Finance Director – Corporate Medicaid

• Job Reference: 258790975-2
• Date Posted: 5 April 2021
• Recruiter: Anthem Inc.
• Location: Houston, Texas
• Salary: On Application
• Sector: Banking & Financial Services
• Job Type: Permanent

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Job Description

Description SHIFT: Day JobSCHEDULE: Full-timeResponsible for all financial reporting analysis/cost and budget functions for Medicaid business unit. Provides financial leadership, decision support and strategic direction to support the senior management team’s achievement of the business plan. Primary duties may include, but are not limited to: Provides decision support/analysis and financial leadership to business unit President and senior management team. Conducts analysis and reporting to understand trends, variances and identify opportunities for margin and operational improvement. Leads the preparation of budget and forecasts that represent the best projection of future performance. Works with management to determine assumptions and identify new initiatives for the business unit. Ensures alignment of budget/forecast to business plan.Qualifications Requires a BS/BA in accounting or finance; 5-7 years of progressively more responsible experience in a high level financial analysis position for a publicly held company; experience supporting senior management; prior leadership experience; or any combination of education and experience, which would provide an equivalent background. MBA, CPA, CFM, or CMA preferred.Experience with Hyperion Essbase and/or Smart ViewExperience with budgeting and forecastingMicrosoft Office (Outlook, Excel)PreferredMBA, CPA, or CMASQL experienceExperience with month end close processExperience in healthcare and/or health insurance industryMicrosoft AccessMS PowerPointWe 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.

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The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. In 2020, ODM introduced a new vision for Ohio’s Medicaid program — one that strengthens Ohio’s future and ensures everyone has the chance to live life to its full potential.

Today, more than 90 percent of Ohio Medicaid members are supported by managed care organizations. During the year ahead, ODM will begin implementing a new vision for care; focusing on the individual, a strong partnership among MCOs and the department, and supporting specialization in addressing critical needs.

A program that puts the individual first

Adopting Governor DeWine’s philosophy of service to Ohioans, ODM embarked on an aggressive effort to redesign its managed care program. The goal is to provide more personal, holistic care and supports for millions of Ohioans served by Medicaid. Listening to feedback from more than 1,100 individuals and organizations we identified five procurement goals that would put the individual front and center of Medicaid’s program and policy decisions. They are:

• Emphasize a personalized care experience
• Improve care for children and adults with complex behavioral health needs
• Improve wellness and health outcomes
• Support providers in better patient care and
• Increase program transparency and accountability

UNLESS REQUIRED BY LEGISLATION OR UNION CONTRACT, STARTING SALARY WILL BE SET AT STEP 1 OF THE PAY RANGE

Office: Strategic Initiatives

Classification: Medicaid Health Systems Administrator 2 (PN 20097166)

Job Overview:

The Ohio Department of Medicaid (ODM) is seeking an experienced healthcare administrator to manage all aspects of ODM’s Comprehensive Primary Care (CPC) program. As the CPC Program Manager, your responsibilities will include:

• managing annual rule and state plan amendment updates
• aligning the CPC program with federal and state priorities and requirements
• overseeing the updating of outcome measures and provider requirements annually
• collaborating regularly with ODM staff, vendors, managed care plans and providers regarding the CPC program
• overseeing CPC program reporting, payments, data issues, outcomes and policies
• determining how the CPC program interfaces with other ODM programs
• insuring timely and accurate provider communications regarding the CPC program

The preferred candidate will be detail-oriented, a skilled collaborator and display great organizational abilities.

Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 24 mos. exp. in planning & administering health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data analysis).

Or 24 months experience as a Medicaid Health Systems Administrator 1, 65295.

Note: education & experience is to be commensurate with approved position description on file.

• Or equivalent of Minimum Class Qualifications for Employment noted above.

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*Description* The Associate Director, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Associate Director, Utilization Management Nursing requires a solid understanding of how organization capabilities interrelate across department(s)..*Responsibilities* As Humana’s Medicaid membership continues to grow, the National Medicaid Clinical Operations team is expanding our shared services organization to enhance the clinical delivery process. The Associate Director, Utilization Management Nursing uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), and could lead multiple managers or highly specialized professional associates..*_Detailed Responsibilities include:_* Leads National Medicaid Utilization Management process and teams responsible for supporting.*_new Medicaid Market Clinical Operations delivery_* including: + Developing and implementing Clinical Prior Authorization policies, processes, detailed workflows, and leading the Centralized Utilization Management Outpatient operations team; + Hiring and directly leading a team of Utilization Management nurses and support staff responsible for reviewing and processing clinical authorizations and clinical claims reviews; + Working closely with Medicaid market Utilization Management leaders to collaboratively design processes for market staff to manage full spectrum of Utilization Management authorizations; + Working with Market Medical Directors and vendors to develop processes for routing cases for medical necessity decisions; + Develop IT business requirement, rule development, and training content for administering utilization management process in Humana’s clinical systems; + Collaboratively develop Utilization Management reporting requirements to assure operational oversight and address state reporting requirements for supporting all Medicaid states; + Implementing operational support tools and identifying operational best practices and process opportunities; + Assure compliance with state timeframes for turnaround times on authorization requests and delivery of Utilization Management services. + Participate in on-call rotation program to provide after hours, 24/7 clinical coverage requirements..*Required Qualifications*.Bachelor’s Degree in Nursing;.Active Compact Registered Nurse license, without restrictions or disciplinary action;.7+ years of Utilization Management nursing experience.5+ years of Managed Care experience.5+ years of Utilization Management operational leadership experience.2+ years of Medicaid experience.2+ years developing collaborative partnerships with enterprise cross-functional teams.Recent working knowledge and familiarity with MCG medical criteria and administering clinical practice guidelines.Ability to lead large scale projects, across cross-functional enterprise teams.Demonstrated experience and recommendations from peers as a customer-focused, team player, with collaborative approach to leading.Ability to participate in on-call rotation program to provide after hours, 24/7 clinical coverage requirements.*Preferred Qualifications*.Master’s Degree in Nursing or Business-related field.*Additional Information* This position is open to working remote (with the ability to support and work in Eastern Time Zone).*Scheduled Weekly Hours* 40

Location Birmingham, AL, United States of America

Industry Other

Employment Agency Humana

Contact Click apply

Reference JS11167_1507492770

Posted Date 4/3/2021 6:54:48 AM

Permalink http://www.jobserve.com/KpTRL

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Clayton, NY

Position Purpose:

• Conduct analysis, pricing and risk assessment to estimate financial outcomes. Provide expertise and technical support in matters related to the successful and financially sounds operations of the company’s health plan businesses.
• Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes.
• Negotiate capitation rates with State agencies
• Oversee health plan experience, identify trends and recommend improvements
• Research and identify new business opportunities
• Work with Health Plans to ensure soundness of capitation rates
• Work with State agencies to assess impact of program/policy changes

Education/Experience:  Bachelor’s degree or equivalent experience. 5+ years of actuarial experience.

License/Certification: Fellow or Associate of the Society of Actuaries (or equivalent international certification). Member of American Academy of Actuaries (or equivalent international membership).

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

Clipped from: https://jobing.com/job/backfill_fb76279729bf/34996341?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

UnitedHealthcare is a company that’s on the rise. We’re expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn’t about another gadget, it’s about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life’s best work.(sm)

You’ll enjoy the flexibility to telecommute* from anywhere within United States as you take on some tough challenges.

Primary Responsibilities:

* Serves as the dental Medicare product SME, understands the claims administrations systems requirement and identifies system changes needed. Work with implementation developers and monitor outcomes for change requests
* Represents dental Medicare with internal partners – QuEST and M&R Compliance
* Service as operational implementation business lead for new or changing regulations with teams
* Responsible for monthly internal QuEST monitoring to ensure Medicare program is being managed according to customer expectations and quarterly M&R ODAG universe reporting
* Responsible for changes to the ODAG universe based on client requirements
* Serve as primary functional liaison to UHC regulatory resources to ensure regulatory requirements and systems change projects are incorporated into project pipelines
* Develop opportunities to better align Medicare support for all of dental including private label Medicare support and reporting requirements
* Acts as a functional owner in applying contract terms or changing regulations for the Facets and Skygen platforms with project oversight for remediation efforts and change management
* Support implementation projects and serve as SME/consultant for regulatory requirements and process implementation
* Consult in the development of policies and procedures and workflow guidelines for process and regulatory adherence
* Coordinate and perform UAT for key systems and reporting change/upgrade processes
* Coordinate, represent and participate in CMS, OIG, Medicaid & Medicare Audits for the Dental organization
* Support and execute compliance projects
* Support FACETS system configuration oversite: TB499 table, BPL, Eligibility Mapping, CMS and EOB Tables, ELGS, CEOB, IDN letter, eCFI and Print Trail projects
* Establish and Maintain Vendor/Process Quality Oversite and Audit programs
* Develop audit reports/data universes and processes for monitoring key functional areas (claims, prior auths, call)
* Review sample data/process elements for compliance with regulatory and contract provisions
* Formalized work with Account Managers and Implementation Managers to review UAT of product/benefit change projects or regulatory compliance
* Review audit reports/data universes and processes for monitoring key functional areas (claims, prior auths, reports, etc.) and ensure contract compliance
* Reporting Oversight and Consultation
* Consultation on business rules for CMS reporting (Medicare CMS reporting): Analysis, requirements review/mapping, change management, QA/UAT of reporting output
* Document and define processes and control standards for various universe reporting projects (Medicare/CMS, Medicaid)
* Catalog reporting to ensure compliance with contract requirements

Functional Competencies:

* Analyze RFP/contract language with respect to regulatory requirements and incorporate requirements into project plans
* Assist internal and/or external business partners with completion of tasks and resolution of issues and problems with program
* implementation
* Establish and/or implement internal and/or external service level agreements in order to ensure ability to monitor and measure program performance (e.g., turnaround time; quality; effectiveness)
* Review, create, and/or maintain workflows to ensure they are up-to-date and operationally efficient
* Provide guidance, expertise, and/or assistance to internal and/or external partners (e.g., claims; call center; benefits; clinical) to ensure programs and strategies are implemented and maintained effectively
* Communicate with and help internal and/or external partners interpret contractual requirements in order to ensure effective problem solution and strategy implementation
* Demonstrate understanding of and adhere to relevant policies, procedures, and regulations
* Stay abreast of changes and/or updates in relevant policies, procedures, and regulations
* Serves as a key resource on complex and/or critical regulatory issues
* Performs business analyses on benefit and regulatory change requirements
* Participate in the definition of project roles to drive the gathering of detailed business, functional and non-functional requirements
* Gather information needed for the definition of requirements (e.g., business use cases, user stories)
* Develop business context diagrams (e.g., business data flows, process flows) to analyze/confirm the definition of project requirements

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

* Bachelor’s degree or equivalent work experience
* 5+ years of Product Management, Business Analysis, or Project Management experience
* 2+ years of experience working with vendor relationships
* 2+ years of experience in claims systems analysis, configuration, or process work
* Experience with Medicaid and/or Medicare Compliance
* Experience managing projects involving operational initiatives
* Operations experience within a matrix organization
* Experience leading matrix organizational projects/initiatives, preferably in a healthcare insurance or provider environment
* Advanced Excel skills (Expertise with manipulating data, Pivot tables, Macros, advanced analysis features)
* Ability to work with reporting systems such as Business Objects, and produce basic reports or extracts of data
* If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

* Healthcare administration or healthcare benefits administration experience
* Experience with Dental
* Intermediate experience with reporting and analysis tools including Excel, other reporting and database query software tools such as Access or SQL
* Ability to quickly build strong meaningful relationships both internally and externally
* Experience in the healthcare industry
* Ability to prioritize and handle large volumes of operational tasks and projects simultaneously
* Ability to communicate complex information tailored specifically to the audience so that it is easily understood

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we’re presented with an opportunity to make a difference on a scale we couldn’t imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you’ll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You’ll help write the next chapter in the history of health care. And you’ll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life’s best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

* All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Sr. Compliance Product Manager, Compliance Product Manager, Compliance, Product Manager, Medicaid, Medicare, Dental, Product Management, Business Analysis, Project Management, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote

Clipped from: https://www.zippia.com/montrose-mn-jobs/senior-product-manager-dlp/?70a11ebcf80b614e710d4120bfff0cd83e2c45df&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Position Summary

Primarily responsible for thorough review of Medicaid managed care contracts and comparison of such contracts against Medicaid claims to identify underpayments for the assigned client.

Duties and Responsibilities

• Build strong, lasting relationships with clients, payors and BLS personnel
• Review insurance contracts to gain thorough understanding of payment methodologies
• Examine claims and calculate reimbursement based on contract terms to determine accuracy of payment through use of various reports and supporting documentation
• Contact insurance company to obtain missing information, explain and resolve underpayments and arrange for payment or adjustment processing on behalf of client
• Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting
• Maintain regular contact with necessary parties regarding claims status including payors, clients, managers, and other BLS personnel
• Direct claims to and coordinate and support BLS specialty units
• Attend client, department and company meetings
• Comply with federal and state laws, company policies and procedures

Skills and Experience

• Minimum 3-years Medicaid experience working with claims and/or billing
• Accounts receivable/follow-up experience
• Moderate computer proficiency including working knowledge of Microsoft Word and Excel
• High school diploma or equivalent
• Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
• Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
• Ability to write routine correspondence (in English)
• Ability to define problems, collect data, establish facts and draw valid conclusions
• Strong customer service orientation
• Excellent interpersonal and communication skills
• Strong team player
• Commitment to company values
• Associate or Bachelors Degree preferred but not required

Disclaimer: BLS salaries are intentionally not posted and are based on level of experience. Some sites arbitrarily post salaries but are not an accurate representation.


Candidates must be currently and in the future authorized to work in the United States on a full-time basis. BLS does not sponsor candidates for permanent residency.

Clipped from: https://www.glassdoor.com/job-listing/medicaid-analyst-revecore-JV_IC1160827_KO0,16_KE17,25.htm?jl=4047300997&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic
 

Medicaid Specialist

• Job Reference: 258914472-2
• Date Posted: 5 April 2021
• Company: HCR
• Location: Huntingdon Valley, Pennsylvania
• Salary: On Application
• Sector: Healthcare & Medical
• Job Type: Permanent

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Job Description

ProMedica is a mission-based, not-for-profit health and well-being organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 49,000 employees, 12 hospitals, 2,500+ physicians and advanced practice providers with privileges, 1,000+ healthcare providers employed by ProMedica Physicians, a health plan, and senior care services.ProMedicas senior care division, formerly known as HCR ManorCare, operates 335+ assisted living facilities, skilled nursing centers, memory care communities and hospice and home health care agencies. Services are provided in 26 states and currently operate under the brand names Heartland, ManorCare, ProMedica and Arden Courts. Over the next 18 months, the senior care entities will begin to rebrand to ProMedica.Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address and lead in social determinants of health, champion healthy aging and cultivate innovative solutions. For more information about ProMedica senior care services, please visit . Description HCR ManorCare provides a range of services, including skilled nursing care, assisted living, post-acute medical and rehabilitation care, hospice care, home health care and rehabilitation therapy.The Medicaid Specialist assists patients in the skilled nursing centers secure Medicaid benefits.In return for your expertise, you’ll enjoy excellent training, industry-leading benefits and unlimited opportunities to learn and grow. Be a part of the team leading the nation in healthcare.Educational Requirements High School plus additional training leading to an Associate’s Degree in Business or Social Services. Position RequirementsThree to twelve months with knowledge of medicaid rules and regulations.Category Accounting – Billing Posting ID Ad Feed

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Job Description:

Essential Job Functions
 

• Performs standard, recurring processing and quality tasks in support of outsourced services within a specific industry and functional area. Demonstrates knowledge and skill in assigned work processes.
• Develops understanding of the client’s business and applies knowledge to support efficient procedures and adherence to service level agreements. Contributes to problem identification and resolution.
• Interprets, audits and reconciles reports for accuracy or completeness. Prepares and maintains standard reports for management and clients.
• Handles company confidential data according to policy and guidelines. Adheres to existing security policies and procedures.

Basic Qualifications
 

• High school diploma or G.E.D.
• Two or more years of experience with business process service delivery and improvement, preferably in an outsourcing environment
• Experience working with client company product and/or services
• Experience working with client company industry and/or functional area
• Experience working with business solutions software

Other Qualifications
 

• Communication skills
• Personal computer and business solutions software skills
• Organization skills to balance and prioritize work
• Ability to multi-task
• Ability to work independently and as part of a team

Work Environment
 

• Office environment

Gainwell Technologies is an equal opportunity employer. We welcome the many dimensions of diversity. Accommodation of special needs for qualified candidates may be considered within the framework of the Gainwell Technologies Accommodation Policy.

In addition, Gainwell Technologies is committed to working with and providing reasonable accommodation to qualified individuals with physical and mental disabilities.

57004578

Clipped from: https://www.gettinghired.com/job-details/3604141/medicaid-agent/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Senior IT Project Manager (Remote)

• Job Reference: 258295550-2
• Date Posted: 4 April 2021
• Recruiter: Humana
• Location: Birmingham, Alabama
• Salary: On Application
• Sector: I.T. & Communications

Job Description

*Description* The Sr. IT Project Manager oversees various system projects and/or programs of a highly complex Matrix environment. The Sr. IT Project Manager work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action..*Responsibilities* The Sr. IT Project Manager assembles and leads project teams, identifies appropriate resources needed, and develops schedules to ensure timely completion of project. Often actively manages stakeholder partnerships and mitigates risks. Familiar with the system scope and project objectives, as well as the role and function of each team member, in order to effectively coordinate the activities of the team. When managing programs, oversees the interdependencies and integration of interrelated projects, and sets strategies and leads program execution to deliver longer term business value. Can possess specialized knowledge of Software Development Life Cycle (SDLC), Agile concepts and practices and Information Technology Infrastructure Library (ITIL) frameworks used to manage risks and issues unique to technology projects. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Is able to work independently with minimal direction. Able to deliver quality leadership and results to our stakeholders, business and IT partners.*Required Qualifications* + Bachelor’s degree or equivalent experience + 5 or more years of technical project management experience + Demonstrated experience in technical product selection, technical design and practical implementation of IT solutions + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + Experience working with project budget management + Presentational and meeting facilitation skills.*Preferred Qualifications* + Master’s Degree in Business Administration + Previous Medicare/Medicaid experience + Longevity working in data warehouse, decision support and reporting system environments + Working knowledge of Oracle and IBM Relational Database Management Systems, executive information systems and statistical software packages + Comprehensive knowledge of development languages, tools, and utilities, including Cobol, CICS, DB2, ASP, COM, .NET and SQL + Six Sigma and/or Project Management Institute certification + Agile Safe certification + ServiceNow PPM experience.*Additional Information* LI#Remote.*The following policy applies ONLY to associates working in the state of Arizona:* Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, Humana has adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter..*Scheduled Weekly Hours* 40

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