Category: Curator- Job Hunter

 
 

ProMedica is a mission-based, not-for-profit health and well-being organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 49,000 employees, 12 hospitals, 2,500+ physicians and advanced practice providers with privileges, 1,000+ healthcare providers employed by ProMedica Physicians, a health plan, and senior care services.

ProMedica`s senior care division, formerly known as HCR ManorCare, operates 335+ assisted living facilities, skilled nursing centers, memory care communities and hospice and home health care agencies. Services are provided in 26 states and currently operate under the brand names Heartland, ManorCare, ProMedica and Arden Courts. Over the next 18 months, the senior care entities will begin to rebrand to ProMedica.

Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address and lead in social determinants of health, champion healthy aging and cultivate innovative solutions. For more information about ProMedica senior care services, please visit www.promedicaseniorcare.org.

Description

HCR ManorCare provides a range of services, including skilled nursing care, assisted living, post-acute medical and rehabilitation care, hospice care, home health care and rehabilitation therapy.

The Medicaid Specialist assists patients in the skilled nursing centers secure Medicaid benefits.

In return for your expertise, you’ll enjoy excellent training, industry-leading benefits and unlimited opportunities to learn and grow.  Be a part of the team leading the nation in healthcare.

Educational Requirements

High School plus additional training leading to an Associate’s Degree in Business or Social Services.

Position Requirements

Three to twelve months with knowledge of medicaid rules and regulations.

 
 

Category

Accounting – Billing

 
 

Clipped from: https://careers.promedicaseniorcare.org/job/dublin/medicaid-specialist/5346/5334686032?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Req ID: 113285

NTT DATA Services strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now.

We are currently seeking a Director – Medicaid IT Strategy to join our team in Little Rock, Arkansas (US-AR), United States (US).

Position Description (Overview of job) Working within NTT DATA Services State Health Consulting (SHC), you will develop and drive the growth of SHC’s Medicaid IT Strategy advisory services. In this role, you will assist state agency customers with strategic planning efforts to define their modular strategy and develop the required Advance Planning Documents (APDs) to obtain funding for planning, implementation (DDI), and operations (O&M) of their modular solutions. Aligning to an Outcomes Based Certification (OBC) model, you will assist state agency customers to define and evaluate outcomes as part of injecting improvements within their Medicaid Enterprise. You will bring additional Medicaid IT Strategy talent to our consulting organization, mentoring and leading your team to deliver value for state agencies and thereby grow these services. Job Responsibilities Refer to position description above Basic Qualifications 10+ years of IT experience in Medicaid or a Healthcare Payer environment 5+ years of experience in a leadership role with responsibility for the delivery of large-scale programs and projects 5+ years of experience in software engineering methodologies 5+ years of experience with agile/hybrid Software Development Life Cycle (SDLC) B.S. degree Preferred Skills 5 to 7+ years of experience as current or former CMS Central Office Data and Systems Division member Advanced degree such as MBA preferred

About NTT DATA Services

NTT DATA Services is a global business and IT services provider specializing in digital, cloud and automation across a comprehensive portfolio of consulting, applications, infrastructure and business process services. We are part of the NTT family of companies, a partner to 85 % of the Fortune 100.

NTT DATA Services is an equal opportunity employer and will consider all qualified applicants for employment without regard to race, gender, disability, age, veteran-status, sexual orientation, gender identity, or any other class protected by law.

Clipped from: https://helponebillion.com/job/f04b49e4e905c3d7aac6304bd0df743f/Director-Medicaid-IT-Strategy?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description


Essential Job Functions

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

Basic Qualifications

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

Other Qualifications

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

Work Environment

• Office environment

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-agent-at-gainwell-technologies-2440678734/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Details

Eligibility Specialist II (TL- MAGI)

This listing closes on 3/12/2021 at 5:00 PM Eastern Time (US & Canada).

Salary

$27,527.00 – $50,930.00 Annually

Location Richland County, SC

Richland County, SC

Job Type

Temporary Grant – Full-Time

Agency

Department of Health and Human Services

Job Number

61100345

Closing date and time

3/12/2021 at 5:00 PM Eastern Time (US & Canada)

Agency Specific Application Procedures:

All applicants must apply online.

Class Code:

GA44

Position Number:

61100345

Normal Work Schedule:

Monday – Friday (8:30 – 5:00)

Pay Band

Band 4

Hiring Range – Min.

$27,527.00

Hiring Range – Max.

$31,656.00

Opening Date

03/08/2021

EEO Statement

Equal Opportunity Employer

• Description
• Benefits
• Questions

Job Responsibilities

 
 

This position is located in Eligibility, Enrollment and Member Services (EEMS), Richland County. The MAGI Eligibility Specialist II (Eligibility Specialist Team Lead) is the front-line of beneficiary access to the Medicaid program. This position collects and evaluates documentation from applicants to determine individual and family eligibility for the program. Eligibility Specialists ensure the integrity of the Medicaid program by completing all eligibility determinations, reviews, and eligibility changes in an accurate and timely manner. In addition to meeting minimum standards for timely determinations in accordance with the Department’s EPSM, serves as a subject matter expert and first tier escalation authority for individuals on their team.

• Uses various information sources, electronic tools, and systems provided by the Department to collect, assemble, evaluate, and act upon information provided by applicant/beneficiaries and third parties to make timely eligibility determinations, reviews, and changes of circumstance. Follows policies and procedures for the collection and analysis of applications and documentation and collects additional information for beneficiaries as necessary with the least burden to the applicant/beneficiary as possible. Performs follow-up activities in an efficient and effective manner, using the communication method most appropriate for obtaining outstanding information. Documents all notes and steps clearly and completely for review and hand-off to other specialists.

 
 

• In addition to meeting minimum standards for timely determinations in accordance with the Department’s EPSM, serves as a subject matter expert and first tier escalation authority for individuals on their team. Provides weekly individualized guidance for up to 4 team members and provides recommendations for the relevant team supervisor for performance evaluations and periodic counseling. Assists new and underperforming team members with developing work improvement strategies.

• Proficient with all processes, policies, procedures, and system updates to ensure that all eligibility determinations, reviews, and changes are completed accurately with satisfactory documentation. Makes accurate determinations as to individual eligibility based on the rules and standards detailed by the department as defined in written performance standards for the relevant type of determination needed. Resolves discrepancies in a timely manner. Follows appropriate escalation processes as outlined in eligibility process documentation. Labels all documentation, records decision and notes clearly and accurately, and in the appropriate systems of record.
• Maintains a professional demeanor and communication style, ensuring that communication and interactions with co-workers, supervisors, and beneficiaries is clear, polite, and concise. Participates in customer service and privacy training and ensures that confidential or private information is maintained in accordance with State and Federal law as articulated through departmental policies and training.
• Attends all mandatory meetings, trainings, and events as directed by supervisory staff and agency leadership. Maintains awareness of and complies with all agency policies, to include privacy, confidentiality, standards of conduct, performance, leave and compensation, vehicle use and travel, and financial controls. Maintains appropriate certification and training to perform emergency management evacuation and shelter duties as necessary. Performs other duties as assigned by supervisory staff and agency leadership. 

 
 

  
 

Minimum and Additional Requirements

A high school diploma and relevant program experience.  A bachelor’s degree may be substituted for the required program experience.

Additional Requirements:

• Occasional overnight travel.
• Overtime and/or weekend work wit Deputy approval.
• Sitting or standing for long periods of time.
• Lifting requirements: 20 lbs.

Preferred Qualifications

• Eligibility Specialists must have a familiarity with computers, standard Microsoft Office software, internet browsers, and the ability to read, write, and speak English in a clear and concise manner.  
• Must be able to perform basic mathematical computations.  
• Eligibility Specialists must be able to work in a professional office environment with a diverse group of teammates and provide excellent customer service either face to face, telephonically or through written communication.  
• Eligibility Specialists must be able to learn, retain, and apply information about federal rules and standards for processing Medicaid eligibility determinations.  
• Specialists must maintain productive workspaces and must perform tasks in an effective manner to ensure the completeness, accuracy, and timeliness of eligibility determinations.  
• Demonstrates high performance standards.

.

Additional Comments

Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purpose. All applicants must apply online. All correspondence from the Office of Human Resources will go through electronic mail.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions, including but not limited to lactation), national origin, age (40 or older), disability or genetic information.

Benefits for State Employees

 
The state of South Carolina offers eligible employees generous benefits, including health and dental insurance; retirement and savings plan options; and paid vacation and sick leave. Plus, work-life balance programs such as telecommuting and flexible work schedules are available to employees of some state agencies.
 
Insurance Benefits
Eligible employees may enroll in health insurance, which includes prescription coverage and wellness benefits. Other available insurance benefits include dental, vision, term life insurance, long term disability and flexible spending accounts for health and child care expenses.
 
Retirement Benefits
State employees are also offered retirement plan options, including defined benefit and defined contribution plans. Additionally, eligible employees may elect to participate in the South Carolina Deferred Compensation Program, which is a voluntary, supplemental retirement savings plan offering 401(k) and 457 plan options.
 
Workplace Benefits
State employees may also be eligible for other benefits, including tuition assistance; holiday, annual and sick leave; and discounts on purchases, travel and more.
 
Note: The benefits above are available to most state employees, with the exception of those in temporary positions. Employees in temporary grant and time-limited positions may be eligible for all, some or none of these benefits as benefits are associated with each position type. For these positions, contact the hiring agency to determine what benefits may be available.
 

01

The responses you provide to these Supplemental Questions will be used in combination with your application to determine whether you meet the minimum qualification requirements. Failure to provide detailed and complete information may result in your application being rejected. Any misrepresentation or omissions will result in your disqualification from employment and/or termination. When applying for this position, I understand that I must thoroughly complete the Education and Work Experience sections of my application and the Supplemental Questions. Please do not submit a resume in place of completing the Education, Work History and Supplemental Questions. This includes a detailed description of each position that I feel qualifies me for the job I am seeking. I have read the above statement and understand that failure to provide sufficient detailed information may result in my application being rejected. I also understand that I may not submit resumes in lieu of filling out the application or answering the Supplemental Questions. I acknowledge that I have read, understand and agree with the above.

• Yes
• No

02

If selected to be hired for this position, are you willing to accept a salary within the posted range $27,527 – $31,656?

• Yes
• No

03

What is your highest level of education achieved?

• Less than a twelfth grade education
• High School Diploma or equivalent
• Some College
• Associate Degree
• Bachelor’s Degree or higher

04

Please select the option that best describes your professional experience in customer services, social services, human services, data entry and/or Medicaid processing.

• No Experience
• Less than one year
• One year to less than three years
• Three years to less than five years
• Five or more years

05

Please briefly explain your experience in customer services, social services, human services, data entry and/or Medicaid processing. Note: Please see application/resume or N/A is not an accepted answer.

06

Have you ever been an employee of the SC Department of Health and Human Services? If yes, please list the department and your supervisor.

07

How did you hear about this position?

• SCDHHS Website
• careers.sc.gov
• Career Fair(s)
• Information Session(s)
• SCDHHS Employee
• Job Ad(s)
• Indeed.com
• Higher Education Resource(s)
• LinkedIn.com
• NAMD
• Careerbuilder.com
• SCHA (Hospitalcareers.com)
• Glassdoor.com

08

If you learned of this posting from a SCDHHS employee, please list his/her name.

* Required Question

Agency State of South Carolina Phone 803-898-2670

Agency Department of Health and Human Services Address 1801 Main Street, Suite 224


Columbia, South Carolina, 29201

Apply

Clipped from: https://www.governmentjobs.com/jobs/3006824-0/eligibility-specialist-ii-tl-magi?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Essential Job Functions

• Provides more complex design documents and translates into component-level designs to accelerate development. Assists in developing strategy, design and data gathering approaches.
• Provides high level design expertise in support of development team efforts to provide flexible reusable components to increase cost effectiveness. Analyzes, designs and reviews design of applications and suites of applications to ensure that customer specifications are satisfied.
• Utilizes experience in development methodologies, coding documentation, testing methodology and industry standards to define and develop project requirements, functional specifications and detailed design of application solutions for clients.
• Provides leadership and work guidance to less experienced personnel. Guides the work of less experienced developers to create, maintain and communicate details of application designs to ensure that designs are according to specifications.
• May provide technical consulting on complex projects. Devises or modifies procedures to solve complex problems considering computer equipment capacity and limitations, operating time and form of desired results.

Basic Qualifications

• Bachelor’s degree or equivalent combination of education and experience
• 6+ years of coding experience – C, Unix
• 2+ years of experience coding in Python
• Experience working with software design, software development life cycle, and development methodologies and implementation
• Ability to interact with customers for the purpose of developing and understanding requirements
• Experience with Medicaid and/or TMSIS

The preferred location for this role is Conway, AR. However, remote or home-based work from other locations within the United States may be considered.

Clipped from: https://jobs.gainwelltechnologies.com/job/12270059/

 

 
 

 
 

Overview:

BerryDunn is seeking a Staff Consultant for BerryDunn’s Medicaid Practice Area within our Government Consulting Group. Our Medicaid Practice Area focuses on supporting decision makers in state Medicaid agencies throughout the country in the design, development, financing, implementation, and evaluation of their Medicaid programs. In order to do this, our team applies our knowledge and skills in the areas of, federal policy and legislative analysis, Medicaid program design and development, and information systems technology. Serving as trusted advisors, our contributions allow policymakers and institutions to focus on their objectives with the information and tools they need to make the right decisions to achieve their program goals. The culture at BerryDunn is collegial, collaborative, and mutually supportive. Currently, our team is engaged with Medicaid projects at different stages with focus on Medicaid policy development, system implementation, and program transformation. As a result, we are looking for interested, qualified professionals to join our growing team as a Staff Consultant. You would be reporting to senior members of our Medicaid Practice Area and would have experience or relevant coursework with government, public policy, healthcare, and/or the Medicaid program. You will work out of our Portland, ME office. The start date for this role will be in July of 2021.

Travel Expectations: Willingness to travel 35-50% (While 35-50% of travel is a requirement of the role, due to COVID-19, non-essential travel has been temporarily suspended.)

Responsibilities:

You will:

• Assist in providing consulting services to clients under the supervision of more experienced consultants.
• Follow appropriate diagnostic, data collection, fact-finding, and data analysis practices.
• Assist in conducting research, assisting with detailed and technical aspects of the engagement, documenting the engagement and assisting with engagement reporting.
• Perform assigned administrative tasks.
• Develop concise summaries, reports, and presentations of complex data for client leadership.
• Facilitate meetings and interviews with client stakeholders.
• Assist with project management tasks such as tracking and reporting project progress, maintaining project document repository, and reviewing deliverables for quality assurance.
• Provide ad hoc assessments and briefings in response to client requests.
• Continue to grow professionally through a program of self-development and formal continuing professional education programs.
• Participate/Support firm-wide initiatives, including new business development.
• Work toward obtaining appropriate professional certifications.
• We encourage involvement in civic and professional activities.

Qualifications:

Our Benefits:

We value our employees and offer a variety of attractive benefits, in addition to being part of a high-powered, effective team! Here are just a few of our attractive benefits:

• Health, Dental, Rx and Vision Insurance
• Health Savings Account (HSA); Employer contribution
• Responsible Paid-Time-Off policy, including Paid Family Leave
• 401(K) profit sharing plan with employer match after one year
• Life and AD&D Insurance
• Long-term Disability Insurance
• Long-term Care Insurance
• Tuition Reimbursement, Continuing Professional Education, and CPA Exam
• Wellness Programs
• Mentor Programs

About BerryDunn:

BerryDunn is a CPA and Management Consulting firm with over 500 employees throughout the country that provide a full range of services including Management and IT Consulting, Health Analytics/Actuarial Consulting, Audit, Accounting, and Tax. We are headquartered in Portland, Maine, with offices in Arizona, Connecticut, New Hampshire, and West Virginia. BerryDunn has maintained steady growth over its 40+ year history, and the firm is regularly named to national “Top 100” lists, including recent recognition for being a “fastest-growing” firm. We partner with clients across the United States and Canada, and we attribute our growth to attracting, developing, and retaining outstanding employees who help our clients create, grow, and protect value.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

 
 

Clipped from: https://www.glassdoor.com/job-listing/staff-consultant-medicaid-berry-dunn-mcneil-parker-JV_IC1135898_KO0,25_KE26,50.htm?jl=3760526702&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Pharmacy Business Analyst – Medicaid

Full Time Permanent Role

Conway, Arkansas

• Management of procedures associated with systems change orders
• Ensure the integrity of pharmacy data used in claims processing
• Management of requests for claims adjustments
• Informational resource for call center staff
• Informational resource pertaining to inquiries, system configuration, and data files
• Support and back-up of Account Pharmacy Services Director and PBM Operational Account Manager as appropriate

Minimum Qualifications:

• Extensive knowledge of Medicaid claims processing, data management, pharmacy practices, and the Nevada Medicaid program

Preferred Qualifications:

• Nationally Certified Pharmacy Technicians (certified through PTCB) and licensed in the State of Nevada

Clipped from: https://www.learn4good.com/jobs/arkansas/healthcare/237083724/e/

Location: Center Ridge
 

 
 

 
 

The Medical Director will be responsible for managing health plan medical costs and assuring appropriate health care delivery for plans and members. They will be responsible for leading the organizations efforts to achieve excellence in healthcare affordability, quality, member experience, and improved population and member outcomes. They will serve as a clinical leader for teams dedicated to concurrent review, prior authorization, case management and clinical coverage review.

– Share the health plan’s passion for evidence-based medicine and be comfortable applying evidence-based guidelines. Collaborate with other senior leaders in efforts that enhance the quality of care delivery, improve outcomes, and improve value delivered to our members.
– The Medical Director can expect to perform the following functions:
– Support pre-admission review, utilization management, concurrent and retrospective review process and case management.
– Provide professional leadership and direction in the utilization/cost management (UM) and clinical quality improvement (QI) of the health plan, as measured by benchmarked UM and QI goals.
– Work collaboratively as a clinical resource to other plan functions that interface with medical management such as provider relations, member services, benefits, claims management, etc.
– Ensure members receive safe, effective, equitable, efficient, timely and patient-centered health care services within their health plan benefits.
– Carry out medical policies at the health plan consistent with NCQA and other regulatory bodies.
– Participate and/or chair clinical committees and work groups as assigned. 
– Review medical care, medical service, and pharmacy requests against established clinical guidelines and make approval and denial determinations in accordance with evidence-based standards, organizational policies and procedures, and regulatory requirements.
– Identify potentially unnecessary services and care delivery settings, and recommend alternatives, as appropriate.
– Review appeals of medical and pharmacy denials against established clinical guidelines and make approval and denial determinations in accordance with evidence-based standards, organizational policies and procedures, and regulatory requirements.
– Identify opportunities for corrective action plans to address issues and improve plan and network managed care performance.
– Collaborate with Provider Networks and Medical Director team in creating and maintaining programs that incentivize providers to achieve selected utilization/cost and quality outcomes.
– Participate in the retrospective review and analysis of plan performance from summary data of paid claims, encounters, authorization logs, compliant and grievance logs, and other sources.
– Provide periodic written and verbal reports and updates as required in the Quality Management Program description, the Annual QI Work Plan.
– Assure plan conformance with legal and regulatory requirements; support NCQA qualification activities, including site visits and response to accrediting and regulatory agency feedback.
– Participate in risk management, claims administration, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, nutrition service review, provider orientation, credentialing, profiling, etc.
– Conduct quality improvement and outcomes studies as directed by the state and federal regulatory agencies, the Quality Management Committee, Medical Advisory Committee, Peer Review Committee, and management.
– Support grievance process, as led by Chief Medical Officers, ensuring a fair outcome for all members.
– Monitor member and provider satisfaction survey results and implement changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and plan participants.
– May be asked to chair various health plan committees, such as Quality Management subcommittees on Peer Review or Credentialing.
– Promote wellness and ensure programs of prevention, education and outreach to members and providers consistent with the company’s Mission, Ambition, and Values
– Perform and oversee in-service staff training and education of professional staff.
– Contribute to the development of strategic planning for existing and expanding business; recommend changes in program content in concurrence with changing markets and technologies.
– Participate in key marketing activities and presentations, as necessary, to assist the marketing effort.

 
 

Clipped from: https://jobs.bswhealth.com/us/en/job/20016524/Medical-Director-Medicaid?src=JB-11200&utm_source=NHCN&rx_medium=post&rx_paid=1&rx_r=none&rx_source=nationalhealthcarecareernetwork&rx_ts=20210301T002547Z&rx_viewer=4077583b7a6911ebbd5d4f4660b20cf20677cb7d739c427aa8d432cd70253eb9&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Manages the day to day account relationship. Supports the development of and executes on ongoing strategy to ensure retention and growth by providing solutions that align with customer`s overall business and human capital management objectives. Develops strong relationships with internal matrix partners that support achievement of strategic alignment (IT, Finance, Product Development, Claims, Legal etc.). Under guidance, takes the leadership role in coordinating these resources to achieve business objectives, maintain account satisfaction, and ensures that the company’s products and services support customer`s needs.

Seeking candidates with account management experience in behavioral health or MediCal (Medicaid). Candidate must reside in the California market area.

·Customer Relationship:  Supports the account management team in developing and maintaining a strategic business plan that fully reflects global customer’s business objectives and how the company’s solutions align with those objectives and specifically guides the company’s operational, financial, network, clinical and relationship initiatives.

·Understands the customer’s structure and demonstrates the ability to apply this knowledge in business and retention planning for the client.

·Ensures Service Level Agreement performance, assurance of accuracy of claims payment and administrative policies, rate maximization through ongoing benefit analysis and adherence to requirements of the account?s legal/regulatory environment.

·Owns overall account satisfaction within the company as well as satisfaction with all specific areas particularly account management. 

·Develops strong relationships which penetrate the customer at various levels from day to day contacts to senior leadership involving other internal staff to maintain multiple connections and strengthen the overall relationship.

·Develops strong relationships and contacts within the company that are supportive of the achievement of customer service requirements including attainment of performance guarantees and minimization of performance penalty expense.

·Ensures all Customer and Account-Facing services are provided in a consistent and timely fashion.

·Supports the Internal Customer Operating Model.

·Resolves or appropriately escalates customer service issues in conjunction with operations (claims, service, and systems).

·Provides mentoring to the account management team in effective problem solving and servicing of the account.

·Develops, introduces, and executes the customer governance process.

·Builds relationships and alliances with matrix partners.

·Compliance: Coordinates with the compliance department on knowing and understanding regulations and the implication to customer impact.

·Maintains a client audit schedule to ensure a proactive approach in supporting critical client compliance.

·Coordinates all customer audit preparation and execution.

·Proactively communicates to internal and external contacts.

·Demonstrates thorough contract understanding and detailed knowledge of business requirements.

·Coordinates with legal to ensure contract compliance.

·Reporting: Defines customer reports and ensure coordination with the client.

·Oversight of reporting calendar to ensure timely submission.

·Analyzes data and reporting and executive summary development.

·Prepares and supports presentation of customer reports with meaningful analytics, trending and recommendations for program improvement based on findings.

·Ensures all client reports have an executive summary and explanation of data.

·Financial: Ensures revenue goals are met, cost of care and administrative expenses are managed and segment profit targets are achieved for assigned account (s).

·Demonstrate a thorough knowledge of Cost of Care and implications internally and for the client.

·Ensures performance standards are measurable and realistic to achieve and/or exceed to avoid penalties.  Partners with Operations and Network on monitoring.  Manages methodology, reporting and communications.

·Directly participates and supports manager on all renewal activities.

·Manages risks and develop opportunities associated with underwritten rates.

·Up-Sell/Product/Growth: Analyzes account benefit and ability to apply this knowledge to growth.

·Drives up-sell and renewal activities across assigned account(s).  Negotiates and/or supports negotiation of rates and contractual terms with customers that result in achieving segment profit targets and creatively adjusts features and service delivery models that increase efficiency and improve value to the customer and/or margin for the company.

·Identifies products and services that bring solutions to the customer based on a thorough understanding of the customer’s strategic business goals and the business needs.

·Demonstrates depth of knowledge of the company’s products and how multiple products are interdependent within the customer contract deliverables and outcomes.

·May oversee staff as appropriate.

Other Job Requirements

Responsibilities

• Proficient in MS Office suite.
• Excellent verbal and written communication skills.
• 7+ years’ relevant experience.
• If degree requirement not met, will consider with 10 years of experience.

General Job Information

Title

Account Executive (Behavioral Health/Medicaid)

Grade

27

Work Experience

Account Management

Education

Bachelors

License and Certifications – Required

License and Certifications – Preferred

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

 
 

Clipped from: https://careers.magellanhealth.com/us/en/job/R00000036926/Sr-Account-Executive?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job ID: 948586
Facility: Access East, Inc
Location: Greenville, NC
FT/PT: Full-Time
Reg/Temp: Regular
Date Posted: Feb 18, 2021

Job Description

Vidant Health

About Vidant Health

Vidant Health is a regional health system serving 29 counties in eastern North Carolina. We are working every day to improve the health of the 1.4 million people we serve. Vidant Health is made up of 8 hospitals, physician practices, home health, hospice, wellness centers and other health care services. Vidant Medical Center is affiliated with the Brody School of Medicine at East Carolina University. As a major resource for health services and education, Vidant Health strives to support local medical communities and to work with providers throughout the region to deliver quality care. Our goal is to enhance services that are available locally and to eliminate barriers involving time, distance and lack of awareness that sometimes prevent patients from receiving the care they need.

Position Summary

The Social Worker (SW) coordinates the delivery of care across the continuum and social work services to all inpatient and observation units of the hospital and designated outpatient and ambulatory treatment units. The SW provides collaboration and oversight in complex clinical issues to Nurse Care Managers (RN CM) and Discharge Coordinator (DC) staff. This role requires interaction with a variety of patient populations including, but not limited to, neonatal, pediatric, adolescent, adult, geriatric and behavioral health.

Provides advanced practice social work services related to patients’ and family members’ current and post-acute psychosocial and clinical needs. Completes psychosocial assessments; provides crisis intervention, emotional support, and short-term counseling with regard to diagnosis, treatment, and cross continuum care plans; and creatively identifies and accesses resources to optimize effective and efficient patient care outcomes in collaboration with other members of the – interdisciplinary team.

The SW is accountable for the management of identified complex care planning and social work functions for
assigned patient care area using advanced social work theory and advanced clinical practice skills appropriate to the age of the patient incorporating the patient/family’s social and emotional state. Utilizes principles of individual, group and family therapy theories.

Proactive development, implementation and ongoing revision of an interdisciplinary plan of care. Negotiation and collaboration with the interdisciplinary team, community resources and payers to facilitate timely and cost effective care plans that enhance appropriate health and social services in the continuum of care are imperative.

Minimum Requirements

• Required Masters of Social Work degree from a CSWE accredited school of social work is required
• CPR training within one year of hire is required
  
  

Preferred Requirements

• 2 years of recent experience as a social worker in a health-related environment. Licensed
• Clinical Social Worker/Licensed Clinical Social Worker Associate Certification in Case Management.

Other Information

• Monday – Friday 8:00 – 4:30 pm
• Initial 90 day orientation will be onsite in the Greenville Access East office location
• Position will evolve into rotating days in the office, in a practice clinic, and remote work from home
• Future home visits will begin after COVID restrictions are lifted

General Statement

It is the goal of Vidant Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer.   Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

 
 

Clipped from: https://careers.vidanthealth.com/jobs/6179925-social-worker-medicaid-care-management-greenville-nc?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic