Clipped from: https://www.linkedin.com/jobs/view/medicaid-rebate-program-specialist-work-flex-at-purdue-pharma-l-p-3402185699/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Purdue Pharma L.P. and its subsidiaries develop, manufacture and market medications and consumer health products to meet the evolving needs of healthcare professionals, patients, and caregivers. We were founded by physicians, and we are currently led by a physician. Beyond our efforts to provide quality medications, Purdue is committed to supporting national, regional and local collaborations to drive innovations in patient care. Privately held, Purdue is pursuing a pipeline of new medications through internal research & development and strategic industry partnerships.

 
 

For close to two decades Purdue has engaged in many initiatives to stem prescription opioid abuse. We are committed to bringing lifesaving relief to communities and individuals suffering from substance use disorder and overdose. We are currently developing or supporting the development of two essential life-saving opioid overdose reversal medications and have the capability to manufacture others for medication assisted treatment. Providing these medicines has the potential to improve and save countless lives.

 
 

We are driven by our purpose: Compassion for patients and excellence for science inspire our pursuit of new medicines.

 
 

We are building an exciting path forward, and we are committed to recruiting a dedicated team of professionals who advance our expertise through a commitment to Purdue’s Values: Integrity and Courage , underpinned by Innovation , and always in Collaboration with each other.

 
 

At Purdue Pharma and our subsidiaries, you have a unique career opportunity to work differently, uncover and seize new opportunities, and take a hands-on, ownership approach to your work. We go beyond traditional roles and find creative ways to extend our skills and interests, challenging ourselves to contribute in different, meaningful ways. We strive to create an environment where you can bring your best to work each day. We welcome the opportunity to have you on our team!

 
 

We respect diversity and accordingly are an equal opportunity and an affirmative action employer. Qualified applicants will receive consideration without regard to: actual or perceived race, sex or gender (including pregnancy, childbirth, lactation and related medical conditions), national origin, ancestry, citizenship status, religion, color, age, creed, sexual orientation, marital status, gender identity or gender expression (including transgender status), protected medical condition as defined by applicable state or local law, genetic information, physical or mental disability, veteran status and military service, or any other characteristic protected by local, state, or federal laws and ordinance.

 
 

For more information about your rights under Equal Employment Opportunity, visit:

 
 

• EEOC Know Your Rights
  
• EEOC Know Your Rights (Spanish )
  
• USERRA Rights
  
• Family and Medical Leave Act (FMLA)
  
• Employee Polygraph Protection Act (EPPA)
  
• E-Verify (English and Spanish)
  
• Right to Work (English and Spanish)
  
• Pay Transparency Nondiscrimination Provision (English)
  
• Pay Transparency Nondiscrimination Provision (Spanish)
  

 
 

We strive to make our Career opportunities website accessible to all users. If you need an accommodation to participate in the application process, please email: careers@pharma.com
. This email is not for general employment inquiries or vendors; rather it is strictly for applicants who require assistance accessing our careers website .

 
 

Job Summary

 
 

The Medicaid Program Specialist will be responsible for coordinating the day-to-day operations of Purdue’s Medicaid drug rebate payment program obligations governed by Purdue’s master service agreement with the Center for Medicare and Medicaid Services (CMS) Medicaid Drug Rebate Program and governing regulations.

 
 

Primary Responsibilities

 
 

• Collaborate with Purdue’s third-party Medicaid processing vendor to validate all state Medicaid rebate invoices in accordance with industry best practices and within their respective payment deadlines and coordinate payments to the States.
  
• Validate Medicaid payment packages for accuracy.
  
• Manage state Medicaid invoice identification of disputes, and implement and monitor dispute tracking log, and liaise with States and Purdue’s third-party Medicaid processing vendor on dispute identification and resolution.
  
• Build and maintain strong State and Pharmacy Benefit Administrator relationships and manage the relationships with state Medicaid agencies.
  
• Manage the Medicaid dispute resolution process to maintain current and accurate books between Purdue and state Medicaid agencies.
  
• Perform trending analysis and invoice reconciliation to identify utilization disparities, and abnormal trends, and research trends with states.
  
• Calculate and validate state supplemental rebate and State Pharmaceutical Assistance Program (SPAP) invoice amounts.
  
• Have an understanding of Purdue’s Revitas Flex Medicaid system, train other users on software.
  
• Support Purdue’s third-party Medicaid processing vendor with testing of new software due to government pricing systems upgrades and/or changes in pricing methodology.
  
• Ensure all invoice data is properly archived and maintained in order to comply with all Federal guidelines and audit requirements.
  
• Perform financial modeling to aide in financial accruals process related to Medicaid rebate liability, and to support inquiries from other company stakeholders.
  
• Update and maintain SOPs as appropriate.
  
• Depending on skill set, provide back up support to government pricing functions for the calculation of Average Manufacturer Price (AMP), Best Price (BP), and potentially other government price reporting obligations.
  

 
 

Education And Experience Requirements

 
 

• Minimum 3-5 years of industry experience in healthcare, pharmaceutical and/or medical device industry preferred
  
• Minimum 2 years of experience working in the areas of, Medicaid, government pricing, rebate adjudication, contract management process/systems, document control, etc.
  
• Bachelor’s degree
  

 
 

Necessary Knowledge, Skills, And Abilities

 
 

• Technical Skills: Proficient in Outlook, MS Excel and MS Word. Knowledge of SAP and Revitas Flex Medicaid / Contract Sphere or other pharmaceutical contract/rebate/membership systems a plus. Must possess technical skills sufficient to learn new systems, understand system functionality well, and test systems when required.
  
• Market understanding – Good understanding of the Medicaid Drug Rebate Program, and general understanding of government price calculations such as Average Manufacturer Price (AMP), Medicaid Best Price (BP) and reporting processes. Understanding of the involvement of legal/regulatory and compliance in the government market. Proven understanding of current health care environment, regulations, and health care reform laws.
  
• Contract Interpretation – Ability to understand and interpret contract language related to government price calculations.
  
• Organization skills – Must possess good capability of organizational skills and ability to manage multiple projects at one time. Ability to adjust to changing needs within the organization and flexibility to change priorities as needed. Must be able to work under strict deadlines.
  
• Communication – Must possess strong written and verbal communication skills to interact with external and internal customers.
  
• Analytics: must be good with numbers, able to analyze data and trends and data discrepancies, good critical reasoning skills. Strong analytical skills and attention to detail with the capability to appropriately define issues, questions data; to comprehend qualitative and quantitative methods to perform accurate analysis. Ability to creatively think about different problems and devise pragmatic solutions.
  
• Strong interpersonal skills with demonstrated ability to work well with others, manage work with counterpart(s) at Purdue and drive towards consensus.
  
• Attention to detail and deadlines, a strong work ethic, and a history of adherence to policies and procedures are critical.
  

 
 

Physical And Environmental Requirements

 
 

• Perform job functions in various positions that may require sitting, stooping, balancing, kneeling, crouching, twisting, and/or reaching. While sitting for an extended period of time on a routine basis, incumbent may use the following equipment: Personal computer, telephone/ other voice communication devices, copier, fax, scanners, or other specialized equipment used in an office setting.
  

 
 

Additional Information

 
 

• Work-flex roles can be performed through a combination of on-site and remote-based work.
  
• Employee should be located in the following states: CT, NJ, NY
  
• Relocation assistance not provided.
  

 
 

Minimum required education, experience, knowledge, skills and abilities are included in the posting. The position will be filled at the level commensurate with the successful candidate’s education, experience, knowledge, skills, and abilities.

 
 

The job description is not an exhaustive list of all functions that the employee may be required to perform, and the employee may be required to perform additional functions. Additionally, the company may revise the job description at any time.

 
 

Apply Now

Clipped from: https://www.learn4good.com/jobs/tulsa/oklahoma/healthcare/1887844755/e/

Medical Management – Medical Director Medicaid 145-2047

Tulsa, OK, USA Req #75

Saturday, December 10, 2022

JOB SUMMARY:

 

The Medicaid Medical Director will serve as an organizationally focused leader and have primary responsibility for assisting the Senior VP & Chief Medical Officer in designing, building, and operating the Medical Management functions for Medicaid. This clinician will additionally have responsibility for Medicaid care management and utilization management operations in conjunction with other leaders. This key role sets the tone and provides leadership to a large team of nurses and support staff in support of numerous initiatives and function and in pursuit of optimal patient care and population health.

Places emphasis on quality improvement, member experience and safety, and designs programs in support of this effort.
 

KEY RESPONSIBILITIES:

 

• Provide leadership and primary responsibility for Medicaid Medical Management functions.
  
• In cooperation with other leaders and stake holders understand state Medicaid program requirements and guide Medicaid operations to ensure program compliance and functioning ls.
  
• Provide oversight for clinical operations and decision making for the Community Care programs.
  
• Work with teams of nurses on pre-authorization and care management functions and initiatives.
  
• Support and guide quality improvement activities and develops programs for strategic implementation.
  
• Management of and/or participation in internal company committees as directed.
  
• The Medical Director is available for real time consultation with the initial clinical reviewers.
  
• Perform timely and responsive Peer to Peer reviews.
  
• Develop and maintain effective working professional relationships with medical and operational leaders of participating Medicaid provider organizations. The individual will strive to maintain excellent levels of communications with the networks and their related medical group, management, and quality staff.
  
• Develop and maintain effective working professional relationships with engaged community benefit organizations participating in the Medicaid network.
  
• Perform other special projects and duties as directed by the executive staff of Community Care Managed Healthcare Plans.
  

QUALIFICATIONS:

 

• Ability to effectively lead, direct and supervise others.
  
• Ability to converse and write fluently in English.
  
• Successful completion of Health Care Sanctions background check.
  

EDUCATION/

EXPERIENCE:

 

• Graduation from accredited medical school with residency-training in a relevant specialty with a minimum 5 years work clinical experience in their field.
  
• Current and active unrestricted license to practice medicine in the State of Oklahoma.
  
• Demonstrated leadership ability and experience in complex medical organizations required.
  
• Post-graduate management training or advanced degree is a plus, but not a requirement.
  
• Proven experience in data analysis, quality improvement processes, and/or practice transformation work a plus but not required.
  
• Must be board certified and maintain certification.
  
• Experience at health plan company preferred, but not required.
  

Community Care is an equal opportunity riminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Clipped from: https://www.adzuna.com/details/3771046782?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 

Position Purpose: Oversee the product development and management of health and wellness products for the Medicaid (and other government programs) market.

• Design, develop, implement, and manage new and existing products from initial conception through service delivery
• Lead new product development efforts and cross-functional teams to develop and execute detailed project plans, outline workflows, sales and marketing collateral content, staffing models and product pricing, and client reporting specifications
• Monitor market trends to identify new product opportunities or enhancements to existing products
• Review product performance and outcomes and make recommendations for program improvements
• Respond to product inquires and assess new product requests
• Participate in the development of business strategy for the Medicaid market
• Ensures legal and regulatory compliance of new products and product enhancements
• Conduct training sessions for various internal teams on products

Education/Experience:

• Bachelor’s degree in Communications, Business Administration, or related field.
  
• 5+ years experience with health care or Medicaid product development/management, marketing, or project management in a managed care or insurance environment.
  
• Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
  

The above responsibilities will apply to the oversight of the Marketplace and Essential Health plan products for Fidelis Care.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Clipped from: https://www.themuse.com/jobs/cvshealth/network-valuebased-contracting-medicaid-regional-ne-lead-directorva-7b03e3?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description
Candidates must reside in VA with commutable distance to Richmond office location or must be able and willing to relocate to VA. Candidates may have an opportunity for relocation assistance.

The Regional Lead Director, Network Management VBC-Northeast Region is accountable for working with our strategic provider partners to develop innovative value-based solutions to meet total cost and quality goals for our Medicaid businesses. This role leads a team of approximately 3 employees.

-Responsible for designing conceptual models, initiative planning, and negotiating high value/risk contracts with the most complex and challenging, market/region/national, largest group/system or highest value/volume of spend providers in accordance with company standards in order to maintain and enhance provider networks, while working cross functionally to ensure consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives.
-Drives or guides development of holistic solutions or strategic plans negotiates and executes contracts with the most complex, market /region/national, largest group/system or highest value/volume of spend providers with significant financial implications.
-Works with Territory Performance Team to manage contract performance and drives the development and implementation of value based contract relationships in support of business strategies.
-Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined groups.
-Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.
-Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives.
-Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.
-Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.
-Collaborates with internal partners to assess effectiveness of tactical plan in managing costs. May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met.
-Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.

Pay Range
The typical pay range for this role is:
Minimum: 100,000
Maximum: 221,000

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
-Resides commutable distance to Richmond office location or willing to relocate to commutable distance to Richmond office location
– Minimum 8+ years of related experience and expert level negotiation skills with successful track record negotiating contracts with large or complex provider systems.
-Experience developing, negotiating, executing and managing value-based arrangements. Strong understanding of value-based metrics and analytics.
-Must understand strategy around risk arrangements
-Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.
-Experience leading a team
-Strong communication, critical thinking, problem resolution and interpersonal skills.

Preferred Qualifications
-Project and/or Program Management
-Provider Relations for VBS

Education
Bachelor’s Degree or equivalent experience

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://cigna.talentify.io/job/product-management-advisor-medicaid-solutions-work-from-home-express-scripts—cigna-22024768?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Cigna

Pay $86800.00 – $144600.00 / year

Location

Employment type Full-Time

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• Job Description
  

 
 

Req#: 22024768

• The Product Management Advisor will focus on managing specific Regulated Market capabilities. This position will ensure their capabilities are compliant with CMS and /or state guidance, execute monthly operational support, and implement new enhancement opportunities. This position will also support cross-functional initiatives that may be unrelated to the capabilities they own.
  

  Essential Functions:
  

• Be the recognized Subject Matter Expert and product advocate with all cross-functional areas of the organization
  
• Understand and ensure compliance to CMS /state guidance and regulations
  
• Support the product development life cycle leveraging agile methodology, partnering with Business and Technical Product Owners to implement enhancements
  
• Analyze trends and develop recommendations to ensure client requirements and compliance metrics are met
  
• Develop and deliver training to clients and internal resources
  
• Ensure internal/external policies and procedures are documented, maintained, and followed
  
• Support business documentation of compliance actions for routine guidance, execution of routine monitoring, or communication of client impacts internally
  
• Document project scope and project plan, tracking of project deliverables, and communication of project status
  
• Support internal/external audits for your capabilities
  
• Appropriately interact with account teams and clients
  
• Accountable for work plan goals that roll up to functional unit objectives
  
• Ability to see business needs outside of one’s own work area
  
• Understand and use system tools to research issues and concerns
  
• Cross-train and support other team initiatives where appropriate
  

  Qualifications:
  

• Bachelor’s degree in related field or 3-5 years relevant experience in healthcare, communications, marketing, or product management within Medicaid
  
• Strong analytical, planning, problem identification and resolution skills required
  
• Demonstrated project management skills
  
• Excellent presentation development skills, including slide composition and documentation
  
• Effective communication with internal and external individuals in various functional areas and at various levels of management
  
• Knowledge of healthcare industry, health insurance, or PBM highly preferred
  
• Demonstrated ability to prioritize and manage work load to meet deadlines and drive deliverables
  
• Advanced MS Excel, MS Access, SQL skills are highly desirable
  

  If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
  

  For this position, we anticipate offering an annual salary of 86,800 – 144,600 USD / yearly, depending on relevant factors, including experience and geographic location.
  

  This role is also anticipated to be eligible to participate in an annual bonus plan.
  

  We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna .
  

  About Cigna
  
  

  Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?
  

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

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

  Cigna has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
  
  

• About the company
  

 
 

Cigna is an American worldwide health services organization based in Bloomfield, Connecticut.

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Clipped from: https://www.localjobs.com/job/providence-ri-senior-actuary-medicaid-remote?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose:

– Support high profile Medicaid Actuarial projects, functional responsibilities and initiatives designed to support all of Centene’s Medicaid markets.

– Conduct analysis, pricing and risk assessment to estimate financial outcomes.

In this Senior Actuary role, you will:

– Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes

– Identify, initiate and lead organizational changes to improve business processes and collaboration across the organization

– Lead and participate in data and financial analysis; manage and own projects

– Lead and teach less experienced team members

– Lead and develop models and tools to support department leadership and Medicaid Actuarial state teams in areas such as trend analysis, experience analysis, monitoring and analyzing financial performance

– Communicate cross functionally, with leadership and with other team members to gather input, provide status and communicate results

Important Note: This position is fully remote. However, due to the needs of the business, ideal schedule for this Senior Actuary role is Arizona Time, however we can be flexible.

Required Certification: Fellow (FSA) or Associate (ASA) in Society of Actuaries (or equivalent international certification.

**Education/Experience:**

+ – Bachelor’s degree in Business or related field.

+ – 7+ years of actuarial experience and Associate in Society of Actuaries (ASA) certification

+ – Or, 5+ years of actuarial experience and Fellow in Society of Actuaries (FSA) certification.

**License/Certification:**

+ – Fellow (FSA) or Associate (ASA) in Society of Actuaries (or equivalent international certification); Member of American Academy of Actuaries (or equivalent international membership).

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.

**TITLE:** Senior Actuary – Medicaid (Remote)

**LOCATION:** Various, Rhode Island

**REQNUMBER:** 1395250

Clipped from: https://www.linkedin.com/jobs/view/medicaid-business-development-capture-director-at-elevance-health-3402714973/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

• Job Family: Business Development and Planning
  
• Type: Full time
  
• Date Posted:Dec 14, 2022
  
• Req #: JR12136
  
  
  

Location:

• VA, Norfolk
  
• National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
  
  
  

Description


Our Government Business Division’s Growth Team is looking for a Business Development Capture Director – Medicaid to join its Business Development and Capture Group. Our Business Development Capture Director is a high-performing individual contributor role responsible for positioning and capture execution of Medicaid health plan procurement and reprocurement opportunities. He/she is responsible for managing the strategy and preparations for upcoming Medicaid RFPs. He/she partners with Plan Presidents to lead the cross functional team of health plan leaders and business development to identify gaps, mitigate risks, and develop solutions and strategy in months prior to an RFP.


[This position can work remotely from any US Elevance Health location]


Responsible for positioning and capture execution of Medicaid health plan procurement and reprocurement opportunities.


Primary Duties May Include, But Are Not Limited To


Monitor and evaluate white space opportunities to make go/no-go recommendations to executive leadership.


Develop and execute plans for the pursuit and capture of all Medicaid managed care procurement opportunities, including Alliance partnership opportunities.


Leads the cross functional team of Growth Partners, Health Plan leaders, and Alliance partners (as applicable) to develop winning strategies and identify and mitigate risks and opportunities.


Participates in bid decisions and develops recommendations for gate reviews.


Collaborates with Health Plan Presidents and Health Plan leaders to understand current and emerging customer needs and requirements.


Obtains market intelligence and competitive data to develop market strategy.


Participates in all levels of proposal development and draft review, providing active feedback and recommendations for improvement.


Provides mentorship and coaching to other members of the broader Business Development team.


Minimum Requirements

• BA/BS degree in a related field and a minimum 10 years of experience in strategic planning and business development in Medicaid programs; or any combination of education and experience, which would provide an equivalent background.
  
  
  

Highly Preferred Experience

• Previous P&L and/or business development experience and project management experience in Medicaid managed care setting.
  
• Experience leading capture and proposal activities for significant opportunities ($1B and more) strongly preferred.
  
• Experience in a capture function or executive leadership function for a managed care based product for state Medicaid agencies.
  
• State Medicaid agency experience or federal agency experience with CMS.
  
• MBA, MPH, or MPP preferred.
  
  
  

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $140,240 to $252,432


Locations: Colorado; Nevada, Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY


In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
  
  
  

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.


Be part of an Extraordinary Team


Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.


We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?


We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.


Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.


EEO is the Law


Equal Opportunity Employer / Disability / Veteran


Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

• EEO Policy Statement
  
• EEO is the Law Poster
  
• EEO Poster Supplement-English Version
  
• Pay Transparency
  
• Privacy Notice for California Residents
  
  
  

Elevance Health, Inc. is an E-verify Employer


Need Assistance?


Email us (elevancehealth@icareerhelp.com) or call 1-877-204-7664

Clipped from: https://jobs.gainwelltechnologies.com/job/Any-city-Business-Analyst-Medicaid-KS-99999/946421400/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

 
 

Summary

As a [[Business Analyst- Medicare]] at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Your role in our mission

Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas.

• Help coordinate a business analyst team’s duties and activities on IT projects and nurture newer team members by providing guidance and support
  
• Be a knowledgeable bridge between clients, project managers and technical staff to define, document and share business requirements and expected impact 
  
• Work with the client to develop business specs at the start of a technical project
  
• Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals
  
• Help verify that all requirements have been met by approving and validating test results    
  
• Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work 
  

What we’re looking for

• 6+ years of experience in Business Analyst, Medicaid or Medicare.
  
• 6+ years of business functional experience in one or more areas such as Eligibility, Claims, Provider.
  
• Strong SQL knowledge. Ability to write complex queries.
  
• Ability to gather requirements effectively; document requirements and confirm observations with business owners. Also, to perform fit/gap analysis based on requirements.
  
• Experience using Microsoft Office Tools, specifically Excel.
  
• Ability to create detailed and thorough design documents and test plans/execution for medium to large initiatives.
  
• Being able to research, analyze, validate and document business requirements.
  

What you should expect in this role

• All US locations may be considered including remote. 
  

 
 

The pay range for this position is $63,100.00 – $90,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

 
 

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

 
 

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

Clipped from: https://www.ziprecruiter.com/c/Horizon-Blue-Cross-Blue-Shield-of-New-Jersey/Job/Mgr,-Medicare-&-Medicaid/-in-Pennington,NJ?jid=626ce7ea19076234&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:
The Manager, Medicare and Medicaid Risk Adjustment is responsible to act as the lead for multiple data projects and tasks working directly with the Director, Risk Adjustment Revenue. This position will be actively involved in managing the company’s Medicare and Medicaid risk adjustment revenue management and analysis. This position will work interdepartmentally as well as with outside vendors, such as, but not limited to, Inovalon, Cognizant, Cognisight, Apixio, Change Healthcare, Pharmacy Benefit Administrator (PBA), Membership Systems, etc., in matters related to the membership, revenue, risk adjustment accuracy, and data submission completeness & accuracy. Lead an analytics-focused team and manage a coordinated, cross-functional and integrated process across the organization with partners in Service, Informatics, HCM&T, and IT to implement the programs and streamline and leverage activities.

• Manage the existing Medicare risk adjustment programs, ensuring risk score accuracy capabilities, timely and accurate data submissions, financial impact and related functions. Responsible for managing the Medicare Risk Adjustment Processing System (RAPS) and Encounter Data Processing (EDPS) Submission process and reconciliation of submissions against claims data. Coordinate the work of government audit on risk adjustment data (RADV Audit). Assist in implementation and management of Risk Adjustment related vendor activities.
  
• Oversee DSNP vendor relationships, establishing clear performance goals and expectations. Coordinate the operations for vendors in developing data extracts for accurate and timely RAPS/EDPS submissions as it relates to chart review and in-home assessments. Track vendor progress in meeting deadlines, reporting accurate and complete data.
  
• Establish appropriate receivable balances and the application of monthly payment remittances from the Centers for Medicare and Medicaid Services (CMS) and New Jersey State Department of Human Services Division of Medical Assistance and Health Services (DMAHS).
  
• Manages the DSNP NJ State/CMS reconciliation of preparation and distribution of monthly premium and enrollment derived from the Monthly Membership Report (MRR) and Remittance Advice (RA) respectively.
  
• Prepare and analyze financial data and reports and for maintenance and reconciliation of receivable balances and accounts. Implement and monitor basic control processes, communications improvements, and analysis.
  
• Oversee Medicaid Pharmacy Benefit Administrator (PBA) ensuring timely and accurate Encounters submissions & reconciliation aligning with the TR65 certification. Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and plan’s objectives.
  
• Manage data assurance and reconciliation of Medicare Prescription Drug Event (PDE) data interdepartmentally.
  
• Responsible for duties including training, development, communication and implementation of office audit standards, policies and procedures, reviewing monitoring, establishing tasks, setting goals and evaluating of employee work performance, reviewing operational programs, establishing work priorities, and researching technical and procedural issues related, but not limited to the actions that could potentially affect the member premium. Work in partnership with customers, vendors, and other key stakeholders to deliver the service and products required. Create/revise policies and procedures in accordance with the State and federal requirements and maintain compliance.
  
• Manage, develop and train four – six staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.
  

Education/Experience:
 

• Bachelor degree preferred from an accredited college or equivalent work experience
  
• Requires a minimum of five to eight years of experience in Accounting, Revenue and/or Healthcare Accounts Receivable Management, preferably for a payer organization
  
• Requires premium and/or healthcare receivable management experience (claims processing experience is preferred).
  
• Requires experience processing and analyzing large data files including directing the development of queries and reports to support the management of accounts receivable balances.
  
• Experience in the Medicare and/or Medicaid Managed Care industry is preferred.
  

Knowledge:
 

• Requires working knowledge of personal computers and supporting windows based environment including MS Access, Excel, and Word.-Requires knowledge of claims processing.
  
• Prefers knowledge of industry standard claims coding.
  
• Requires knowledge of provider contracting.
  
• Prefers knowledge of claim system configurations.
  
• Prefers project management skills.
  
• Knowledge of CMS Risk Adjustment Process (RAPS), State and Federal Encounters-Reporting, Part D, Premium Billing, Membership Reconciliation, CMS and State of NJ Revenue Cycle desired.
  

Skills and Abilities:
 

• Requires analytical and problem solving skills.
  
• Requires strong oral and written communication skills.
  
• Requires the ability to adapt to change and meet deliverables in a fast paced, dynamic environment.
  
• Requires the ability to research and resolve problems through interaction with companywide personnel.
  
• Requires the ability to organize and prioritize work assignments.
  
• Requires effective verbal and written communication skills and demonstrate the ability to work well within team.-Requires the ability to work independently and coordinate projects.
  

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

Clipped from: https://www.sentaracareers.com/job/17313048/manager-product-performance-medicaid-richmond-va/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

At Sentara Healthcare, one of our values is to keep you safe.
Sentara Healthcare and many other companies across the US are being targeted by cyber criminals who are impersonating representatives of the company, claiming to have job offers. Sentara will never ask you for banking or personal identification information via email or text. We will never ask an applicant to pay money for training, supplies, or other so-called expenses. If you suspect you have received a fraudulent job offer, e-mail taadmin@sentara.com.

Award-winning: Sentara Healthcare is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering more than 500 sites of care including 12 hospitals, PACE (Elder Care), home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan.  The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years.  U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years.  Sentara offers professional development and a continued employment philosophy!

When you join Sentara in a professional or management role, you become part of a progressive team of business leaders and operational experts. Our organization and our people are highly respected for the knowledge and innovation that we demonstrate each day. Working with us is an opportunity to have a positive influence on our growth and the communities we serve.

Overview

Responsibilities

Qualifications

Overview

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 Plus Bonus, Career Advancement Opportunities, Work Perks, and more.

Along with competitive salary we also offer the following benefits:

Adoption, Infertility, and Surrogacy Reimbursement

Educational Assistance Programs, including Tuition Assistance

Emergency Back-Up Care

Financial Wellness Tools, including extra student debt payments on your student loans.

Medical, Dental, and Vision Benefits

Paid Annual Leave (PAL)

Paid Parental Leave

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

#Indeed, Talroo

Responsibilities

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

Qualifications

License/Certification

Education

• Master’s Level Degree
  
• Bachelor’s Level Degree
  

Experience

• Managed Care 5 years
  
• Medicare Previous Experience
  

Skills

 
 

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.