Category: Curator- Job Hunter

 
 

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

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

 
 

 
 

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

 
 

 
 

This is an office based position and will be required to report to 9133 West Russell Road Las Vegas, NV post Covid.  Remote work within the state of NV will be allowed until Anthem is cleared to return to the office.    

 
 

 
 

The selected candidate will be supporting the NV Medicaid market, including implementation of new products, supporting the plan President and operations lead. This associate will be the go to person for the state on a daily basis.

 
 

 
 

Responsible for operations functions, including coordination between internal departments, ensuring the appropriate strategy, tactics and processes are in place to affect solid organizational operations and oversight.

 
 

 
 

 
 

Primary duties may include, but are not limited to: 

 
 

   
 

 
 

Champions initiatives by developing and managing key relationships with state agencies, regulatory, Medicaid/SCHIP and other stakeholders as appropriate.

 
 

Resolves programmatic challenges related to operations including member issues, provider claims issues, provider network/contract configuration issues, etc.

 
 

Serves as liaison to Health Plan support services, which could include: Claims, Enrollment, NCC, PDM/PDQ, configuration; Quality, Regulatory Compliance, IT, Reimbursement policy, etc.

 
 

Identifies opportunities for Operational Excellence and works to create seamless processes between shared services and the Health Plan.

Clipped from: https://anthemcareers.ttcportals.com/jobs/6058761-nv-medicaid-state-ops-dir?tm_job=PS43144&tm_event=view&tm_company=2522&bid=56

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

Develops and implements key operational indicators to be used for monitoring and analysis of the Health Plan operations.

 
 

Serves as a liaison with state regulatory agencies when appropriate.

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

 
 

Resolves programmatic challenges related to program operations including member issues, provider claims and provider network.

 
 

 
 

Represents business unit on national/state/regional boards, task forces, and work groups that impact the health care delivery system and other key health care issues.

Collaborates with senior management to develop and implement new programs to enhance relationships with key stakeholders and to promote programs and services.

Ensures all policies and procedures related to Field Operations are compliant with all applicable laws and regulations governing the State Sponsored Business.
 

Qualifications

• Requires a BA/BS in Business, Healthcare Administration or related field
• 10 years of relevant experience including 8 years of in-depth experience in managed care operations
• Or any combination of education and experience, which would provide an equivalent background
• Masters degree preferred
• Six Sigma Black Belt preferred
   

 
 

 
 

This is a Director level position, operating as an individual contributor without direct reports.

 
 

 
 

Additional skills:

 
 

OPERATIONS EXPERIENCE / PROVIDER CONTRACTING EXPERIENCE A PLUS

 
 

FACETS KNOWLEDGE A PLUS

 
 

MS OFFICE

 
 

STRONG COMMUNICATION SKILLS

 
 

PEOPLE MANAGEMENT A PLUS

 
 

MEDICAID EXPERIENCE A PLUS

 
 

ABILITY TO MEET WITH PROVIDERS WHEN NECESSARY  

 
 

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.  Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

 
 

Job Description:

• Processing Provider Enrollment applications submitted by Medicaid enrolled providers.
• Working on complex Provider Enrollment applications that are under strict deadlines.
• Ensuring Provider Enrollment applications are following Medicaid policy and procedures.
• Working with both Gainwell and State employees.
• Providing outreaches to providers if needed.

 
 

• Processing 377+ applications through analyst review within a week, with 0 errors identified. 
• Processing 213+ applications through quality review within a week, with 0 errors identified. 

Education and Experience:

• High School Diploma or equivalent; may hold 2 year post- high school Degree; may hold Bachelor’s degree.

Knowledge and Skills:

• Ability to follow written policies, procedures and guidelines.
• Self-motivated with good time management and organizational skills.
• Ability to read and interpret basic to moderately complex documents such as operating and maintenance instructions, procedure manuals, and government/healthcare guidelines.
• Excellent written and verbal communication skills and customer service skills.
• Insurance background preferred.
• Provider Enrollment background preferred.
• Experience with Medicaid policy preferred.
• Experience with Medicaid Provider Enrollment submissions preferred.
• Knowledge of Medicaid systems desired.
• Ability to access and retrieve information using a PC and basic understanding of Microsoft office products.
• Ability to work on assignments with limited instruction from leadership.
• Ability to work under pressure with strict deadlines.
• Multitasking and detail oriented.

Being flexible to learn another provider type/application in order to help the department succeed

 
 

Clipped from: https://jobs.gainwelltechnologies.com/job/12020070/

 
 

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

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

Job Title: MO Plan President (Medicaid)

Location: St. Louis, MO

Responsible for leading the fiscal, operational management, legislative and regulatory objectives of the Health Plan including running a plan and leading cross-functional teams. A leader must focus on what it takes to win in the market every day, driving the ground game, strategy, meeting the state’s goals and company’s goals, driving growth within the market, implementing community health and population health programs, addressing health disparity gaps while meeting financial, compliance and performance objectives.  The leader of the health plan will bring thought leadership and innovations to the state customer, demonstrating the value of managed care.  Developing high performing, high potential talent within the team and other functional areas who are mission-driven is critical to success.

Primary duties may include, but are not limited to: 

• Aligns strategy and leadership to achieve business goals and build a culture of accountability with people who are results-driven, innovative and committed to excellence
• Establishes strategies that create or sustain a competitive advantage
• Manages the Profit & Loss of the assigned Health Plan
• Execution on the operating gain, growth, cost of care commitments, revenue and quality accreditation goals 
• Collaborates with shared services including but not limited to Provider Services, Clinical, Operations and Quality to reach Health Plan objectives
• Ensures contract compliance, as well as oversight of risk management programs
• Manages customer and regulatory relationships, including state regulatory and legislative processes
• Responsible for strategic growth through local relationships; local community engagement with FQHCs and CBOs; and maximize visibility, innovation, and improve reputation
• Proven track record of leading a highly matrixed team
• Hires, trains, coaches, counsels, and evaluates the performance of direct reports. Develops talent.

 
 

Qualifications

• 12 years relevant experience, including 8 years’ experience in government-sponsored health insurance programs; managed care or healthplan experience
• Managed Care Organization (MCO) and Medicaid experience required
• Proven track record of progressive responsibility leading teams within a matrixed environment
• Requires a BA/BS in Business, Healthcare Administration or related field or any combination of education and experience, which would provide an equivalent background
• Master’s degree preferred
• Travel may be required

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/6048642-medicaid-plan-president-mo?tm_job=PS41818&tm_event=view&tm_company=2522&bid=56

 
 

 
 

The Director of Quality Management (QM) will lead and direct the efforts of the QM Department staff in the collection, analysis, and reporting of quality data metrics. The Director will facilitate improvement projects, assessing for and implementing risk reduction measures and assessing and coordinating activities related to achieving and maintaining ongoing regulatory compliance. The Director will work collaboratively with clinical leadership staff in support of quality goals and objectives and serves as subject matter expert to ancillary areas by providing strategic improvement plans with a focus on quality operations. Acts as LIBERTY Dental Plan’s point‐person for interactions with regulatory agencies and provides corporate-wide support for quality outcomes and related initiatives as developed and implemented.

 
 

Essential Duties:

• Responsible for the overall department operations, monitoring and compliance of all quality policies and procedures, contractual obligations and URAC activities and performance; determines thresholds for action plans when needed.
• Provides leadership to quality staff; ensures validity of measurement, accuracy of data, patient safety and regulatory compliance with quality improvement.
• Facilitates organizational enhancement of quality of care, processing and system improvements, and compliance through comprehensive quality assessment and improvement programs.
• Oversees the effective development, implementation, and evaluation of the QM Programs, workplans, key performance indicators, planned activities and interventions.
• Leads a visible and transparent project prioritization process to align resources with initiatives and to ensure interdisciplinary efforts are in support of organizational strategic priorities.
• Collaborates with quality initiative teams and process innovation to improve care delivery and documentation.
• Continuously reviews all applicable State and Federal regulations and proposes changes to existing QM policies and procedures, ensuring consistency across all product lines.
  

Clipped from: https://www.paycomonline.net/v4/ats/web.php/jobs/ViewJobDetails?job=46621&clientkey=FA85C9F98D78F8540353D8E367B0B6BC

 
 

Registered Nurse

The City of Alexandria is located in northern Virginia and is bordered by the District of Columbia (Potomac River), Arlington and Fairfax counties. With a population of approximately 150,000 and a land area of 15.75 square miles, Alexandria is the seventh largest city in the Commonwealth of Virginia. Alexandria has a charming waterfront and is a unique and historic place to live and work. About one-quarter square miles in the city have been designated as a national or local historic district. We proudly embrace our rich history and seize the endless opportunities that lie ahead. If you are interested in working for the vibrant City of Alexandria, we invite qualified candidates to apply for our Registered Nurse position.

An Overview

The Registered Nurse is responsible for coordination, implementation and evaluation of consumer s health care. In conjunction with the residential staff, maintains all health care and training documentation and requirements to assure consistency and compliance with the licensure standards; Develops and conducts training for all residential staff; Acts as a liaison between Physicians, Pharmacists, medical health insurance companies and other health care personnel; Performs administrative and coordinating duties as required.

What You Should Bring

The ideal candidate should have knowledge of nursing and clinic policies and procedures; good knowledge of approved medical terminology and abbreviations; good knowledge of the function, use, maintenance, and safety precautions of all equipment used; ability to clinically evaluate patients/clients before medicating; ability to monitor clients on a variety of medications; ability to communicate clearly and effectively, both orally and in writing; ability to provide nursing services to difficult and complex patient and client cases; ability to establish and maintain effective working relationships between staff, hospital employees, administration, physicians, visitors and patients; ability to chart accurately, legibly, and completely all entries on medical records/controlled substance inventories.

The Opportunity
 

• Coordinates care for consumers needing treatment for chronic medical/psychological problems;
   
• Assess consumers for current health status;
   
• Refers consumers with medical needs to an appropriate resource for care;
   
• Performs treatment procedures for consumers when feasible;
   
• Follows up on consumers receiving medical care;
   
• Schedules appointments, and verifies appointment when necessary;
   
• Coordinates care for consumers, develops and implements nursing plan for consumers;
   
• Develops and implements nursing care for consumers with a variety of special medical needs;
   
• Evaluates and modifies health care treatment as needed for all consumers;
   
• Develops and conducts approved health care training such as, but not limited to medication administration and annual medication refresher training;
   
• Provides feedback and follow up for staff as needed;
   
• Performs related duties as assigned.
   

About the Department

The Center for Adult Services (CAS) provides programs and services in Aging; Adult Protective Services; Clinical & Emergency Services; and Community & Residential Support Services for seniors and for persons with mental illness, intellectual disabilities and substance use disorders. CAS provides compassionate and effective person-centered services based on best practices. Our teams support self-determination, safety and recovery for Alexandria residents affected by abuse, neglect, mental illness, intellectual disabilities and substance abuse disorders.

Minimum & Additional Requirements

Graduation from an accredited school of Nursing; eligibility for, or current licensure with the State Board of Nursing of the Commonwealth of Virginia as a Registered Nurse. or any equivalent combination of experience and training which provides the required knowledge, skills, and abilities.

Preferred Qualifications

Basic computer skills and two years of experience in Mental Health, Mental Retardation and Substance Abuse environment. Must have a valid driver’s license.

Notes

This position requires the successful completion of pre-employment background checks including but not limited to: FBI/Federal Records Check; VA State Child Abuse/Neglect Registry; Medicare/Medicaid Fraud Database; education/certifications; drug screening; and driver’s license.

Schedule:

Monday through Friday 9:00AM – 5:00PM, occasional weekends and evenings.

As an Essential Employee, staff will be expected to be at work during weekends, holidays, or inclement weather if they have been scheduled.

 
 

Clipped from: https://jobs.washingtonpost.com/job/41723674/registered-nurse/

 
 

 
 

The Performance Improvement Manager partners with business leaders to drive performance improvement and transformation efforts aligned to organizational strategy and goals. He/she is responsible for coordinating improvement focused on increasing efficiency and reducing costs through the application of performance improvement, quality tools and methodologies.

Duties and Responsibilities:

• Works with business leaders to discover and identify project opportunities
• Organizes and leads assigned performance improvement projects using methods of team building, data gathering and analysis, process mapping, and problem solving
• Establishes appropriate tools to monitor progress of planned improvement implementation and achievement of expected benefits
• Develops and maintains required documentation throughout the project life cycle
• Builds and develops working relationships through coaching/mentoring of project team members and business partners to foster a culture of continuous improvement
• Participates in developing and delivering training content in support of the Performance Improvement Strategy
• Additional duties as assigned

Minimum Qualifications:

• Bachelor’s degree from an accredited institution or equivalent relevant work experience
• Certification in Lean Six Sigma or other process improvement methodology training
• Experience working with data sets and/or Microsoft Excel modeling
• Experience utilizing valuation and impact analysis methodologies
• Experience using workflow diagramming applications to document business processes

Preferred Qualifications:

• Master’s degree from an accredited institution
• Experience teaching Lean Six Sigma or other process improvement methodologies
• Healthcare/ Health Plan work experience
• Knowledgeable of Department of Health (DOH) and Center for Medicare & Medicaid Services (CMS) regulations
• Knowledge of Scaled Agile Framework

Compliance & Regulatory Responsibilities: N/A

License/Certification: Lean Six Sigma or other PI methodology

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

 
 

Clipped from: https://www.indeed.com/viewjob?jk=da70f3455feb692e&tk=1eq2deimjt51g801&from=serp&vjs=3&advn=1768959768617549&adid=344627720&ad=-6NYlbfkN0C2UqVY0eO9XBLriZEDdTcgBPf9YGxYHxIXZwdXEwTqdjz7xEP9PkiOUMfX5Uxmvzghs3SsUlJUivDMUoXLQgimtD0kJ72GaQAMeMJ5stJim9l6yehHFBhhcCBpFXRZYAZaysVJ8Mnb34MfE7XROSMPqYoGeeuqXFfaPzeSIunbt886JuMKrFcQXfdw9hRCwf79uPfknFnweC0kqQ1ZNv4WKoNxGM-1eYXoJqTMfK8EvW9_wduuRt7qTSrSrvnc3JnrddzAwsFOyVeXLR4ZfahNVQUnBStEKN9bB6vSyf-AQJZHIOF3ND7MA6sBQx87GOqJVVL6mWDBJw==&sjdu=0ZFwD5rbjMRcHz87Kzx_g0JUzSLjEAZRvUrbA1HeVjWZWXcLm8CKxcO1rj6wLuxXE8EVOzevHSgNE0hpvmRlEc7RE1uUWRT2yHXlOSm0YIjJ7SxhCvNfmkv_eBPAn3D-z4jo6uMatbSKr4nMbRfrzQ

 
 

 
 

Clipped from: https://vhr-otsuka.wd1.myworkdayjobs.com/en-US/External/job/Remote/Associate-Director—State-Government-Affairs—Advocacy_R319?mode=job&iis=Job+Board+-+Indeed&iisn=Indeed.com

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• LOCATION: REMOTE NJ, DC OR MD

The Associate Director, State Government Affairs & Advocacy, Mid Atlantic Region will be responsible for interfacing with  patient advocacy groups, professional associations, government officials, and coalitions to align healthcare policy, advocacy, and legislative priorities at the state level. Other responsibilities include;

• Develop strategies and coordinate initiatives with alliances that promote access to therapies, preserve patient/provider choice, and eliminate barriers to treatment.
• Help shape and influence healthcare policies and provide feedback to OAPI regarding emerging regulatory/legislative issues that impact OAPI business.
• Interact with state policy decision-makers and influencers, advocacy leaders, governor’s office policy staff, relevant state legislative committee chairs, members, and support staff and Medicaid policy officials regarding issues impacting access to the continuum of care within the health care delivery system, in accordance with OAPI strategic objectives.
• Develop working partnerships to support OAPI goals (i.e. consumer advocacy groups, professional associations, provider/medical organizations, government agencies, government officials, community leaders)
• Identify key influencer stakeholders and work within a team environment to develop strategies to effectively support OAPI policy positions.
• Conduct all activities in compliance with all applicable local, state, and federal laws and regulations and company policies.
• Position OAPI policy platform and corporate commitment; liaising between State MH authority, Medicaid Directors, and Patient Advocacy organizations.
• Monitor federal, state, and local payer systems and regulatory/legislative trends that potentially impact access to treatment and OAPI initiatives.
• Gain insight regarding risks, issues, and opportunities through alliance development, translating into value-added propositions.
• Represent OAPI in state PhRMA task force activities within assigned states.
• Manage relationships and activities with local lobbying counsel in support of OAPI’s crisis issues and/or opportunities.
• Communicate potential access risks to internal OAPI team with a sense of urgency, embracing a “no surprises” philosophy.
• Collaborate cross-functionally across OAPI departments to ensure favorable access/non-disadvantaged positioning.
• Develop and implement state/regional advocacy plans on an annual basis.
• Participate and drive in Matrix Team meetings.
• Execute appropriate marketing/policy initiatives with stakeholders through discussions, formal presentations, workshops, and programs as directed.
• Implement patient and caregiver education and outreach programs via advocacy and professional organizations as directed.
• Represent OAPI at state/local conferences, symposia, and events, with the goal of becoming a recognized partner within the stakeholder community.

Qualifications Required:  

• Bachelor’s degree, Master’s degree preferred
• Demonstrated knowledge in federal, state, and local healthcare  delivery systems, payer reimbursement, and policies impacting access to appropriate treatment.
• Establish a network of key patient advocacy groups, professional associations, and coalitions.
• Working knowledge of state policy and legislative environment; preferred executive-level lobby and regulatory experience.
• Neuroscience and Nephrology disease state knowledge is preferred.
• Proven track record in aligning and mobilizing advocacy organizations to shape the healthcare environment and advance initiatives.
• Established high-level relationships with a network of key thought leaders and influencers.
• 3-5 years within the pharmaceutical industry preferred; with direct reports and/or manager-level positions.
• Experience in working with Matrix Teams. Skills and Competencies
• Demonstrated networking, consensus building, and influencing skills.
• Strong communication and presentation skills, interacting with both external and internal audiences.
• Critical thinking skills, relationship management, conflict resolution, and the ability to work collaboratively.
• Demonstrated skills in leading and managing projects and the ability to work cross-functionally.
• Ability to effectively position messaging to multiple stakeholders, while working towards a common goal.
• Strong strategic planning ability, considering short-term and long-term implications of initiatives.
• Ability to quickly distill complex information from multiple sources into an easy-to-understand message.
• Self-starter, ability to proactively direct and manage cross-functional and cross-geographic teams.
• Ability to foster stakeholder cooperation; coordinate projects, manage community partnerships.
• Ability to be tenacious and resilient under pressure, while maintaining a strong sense of integrity.
• Scenario planning skills; recommend novel strategies to mitigate risk and capitalize on opportunities.  

Disclaimer:  This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will receive consideration for employment without regard to their protected veteran or disabled status, or any protected status.

Statement Regarding Job Recruiting Fraud Scams

Job postings, job offers, or introductions to enter into a business relationship with Otsuka through a third-party vendor may be unauthorized. Avoid being the subject of a scam by dealing only directly with Otsuka through its official Otsuka Career website https://vhr-otsuka.wd1.myworkdayjobs.com/en-US/External . Any authorized third-party vendor job boards should redirect any inquiry to this Otsuka Career website.

•  
   
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• Otsuka Pharmaceutical Co., Ltd. is a global healthcare company with the corporate philosophy: “Otsuka–people creating new products for better health worldwide.” In the U.S., Otsuka is comprised of two companies, Otsuka America Pharmaceutical, Inc., and Otsuka Pharmaceutical Development & Commercialization, Inc., that share a deep commitment to the development and commercialization of innovative products in the spaces of neuroscience, nephrology, and digital medicine.

Driven by our purpose to defy limitation, so that others can too, we have an unwavering belief in doing more and transcending expectations. In going above and beyond—under any circumstances—for patients, families, providers, and for each other. It’s this deep-rooted dedication that drives us to uncover answers to complex, underserved medical needs, so that patients can push past the limitations of their disease and achieve more than they thought was possible each and every day.

OPDC and OAPI are indirect subsidiaries of Otsuka Pharmaceutical Company, Ltd., which is a subsidiary of Otsuka Holdings Co., Ltd. headquartered in Tokyo, Japan. The Otsuka group of companies employed 47,000 people worldwide and had consolidated sales of approximately USD 13 billion in 2019.

We invite you to explore our open positions for an opportunity to join our 1,700 colleagues in the U.S. whose passion for our mission and pride in our company have earned us certification as a Great Place to Work by the Great Place to Work Institute.

Clipped from: https://jobs.ssmhealth.com/job/11922803/government-affairs-director-madison-wi/

PRIMARY RESPONSIBILITIES

• Ensures organization is compliant with all aspects of the Medicare, Medicaid, and other applicable compliance program requirements defined by the Center for Medicare and Medicaid Services (CMS) and applicable state Medicaid agencies, both with respect to internal operations and vendor solutions. Serves as the primary point of contact for and lead facilitator of regular meetings with CMS Account Manager.
• Oversees accurate and timely data submission and reporting to regulators of government programs. Responsible for ensuring timely and accurate responses are provided to regulators and/or auditors in relation to general inquiries, corrective actions, and necessary deliverables.
• Manages the preparation and review of annual compliance training materials, company intranet articles and/or other training and education materials. Oversees continuous readiness activities, audit support and coordination activities, and remediation activities, related to all Medicare, Medicaid, and regulatory audits.
• Facilitates and supports the annual Compliance Program Effectiveness (CPE) audit and serves as business owner of relationship with external auditors selected to perform the audit.
• Provides operational areas with compliance support and guidance related to Medicare, Medicaid, and GPO requirements and facilitates organizational response to incidents of noncompliance. Performs the annual Compliance Program Effectiveness (CPE) Assessment and develops and implements annual compliance work plan.
• Establishes and maintains performance metrics and provides regular performance dashboards, report-outs of significant matters, and compliance updates.
• Ensures that processes are in place to identify new laws, regulations, sub-regulatory guidance, and contractual requirements applicable to government programs lines of business; distributes new requirements to staff and business partners responsible for or impacted by implementation, and monitors progress of implementation.
• Analyzes the regulatory environment and legal requirements applicable to Medicare, Medicaid, and other government regulated programs and identifies risk areas.
• Serves as government programs compliance subject matter expert in support of growth and expansion initiatives.
• Performs other duties as assigned.

EDUCATION

• Bachelor’s degree or equivalent combination of experience and education

EXPERIENCE

• Five years’ experience

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.

 

Position Purpose:

Oversee and direct all population health functions for the assigned business unit based on, and in support of the company’s strategic plan. 

• Lead complex projects including affordability analyses around medical and pharmacy expense, business analysis, documentation of business requirements, and defining current/future scope of work. 
• Create and manage clinical affordability projects with internal partners, including but not limited to pharmacy, other clinical and network affordability teams, and pilots. 
• Create innovative solutions and process enhancements to drive financial and quality success. 
• Lead Clinical Model development and process support for the program in all approved state regions to align with the Clinical Model and meet the requirements for the program by supporting reports , technology and core team. 
• Identify trends between Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Member Engagement; create programs/pilots to improve engagement with strategic partners. 
• Establish the organizations focus and direction regarding models of care that incorporate needs of all lines of business, focusing on quality and operational efficiencies across the organization.
• Create and measure business and clinical outcomes with respect to the provision of clinical support for practice transformation and successful transition of practice to shared savings/risk contract.

Education/Experience: Medical Doctor or Master’s degree in Nursing, Therapy, Pharmacy, Public Health/Administration or related field. MBA preferred. 8+ years of clinical experience in the Healthcare industry. Broad understanding of HEDIS and how it is used to drive business growth and efficiencies. Ability to develop, execute and improve clinical programs across large or multiple business units. Ability to identify, create and tracking clinical program opportunities for population health management. Prior experience in an innovation field, long term project, or evidence of driving successful clinical practice innovative solutions.

Licenses/Certification: Unrestricted license as MD, DO, PA, PT, OT, ST, RpH or PN in applicable state(s).

For Carolina Complete Health plan: Individual responsible for providing oversight and leadership of all prevention/population health, care management and care coordination programs, including Local Care management plan, AMH model and care management delivered by Local Health Departments. Must reside in North Carolina; More than 5 years of demonstrated care management/population health experience in a large healthcare corporation serving Medicaid beneficiaries; NC licensed clinician (e.g. LCSW, RN, MD, DO). Must reside in North Carolina.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Clipped from: https://jobs.centene.com/us/en/job/CENTUS1206312EXTERNALENUS/Vice-President-Population-Health?utm_source=indeed&src=JB-10067&utm_medium=phenom-feeds&src=JB-10067

 

Job Title

Description

Job Summary: Oversees network and analytics strategy and execution for Delta Dental’s government business, including delivery of Medicaid and Medicare population health strategies. Directs matrix-oriented delivery model that ensures enterprise is delivering government-specific solutions unique to federal and state regulations.

Primary Job Responsibilities

1. Directs the daily activities of the team responsible for government programs network management, clinical performance, social determinants of health (SDOH), and the application of data analytics in maintaining optimal results.

2. Develops, recommends, and implements short and long term action plans in order to ensure the achievement of business unit goals.

3. Serves as leader in the development and monitoring of Medicare and Medicaid networks.

4. Establishes analytics function within the government programs business unit that is integrated into decision-making.

5. Communicates with and advises executive management on the planning and activities of government business.

6. Create and maintains governance of operational issues pertaining to government programs.

7. Supports business development efforts and serves as primary point of contact for network issues with clients.

8. Interviews, hires, evaluates, manages, and develops staff in order to ensure accountability for the achievement of departmental and individual goals and objectives.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

Location

Delta Dental MI-Farm Hills-DDFH

Requirements

Position requires a bachelor’s degree with an emphasis in business administration or a related field, seven years of experience in Medicaid, Medicare, insurance and / or clinical operations, and three years of leadership experience.

Position requires experience in provider contract network development, management, optimization and familiarity of various provider compensation models including fee-for-service, capitation, value-based reimbursement, risk sharing, etc.

Position also requires advanced knowledge of the managed care industry, strong verbal and written communication skills; strong interpersonal skills; and the ability to resolve complex problems using independent judgment.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Clipped from: https://recruiting.adp.com/srccar/public/RTI.home?c=1214201&d=TRI&rb=INDEED&r=5000670111306#/