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Medicaid Specialist I MS

 
 

Job Details

Medicaid Specialist I

This listing closes on 3/12/2021 at 11:59 PM Central Time (US & Canada).

Salary

$27,346.56 Annually

Location 73 – UNION COUNTY, MS

73 – UNION COUNTY, MS

Job Type

Full-Time

Department

0665 – MEDICAID DIVISION

Job Number

3103-0665-20210308un

Closing date and time

3/12/2021 at 11:59 PM Central Time (US & Canada)

Characteristics of Work

This is investigative work involving the interpretation of policy to determine Medicaid eligibility for families and children and aged, blind, and disabled individuals. The incumbent makes the initial and continuing determinations of eligibility for Medicaid recipients who live in private and institutional settings. Limited supervision is received from administrative supervisors who oversee a regional office or Central Enrollment Office.

Examples of Work

Examples of work performed in this classification include, but are not limited to, the following:

 
 

Assumes responsibility for a Medicaid eligibility determination caseload for a designated territory within a region. 

 
 

Investigates and verifies accuracy of information provided by recipients under the Medicaid programs to determine compliance with State and Federal laws, rules, and regulations.

 
 

Determines an applicant’s eligibility for institutional care based on State and Federal guidelines and verifies the accuracy of information listed on the applicants’ applications.

 
 

Maintains effective public relations with medical facilities and federal, state, county, and city agencies within assigned territory.

 
 

Verifies accuracy of information listed on applicants’ applications including income, bank accounts, and any other assets.

 
 

Makes determination of an applicant’s eligibility based upon established criteria.

 
 

Visits contact centers and medical facilities; assists other regional offices on an as-needed basis.

 
 

Performs related or similar duties as required or assigned.

Minimum Qualifications

These minimum qualifications have been agreed upon by Subject Matter Experts (SMEs) in this job class and are based upon a job analysis and the essential functions. However, if a candidate believes he/she is qualified for the job although he/she does not have the minimum qualifications set forth below, he/she may request special consideration through substitution of related education and experience, demonstrating the ability to perform the essential functions of the position. Any request to substitute related education or experience for minimum qualifications must be addressed to the Mississippi State Personnel Board in writing, identifying the related education and experience which demonstrates the candidate’s ability to perform all essential functions of the position.

EXPERIENCE/EDUCATIONAL REQUIREMENTS:

Education:

A Bachelor’s Degree from an accredited four-year college or university.

OR


Education:

An Associate’s Degree or completion of sixty (60) semester hours from an accredited college or university;

AND


Experience:

Two (2) years of experience related to the described duties.

Substitution Statement
:

Above an Associate’s Degree or completion of sixty semester hours from an accredited college or university, related education and related experience may be substituted on an equal basis.

Essential Functions

Additional essential functions may be identified and included by the hiring agency. The essential functions include, but are not limited to, the following:

1. Maintains caseload for Medicaid eligibility.


2. Maintains good public relations and customer service.


3. Collects eligibility data information.


4. Visits Medicaid contact centers and/or long-term care facilities.

Health/Prescription Insurance

Eligible employees have the opportunity to participate in the state’s health and prescription insurance program. Employees may select either single or family coverage with affordable co-payments. More detail can be found at Know Your Benefits.

 
 

Wellness Benefits

Employees are eligible for a wellness and health promotion program. This plan provides annual benefits for certain services with first-dollar coverage with no deductible.

 
 

Life Insurance

All eligible employees receive an actual term life insurance policy upon employment. The policy coverage is two times the employee’s annual salary to a maximum of $100,000. More detail can be found at Life Insurance Choices.

 
 

Optional Insurances

Many agencies offer discounted premiums for dental, vision, and cancer insurance.

 
 

Flexible Spending Accounts

Many state agencies provide opportunity for employees to participate in pre-tax spending accounts. These accounts allow employees to withhold childcare expenses and unreimbursed medical expenses prior to application of state and federal taxes.

 
 

 
 

Paid Personal Leave and Sick Leave

Full-time employees receive paid time off for personal needs and for sick leave. Leave begins accruing after one month of employment and may be used as it is accrued. Employees earn approximately 18 days of personal leave annually and 12 days of sick leave annually.

 
 

Military Leave

In accordance with federal law, all employees serving in the armed forces or the military reserves are entitled to 15 days per year for military training.

 
 

Holidays

Employees receive up to 10 paid holidays to enjoy many of our nation’s celebrations with family and friends.

 
 

Retirement Programs

The State of Mississippi provides all its employees a Defined Benefit/Defined Contribution Retirement Program. Employees become vested in the State’s retirement system after 8 years of employment. Both you and your employing agency contribute toward your retirement.   More detailed information regarding the State’s retirement program can be found at http://www.pers.state.ms.us

 
 

Deferred Compensation

State agencies offer several opportunities for their employees to participate in a deferred compensation voluntary retirement savings plan. More information can be found at Deferred Compensation.

 
 

State Credit Union

All state employees are eligible to participate in the Mississippi Public Employees’ Credit Union. This organization offers state employees special savings and borrowing plans. For more information about this program, call 601.948.8191.

 
 

 Tuition Reimbursement

Many state agencies provide opportunities for their employees to achieve higher education through tuition reimbursement. Common programs include medical and nursing fields, accounting, and business/administrative fields.

 
 

Career Development and Training

The Mississippi State Personnel Board offers several management and administrative certification programs, as well as professional development courses to enhance employee value to the agency. Individual agencies also offer technical training and allow membership in professional organizations to employees in their specific fields of employment.

 
 

Promotional Opportunities

Employees who have completed 6 or more months of service are eligible for promotional opportunities within state government employment. Minimum qualifications must be met.

 
 

Career Ladders

Many job classifications provide career-ladder opportunities based upon attainment of competencies. These career ladders can increase an individual’s salary, provided funds are available within the agency.

 
 

01

What is the highest level of education (or semester hours of college) you have completed from an accredited college or university?

  • None
  • GED or High School Equivalency Diploma / High School
  • 1 year / 30 semester hours
  • Associate’s Degree / 2 yrs / 60 semester hours
  • 3 years / 90 semester hours
  • Bachelor’s Degree
  • Master’s Degree
  • Specialist Degree
  • Doctorate Degree

02

How many years of related experience do you have? (refer to the job posting for an explanation of related experience)

  • No experience
  • 1 year of experience
  • 2 years of experience
  • 3 years of experience
  • 4 years of experience
  • 5 years of experience
  • 6 years of experience
  • 7 years of experience
  • 8 years of experience
  • 9 years of experience
  • 10 years of experience
  • More than 10 years

* Required Question

Agency State of Mississippi Phone 601-359-1406 Website http://agency.governmentjobs.com/mississippi/default.cfm

Address 210 East Capitol Street
Suite 800
Jackson, Mississippi, 39201 Clipped from: https://www.governmentjobs.com/jobs/3005454-0/medicaid-specialist-i?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Finance Director – Corporate Medicaid Job Opening in Atlanta, GA at Anthem Career Site

 
 

 
 

Job Posting for Finance Director – Corporate Medicaid at Anthem Career Site

Description

SHIFT: Day Job

SCHEDULE: Full-time


 

 
 

Responsible 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 View
  • Experience with budgeting and forecasting
  • Microsoft Office (Outlook, Excel)

 
 

Preferred

  • MBA, CPA, or CMA
  • SQL experience
  • Experience with month end close process
  • Experience in healthcare and/or health insurance industry
  • Microsoft Access
  • MS PowerPoint

 
 

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/finance-director-corporate-medicaid/baaffe00-15df-45a3-893c-4ecb58b8ed8e?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Data Governance Product Owner – Government Business Segment (Medicare/Medicaid) – Evernorth

 
 

Role Details

As part of the Data Strategy team for the Government Business Segment, the Data Governance team uses governance and quality best practices to support operational, technological, and analytic efficiencies and enhancements across the Medicare and Medicaid lines of business. Team responsibilities include, but are not limited to: risk assessment, data quality auditing, metadata management, and knowledge management.

The Product Owner is a member of a cross-functional Data Governance team and helps translate business needs across multiple data areas into targeted solutions. In coordination with the Medicare and Medicaid Data Governance Lead, the Product Owner is responsible for defining the vision, scope, and prioritization of product development and enhancement. The Product Owner also reviews the quality of the product that the team produces, and provides expert content/professional leadership on complex assignments and projects.

The Product Owner exercises considerable creativity, foresight, and judgment in conceiving, planning, and delivering initiatives. While focused on providing thought leadership within the Data Governance team, the Product Owner also works on broader projects, which require a deep understanding of the wider business. This individual will work with business, technology, and solution teams across the Medicare and Medicaid lines of business to define User Stories and prioritize the team backlog, and will be responsible for guiding the team on story estimates and sequencing. 

This position is with Evernorth, a new business within the Cigna Corporation. 

Job Responsibilities

  • Uses data governance knowledge and practices to provide comprehensive consultation to business and IT stakeholders
  • Serves as product owner as part of an Agile team
  • Collaborates with disparate stakeholders to define and prioritize solution needs
  • Drives priorities to execution with clear understanding of business value across Medicare and Medicaid lines of business
  • Provides guidance and clarification to cross-functional Data Governance team, including backlog grooming, sprint planning, testing, and project prioritization
  • Understands business priorities and converts them to Features, User Stories and Technical Designs to build and prioritize the product backlog for sprint teams
  • Works with team on a daily basis in providing inputs on user stories and removing road blocks
  • Provides timely communication of progress and blockers to stakeholders and Data Governance leadership
  • Reviews quality monitoring data to provide guidance on, and prioritization of, remediation engagement efforts
  • Supports the strategic implementation and development of best practice data governance initiatives

Knowledge, Skills, and Abilities

  • Extensive experience with Medicare and Medicaid products
  • Experienced in data management, data quality, and data governance practices
  • Self-driven and able to function with minimal direction from Manager
  • Has the ability to engage business and data stakeholders to resolve questions or issues
  • Must have the ability to handle multiple and sometimes competing priorities in a fast-paced environment
  • Must be a quick learner and a team player
  • Must have strong analytical and problem-solving capabilities
  • Able to strategize across complex, cross-functional projects and initiatives
  • Experience in Agile Methodology and previous experience as a product owner for Agile teams
  • Familiarity with SQL

Core Competencies

  • Drives Engagement
  • Manages Ambiguity
  • Drives Vision and Purpose
  • Organizational Savvy
  • Strategic Mindset
  • Manages Complexity
  • Ensures Accountability
  • Cultivates Innovation
  • Interpersonal Savvy

This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.

When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make?  To see our culture in action, search #TeamCigna on Instagram.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

 
 

Clipped from: https://jobs.cigna.com/us/en/job/21003937/Data-Governance-Product-Owner-Government-Business-Segment-Medicare-Medicaid-Evernorth?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Manager, Actuarial Services – Medicaid Job Opening in Clayton, MO at Centene Corporation

 
 

Centene Corporation

 
 

 Clayton, MO Full Time

Job Posting for Manager, Actuarial Services – Medicaid at Centene Corporation

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://www.salary.com/job/centene-corporation/manager-actuarial-services-medicaid/ac942d02-5829-4692-ae8f-e54dc9c9d0f2?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Medicaid Specialist, Gulfport, Mississippi

 
 

The Division of Medicaid has vacant Medicaid Specialist positions in the Gulfport, Pascagoula, and Picayune Regional Offices.  If you are interested in the position, please access the Mississippi State Personnel Board’s website. 

You can now apply online by clicking on the job title you are interested in, and then clicking on the “Apply” link! If this is the first time you are applying using our “New” online job application, you will need to create an account and select a Username and Password. After your account has been established, you can create an application by clicking on the “Build a Job Application” link. This application can be saved and used to apply for more than one job opening.

Important   Note: We are no longer using information from our previous application system. In order to submit a new application, a new account must be created. Thank you for your interest in employment with the State of MS.

Online applications are stored on a secure site. Only authorized employees and hiring authorities have access to the information submitted.

Clipped from: https://www.fox8jobs.com/jobs/medicaid-specialist-gulfport-mississippi/243486841-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Certified Project Manager (PMP) – Public Health/EHR/Medicaid Job in Frankfort, KY at NTT DATA, Inc.

 
 

NTT DATA, Inc. Frankfort, KY

We are seeking experienced Senior Project Manager candidates with PMP certification for an Enterprise-Level Electronic Health Records position (EHR/HIT). A Public Health background is preferred.

Job Responsibilities Include:

  • Responsible for coordination, planning, and organization of project activities.
  • Interface with all areas affected by the project, including end users, vendors, and project staff.
  • Perform analysis and negotiation of project scope, budget, and schedule and perform management of the vendor contract.
  • Assist with planning of resources for projects.
  • Proactively manage and track project risks, issues, budget, and schedule.
  • Keep business sponsors and management advised of project status.
  • Ensure that applicable system design life cycle (SDLC) processes are being followed.
  • Oversee vendor and project team members’ work and deliverables to ensure compliance with contract.
  • Experience in implementing Federal and/or State regulation changes.
  • Provide project status reports

Basic Qualifications:

  • 5+ years of Project Management experience in an enterprise environment utilizing Microsoft based technologies
  • Active PMP Certification.

Preferred Skills:

  • Prior IT experience in the Public Health domain and managing IT projects.
  • Prior process improvement experience.
  • Requests for proposal or bid development.
  • Experience with healthcare research, healthcare planning, and healthcare financial management.
  • Experience with healthcare policy interpretation, development, and implementation.
  • Research skills.
  • Proficient in standard project management tools and methodologies, excelling in Microsoft Project, and PMI methodologies.
  • Must be experienced in management of vendors and contracts for large scale information technology projects.
  • Experience with analysis of regulatory authority, legislative action, and CMS guidelines.
  • Demonstrated ability to lead large project teams.
  • Prior experience managing issues, scope, quality, escalations, and risks.
  • Proven track record of successfully managing IT projects, collaborating across business and IT teams.
  • Possess strong written and verbal communication skills.
  • Ability to lead meetings, lead project teams, and communicate effectively at all levels within the project.

The Company is an equal opportunity employer and makes employment decisions on the basis of merit and business needs. The Company will consider all qualified applicants for employment without regard to race, color, religious creed, citizenship, national origin, ancestry, age, sex, sexual orientation, genetic information, physical or mental disability, veteran or marital status, or any other class protected by law. To comply with applicable laws ensuring equal employment opportunities to qualified individuals with a disability, the Company will make reasonable accommodations for the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or an employee unless undue hardship to the Company would result.

Clipped from: https://www.ziprecruiter.com/c/NTT-DATA,-Inc./Job/Certified-Project-Manager-(PMP)-Public-Health-EHR-Medicaid/-in-Frankfort,KY?jid=2996500aa70930fb&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Medicaid Driver w/ CDL – Waterloo, New York,

  • Transportation
  • Waterloo, NY, USA
  • Hourly
  • Casual

Flexible Hours

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Mozaic is hiring for a Medicaid Driver w/ a CDL. This position is a driving position where you are responsible for providing safe and reliable transportation from individuals homes to medical appointment sites.

Medicaid Driver w/ CDL Required Experience:

– One (1) year experience driving individuals to and from appointments preferred

Medicaid Driver w/ CDL Required Education:

-High School diploma or GED preferred

Medicaid Driver w/ CDL Other Requirements:

-Valid and acceptable CDL NYS Driver’s License with class P endorsement

Medicaid Driver w/ CDL Hours:

Monday – Friday Flexible Hours

Mozaic is EEO/AA Employer/Vet/Disabled

Clipped from: https://www.applicantpro.com/openings/mozaic/jobs/1702656/NY-New-York/Waterloo/Medicaid-Driver-w-CDL?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

McKinsey & Company Senior Expert, Medicaid Job

 
 

Size : 10000+ Employees

QUALIFICATIONS

  • Undergraduate or Master’s degree, MBA, MHA preferred; outstanding record of academic achievement
  • 7+ years of experience in a Medicaid role (i.e., state/federal government, Medicaid managed care organization, Medicaid consulting or investment), with increasing responsibility and leadership
  • Experience in and strong knowledge of healthcare sector overall and Medicaid in particular (e.g.., federal Medicaid policy, private sector Medicaid MCO industry dynamics and competitive landscape; Medicaid IT/analytics; duals and special needs populations)
  • Experience designing, building, and/or deploying analytical assets in a professional services environment using healthcare data (e.g., claims data), through commanding resources from across domains
  • High level of entrepreneurship, professionalism and excitement to expand client service and tools
  • Able to provide leadership over and influence individuals and across multiple stakeholders from different levels, backgrounds by tailoring approach
  • Strong problem-solver who can quickly process complex information and present it clearly and simply during change transformation efforts with clients
  • Able to multi-task, work under pressure and deliver accurate and high quality results
  • Delivery-focused mindset, with unquestionable ability to deliver against firm timelines and deadlines, while managing set resources and budgets

 
 

WHO YOU’LL WORK WITH

You’ll work with McKinsey’s Healthcare Practice in one of our offices in North America.

Our healthcare practice is home to 500+ colleagues in North America consisting of consultants, deep content and technical experts, technologists, and operational leaders. We come together, often as blended teams to improve healthcare. Our healthcare practice serves North American payors, providers and services companies and works with both public sector and private sector healthcare organizations.

Our practice is organized around domains, which house intellectual property and expert practitioners, centers of excellence, and tribes (cross-functional special teams working to bring a distinctive approach to our clients in practice priority areas like digital and analytics).

WHAT YOU’LL DO

You will be the leader for our Medicaid and state healthcare domain.

You will lead the development and codification of distinctive, client-ready knowledge assets on Medicaid and state healthcare topics, and to manage the delivery and deployment of these assets to our clients in collaboration with client service teams. You will also be responsible for independently leading planning, design, development and delivery activities in collaboration with Medicaid Domain leadership, and will have the versatility required to excel in both client-facing and internal engagements and roles.

 

Clipped from: https://www.glassdoor.com/job-listing/senior-expert-medicaid-mckinsey-company-JV_IC1128808_KO0,22_KE23,39.htm?jl=3715189369&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Director, Medicaid Performance Improvement in Johns Hopkins Health Care, Hanover, MD | Johns Hopkins Medicine

 
 

Requisition #: 332283

Location: Johns Hopkins Health Care, Hanover, MD 21076

Category: Leadership

Work Shift: Day Shift


Work Week: Full Time (40 hours)


Weekend Work Required: No


Date Posted: March 8, 2021


Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHC is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC has become a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve. If you are interested in improving how healthcare is delivered, join the JHHC team.

Position Summary:

Under the direction of the AVP/ Sr. Director Quality Improvement, this execution-focused position of the Director, Medicaid Initiatives and Performance Improvement will support all Value Based Purchasing (VBP) and performance related activities for the Medicaid line of business, Priority Partners Managed Care organization (PPMCO), for JHHC.

Responsible for developing and driving the enterprise wide Medicaid VBP and performance improvement strategy and implementation through evaluating strategies, external capabilities and vendors to help drive best-in-industry Medicaid performance. Responsible for identifying innovative strategies to set market leading performance for PPMCO VBP measures. Must have deep industry connections to cutting edge strategies and external partners that can accelerate and maintain as an industry leader. Works collaboratively with PPMCO, enterprise leaders, and internal leadership to establish baseline capabilities and develop strategies for capability enhancement. Extensive market knowledge and research capability is necessary to best be able to evaluate opportunities. Collaborates and coordinates work with peers, other departments within matrix/shared service partners (including but not limited to Provider Relations, Pharmacy, Care Management, Utilization Management, Compliance, Appeals, Marketing and Communications, and IT).

This position will be responsible for the planning, development and execution of activities that support the Maryland Department of Health (MDH) or External Quality Review Organization (EQRO), Qlarant required deliverables such as audits, corrective actions, performance improvement plans (PIPs) as well as VBP strategies. In addition, this position will be responsible for executing performance management initiatives in accordance with VBP performance measures.

Task requirements for position:

Under the direction of the AVP/ Sr. Director Quality Improvement, this execution-focused position of the Director, Medicaid Initiatives and Performance Improvement supports all Value Based Purchasing (VBP) and performance improvement related activities for the Medicaid line of business, Priority Partners Managed Care organization (PPMCO), for JHHC.

This position is responsible for the planning, development, and execution of activities that support the Maryland Department of Health (MDH) or External Quality Review Organization (EQRO), Qlarant required deliverables such as audits, corrective actions, performance improvement plans (PIPs) as well as VBP strategies. The incumbent is responsible for supporting additional regulatory and accreditation requirements as well as other relevant needs for Medicaid line of business.

Requirements:

  1. Education:

Bachelor’s degree in health administration or a related field required. Advanced coursework and/or Master’s degree preferred. Minimum 3-5 years of managed care experience, specifically in government programs, is required.

B. Knowledge:

Managed Care Organizations (MCOs), VBP expertise, health systems operations, health care reimbursement models, quality improvement model

C. Skills:

Must be results oriented individual with demonstrated implementation, collaboration and relationship building capabilities; high level of detail and organization; strong qualitative and quantitative analytical skills; Ability to communicate effectively, both orally and in writing; ability to prioritize and coordinate multiple tasks and work well under pressure; ability to develop policies, procedures, and workflows; strong research and data interpretation skills; good judgment; confidentiality, initiative and self-motivation

D. Required Licensure, Certification, Etc.:

N/A

E. Work Experience:

Minimum of 8- 10 years of healthcare experience with thorough knowledge of healthcare quality improvement, industry standard performance measures, healthcare reimbursement including valued based purchasing methodology and management, managed care, and tactics that result in member and provider engagement. Prefer 3-5 year supervisory experience.

F. Machines, Tools, Equipment:

PC, PC applications, and general office equipment. Thorough knowledge of Microsoft software applications

Dimensions:

A. Budget Responsibility:

Ability to anticipate financial reporting, forecasting, and operational issues, assess implications, determine impact, develop, and implement appropriate action plan; Makes cost conscious decisions regarding purchase recommendations and spending. Considers cost effective alternatives.

B. Authority/Decision Making Level:

Independently makes decisions on all issues related to the department and vendor relationship. Organizes and prioritizes work to meet changing priorities. Makes decisions within the scope of authority and established guidelines. Able to manage data, resources, processes and tools to effectively translate business needs into effective and/or innovative solutions.

C. Supervisory Responsibility:

Ability to motivate staff as well as both internal and external customers; ability to diagnose problems and take the lead role in resolving them; ability to interact with a wide variety of health care professionals;

Problem Solving:

Work requires incumbent to be capable of accurately diagnosing performance gaps and thinking strategically to resolve underlying problems. Also resolving issues before health plan performance results are impacted.

Information Management:

Must be able to draw conclusions from data, report and track trends, and recommend solutions.

Working Conditions:

Works in a normal office environment where there are no physical discomforts due to temperature, noise, dust, etc.

Work frequently produces a high level of mental/visual strain due to extended use of PC

Work may require light lifting, stooping, or bending

 
 

Clipped from: https://jobs.hopkinsmedicine.org/job/director-medicaid-performance-improvement-leadership-johns-hopkins-health-care-332283-3e43d/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Supervisory Health Insurance Specialist- CMS

Clipped from: https://www.usajobs.gov/GetJob/ViewDetails/594282000?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Department of Health And Human Services
Center for Medicaid and CHIP Services (CMCS)

 
 

Duties

Summary

This position is located in the Centers for Medicare & Medicaid Services (CMS), Center for Medicaid and CHIP Services (CMCS), Data and Systems Group (DSG), Division of Business and Data Analysis (DBDA).


As a Supervisory Health Insurance Specialist, GS-0107-15, you will serve as the Director leading the data support services and the development of analytics products using Medicaid and CHIP datasets to support internal and external data product users and the public.

Learn more about this agency

Responsibilities

  • Lead and manage the design, development, implementation, of an enterprise-wide Medicaid and CHIP data analytics suite of products in coordination with DSG divisions.
  • Collaborate with leaders across CMCS and CMS in regards to data analytic product development, operational support of data products.
  • Manage and provides statistical, data analytic, and business intelligence support to CMCS components and key CMS stakeholders.
  • Oversee the implementation of data use, its processes, and business intelligence strategies in support of Medicaid and CHIP.

Travel Required

Occasional travel – You may be expected to travel 10% for this position.

Supervisory status

Yes

Promotion Potential

15

Requirements

Conditions of Employment

  • You must be a U.S. Citizen or National to apply for this position.
  • You will be subject to a background and suitability investigation.
  • Time-in-Grade restrictions apply.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.


Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.


In order to qualify for the GS-15, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-14 grade level in the Federal government, obtained in either the private or public sector, to include:
1. Leads a set of teams in the design, development, implementation, of an enterprise-wide Medicaid and CHIP (or equivalent national health care operation) data analytic suite of products and support services delivering measurable value to the data user community served;
2. Manages data work and budget activities for data analytic teams who provide statistical, data analytic, and business intelligence support and use modern methods in engagement such as human centered design to ensure goals are met and resources are used to efficiently deliver business value;
3. Leads secure data analytic product portfolio development and operations supporting the needs of customers engaged in health insurance and/or National healthcare operation such as Medicare, Medicaid, CHIP or equivalent health care program: AND
4. Preparing written documents for diverse audiences; e.g., end users, financial staff, senior leadership, and other non-technical audiences.


Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.


Time-in-Grade: To be eligible, current or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.


Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11050478

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: No

Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Not Required



Location will be determined upon selection Salary Information: Atlanta, GA $134,938-$172,500; Boston, MA $142,615-$172,500; Chicago, IL $142,041-$172,500; Dallas, TX $138,053-$172,500; Denver, CO $140,428-$172,500; Kansas City, MO $129,382-$168,196; Philadelphia, PA $139,224-$172,500; New York, NY $147,994-$172,500; San Francisco, CA $156,235-$172,500; Seattle, WA $140,306-$172,500; Woodlawn, MD $144,128-$172,500


Full-Time Telework Program for CMS Employees: CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page.


Additional Forms REQUIRED Prior to Appointment:

  • Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
  • Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
  • Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.

The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.


If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.

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How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with any interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.


Once the announcement has closed, your online application, resume, transcripts and CMS required documents will be used to determine if you meet eligibility and qualification requirements listed on this announcement. If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration. Please follow all instructions carefully. Errors or omissions may affect your rating.


Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):

  • Building Coalitions/Communications
  • Business Acumen
  • Leading People
  • Managing Change
  • Results Driven

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Background checks and security clearance

Security clearance

Not Required

Drug test required

No

Position sensitivity and risk

Noncritical-Sensitive (NCS)/Moderate Risk

Trust determination process

Credentialing, Suitability/Fitness

Required Documents

The following documents are REQUIRED:


1. Resume
showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/dd/yy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


PLEASE NOTE: A complete application package includes the online application, resume, transcripts and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume, transcripts and CMS required documents, will result in you not being considered for employment.

Benefits

A career with the U.S. Government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Learn more about federal benefits.

Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time, or intermittent. Contact the hiring agency for more information on the specific benefits offered.

How to Apply

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 03/12/2021 to receive consideration.


IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.


We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month, day and year (e.g. June 18, 2007 to April 05, 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.

  • To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  • Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
  • After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
  • You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.

To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to Tanisia.whitlock@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.
 

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Agency contact information

Tanisia Whitlock

Phone

410-786-8433

Email

Tanisia.whitlock@cms.hhs.gov

Address

Center for Medicaid and CHIP Services
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

Once your online application is submitted, you will receive a confirmation notification by email. Your application will be evaluated to determine your eligibility and qualifications for the position. After the evaluation is complete, you will receive another email notification regarding the status of your application.


Within 30 business days of the closing date,03/12/2021, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

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  • Fair & Transparent

The Federal hiring process is setup to be fair and transparent. Please read the following guidance.

Equal Employment Opportunity Policy

The United States Government does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

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Reasonable Accommodation Policy

Federal agencies must provide reasonable accommodation to applicants with disabilities where appropriate. Applicants requiring reasonable accommodation for any part of the application process should follow the instructions in the job opportunity announcement. For any part of the remaining hiring process, applicants should contact the hiring agency directly. Determinations on requests for reasonable accommodation will be made on a case-by-case basis.

A reasonable accommodation is any change to a job, the work environment, or the way things are usually done that enables an individual with a disability to apply for a job, perform job duties or receive equal access to job benefits.

Under the Rehabilitation Act of 1973, federal agencies must provide reasonable accommodations when:

  • An applicant with a disability needs an accommodation to have an equal opportunity to apply for a job.
  • An employee with a disability needs an accommodation to perform the essential job duties or to gain access to the workplace.
  • An employee with a disability needs an accommodation to receive equal access to benefits, such as details, training, and office-sponsored events.

You can request a reasonable accommodation at any time during the application or hiring process or while on the job. Requests are considered on a case-by-case basis.

Learn more about disability employment and reasonable accommodations or how to contact an agency.

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Legal and regulatory guidance