Category: Curator- Job Hunter

Clipped from: https://www.indeed.com/viewjob?jk=bacb8e088be7d19c&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Benefits

Pulled from the full job description

Disability insurance

Health insurance

Opportunities for advancement

Paid time off

Retirement plan

Vision insurance

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them.

You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Call Center Representatives Needed

Interested in supporting Medicaid providers?

Conduent has immediate remote openings

$16.50/HR & Great Benefits

Summary:

Call Center Customer Service Representative. This is a great opportunity to learn Medicaid provider support and the medical billing and claims process for third parties and healthcare providers regarding Medicare Claims.

What you get:

• Full-time employment with benefits
  
• Hourly rate of $16.50/hour starting on day one.
  
• Standard scheduled. 8am – 7pm Monday through Friday,
  
• with an 8 hour shift within the above time, and then Saturdays 9am to 2pm.
  
• Substantial Call Center & Customer Service Training
  
• Great Work Environment with Career growth
  

People who succeed in this role have:

• Positive and energetic attitude.
  
• Ability to communicate clearly and confidently.
  
• Ability to multi-task and manage time effectively.
  
• Attention to detail, grammar, and spelling accuracy.
  
• Must type 25 wpm or more to qualify
  

Responsibilities:

• Using a computerized system, responds to Kentucky Medicaid provider inquiries in a call center environment using standard scripts and procedures.
  
• Gathers information, assesses caller needs, research and resolves inquiries and documents calls.
  
• Provides clear and concise information regarding eligibility, claim status and provider enrollment status.
  
• Follows documented policies and procedures including call handling and escalations.
  
• Overall acts as an advocate for the Medicaid Provider to ensure their needs are met.
  

Additional Duties as Assigned:

• Verify documentation and images.
  
• Attend scheduled staff meetings.
  
• Complete required assigned training.
  
• Track daily task for quality review.
  

Preferred Experience:

• One of year medical insurance or medical office experience.
  
• Computer system experience with data entry and database documentation knowledge.
  
• Call center or professional office experience.
  

Requirements

• Must be at least 18 years of age or older.
  
• Must have a high school diploma or general education degree (GED).
  
• Must be eligible to work in the United States.
  
• Must be able to clear a criminal background check and drug test
  
• Limited physical requirements: Typical office environment. Phone and keyboard for periods of time.
  

Join a rapidly growing customer service organization that can support your career goals and Apply Today!

This is a great opportunity to learn and be a part of the growing medical support community. Conduent offers benefits and advancement opportunities. Come join us and help support our Medicaid providers!

At Conduent, we value the health and safety of our associates, their families and our community. For US applicants while we DO NOT require vaccinations for most of our jobs, we DO require that you provide us with your vaccination status, where legally permissible. Providing this information is a requirement of your employment at Conduent. This does not disqualify you from this position.

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the “Submit” button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduent’s ADAAA Accommodation Policy.

The Colorado Equal Pay for Equal Work Act requires employers to disclose the following information. If the successful applicant will be required to perform work from a physical site outside Colorado, the following information may not apply.Actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation or sick time.

At Conduent, we value the health and safety of our associates, their families and our community. Under our current protocols, we do not require vaccination against COVID for most of our US jobs, but may require you to provide your COVID vaccination status, where legally permissible.

Clipped from: https://www.indeed.com/viewjob?jk=e20c62a811fa8a4e&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Benefits

Pulled from the full job description

Health insurance

Retirement plan

Vision insurance

THE STARTING SALARY FOR A NEW HIRE TO THIS POSITION IS LIMITED TO THE RECRUITMENT RANGE OF $43,500 to $52,103. Salary offers for the selected candidate are based on the candidate’s education and experience related to the position, as well as our agency budget and equity.


The primary purpose of this analyst position is to provide criminal intelligence and data analysis, data organization and data presentation assistance to Medicaid Fraud Financial Investigators pertaining to investigations of Medicaid fraud and abuse. The employee assists Medicaid Fraud Financial Investigators and one or more teams of attorneys and investigators in the detection, investigation, and punishment of fraudulent and non-fraudulent violations of applicable criminal and civil laws pertaining to fraud and abuse by Medicaid providers and in administration of the Medicaid Program.


This analyst will also support the investigation of Medicare and other federal health care fraud cases and investigations which are primarily related to Medicaid fraud involving complex financial analysis. This individual will

• prepare detailed spreadsheets and charts, review medical records, prepare written investigative reports, research public records, analyze facts and documents, and assist in the collection and storage of evidence.
  
• receive, document, research, gather information, and prepare reports of referrals from citizens, providers, recipients, and other professionals within and outside of the Medicaid agency who report Medicaid fraud abuse.
  
• must be able to suggest leads to investigators and assist in preparation of investigative requests for records, subpoenas and search warrants.
  
• must also perform administrative duties to include preparation of management reports and other duties as needed.
  
• This investigator typically works in the office, but may occasionally be required to work in the field to obtain pertinent information.
  

The successful candidate must undergo and successfully complete a comprehensive background check as part of the hiring process.

This position is subject to the Fair Labor Standards Act. This position will require travel and overnight travel

.This position is located in the Medicaid Investigations Division of the Department of Justice. The Attorney General’s Medicaid Investigations Division investigates and prosecutes health care fraud committed by Medicaid providers and the physical abuse of patients and embezzlement of patient funds in Medicaid-funded facilities. These cases protect and recover taxpayers dollars that can be used to provide needed medical services to Medicaid enrollees. These cases also protect our most vulnerable elderly and disabled citizens.

Our Medicaid Investigations Division (MID) is staffed by Department of Justice attorneys, investigators, auditors, analysts, and a nurse investigator, paralegals, and administrative staff. MID provides state and national training opportunities to aid employees in understanding the complexities of health care fraud investigations. This position has the opportunity to work cases in state and federal court in partnership with law enforcement agents with federal and state agencies such the Office of Inspector General, FBI, IRS, NC State Bureau of Investigations, Sheriff’s Offices, and Police Departments

The Medicaid Investigations Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $6,348,028 for Federal fiscal year (FY) 2021. The remaining 25 percent, totaling $2,116,008 for FY 2021, is funded by the State of North Carolina.

MID has recovered more than $900 million in restitution and penalties. MID has helped convict hundreds of persons who defrauded Medicaid or abused patients in facilities receiving Medicaid funds.

The Attorney General’s office and the Medicaid Investigations Division are committed to ending Health Care Fraud. The link below is provided for your information.

https://ncdoj.gov/responding-to-crime/health-fraud/


The North Carolina Department of Justice, led by the Attorney General of North Carolina, represents the State of North Carolina in court and provides legal advice and representation to most state government departments, agencies, officers, and commissions. The Department also represents the State in criminal appeals from state trial courts, and brings legal actions on behalf of the state and its citizens when the public interest is at stake.

Note to Current State Employees:
The salary grade for this position is NC12. State employees are encouraged to apply for positions of interest even if the salary grade is the same as, or lower than, their current position. Please detail ALL work history including non-state service experience. If selected for this position, a new salary will be recalculated taking into consideration the quantity of relevant education and experience, funding availability, and internal equity. Based upon these factors, a pay increase MAY or MAY NOT result.

The State of North Carolina offers employer paid health insurance plus twelve paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information at Employee Benefits.

Knowledge, Skills and Abilities / Competencies

• Considerable knowledge of the assigned program, processes and procedures.
  
• Considerable knowledge of criminal justice and law enforcement procedure, terminology. Ability to interpret, apply, and communicate statutory regulations of the assigned area.
  
• Ability to analyze, interpret, recommend, and implement policy and procedural guidelines.
  
• Ability to instruct and explain standards and procedures.
  
• Ability to establish effective working relationships, including seeking compliance with regulations. Ability to express oneself clearly and concisely in oral and written form.
  
• Ability to work independently and use sound judgment in making decisions.
  
• Ability to use up-to-date spreadsheet and database software, email, Internet Web browsers, and relational databases.
  
• Ability to communicate professionally.
  
• Ability to provide criminal intelligence, to gather applicable records, reports, data, and other information, locate assets, and to organize and present this information to Medicaid Fraud Investigators to assist them in the investigations of Medicaid provider fraud and abuse.
  

Minimum Education and Experience Requirements

Bachelor s degree from an appropriately accredited institution and two years of administrative and/or technical experience in criminal justice or law enforcement as it relates to the area of assignment, or an equivalent combination of education and experience.

Clipped from: https://www.glassdoor.com/job-listing/medicaid-billing-specialist-part-time-alamo-area-council-of-governments-JV_IC1140494_KO0,37_KE38,71.htm?jl=1008386029570&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

This is a non-supervisory position. Duties include: upload claims, correction or manual entry of claims, download claims responses and claims rejects, the research of rejected, suspended and recouped claims, and the preparation of all subsequent general ledger journal entries to the accounting system; Competently use all software required to complete the billing process from the creation of the outbound file or manual entry claims to the receipt of payment or decision to write off the claim is made; Primary software systems used is Netsmart EHR, FMS, Claim MD clearing house, Texas Medicaid and Healthcare Partnership (TMHP), Service Authorization System Online (SASO – a HHSC website), with a special emphasis on Microsoft Excel; Assist in reconciliation process for each billing cycle; Function as resource person for departmental personnel to answer questions and assists with problem resolution; Assist with communicating and act as a liaison between clinical and billing departments; Stay up to date on current laws determining changes in the law and changes with health insurance companies with regards to medical claims, diagnosis and billing codes required, which can be accomplished by attending all training required by the manager.

Administrative Functions: Types various documents including memoranda, letters, reports, forms, and mailing labels, and stores records in accordance with the State of Texas records retention statute, HHSC standards and HIPAA regulations.

Billing Functions: activities include reviewing health care claims submissions, reconciling paid and unpaid claims, identifying errors, researching health care information using various tools such as state websites, providing a quality review of the claims and communicating with payers to resolve pending issues or denials when instructed by management; Download the submission files, response files, ERAs, R&S, MEVAS pages, from various websites used for billing to include TMHP, our clearing house, SASO, etc.; Use TMHP website, SASO and the clearing house site for researching rejections/recoupments and for determining eligibility; Utilize in-house client software for running case recording detail reports for research and claim recording; Will also review, analyze, document, run reports for all claims and use tracking tools within a specified amount of time; Claim uploads, submissions and write offs with the paid verses unpaid claims count; Update manager on progress and final status of claims invoiced, or write offs, and payment and weekly denials; Communicates with our clients, the IDD program staff, and our oversight agencies when directed and approved by the manager; Perform other job related duties as assigned.

Desired Degree/Job Experience: Associates’s degree in finance, accounting, technical, healthcare, business or related field; A minimum of two (2) years experience with medical billing specifically Medicaid and Medicare billing or medical claims processing, and two (2) years general ledger accounting experience; Prefer five (5) years experience with healthcare background in medical claims processing within government program; or any equivalent combination of experience and training which provides the required knowledge, skill and abilities, including proficiency in Microsoft Excel.

This position is a Pay Grade 10 with a starting hourly rate of $18.77. This is a non-exempt position.Open until Filled. Only electronic online applications will be accepted.

AACOG offers a generous benefits package. These benefits can be reviewed at https://aacog.com/sites/default/files/2022-11/ADVANTAGES%20of%20WORKING%20for%20AACOG%202023_2.pdf

Job Type: Part-time

Pay: From $18.77 per hour

Benefits:

• Dental insurance
  
• Employee assistance program
  
• Flexible spending account
  
• Health insurance
  
• Life insurance
  
• Paid time off
  
• Tuition reimbursement
  
• Vision insurance
  

Schedule:

• 8 hour shift
  
• Monday to Friday
  

Ability to commute/relocate:

• San Antonio, TX 78217: Reliably commute or planning to relocate before starting work (Preferred)
  

Work Location: One location

Clipped from: https://www.learn4good.com/jobs/new-york-city/new-york/business/1971383977/e/

Position:  Manager, Product Performance – Medicaid
 

The Product Performance Medicaid Manager will have experience in data analytics and Managed Care. Specifically, they will analyze complex business problems and issues using data from internal and external sources to provide insight to decision makers. They would identify and interpret trends and patterns in datasets to locate drivers and influences. Product Performance Medicaid Managers will construct forecasts, recommendations and strategic/tactical plans based on business data and market knowledge.

Must be able to collaborate with internal business areas to modify or tailor existing analysis to meet specific needs. They may participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. The role will work with multiple types of business data, including claims, clinical, eligibility and financial. Job

Requirements Manage and mentor staff of analysts Collaborates with Finance, Analytics, Cost of Care and Clinical teams in support of the Director of Product Performance to ensure all products in Government Programs are performing at or above established financial and operational targets. The position leverages existing reporting and performs ad hoc analysis to provide visibility into emerging trends and areas of opportunity that need the attention of the business.

Working with leadership to define and stratify analysis requirements enabling leadership to meet strategic goals and tactical objectives. Lead and/or support margin improvement initiatives by working with internal business areas and vendors to ensure identified opportunities are implemented Collaborate and lead discussion with business area leadership to ensure issues and high priority projects have accountable owners and satisfactory progress to ensure financial, operational and compliance performance objectives are met Candidates must also have experience with identifying potential problems or opportunities to avoid issues and maximize opportunities by understanding what reporting/data is needed to monitor performance of Government Programs to identify and engage appropriate business owners.

Using knowledge of organizational informatics infrastructure, analytical tools, information systems, and other data stores to construct analytical models to support program evaluation, operational and clinical analyses, and reporting for responsible business units or organizations. Designing and implementing analytical solutions to improve processes, measure clinical quality goals, and meet regulatory reporting and analysis requirements. Manage dedicated production and support resources.

Qualifications:

Education Bachelor’s Degree or equivalent experience Master’s Degree preferred Experience 5+ years in a managed care organization Medicaid experience preferred MS SQL Server experience required

Virginia Premier, a division of Sentara Health Plan is currently seeking a Manager for Medicaid Product Performance. The Product Performance Medicaid Manager will have experience in data analytics and Managed Care. Specifically, they will analyze complex business problems and issues using data from internal and external sources to provide insight to decision makers. They would identify and interpret trends and patterns in datasets to locate drivers and influences.

Product Performance Medicaid Managers will construct forecasts, recommendations and strategic/tactical plans based on business data and market knowledge.

Must be able to collaborate with internal business areas to modify or tailor existing analysis to meet specific needs. They may participate in management reviews, including presenting and interpreting analysis results, summarizing conclusions, and recommending a course of action. The role will work with multiple types of business data, including claims, clinical, eligibility and financial.

Minimum Qualifications:

 

• Bachelor’s Degree or equivalent experience
  
• Master’s Degree preferred
  
• 5+ years in a managed care organization
  
• Medicaid experience preferred
  
• MS SQL Server experience required
  

Sentara Health Plan is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier.

Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans, and plans serving Medicare and Medicaid enrollees.

With more than 30 years’ experience in the insurance business and 20 years’ experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services – all to help our members improve their health.

Benefits:

Sentara offers an attractive array of full-time benefits including Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B with matching funds, 401a, Performance…

Clipped from: https://www.adzuna.com/details/3826861411?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Family *:
Strategy & Transformation Consulting
Travel Required *:
None
Clearance Required *:
Ability to Obtain Public Trust
What You Will Do *:
Guidehouse is seeking a highly motivated, passionate, and detail-oriented Medicaid Data Analytic Coach to support the analysis of State Medicaid data. The ideal candidate will have a strong client service background, acute attention to detail, experience with Medicaid data and analytic tools (e.g., Python, PySpark, R, RStudio) and AWS cloud data architecture.
Job Description/Responsibilities:
– Collaborates with cross-functional team using data analytics, validation, computational checks, cleansing and standardization processing to identify data quality issues, find root causes, and identify solutions.
– Utilizes analytical, statistical, and programming skills to collect, analyze, and interpret large data sets.
– Develops custom data models and algorithms to apply to data sets and determines causes of failed data quality checks.
– Evaluates the effectiveness and accuracy of new data sources and data gathering techniques.
– Uses predictive modeling to increase and optimize user experiences, system capabilities, and other business outcomes.
– Documents analyses, creating summaries and presenting written and verbal results to various stakeholders.
– Applies subject matter expertise relative to Medicaid data (eligibility, managed care, claims, encounters, financial, etc.) to coach stakeholders on data compliance.
– Maintains, tracks, and collaborates on multiple distinct user community issues simultaneously; keeping all conversations well documented and ensuring appropriate internal/intra team communications to remediate issues or questions.
– Develops training materials to conduct coaching sessions.
– Provides data coaching and technical assistance to State Medicaid representatives to resolve data issues, including working sessions to enable a deeper understanding of requirements.
– Communicate complex data engineering issues/recommendations to all aspects of users, peers, technical and non-technical community, and internal team members.
– Participates in continuous improvement activities to improve community satisfaction; collaborates with HCD team, Support Analysts, and Engineers.
What You Will Need *:
– Minimum of eight (8) years of experience.
– A Bachelor’s degree in Computer Science, Information Systems, Engineering, Math, or other related scientific or technical discipline.
– CMS or Health Care Industry experience.
– Experience with Python, PySpark, R, RStudio.
– Experience in AWS cloud data architecture and big data technologies, including EMR, Databricks, Hive, Spark, AWS Glue, Athena, and Redshift.
– Ability to communicate technical outcomes with a high degree of detail and precision to technical audiences, while at the same time being able to communicate those outcomes to non-technical audiences in an approachable and understandable manner.
– Exceptional problem-solving abilities, accuracy with work, strong organizational skills, attention to detail and the ability to multi-task while meeting deadlines.
– Due to our contractual requirements, to be eligible for this role, you must be fully COVID-19 vaccinated at time of hire.
What Would Be Nice To Have *:
– Medicaid Data subject matter expertise.
– Data platform certifications (e.g., Databricks), Coding Certifications (Python, R, etc.) and/or AWS Cloud Certifications.
– An agile methodologies and iterative mindset; focused on consumer-oriented solutions and communications.
– Experience applying human centered-design principles during discovery and analysis.
– Experience with Atlassian Jira/Confluence.
The annual salary range for this position is $86,100.00-$172,300.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
What We Offer *:
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Benefits include:
– Medical, Rx, Dental & Vision Insurance
– Personal and Family Sick Time & Company Paid Holidays
– Position may be eligible for a discretionary variable incentive bonus
– Parental Leave and Adoption Assistance
– 401(k) Retirement Plan
– Basic Life & Supplemental Life
– Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
– Short-Term & Long-Term Disability
– Student Loan PayDown
– Tuition Reimbursement, Personal Development & Learning Opportunities
– Skills Development & Certifications
– Employee Referral Program
– Corporate Sponsored Events & Community Outreach
– Emergency Back-Up Childcare Program
– Mobility Stipend
About Guidehouse
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Clipped from: https://www.linkedin.com/jobs/view/cfo-medicaid-louisiana-lead-director-at-cvs-health-3422774040/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description

 
 

*This role must reside near the Kenner, Louisiana office location. You must reside in LA or be willing to relocate near commutable distance to office location. Relocation Assistance Considered*

 
 

We are hiring a Finance Leadership role for Aetna, a CVSH Health Fortune 4 company to support Louisiana Medicaid. You will be full-time office based with some work from home opportunity. Must reside in Louisiana and be within commutable distance to the office location. The Chief Financial Officer (CFO) will implement a defined management process for driving best practices within functions of responsibility. You will direct a group of 4 financial professionals. You will oversee the implementation and monitoring of financial functions that support the business units’ financial plans. You may participate in projects that impact all functional disciplines (non-financial) of the company. You will report to the Executive Director, Division CFO.

 
 

Fundamental Components:

 
 

• Oversee the Louisiana Medicaid Plan’s budget and forecasting processes. Have access to an actuary and ensure that the Louisiana Plan meets state requirements for financial performance and reporting.
  
• Evaluate and analyze the financial impact of key business strategies (i.e. market investments, market exits, acquisitions, etc.).
  
• Analyze and critically evaluate growth opportunities.
  
• Direct the evaluation of business area projects, challenging financial resources, resolving expense savings.
  
• Support the coordination and development of business unit financial plans and forecasts.
  
• Oversee the implementation of processes for achieving business goals.
  
  
  

 
 

Pay Range

 
 

The typical pay range for this role is:

 
 

Minimum: $ 100,000

 
 

Maximum: $ 227,000

 
 

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

 
 

Required Qualifications

 
 

• Minimum 10+ years financial experience including strategic and business planning, financial planning, analysis, P&L, reporting or accounting
  
• Industry knowledge of Healthcare/managed care, insurance
  
• 5+ leadership and people manager experience
  
• Project Management and Process Improvement experience.
  
• Travel up to 10% of the time. In-state travel requires use of personal vehicle. Have valid/active driver’s license and proof of vehicle insurance. Some travel out of state also anticipated for internal meetings.
  
  
  

 
 

Preferred Qualifications

 
 

Medicaid Product knowledge

 
 

Advanced degree in Business and/or FSA/CPA

 
 

Degree in Finance, Accounting, Actuarial Science, or similar disciplines

 
 

Education

 
 

Bachelor’s Degree required

 
 

Business Overview

 
 

Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Clipped from: https://www.learn4good.com/jobs/north-carolina/law_and_legal/1972085215/e/

Position:  Income Maintenance Caseworker I- Adult Medicaid
Location: Lillington
POSITION SUMMARY

Harnett County Department of Social Services is currently recruiting for an Income Maintenance Caseworker I to perform tasks related to the determination of eligibility and providing ongoing caseload management for the Adult Medicaid Program.

DUTIES AND RESPONSIBILITIES

* Determines eligibility for the Adult Medicaid program based on Federal, State and County policies.

* Documents case findings within established time frames accurately to reflect customer’s situation and to substantiate verification of all eligibility factors; initiates and updates data in multiple computer systems accurately.

* Explains and interprets policy and application procedures to clients, and individuals in the community, and assists individuals in completing the application form.

* Responds to inquiries from clients and citizens regarding benefits, application process, and/or program eligibility.

* Performs other related duties as assigned.

MINIMUM QUALIFICATIONS

Education and Experience:

Any combination of education and experience that would likely provide the required knowledge and abilities is qualifying. A typical way to obtain the knowledge and abilities would be:

Graduation from a four-year college/university; or graduation from an accredited associate degree program in Human Services Technology, Social Services Associate, Paralegal Technology, Business Administration, Secretarial Science, or a closely related curriculum; or graduation from high school and two years of paraprofessional, clerical, or other public contact experience which included negotiating, interviewing, explaining information, gathering and compiling of data, analysis of data and/or performance of mathematical or legal tasks with at least one year of such experience being in an income maintenance program;

or graduation from high school and three years of paraprofessional, clerical or other public contact experience which included negotiating, interviewing, explaining information, the gathering and compiling of data, the analysis of data and/ormance of mathematical or legal tasks. Bilingual, English and Spanish is preferred.

Licensing and

Certifications:

None

Knowledge, Skills, and Abilities:

* Considerable knowledge of the program/areas of assignment.

* General knowledge of all agency and community programs and services which could affect the client/applicant.

* Good mathematical reasoning and computational skills.

* Ability to read, analyze, and interpret rules, regulations and procedures.

* Ability to communicate with clients/applicants, the public at large, and public officials to obtain data, and to explain and interpret rules, regulations and procedures.

* Ability to establish and maintain effective working relationships with clients, other agency representatives, reference persons and fellow employees.

* Ability to perform casework functions with structured time frames.

SUPPLEMENTAL INFORMATION

Successful completion of a drug screening and criminal background check will be required as a condition of employment.

GENERAL INFORMATION:

Harnett County is one of the fastest growing counties in North Carolina with approximately 130,000 residents. Our “Strong Roots, New Growth,” describes a county in transition, one that values its rural agricultural heritage while also embracing new growth and industry.

Harnett County is optimally located between North Carolina’s capital city of Raleigh and the internationally recognized Research Triangle Park to the north, and the nation’s largest military installation in Fort Bragg to the south. The county is also centrally located in North Carolina and is within close proximity to the Great Smoky Mountains and Blue Ridge Parkway, and to the numerous Atlantic Ocean beaches and the Outer Banks.

The county offers a wide range of training and development opportunities, a stable career in public service with a balance of work and family life, a competitive salary and benefits package including health and dental coverage, as well as retirement and a free health clinic for employees and anyone in their household. We appreciate your interest in employment opportunities with

Harnett

County.

Harnett County is an Affirmative Action/Equal Employment Opportunity Employer. It is the policy of Harnett County not to discriminate against any applicant for employment, use of age, color, sex, disability, national origin, race, religion, or veteran status.

Harnett County participates in E-Verify to determine employment eligibility to work in the United States.

Clipped from: https://careers.humana.com/job/17568456/quality-improvement-lead-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

If you are an existing CenterWell or Humana
associate, please apply through go/associatecareers using a Chrome or Edge browser.


 

 
 

Description

The Quality Improvement Lead implements performance improvement projects, interventions and programs for Ohio Medicaid business including collaborative health plan quality improvement performance projects, activities and monitors performance and metrics for Ohio Medicaid populations. . The Quality The Quality Improvement Lead implements performance improvement projects, interventions and programs for Ohio Medicaid business including collaborative health plan and Ohio Department of Medicaid quality improvement performance projects, activities, and interventions. This position is responsible for monitoring performance improvement and metrics for Ohio Medicaid populations. The Quality Improvement Lead works independently, sometimes in ambiguous situations, and work may be performed with minimal direction. The Quality Improvement Lead will be expected to lead a team

Clipped from: https://www.ziprecruiter.com/c/Ohio-Department-of-Taxation/Job/HYBRID-Medicaid-System-Access-Manager-(Medicaid-Health-Systems-Administrator-1)/-in-Columbus,OH?jid=40e0884479e7c809&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

THIS POSITION MAY BE TELEWORK ELIGIBLE ON A HYBRID BASIS.

 
 

About Us:

The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. ODM is implementing the next generation of Ohio Medicaid to fulfill its bold, new vision for Ohio’s Medicaid program – focusing on the individual rather than the business of managed care. 

The goals of the next generation of Ohio Medicaid are:

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

 
 

What You Will Do At ODM:

Working Title: Medicaid System Access Manager

Classification: Medicaid Health Systems Administrator 1 (PN 20100580)

Office: Legal Counsel

Bureau: Privacy/HIPAA

 
 

Job Overview:

The Ohio Department of Medicaid (ODM) is seeking a Medicaid System Access Manager to be a part of our Access Request team. As a Medicaid System Access Manager your responsibilities will include:

• Reviewing system access for Ohio Medicaid Enterprise System (OMES) and Single Pharmacy Benefit Manager (SPBM)
  
• Reconciling of user’s access to systems to ensure adherence to the Principle of Least Privilege and Minimum Necessary access to Medicaid member information
  
• Formulating and implementing policies and procedures related to accessing Medicaid information systems to support ODM program needs for ODM Staff, Contractors, and Sister State Agencies
  
• Facilitating end user access to Medicaid information systems through established ODM processes
  
• Overseeing the Access Request mailbox, communication with ODM system vendors, and other partners as needed
  
• Responding to requests for information from internal and external auditors related to Medicaid information systems access
  

 
 

What’s in it for you:

At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:

Medical Coverage

• Quality, affordable, and competitive medical benefits are offered through the available Ohio Med plans. 
  

Dental, Vision and Basic Life Insurance

• Dental, vision, and basic life insurance premiums are free after completed eligibility period. Length of eligibility period is dependent on union representation.
  

Time Away From Work and Work/Life Balance

• Paid time off, including vacation, personal, and sick leave 
  
• 11 paid holidays per year
  
• Childbirth/Adoption leave
  

Employee Development Funds

• The  State of Ohio offers a variety of educational and professional development funding that varies based on whether you are a union-exempt employee or a union-represented employee.
  

Ohio Public Employees Retirement System

• OPERS is the retirement system for State of Ohio employees.  The employee contributes 10% of their salary towards their retirement.  The employer contributes an amount equal to 14% of the employee’s salary.  Visit the OPERS website for more information.
  

Deferred Compensation

• The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.
  

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 has 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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UPMC offers a premier benefits package, designed to care for your total well-being — physically, emotionally, and financially — paired with endless opportunities for career advancement and educational growth. Kickstart a rewarding career with UPMC!

Responsibilities:

• Consultant within UPMC Health System; Act as an Actuarial Consultant within the UPMC Health System and perform various activities, Including IBNR calculations, Data Analysis.
  
• Ensure that the departmental work products meet the highest standards of quality.
  
• Reserving: Works with the financial reporting department to develop reserve amounts for IBNR claims, active claims and premium deficiency reserves on a regular or as-needed basis.
  
• Benefits and Product Development: To provide appropriate UPMC management personnel with actuarial valuations of the Impact of any proposed benefit changes or new product designs on an as-needed basis.
  
• Underwriting: Works closely with the underwriting department to:Provide pricing tools to enable underwriting personnel to produce accurate price quotes on request from Sales and Marketing staff in a timely basis, together with whatever appropriate supportive documents may be needed by sales staff to facilitate sales.
  
• Provider Relations/contracting: To provide reports for the purpose of evaluating and advising UPMC HP management on the financial impact of proposed provider agreements or changes to existing agreements on an as-needed basis.
  
• Manage Actuarial Department: Supervise Actuarial department and various entities within UPMC Health Plan as needed to ensure department goals and objectives are met.
  
• Pricing: To develop product pricing levels, factors and methods to ensure premium and revenue flow adequate to cover medical and administrative costs and profit margins for the various product lines consistent with corporate strategic goals. Also, to advise UPMC Health Plan senior management on the financial impact of any special pricing or contract arrangements which may affect health plan financial profitability.
  
• Work with the UPMC HP Appointed Actuary to ensure satisfactory filings of annual Statements of Actuarial Opinion and associated memoranda.
  
• Direct the development and assessment of underwriting methods and tools in order to enhance the ability of underwriting staff to accurately identity and quantify risk, and so produce price quotes which appropriately match premium to risk.
  
• Supervise Actuarial department personnel to ensure that departmental objective and goals are achieved in a timely manner
  
• Forecasting: To provide UPMC HP senior management with regular and ad hoc reports which communicate current and future near- and long-term projections of financial performance of the various health product lines in order to facilitate corporate decision and the development of corporate strategies and goals.
  
• Compliance: Ensure that all required statutory rate filings are submitted appropriately, and that all rates, factors and methods are in compliance with applicable state and federal regulations. Ascertain and comply with filing and actuarial requirements for participation in government-sponsored health plans as appropriate.
  
• Additional Business: Ability to learn new lines of business to help UPMC Health Systems to expand into different arenas such as Slop Loss Insurance or Workers Compensation.
  

Qualifications

• Minimum Bachelors degree in mathematics, statistics, actuarial science, economics or related field.
  
• Advanced degree preferred.
  
• 8 plus years of experience in progressively more responsible actuarial work in health insurance/managed care or equivalent training/education.
  
• Experience with both commercial and government health programs preferred, specific involvement with the new MMA regulation; in-depth understanding of health insurance market dynamics.
  
• Excellent problem-solving and analytical skills.
  
• Good oral and written communication skills.Strong PC skills.
  
• Data retrieval skills and relational database experience.