Category: Curator- Job Hunter

 
 

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

Office: Policy

Bureau: Behavioral Health Policy

Classification: Medicaid Health Systems Administrator 1 (PN 20093477)

Job Preview:

The Ohio Department of Medicaid is seeking an experienced professional to be a part of our Behavioral Health Policy unit. As a Behavioral Health Policy Administrator, your responsibilities will include:

• working alongside a team of dedicated staff engaged in policy development and implementation
• assisting in the development and design of Medicaid Behavioral Health policies and initiatives
• evaluating and directing organizational compliance of Behavioral Health policies
• researching and analyzing the impact of state and federal legislation on Medicaid service delivery systems
• coordinating and directing the implementation of Behavioral Health policy and compliance initiatives in the fee for service and managed care delivery systems
• coordinating the review, preparation, clearance and filing of program rules, manuals and handbooks
• ensuring that policies and procedures comply with federal and state regulations
• participating in the coordination of policy development teams involving the delivery of services and access to care for individuals with behavioral health needs
• assisting in the development of state plan amendments and communicating policy changes to the Centers for Medicare and Medicaid Services
• providing technical assistance to managerial and supervisory personnel involved in the implementation of improvements or new programs

The preferred candidate will have a passion for learning, collaborating and contributing to the development of policies and programs that help improve the lives of Medicaid enrolled individuals with behavioral health conditions.

Job Description:

Under general direction, serves as agency manager of Medicaid program(s), &/or initiatives to research, analyze & evaluate the ongoing implementation of one statewide component of Medicaid health systems (i.e., substance use disorder services): Plans, manages, evaluates & directs organizational compliance of rules, policies & regulations related to behavioral health services (e.g. development & design of initiatives regarding Medicaid policies & procedures for substance use disorder services); directs & coordinates interoffice teams assisting with the organizational development & design of operational processes; researches, evaluates/analyzes state & federal legislation impacting Medicaid service delivery systems; monitors status of pending legislation; develops, drafts & defends program rules, policies, & procedures for delivery system; participates in the development of response to legislative issues; recommends legislative changes.

Coordinates & directs the implementation of departmental policy & compliance initiatives involving behavioral health policy; assists in the development & implementation of benefit plan policies & initiatives in both the fee for service & managed care delivery systems (e.g., initiatives which may include utilization management & care management strategies); coordinates review, preparation, clearance & filing of program rules, manuals & handbooks, ensures that policies & procedures comply with federal & state regulations by researching applicable regulations & working directly with appropriate federal & state agencies; participates in the coordination of policy development teams involving the delivery of services & access to care for consumers with behavioral health conditions; assists in the development of state plan amendments communicating policy changes to the Centers for Medicare & Medicaid Services (CMS) in order to receive federal matching funds for the Medicaid program(e.g., formulation & coordination of research documentation supporting the state plan amendment); advises supervisor regarding issues & problems; provides technical assistance to managerial & supervisory personnel involved in the implementation of improvements or new programs (e.g., researches & evaluates health care market developments & trends, analyzes value purchasing strategies involving fee for service & managed care delivery systems).

Prepares comprehensive written reports summarizing findings & recommendations of program policies; speaks to community groups, advocacy organizations, legal community, provider associations federal staff &/or public; responds in writing & verbally to sensitive inquiries & contacts from public, providers & government officials; provides assistance to teams to research, develop, analyze & evaluate strategic policies regarding the purchasing of services for Medicaid consumers (i.e., assists in the development & design of utilization management & quality assurance activities including the development & design of prior authorization of medical services for Medicaid consumers); writes requests for proposal & assists in the management of contractor activities).

Performs other related duties as assigned (attends staff meetings & training, coordinates & conducts public presentations, provides advice to public officials, maintains logs, records & files; travels to meeting sites).

Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 mos. exp. in the delivery of a health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data base analysis).

Or 12 months experience as a Medicaid Health Systems Specialist, 65293.

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

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

 
 

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Humana

 
 

Birmingham, AL Full-timeWork from home

• Responsibilities The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members.
• The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
• Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations.
• Additional Work At Home Requirements Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).
• Preferred Qualifications BSN or Bachelor’s degree in a related field Health Plan experience Previous Medicare/Medicaid Experience a plus Call center or triage experience Bilingual is a plus Previous experience in utilization management
• Additional Information In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities.
• Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.
• This position may be subject to temporary work at home requirements for an indefinite period of time.

Posted 13 hours ago

 
 

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Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company, it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health benefits companies and a Fortune Top 50 Company.

This position may be remote within NC and will be responsible for overseeing a designated region of NC. Home office location: 11000 Weston Parkway, Cary, NC. Candidates must reside in the state of NC or neighboring states. Currently, this position is remote due to COVID. Once we resume all standard operations, travel time for this position will be as indicated under the Requirements section.

The Provider Clinical Liaison supports primary care groups in Advanced Medical Home population health activities. This position serves a key role in Healthy Blue’s geographically organized provider support. The Clinical Liaison is responsible for managing quality and medical expense goal metrics for primary care groups by assisting in connecting high risk members and those having HEDIS gaps to their medical homes, to establish care plans that improve health outcomes.

Primary duties include:

• Use Healthy Blue databases and tools, including risk adjustment tools to identify opportunities for improvement in quality and costs for members in assigned practices
• Develop an operational plan for each medical practice to deploy office personnel and coordinate with Healthy Blue resources to optimize performance on targeted quality measures and to improve clinical and cost outcomes for members identified to have high clinical risk
• Coordinate scheduling of high risk members and those having HEDIS gaps for appointments
• Communicate with medical office personnel about identified gaps in care that will be apparent to the practitioner at the patient encounter
• Meet with physicians and other clinical personnel to problem solve and develop engagement plans for high risk members
• Work with practitioners and office staff to improve documentation of diagnoses, including specific manifestations, facilitate access of members to Healthy Blue case management, population health, and behavioral health programs as indicated, and help coordinate services provided by practice and Healthy Blue personnel
• Serve as the subject matter expert for primary care practices on all Healthy Blue clinically focused program
• Conduct periodic meetings with each practice to track progress towards implementing the project plan and attaining goals established in the engagement contract
• Support the Healthy Blue Provider Collaboration Lead in organizing and implementing support to achieve targeted revenue, medical expense, and quality goals for the assigned region
• Assures compliance to practice guideline, delegation and continuity and coordination of care standards
• Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of results.

Qualifications

Requires:

• BA/BS in Nursing.
• Minimum 5 years of clinical experience
• Demonstrated commitment to clinical quality improvement
• Unrestricted RN license in the state of North Carolina.
• This position requires field work, visiting providers, approximately 75% of the time.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

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Description: JOB PURPOSE:This position leads the OK Medicaid division This role requires indirectly leading/directing other divisions that support government business. This leadership team will direct multiple functions within the enterprise such as, IT, OK Plan Network functions, Government Clinical, Customer Service, Compliance, Medical Directors and Finance. This individual would own the strategy in partnership with the state of OK and the President of Medicaid with a high level of complexity.

JOB REQUIREMENTS: Bachelor’s degree 5 years in a leadership/management position. 12 years health care experience and knowledge of contract interpretation. Knowledge of contract provisions relating to hospital, home health agencies, nursing facilities, and other Medicaid providers 5 years experience with Medicaid Budgeting/accounting experience. Excellent verbal and written communication skills; ability to convey detailed, complex information in a clear, concise, and accurate manner. Ability to make presentations to various groups. Excellent analytical, critical thinking, planning, time management, and organizational skills. Experience managing diverse groups and multiple priorities/activities effectively and independently. Experience interacting effectively with all levels of management and external customers. Experience monitoring budget and productivity standards and the ability and knowledge to define and coordinate systems issues with IT Experience negotiating for additional revenue, changes to contract parameters and new business. PC proficiency to include Word, Excel, PowerPoint, and email. Travel required. PREFERRED JOB REQUIREMENTS: Experience with government contracts. Management experience in a health care or managed care environment Experience in the health care industry. Knowledge of the Medicaid Managed Care programs.

Location: OK – Oklahoma City Activation Date: Wednesday, February 10, 2021 Expiration Date: Saturday, February 27, 2021 Apply Here

Blue Cross and Blue Shield of Illinois, Montana, N

Address

Oklahoma City, OK

73163 USA

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BASIC FUNCTION:
This position is responsible for the management oversight of Medicaid claims and customer service in collaboration with HCSC Enterprise Medicaid and in accordance with contractual and regulatory requirements. Serve as point of contact with HCSC Enterprise Medicaid Operations and coordinate with key functional areas across the organization, local vendors, and 3rd party business partners with the development and implementation of Medicaid Operations. Serve as business lead responsible for implementing HFS and CMS regulatory and contract changes (i.e., state fee schedule benefit changes and annual regulatory changes) including process and system changes. Position will also oversee Medicaid Member Services and responsible for managing relationships with local Medicaid vendors.

JOB REQUIREMENTS:
Bachelor Degree and 4 yrs operations experience OR 8 years experience working in health insurance operations
3 to 4 years experience leading and managing teams
Experience in project management
Experience managing operations for Medicaid, Dual Demonstration or other related Medicaid Medicare Advantage programs
Experience in business planning, time management, project management and organization skills with ability to multi-task and manage multiple, concurrent projects and priorities
Experience planning and driving business initiatives through implementation
Possess leadership, communication skills (oral and written) and ability to exercise strong interpersonal skills in varying, cross-functional situations
PC proficiency to include Word, Excel, PowerPoint and Lotus Notes

PREFERRED JOB REQUIREMENTS:
Background in administration of contracts for State and Federal Government.
Experience managing vendor relationships
Facet knowledge preferred
Blue Chip knowledge preferred
*Knowledge of call center management and performance monitoring

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Requirements:
Expertise Claims & Customer Service Job Type Full-Time Regular Location OK – Oklahoma City

 
 

Clipped from: https://www.themuse.com/jobs/hcsc/manager-medicaid-operations-af10ed?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Resp & Qualifications

Position Summary:

 
 

The Manager of Marketing develops marketing strategies and tactics to ensure membership growth within state and federal regulatory guidelines.

 
 

Duties and Responsibilities

• Develop and implement both print and digital communications that are effective.

 
 

• Oversee management and approval of communications for all externally facing documents and ensuring that all documents meet the Company’s brand standards.
• Collaborate with the Compliance Department to ensure marketing materials are compliant with necessary state and federal guidelines.
• Work with vendors to produce materials that meet industry standards and meet all regulatory requirements.
• Project manage marketing initiatives.
• Other duties as assigned.

Education, Experience and Qualifications:

• Bachelor’s degree
• 5-7 years of experience in healthcare marketing; preferably within a Managed Care environment
• Knowledge of Medicaid and Medicare programs

 
 

Knowledge, Skills and Abilities:

• Excellent verbal and written communication skills
• Strong organizational skills with attention to details
• Strong project management experience
• Strong computer skills are essential
• Creative problem solving skills
  
   

Computer Skills

 
 

• Microsoft Office to include Word, Excel, PowerPoint, Outlook and Visio,
• Proficiency with InDesign
• Proficiency with Adobe Professional Suite

 
 

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 3.10.21

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

PDN-92b5970a-def2-4b69-9f55-fca46a80b2eb

 
 

Clipped from: https://www.techlatinojobs.org/job/manager-of-medicaid-marketing-timonium-maryland-3247908?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Location: Baltimore, MD, US

Company: NTT DATA Services

Req ID: 113288 

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 of Medicaid Security Services to join our team in Baltimore, Maryland (US-MD), United States (US).

Working within NTT Data Services State Healthcare Consulting (SHC) technology group, you will develop and drive the growth of SHC’s security advisory and security offerings. In this role, you will support our State Agency customers in making sound security decisions while establishing yourself as a trusted advisor to our customer CIOs/CISOs. Recent familiarity with Cybersecurity in large-scale Healthcare environments is a must, as well as the ability to communicate a long-term vision for Security in the Healthcare industry in various forums. You will be part of leading and mentoring a growing group of senior security specialists while bringing in additional security advisory talent to grow our business.

• Minimum 5 years in Medicaid, State Health and Human Services or Commercial Healthcare
• Minimum 10 years in large-scale Enterprise Security
• Minimum 3 years of experience negotiating security challenges in the current and future state of business operations
• Minimum 5 years of experience working with current security technology offerings and trends in both centralized and distributed networks
• Minimum 5 years of experience with and understanding of how to prepare an organization with the right tools, skills, resources, relationships and capabilities against growing information security risks.
• Minimum 3 years of direct experience contributing to the design and approval of a comprehensive government security strategy

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://careers-inc.nttdata.com/job/Baltimore-Director-of-Medicaid-Security-Services-MD-21201/714016200/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Reporting to the Head of Product, the Director of Medicaid ensures operational excellence and regulatory compliance of all Medicaid products, owning the full spectrum of product strategy and operations. The Director will support key analytical activities to support the Plan’s strategic position, and will be proactive

in identifying opportunities for performance improvement.

Job Description

• Provide oversight of Plan and vendor operations as they relate to the Medicaid line of business aligning outcomes to strategic goals & regulatory requirements.
• Develop & manage operational reports to track operational effectiveness.
• Partner with operational departments including Claims, Customer Service, Finance, Enrollment, Vendor Management, & Medical Management to design processes ensuring effective & efficient operations.
• Support key stakeholders in driving initiatives to meet quality & customer satisfaction goals.
• Maintain customer focus throughout Plan operations to ensure a seamless & excellent customer experience.
• Provide deep knowledge of & insight into the regulatory & market environment of Medicaid in New York to support the development of product strategy.
• Identify & integrate operational best practices, partnering with key departments to optimize processes across the organization such as benefits administration, risk adjustment, marketing & communications, customer experience.
• Monitor & analyze regulatory activity ensuring compliant operations & implementation.
• Perform competitive & market analysis.
• Partner with internal & external stakeholders on key strategic, regulatory, & operational projects.

Minimum Qualifications

• Bachelor’s degree from an accredited college or university in an appropriate discipline required.
• Master’s degree in business, healthcare or public administration strongly preferred.
• Minimum 5 years experience at a Health Plan with Medicaid Managed Care in a product management or compliance role.
• Thorough knowledge of Medicaid regulatory environment in NYS.
• Experience working with NYS enrollment transactions & encounter data submissions.
• Thorough understanding of interconnected managed care operations
• Demonstrated ability to develop workflows, policies, procedures.
• Demonstrated ability to identify opportunities for improvement & implement solutions.
• Excellent written & verbal communication skills
• Excellent analytical skills demonstrated by an ability to use actionable data to support decisionmaking, and to proactively identify opportunities.
• Highly collaborative, and demonstrating good judgment in seeking consensus & input from multiple stakeholders to drive decision-making.
• Ability to take initiative & think independently
• Demonstrate understanding & acceptance of the MetroPlus Mission, Vision, & Values

Professional Competencies

• Leadership
• Results-driven
• Business acumen
• Systems orientation
• Process improvement
• Data-driven decision-making
• Customer focus
• Written/oral communication
• Resourcefulness
• Ability to work effectively in a fast-paced & constantly evolving environment

 
 

 
 

Clipped from: https://www.theladders.com/job/director-of-medicaid-metroplus-org-new-york-ny_44964596?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Internal Number: R11310

About Banner Health

You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc…ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.

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$ 84,000+

  Job Description – Medicaid Eligibility Advocate Team Lead (26838-188323) Job Description  Medicaid Eligibility Advocate Team Lead( Job Number:  26838-188323)  Work Location : United States-Texas-Irving-PAS – Dallas Schedule : Full-time Job Type : Supervisors Team Leaders & Coordinators    Description  

Are you looking for a work environment where diversity and inclusion thrive? Submit your application today and find out what it truly means to be a part of a team.

We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. Your benefits include 401k, PTO medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program and student loan repayment. We would love to talk to you about this fantastic opportunity.   

As a Lead Medicaid Eligibility Advocate, you will manage and provide leadership to designated areas of responsibility, including direction and supervision of on-site staff. You will be responsible for affecting ongoing quality, productivity and efficiency by actively managing operations of designated facility.

• You will monitor and oversee all daily operational duties and ensure that employees adhere to all operational policies and procedures.
• You will maintain staff work schedules on a weekly or monthly basis.
• You will ensure work flow is consistent and timely for each employee.
• You will enforce disciplinary action as warranted concerning any employee misconduct.
• You will act as primary liaison to hospital staff/management.
• You will respond to daily questions and concerns raised by hospital staff/management in a timely and responsible manner.
• You will be responsible for adjusting staff’s duties as may be required to accommodate procedural changes or additional needs that may occur.
• You will be responsible for maintaining sufficient and qualified staff.

   Qualifications  

What Qualifications you will need:

• Associate’s degree or Bachelor’s degree preferred
• Minimum three years of hospital/medical business office experience with insurance procedures and patient interaction
• Strong familiarity with a variety of the field’s concepts, practices and procedures

 
 

Parallon is an industry leader in revenue cycle services. We partner with over 650 hospitals and 2,400 physician practices nation-wide. Our parent company, HCA Healthcare has been consistently named a World’s Most Ethical Company by Ethisphere and is ranked in the Fortune 100. We are dedicated to ensuring our patients have the best experience even after they leave our facilities.

We are an equal opportunity employer and we value diversity at our company.  We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.

#ParallonBCOM

  :  

 
 

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