsible for leading, managing, planning and all Oklahoma Medicaid appeals and grievance activity (Medicaid; clinical and non-clinical). Assures operations are in compliance with regulatory, sub-regulatory and accreditation standards. Oversee coordination of the Medicaid managed care regulations and program changes and ensure that regulatory or contractual updates have been implemented. Oversee coordination of the contract requirements with Oklahoma Health Care Authority. Also has overall authority to provide direct input and direction into the operational functions of Medicaid customer service to ensure integrated and quality customer service intake specific to all clinical and non-clinical organizational and coverage determinations.JOB REQUIREMENTS:* Bachelor’s Degree and 4 years health insurance experience in contract benefits, claims, medical review or appeals. * Leadership skills to manage staff and work across the organization. * Experience delivering presentations to physicians, legal personnel and committees.* Analytical skills to analyze data and prepare reports. * Knowledge and understanding of the health care industry and regulatory requirements.* Experience writing policies and procedures.* Written and verbal communication skills.* Ability and willingness to occasional travel.PREFERRED JOB REQUIREMENTS:* Knowledge of Medicaid* Knowledge of claims, membership or customer service operations* Experience in managing teams in multiple locations* Audit experience.* Knowledge of accreditation requirements regarding appeals and quality management. HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Requirements: Expertise Other, Claims & Customer Service Other, Claims & Customer Service Job Type Full-Time Regular Full-Time Regular Location OK – Oklahoma City OK – Oklahoma City

 
 

Clipped from: https://b-jobz.com/us/web/jobposting/54de07668b5a?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic