Category: Curator- Job Hunter

 
 

DescriptionThe Lead Quality Engineer carries out procedures to ensure that all information systems products and services meet organization standards and end-user requirements.
The Lead Quality Engineer works on problems of diverse scope and complexity ranging from moderate to substantial.ResponsibilitiesThe Lead Quality Engineer performs and leads tests of software to ensure proper operation and freedom from defects.
May create test data for applications.
Documents and works to resolve all complex problems.
Reports progress on problem resolution to management.
Devises improvements to current procedures and develops models of possible future configurations.
Acts as information resource about assigned areas to technical writers.
Performs complex work flow analysis and recommends quality improvements.
Advises executives to develop functional strategies (often segment specific) on matters of significance.
Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.To support our move to Scaled agile, we need a dedicated Lead to drive end to end testing strategy.
As Medicaid ramps up with new implementation and changes to existing states, a single Lead is required to ensure all testing is completed while establishing a future testing growth strategy.
This person will need to have oversight of cross functional domain work and ensure cross functional dependencies are accounted for and tested.
In addition, this person will be responsible for driving Q-test adoption and testing standardization while driving the team toward end to end testing automation.
This role will have oversight and accountability for all testing for each release through matrix or direct reporting relationship with each areas test lead.This role should have an advanced grasp of the full gamut of the software engineering lifecycle:
requirement gathering, design proposals, implementation, testing and maintenance for the enhancement of both existing and new products & tools.
Will provide leadership to others as well as hands-on design, setup and mentoring to the team in quality planning, automation, frameworks and tools.
Have a good holistic view of the project and architecture.
Works under general direction.
A wide degree of creativity and resourcefulness is expected.Responsibilities+ Develop plans of action for testing new technology products.
This includes identifying areas that need to be tested and designing test strategies that target those areas.+ Work closely with implementation teams, emphasizing to them the importance of responsible, quality testing practices.+ Monitoring the continued quality of technology products and finding ways to increase the quality of those products.+ Proficient in quality automation, tools, frameworks and practices to be able to lead and hands-on mentor team members, often across multiple teams of a project.+ Set strategy, priorities and direction for testing activities of product(s).+ Organize the approach and plan to identify application performance issues.+ Continually seek opportunities to improve, optimize and simplify existing testing processes and methodologies, using automation when possible.+ Work with teams to ensure adequate feature and cross-feature integration and end to end testing is carried out to ensure appropriate test coverage.+ Define product line level testing needs, approach and strategy, in alignment with Product and Management goals.+ Develop and maintain test matrices for key product testing levels.
Matrices should map to test plans, test cases and product requirements.+ Take part in test case reviews where appropriate.+ Carry out all responsibilities in accordance to plan with key stakeholders.Required Qualifications+ Bachelor’s degree+ 8 or more years of technical experience+ 2 or more years of project leadership experience+ Performs and leads tests of software to ensure proper operation and freedom from defects.+ Must be passionate about contributing to an organization focused on continuously improving consumer experiencesPreferred Qualifications+ Masters DegreeAdditional InformationScheduled Weekly Hours40

Clipped from: https://www.jobilize.com/amp/job/lead-quality-engineer-medicaid-remote-work-home-optional-birmingham-3ee24c4ce4514a?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Location:

EAC (Education and Administration Center)

Recruiting Start Date:

03/29/2021

Estimated Start Date:

08/11/2021

The SPED Certified Nursing Assistant (CNA) will perform various direct student care activities under the supervision of a registered school nurse. The CNA will work collaboratively with the special education team and provide direct services as defined within the individual student’s health care plan and/or Individualized Education Plan (IEP).

The following statements are illustrative of the essential functions of the job and other key duties that may be required. The description may not include all functions performed by the incumbents in various locations. The district reserves the right to modify or change the duties or the essential functions of this job at any time.

• Reports consistently for work as scheduled
• Performs other duties as assigned
• Attains proficient or higher evaluations on established Performance Standards
• Performs various direct student care activities under the supervision of a registered school nurse
• Utilizes nursing skills to care for students requiring medical interventions to include, but not limited to: gastrostomy, measuring vital signs, feeding, oxygen administration, diapering, assistance in activities of daily living, helping with grooming, toileting, oral hygiene, performing range of motion exercises, transferring and assisting in ambulation.
• Attends and participates in students’ IEP meetings
• Independently supports and implements students’ IEP goals and objectives in school setting
• Act as a communication link to inform appropriate supervisors of progress, changes, problems, and equipment needs
• Provide ongoing communication with appropriate staff, parents, and supervisors regarding student progress

Knowledge, Skills, and Abilities:

• Ability to adapt to changing technologies and to learn functionality of new equipment and systems
• Ability to communicate effectively verbally and in writing
• Ability to create, access, input, retrieve, and manipulate information in various software systems
• Ability to establish and maintain accurate record keeping, document management, and filing systems 
• Ability to establish and maintain effective working relationships with individuals from many diverse backgrounds and professions including supervisors, administrators, coworkers, staff, students, parents, and the general public
• Ability to follow oral and written instructions
• Ability to greet and interact with the public in a courteous and professional manner
• Ability to maintain confidentiality 
• Ability to manage simultaneous demands and set clear priorities 
• Ability to work days, hours, locations, and assignments as directed by the supervisor within the position responsibilities 
• Ability to work independently without direct supervision
• Commitment to the education of students as a primary responsibility
• Communicates effectively with students and adults in a wide variety of settings
• Computer proficiency including office productivity applications
• Considerable knowledge of policies, procedures, and overall district functions
• Demonstrated ability to manage simultaneous demands and set clear priorities
• Demonstrated ability to work well with others in a team setting
• Demonstrates citizenship, compassion, courage, discernment, excellence, honesty, hope, integrity, patience, perseverance, reliability, respect, responsibility, and trustworthiness 
• Demonstrates effective organizational and time management skills
• Detail-oriented 
• Energetic, creative, innovative, flexible 
• Excellent cooperative, collaborative, and problem-solving skills
• Knowledge of office methods and procedures 
• Knowledge of Special Education, other educational programming, and associated legal requirements as related to the needs of the students assigned to the teacher
• Promotes a positive climate, culture, and community
• Strong organizational, interpersonal, written, listening, and verbal communication skills
• Student-centered and relationship-focused
• Understanding of data privacy laws and their implications for the educational community
• Willingness to participate in ongoing training as required

Work Environment: The work environment characteristics described here are representative of those a staff member typically encounters while performing the essential functions of this job. They are included for informational purposes and are not all-inclusive.

• The noise level in the work environment may alternate among quiet, moderate, and loud.
• The incumbent is frequently required to interact in person and through communication methods with the students, public, and/or other staff.
• The incumbent is required to work scheduled school/work hours and/or days.
• The incumbent may be required to work extended school/work hours and/or days as directed.
• The incumbent operates primarily independently and frequently with others in a professional school environment indoors regularly and outdoors occasionally.

Physical Demands: The following are some of the physical demands commonly associated with this position. They are included for informational purposes and are not all-inclusive. All physical demands, if listed, are considered essential functions

• Sits, stands, walks, stoops, kneels, and crouches/squats while performing duties
• Has oral and auditory capacity enabling interaction interpersonally and/or through communication devices
• Uses eyes, hands, and finger coordination enabling the use of equipment and writing utensils
• Typical demands require staff to lift/push/pull or carry up to 50 lbs.; may have to lift students when assistance is required; able to safely lift 50 lbs. each in a two person lift, and may be higher for some assignments depending on position and student need; climb stairs, ladders, and/or stools; reach, hold, grasp and turn objects; use fingers to operate computer keyboards; feel the shape, size and temperature of objects; and physically restrain students when necessary.
• This position is very active and may require moving from one location to another in short amounts of time depending on the needs of students and staff.

Cognitive Functions: The following are some of the cognitive functions commonly associated with this position. They are included for informational purposes and are not all-inclusive. The staff member may be required to analyze, communicate, compare, compile, compute, coordinate, copy, evaluate, instruct, negotiate, synthesize, reason, and use interpersonal skills.

Required Qualifications:

Certified Nurse Assistant – American Red Cross, First Aid/CPR – American Heart Asc. / Red Cross / Etc., High school graduate -high school diploma or equivalent

Preferred Qualifications:

Experience Working with Special Needs Students

Compensation Range:

$16.58-$30.68

Scheduled Weekly Hours:

37.5

Hours per Day:

7.5 hour(s) per day

Number of Days per Year:

176 days M-F

Benefits Eligibility:

Full-time – Regular

FLSA Status:

United States of America (Non-Exempt)

How to Apply:
New applicants (including current district staff members) must use the Workday application portal. Documents emailed directly to a supervisor will not be considered for application purposes and will not receive a response. A completed online application also includes the following uploaded documents in PDF format:

• A current resume

Please do not call to request site visits or interviews at the school/location. Please direct all inquiries via the email address indicated on the posting

Hiring Manager Email:

shannon.sloger@asd20.org

 
 

Clipped from: https://jobs.asd20.org/special-education-cna-medicaid-funded-21-22-sy-only/job/15926788?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Posting for Government Business Division, Tennessee Medicaid at Anthem Career Site

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.

The Government Business Division Finance Director is responsible for financial leadership, decision support, and strategic consultation to the leadership team in the Health Plan.  This role directs health plan trend analysis, cost of care, financial reporting and analysis, financial operations, cost and budget management and administrative allocations in the Tennessee Medicaid Health Plan, and serves as a key liaison and subject matter expert with our state customer on medical trends, financial/reimbursement policy, payment mechanisms and financial implications of program and benefit changes. 

Primary duties may include, but are not limited to: 

• Health plan P&L owner along with plan president and other functional leaders. 
• Serves as key health plan leader providing financial and strategic insight to other health plan functional areas; operates as a liaison with state partners; leads reimbursement management and negotiation; owns the Medical Cost Trend, cost of care process for plan and mitigation initiatives; and reviews financial statements, reserve development and financial analytics.
• Partners with pricing actuaries to ensure that premium reimbursement is adequate to cover medical trends, administrative expenses and profit. 
• Reviews, analyzes, and presents financial results to health plan and line of business leadership as well as the board of directors.
• Provides decision support for health plan leadership team for operational and business goals. 
• Directs health )
• Achieves Medical Cost, MLR and operational income targets set in forecasts; ensures that provider network contracting obtains optimal financial arrangements; co-develops the setting of Cost of Care (CoC) targets and is responsible for CoC execution.
• Directly interfaces with regulatory and audit personnel and technical consultants as required to ensure fiscal accountability.

Qualifications

• Requires a BS/BA in Finance, Business Administration, or Accounting; 8-10 years of progressive financial experience with strategic and tactical planning, medical trend or business analytics, budgeting/forecasting, and accounting or financial reporting within a health insurance or managed care environment; experience with complex business environments and highly regulated situations; or any combination of education and experience, which would provide an equivalent background.
• MBA 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://www.salary.com/job/anthem-career-site/government-business-division-tennessee-medicaid/95042dd5-36b3-496e-95df-3e8764d54eb0?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Job Description

Doing the right thing is a way of life at Rocky Mountain Health Plans (RMHP). As part of the UnitedHealthcare family of plans, RMHP provides innovative health insurance coverage and personalized attention to individuals of all ages and business of all sizes throughout Western and rural Colorado. RMHP is continually striving to improve the health and wellness of our Members and partners in the state where we live, work, and play – because we’re Colorado, too. You push yourself to reach higher and go further. Because for you, it’s all about ensuring a positive outcome for patients. In this role, you’ll work in the field and coordinate the long-term care needs for patients in the local community. And at every turn, you’ll have the support of an elite and dynamic team. Join UnitedHealth Group and our family of businesses and you will use your diverse knowledge and experience to make health care work better for our patients. In this Medicaid Behavioral Health Outreach Coordinator role, will be an essential element of an Integrated Care Model by relaying the pertinent information about the member needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs. If you are located in Aspen / Glenwood Springs CO, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team Act as a resource to other team members as it relates to behavioral health issues Expect to spend up to 80% of your time in the field visiting our members in their homes or in long-term care facilities. You’ll need to be flexible, adaptable and, above all, patient in all types of situations 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: Undergraduate Degree or 3+ years of experience working within the community health setting in a health care role (or experience as mandated by the state contract) Reside within a commutable distance of Garfield / Pitken County Experience in case management or care coordination 1+ year of experience in Behavioral Health Experience working with MS Word, Excel and Outlook The ability to travel in assigned region to visit Medicaid members in their homes and/or other settings, including community centers, hospitals or providers’ offices You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained Preferred Qualifications: LPN/LVN, CNA, licensed social worker and/or behavioral health or clinical degree A background in managing populations with behavioral health needs Experience with electronic charting Prior field based work experience Doing the right thing is a way of life at Rocky Mountain Health Plans (RMHP). For more than 225,000 members of our unique, physician-founded health care organization, we provide innovative health insurance coverage and personalized attention to individuals of all ages and business of all sizes throughout Western and rural Colorado. As a part of Optum, the fastest growing part of the UnitedHealth Group family of businesses, we’ve enhanced our offerings through sophisticated tools and technologies, superior customer service and a commitment to striving to improve the health and wellness of our Members and partners in the state where we live, work, and play – because we’re Colorado, too. From a career perspective you couldn’t do better. We’re all about quality and making a difference. And can make our opportunities your opportunity to do your life’s best work.(sm)Colorado Residents Only: The hourly range for Colorado residents is $20.77 to $36.88. 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:Medicaid Community Outreach Coordinator. Community Outreach Coordinator, Outreach Coordinator, Behavioral Health, Medicaid, Community health, Case management, Care Coordination, Telecommute, Telecommuting, Telecommuter, Work From Home, Remote, Aspen, Glenwood Springs, Colorado, CO

Clipped from: https://motherworks.com/job/1219721/medicaid-community-healthcare-outreach-coordinator-telecommute-in-aspen-glenwood-springs-co/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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

Office: Policy

Bureau: Long Term Services and Supports

Classification: Medicaid Health Systems Administrator 3 (PN 20047500)

Job Preview:

The Ohio Department of Medicaid (ODM) is seeking an experienced healthcare professional to lead a team of policy administrators in the oversight and monitoring of Home and Community-Based Services (HCBS) policies and programs. As the HCBS Policy Section Chief, your responsibilities will include:

• directing and managing waivers, agreements, and contracts
• setting Section goals and deadlines
• providing coaching, supervision, and guidance
• building a cross-trained supportive team
• managing federal and state regulations
• acting on behalf of higher-level executives as delegated
• developing reports to the Centers for Medicare and Medicaid Services (CMS)
• engaging in intra/inter-agency collaborative mission-driven efforts

The preferred candidate will be an experienced leader in the field of healthcare administration and is a visionary with excellent communication skills.

Job Description:

Under general direction, directs, plans and coordinates one unit of professional Medicaid administrative staff in) all aspects of the Medicaid Home and Community Based Services Programs (i.e., Ohio Department of Medicaid (ODM) waivers, Department of Developmental Disability (DODD) waivers, Ohio Department of Aging (ODA) waivers, case management contracts, Ohio Department of Aging (ODA) Interagency Agreement, etc.) and/or initiatives impacting across ODM areas (e.g., develops program rules; reviews and analyzes legislation; makes program recommendations and proposals; conducts and coordinates internal/external work teams with stakeholders, state partner agencies (e.g., ODA, Department of Developmental Disabilities (DODD), etc.) and other ODM staff; plans and evaluates implementation of policy for Aging, Developmental Disability and medically complex populations; manages oversight for the Ohio PACE program; oversees, plans, develops and coordinates policy initiatives/activities; directs and/or participates on intra-and/or interagency project teams (e.g., ODM, ODA, DODD, Ohio Department of Mental Health and Addiction Services (OMHAS)); lead teams in the development and implementation of strategic policies, procedures, goals and objectives governing core delivery system management functions (e.g., coverage, utilization and quality assurance of services) provided through care management networks of other state agencies and in developing special health related services delivery systems. Supervises assigned staff (e.g., establishes unit goals; assigns work and provides direction; reviews work and provides feedback; establishes goals and monitors and evaluates performance; encourages staff development; approves/disapproves leave requests; recommends disciplinary action; conducts staff meetings; makes recommendations for hire.

Directs project initiatives with other agency representatives and advises higher-level leadership; provides technical direction and assistance to project teams to perform ongoing information and data collection and analysis of other states’ health services delivery systems and funding alternatives for special health related services delivery systems; assists Bureau Chief in developing Medicaid reform initiatives (e.g., ODM, DODD, OMHAS, ODA and other state and local departments which undertake reform); formulates health related policy; coordinates policy development and implementation across sections and/or bureaus; assists higher-level management in developing new and/or revising Medicaid programs; represents Deputy Director and/or Director on programmatic related issues, meetings and/or conferences; acts as liaison with agency personnel and/or outside agencies (e.g., Executive Directors, Deputy Directors, Governor’s Office), providers, advocates, beneficiaries and/or consumers; directs intra/interagency project teams to design and operate ongoing management and program evaluations for medical assistance community-based populations.

Coordinates preparation and/or prepares and reviews reports; assist with budget activities; responds to sensitive inquiries and contacts from public, provider and government officials and assists in development of goals and objectives; prepares and oversees administrative reports and correspondence; plans and delivers presentations; acts as liaison with community and other state and federal agencies; testifies at legislative or other public hearings.

Performs other related duties (e.g., conducts and attends training sessions; conducts and attends staff meetings; travels to meeting sites; maintains logs, records and files).

Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 36 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 base analysis).

• Or 12 months experience as a Medicaid Health Systems Administrator 2, 65296.

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

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

 
 

 
 

Clipped from: https://helponebillion.com/job/65f5fc85bfff55dcf83aac41110ddcfd/HCBS-Policy-Section-Chief-Medicaid-Health-Systems-Administrator-3?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

This leader will be responsible for leading the editorial team, and partnering with design, in the development of a broad portfolio of copy, from more detailed health-related pieces to broader, conceptual campaigns. This is an amazing opportunity for a forward-looking marketer to lead creative for a premier healthcare brand, and be responsible for helping to improve the health of millions of people.

Primary duties:

Lead editorial team to achieve business goals.
Direct marketing communications vision to support local, regional and corporate strategic objectives
Facilitate a collaborative environment that delivers thoughtful, well-executed, and effective creative.
Deliver omnichannel creative solutions that are on-time, on-budget, and on-strategy.
Implement metrics to report and monitor progress against goals.
Research and evaluate trends related to creative outputs and effectiveness.
Collaborate on production and fulfillment of materials.
Hire, train, coach, counsel, and evaluate the performance of direct reports.

Qualifications

BA/BS in Marketing, Business Administration or similar field; 5+ years of marketing or healthcare experience; or any combination of education and experience, which would provide an equivalent background.
Demonstrated ability in strategic leadership, creative leadership, operational/organizational leadership, while working across the matrix and effectively leading a team.
Experience leading creative studios/creative services team in both agency side and client side preferred.
Experience in a highly regulated industry (e.g., insurance, financial services, pharma, etc.) preferred.
Medicare and/or Medicaid experience a plus.
Excellent analytical, negotiation, and presentation abilities.
Excellent managerial and change-management leadership skills.
Master’s Degree in Fine Arts, Business or Health Care Administration a plus.

Clipped from: https://us.trabajo.org/job-66-20210317-1ebcb083b1cebfb783cedae73ed4b15c?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Collabera Irving, TX

Job Description

• Performs root cause analysis on the adjudication of Medicaid, CHIP and Marketplace claims using standard principles, applicable policies, and regulations (State Medicaid requirements, Texas Department of Insurance Prompt Payment requirements, etc.) in order to ensure appropriate processing of claims.
• Prepares and provides audit findings of medium to large scale claims projects within the designated timeframes.
• Identifies process issues and/or system defects and escalates to the appropriate team(s) and Health Plan Operations leadership. Provides recommendations for correction.
• Identifies internal standard operating procedures and/or other related documents that are inaccurate, unclear or contains gaps. Works with the appropriate team(s) to provide recommendations for correction of such documents.
• Constant monitoring of the state and federal regulations to ensure Client’s Healthcare of Texas’ compliance with necessary the changes.
• Research and communicate applicable benefit configuration needs and ensure the accuracy of operational processes within Clients claim’s system based on business requirements.
• Support and collaborate with other departments as needed.

 
 

MUST HAVES:

• 3-5 years’ experience in Health Plan Operations and/or Managed Care (Claims, Configuration, Provider Data and Credentialing, Compliance, Call Center, Appeals and Grievances, etc.)
• 4+ years Texas Medicaid and CHIP managed care claims experience with.
• 2+ years Large-scale Claims Research and Resolution experience
• 2+ years with provider data set-up, benefit configuration, provider configuration and provider contract analysis.
• Demonstrates familiarity in a variety of concepts, practices, and procedures applicable to job-related subject areas.

Billing, Compliance,Managed Care,Appeals,Grievances,Claims,Claims Examiner,Claims auditor,Claims reviewer,healthcare,Health Plan Operations

Company Description

Not only is Collabera committed to meeting and exceeding our customer’s needs, but we also are committed to our employees’ satisfaction as well. We believe our employees are the cornerstone of our success and we make every effort to ensure their satisfaction throughout their tenure with Collabera. We offer an enriching experience that promotes career growth and lifelong learning for our employees. As a result of these efforts, we have been recognized by Staffing Industry Analysts (SIA) as one of the “Best Staffing Firms to Work For” since 2012 – eight consecutive years in a row. Collabera has 60 offices with a presence in 11 countries and provides staff augmentation, managed services and direct placement services to Fortune 500 corporations across the globe.

Collabera

Why Work Here? Collabera has been recognized by Staffing Industry Analysts (SIA) as one of the “Best Staffing Firms to Work For” for 8 consecutive years.

Not only is Collabera committed to meeting and exceeding our customer’s needs, but we also are committed to our employees’ satisfaction as well. We believe our employees are the cornerstone of our success and we make every effort to ensure their satisfaction throughout their tenure with Collabera. We offer an enriching experience that promotes career growth and lifelong learning for our employees. As a result of these efforts, we have been recognized by Staffing Industry Analysts (SIA) as one of the “Best Staffing Firms to Work For” since 2012 – eight consecutive years in a row. Collabera has 60 offices with a presence in 11 countries and provides staff augmentation, managed services and direct placement services to Fortune 500 corporations across the globe.

 
 

Address

Irving, TX

75038 USA

Website

http://www.collabera.com View all jobs at Collabera

 
 

Clipped from: https://www.ziprecruiter.com/c/Collabera/Job/Medicaid-Claims-Auditor/-in-Irving,TX?jid=95cc6e5bf9f18583&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Overview
 

Guidehouse is a leading management consulting firm serving the public and commercial markets.  We guide our clients forward towards new futures that build trust in society and your professional skills along the journey.  Join us at Guidehouse.

Responsibilities

 

ManagingConsultant, you will be a member of our Healthcare Public/payer practice and part of a team responsible for solving the most complex and strategic issues faced by commercial and public health, specifically in Medicaid managed care.  Typically, Managing Consultants work both provide thought leadership and manage deliverables and project teams and receive exposure to a broad range of healthcare projects, including: healthcare managed care models, financial /risk modeling, and actuarial analytic support. You will be working on a variety of small project teams within the company, both receiving and providing regular mentorship from seasoned Guidehouse Consultants, as well as, work with clients allowing you access to senior client executives.   

 
 

Responsibilities:

• Contributes to the overall content of engagement deliverables as well as the project implementation plans; leveraging his/her knowledge of: actuarial analytics (including methodologies, model development and modifications), industry reporting and research and client presentation oversight (reports, findings, exhibits and other materials).
• Accountability for the execution of consulting projects to ensure timely and quality implementation of program deliverables, insuring metrics are achieved. Insure appropriate: communication, scope adjustment /documentation and client relationships are made as the project progresses.
• Will help grow and develop Guidehouse’s actuarial team and solutions internally in a way that fosters career development, fiscal responsibility and culture/brand. You will have the opportunity to recruit, retain, train and guide staff to meet the needs of our project/product/documentation work and our people.
• Responsible for maintaining strong client relationships, and assisting in proposal development, managing and writing responses to RFPs, account management and publications/presentations aimed at winning state actuarial program projects.
• Typical project areas include (but not limited to) actuarially sound capitation rate-setting, determining and measuring managed care plan effectiveness, risk-adjustment methods, medical cost trend management, and forecasting.
• Assist seasoned consultants in developing project approach, strategies, and work plans.  

Qualifications

 

Required Skills

 
 

• 5-8 years of successive, progressive responsibility within healthcare with a focus on healthcare actuarial consulting for public and/or commercial healthcare payers and/or providers.
  experience with demonstrated understanding of actuarially sound capitation rates for Medicaid programs and/or commercial payers –
• Knowledge of innovative payment approaches for healthcare providers, including hospitals, physicians, nursing facilities and other long-term care providers
• 5+ years with supervisory and/or project management experience managing multi-million dollar budgets. P&L management experience a plus.
• Experience and credibility interacting with state officials at the executive and program levels, c-level provider and plan executives, and a strong network within the industry.
• A Bachelor’s degree in computer science, mathematics, statistics, actuarial science or business administration, with an emphasis in data analysis, data grouping and large data sets
• 3+ years of applicable professional experience (e.g. health plan or state managed care data analysis and/or healthcare consulting experience)
• 3+ yrs. experience using SQL, SAS, or other third generation programming language (R, STATA, Python) that drives real value to actuarial work product.
• 3+ yrs. Experience developing analytical models and structuring methodologies
• Excellent quantitative analysis skills and strong data analytics background (financial modeling/planning skills a Plus)
• 1+ yr. of Demonstrated management of mid-size work streams or deliverables
• Proficiency with Excel, including experience in formatting, formulas, pivot tables, etc.
• Ability to travel post-COVID: 10%

Preferred Skills

 
 

• Credentialed ASA or FSA, plus
• Excellent written, verbal and presentation skills.
• A strong team leader and mentor with a track record of developing mid-level and junior staff.

Additional Requirements

 

• The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
• This position is open to candidate virtually from EST, CST, PST  time zone as well as AZ, UT.

Disclaimer

 

 
 

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

 
 

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

 
 

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

 
 

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

 
 

Rewards and Benefits

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

 
 

Benefits include:

Medical, Rx, Dental & Vision Insurance

Personal and Family Sick Time & Company Paid Holidays

Parental Leave and Adoption Assistance

401(k) Retirement Plan

Basic Life & Supplemental Life

Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

Short-Term & Long-Term Disability

Tuition Reimbursement, Personal Development & Learning Opportunities

Skills Development & Certifications

Employee Referral Program

Corporate Sponsored Events & Community Outreach

Emergency Back-Up Childcare Program

Position may be eligible for a discretionary variable incentive

 
 

Clipped from: https://careers.guidehouse.com/jobs/9807?lang=en-us&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Based upon user needs, and a sound understanding of applicable business or clinical systems and industry requirements, formulates and defines average to large project scopes and objectives. Devises or modifies procedures to solve problems, considering software applications capacity, resource availability, operating time and form of desired results. Includes analysis of business and user needs, documentation of requirements and translation into proper system requirement specifications. Participates in project leadership by documenting scope and defining implementation procedures. Provides technical project management, often leading work on new implementations and upgrades of related systems, and handling multiple projects simultaneously. Documents and drives best practices throughout the system. Staff members in this position are effective and self-sufficient in working within a diverse technology. Regularly provides guidance and training to less experienced Business Systems Analysts.
E

ssential Functions

Aware of the implications of applying new/differing technology to the current business or clinical environment, utilizes research and analysis, along with an understanding of relevant business or clinical systems and industry requirements, to define medium-to large sized systems scopes and objectives, for developing new, or improving existing, information systems.
Performs business analysis, working with users to define their needs and then documenting those requirements.
Collaborates with others to troubleshoot issues with existing systems.
Remains current with business or clinical requirements and needs, based upon future industry trends and changes, and understands the implications for existing technology.
Provides mentorship to less senior team members, and is accountable as a role model for customer service excellence.

Qualifications

Required Bachelors Degree or equivalent
Preferred Masters Degree or equivalent
5 years of relevant experience in the field Required
7 years of relevant experience including experience formulating and defining systems scopes and objectives Preferred
Experience in systems development lifecycle including, requirements gathering and design Preferred
Participant in multiple phases of an integrated system implementation Preferred
Background in health care, sciences or information systems Preferred

Clipped from: https://bonzojobs.com/jobs/senior-business-systems-analyst-aca-medicaid-risk-adjustment-southfield-michigan/247720997-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Apply for this job now Location Charleston, West Virginia Job Type Permanent Posted 17 Mar 2021

Description The Office of Health Affairs are West Virginia Universityis seeking applications for a Medicaid Claims Data Specialist (Research Associate) located in Charleston, WV. TheMedicaid Claims Data Specialistis a key participant in the State-University partnership between the West Virginia University Office of Health Affairs and the West Virginia Department for Health and Human Resources (WV DHHR). Overarching responsibilities include implementation and management of a data science training program to assist faculty and staff at Office of Health Affairs in analyzing administrative Medicaid claims and other state data sources. This position will also be responsible for working with the WV DHHR to leverage data resources and support analytic needs, overseeing the use of state data sources for research at West Virginia University, participating in interdisciplinary research and evaluation teams, and providing oversight and management of other data analysts and personnel embedded within the Department for Health and Human Resources. TheMedicaidClaims Data Specialsitwill be an employee of the West Virginia University Office of Health Affairs, however, this individual will be embedded within the Department for Health and Human Resource’s Bureau for Medical Services and will work full-time out of the Office of Health Affairs offices in Charleston, West Virginia. In order to be successful in this position, the ideal candidate will: Provide training in the analysis of administrative Medicaid claims data using SAS or other statistical analysis packages to other faculty, staff, and students at West Virginia UniversityServes as a University representative and liaison to the West Virginia Department of Health and Human Resources for the planning and performance of projects, programs and activities involving health data analytics and program evaluation.Oversee data governance and data stewardship for the West Virginia University Office of Health AffairManage a standardized data science training program for faculty and staff in the West Virginia University Office of Health AffairWork as part of a team to advance the partnership between the West Virginia University Health Sciences Center and the West Virginia Department of Health and Human ResourcesOversee and conduct analyses of Medicaid claims data and other state data sources at the direction of leadership within the Office of Health Affairs or Department for Health and Human ResourceSupport both West Virginia University faculty as well as leadership within the Department for Health and Human Resources in using Medicaid claims data as well as other state data sources to answer research questions of interest to the statManage the use of state data sources for independent research by faculty, staff, and students at West Virginia UniversityEnsure that data analytic and research/evaluation activities are compliant with University-level policies for the responsible conduct of research as well as federal, and state policies.Provides consultation to faculty and government partners regarding preparation of research proposals, design and methodology, data analytics and interpretation of resultsConduct or direct special projects as assigned.Act in other matters and capacities as delegated by leadership within the Office of Health Affairs Qualifications PhD in health or data science-related field; or equivalent amount of combined education and work experience. Two (2) years experience Record of research and achievement in health outcomes and policy research (health services research, public health informatics, health policy, clinical outcomes) as evidenced by publications and / or sustained involvement in a research program. Experience conducting research/evaluation using large administrative claims data sources within the healthcare industry or academic or governmental sectors Experience training and managing other data analysts Extensive knowledge and experience in utilizing large administrative claims databases for research, program evaluation, and policy development. Experience training others in how to analyze administrative claims data using SAS or other statistical package Proficiency in the use of standard statistical analysis packages such as SAS or Ability to project and maintain a positive and collaborative attitude Record of accomplishments in the area of health data analytics. Experience managing other data analyst Strong ability to communicate goals, methods, and results of research initiatives with key stakeholders Proficiency presenting the results of data analyses to diverse groups of stakeholders Valid driver’s license and ability to travel

Apply for this job now

Details

• Job Reference: 247713468-2
• Date Posted: 17 March 2021
• Recruiter: West Virginia University
• Location: Charleston, West Virginia
• Salary: On Application
• Sector: Education
• Job Type: Permanent

 
 

Clipped from: https://50states-jobs.com/jobs/medicaid-claims-data-specialist-research-associate-health-affairs-charleston-west-virginia/247713468-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic