Clipped from: https://www.jobshq.com/job/5348201/claims-research-specialist-medicaid-expansion/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

All about us

You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously.

 

We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.

 

Work environment

This position has the flexibility to be a remote, hybrid or in-office work arrangement. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND.

Pay information

Pay Level: 015

FLSA Category: Non-Exempt Hourly

 

This position is eligible for internal and externa applicants. 

 

A day in the life

The Claims Research Specialist is responsible for using knowledge to conduct research on complex claims and benefits issues and adjust appropriate claims. This role identifies trending issues within claims processing and assists with frontline resolution to ensure that questions or concerns are resolved in a timely manner. This position works directly with various internal departments and external entities to resolve questions pertaining to claims and benefits. This position will work within Medicaid Expansion.

 

Your responsibilities will include:
 

• Conducts in-depth research on claims and benefits issue requests received through internal systems.
  
• Reviews claims errors to determine if it’s a system or manual error, documents research outcomes and adjusts claims per benefits policies and procedures, if necessary.
  
• Follows up with appropriate individuals or areas to gather additional information to remedy issues. Clearly documents sources and validates the accuracy of data/information to resolve inconsistencies.
  
• Acts as resource and support for internal departments and management on issues involving claims and benefits.
  
• Assists various departments with frontline phone inquiries in attempt to resolve questions on initial contact.
  
• Identifies provider inquiry patterns and internal performance issues then communicates concerns to management and/or appropriate team.
  
• Processes Medicare crossover adjustment claims and determines if adjustments are needed.
  
• Researches various specialized requests for the Centers for Medicare and Medicaid Services (CMS) including but not limited to: the verification of a member’s Medicare coverage, identifying and reviewing claims processed by Medicare and Blue Cross Blue Shield of North Dakota, determining appropriate payments to Medicare and processing appropriate claims, communicating with CMS to provide time-sensitive information and collaborating with external collection agencies and internal staff as needed.
  
• Completes requests generated from reports and various departments in the organization resulting from systems issues, fraudulent payments or changes in processes.
  

 

What you need to succeed
 

• High School Diploma or GED 
  
• 1 year of customer service in an office-setting or similar.
  
• Good communication skills to use with our members and other team members. 
  
• Attention to the details to ensure work is accurate. 
  
• Ability to problem solve and work to find resolutions. 
  
• Have a task and goal focused work style.
  

 

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

 

Benefits and perks
 

• Wellness incentives including well-being lifestyle spending accounts, employee assistance program and employee discounts.
  
• Encouraged paid time off including paid holidays and flexible holidays to use as you wish.
  
• 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
  
• Employee recognition, community initiative events and yearly company outings.
  
• Workplace flexibility offering remote, office or hybrid work schedules and the freedom to make time for important commitments.
  
• Our core benefits include health, dental, vision and life insurance, short-term and long-term disability and paid parental leave.
  

 

Job posting policy

Employees new to Blue Cross Blue Shield of North Dakota are eligible to apply for positions within their assigned department after successfully completing 90-days in their role. For positions outside of their department, new employees should attain a minimum of six months of service before applying for a new role. Exceptions to this are acceptable, provided there is good business justification for making the move.

 

Equal opportunity employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@bcbsnd.com.

This job posting will be closed 12/19/2022 at 8:00 a.m. (CT). No further applications will be considered.

Clipped from: https://humana.talentify.io/job/national-medicaid-behavioral-health-quality-lead—humana-r-293587?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Humana

Pay

Location

Employment type Full-Time

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Apply with job updates

• Job Description
  

 
 

Req#: R-293587

Description

The Behavioral Health Lead will report directly to the National Medicaid Quality Director, and be responsible for the development, maintenance, and execution of Humana Healthy Horizon’s National Improvement strategy and operating model for Behavioral Health Quality, and its integration with Physical Health Quality, within the Medicaid line of business.

Responsibilities

The Behavioral Health Lead exercises independent judgment and decision making on complex issues regarding responsibilities and related tasks, works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action. Responsibilities include:

• Provide direction and oversight of the Behavioral Health Quality management model and improvement strategy for the Medicaid line of business at the national level, and further the integration of Physical Health and Behavioral Health Quality.
  
• Develop policy and procedure, and define/improve processes regarding HEDIS and quality measurement data collection and improvement methodology for all Behavioral Health focused measures.
  
• Develop educational materials and strategies to engage practicing Behavioral Health clinicians in improving operational process and clinical care quality in an effort to improve member experiences and health outcomes.
  
• Establish and improve care coordination processes between outpatient Behavioral Health practices, hospitals, and primary care physicians.
  
• Assist in the development of innovative value based payment models for Behavioral Health provider partners.
  
• Drive all Behavioral Health Quality related activities during the implementation of new Medicaid markets.
  
• Provide ongoing wrap-around support to market Quality teams for Behavioral Health related issues, process improvement, and clinical initiatives.
  
• Drive interdepartmental collaboration to achieve business goals
  

  Required Qualifications
  

• Bachelor’s degree in Business, Healthcare, or related field
  
• 5+ years of experience in Behavioral Health or Managed Care Quality Management and Improvement
  
• 3+ years of experience monitoring and improving behavioral health quality measures (example HEDIS or CAHPS) in a quality operations / quality management or office based practice setting
  
• Demonstrated ability to perform moderate to complex data analysis
  
• Previous experience working with behavioral health providers on quality and performance improvement activities
  
• Strong relationship building skills
  
• Excellent written and oral communication skills
  
• Comprehensive knowledge of Microsoft Office Word, PowerPoint, Excel
  

  Preferred Qualifications
  

• Clinical Licensure including: Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Counselor (LPCC), Registered Nurse with behavioral health experience
  
• Certified Professional in Healthcare Quality (CPHQ)
  
• Experience with quality improvement methodology such as plan-do-study-act
  
• Advanced degree in business, healthcare, or related field
  
• Project management experience
  
• Strong business skills, including sales and marketing objectives
  
• Previous experience developing provider facing educational materials
  
• Detail orientated and comfortable working with tight deadlines in a fast paced environment
  

  Work at Home Requirements
  
  

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
  
• Satellite, cellular and microwave connection can be used only if approved by leadership
  
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
  
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
  

  #LI-JB2
  

  Scheduled Weekly Hours
  

  40
  

• About the company
  

 
 

Humana looks at every facet of your life and works with you to create a path to health that fits your unique needs

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Clipped from: https://www.linkedin.com/jobs/view/social-media-fellow-at-health-tech-4-medicaid-3393363360/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

HealthTech4Medicaid (HT4M) is dedicated to supporting innovation in Medicaid. Our purpose is to further improve quality, equity and access to care for Medicaid recipients, their families and communities.

 
 

We are a mission-based market enabler that facilitates cross-sectoral, collaborative partnerships in health technology nationwide. We radically change the pace of innovation in Medicaid through innovative program service delivery, infrastructure/ecosystem development and issue/policy advocacy to facilitate cutting-edge forums and partnerships for entrepreneurs, payers, providers, policymakers, advocates, investors and the Medicaid community.

 
 

HealthTech for Medicaid is seeking a Social Media Fellow to join us for Winter 2023! The fellowship is unpaid for the first 130 hours. We provide fellows the opportunity to do a deep dive into our work in health and tech equity and help create and promote a positive company culture. This position will provide inspired leadership as we grow our organization’s lines of business, which involves making important policy and strategic decisions, as well as the development and implementation of operational policies and procedures.

 
 

Responsibilities include:

 
 

• Producing and scheduling social media content to Twitter, Instagram, Facebook and LinkedIn
  
• Identifying new opportunities to increase HT4M’s presence and engagement on social platforms
  
• Using MailChimp to write and curate content for our newsletter
  
• Brainstorming and developing campaign and programming strategies
  
• Staying on top of Medicaid-related news
  

 
 

Qualifications:

 
 

• Current student or post-grad looking for hands on social media experience
  
• High degree of initiative and independence
  
• Great written and interpersonal communication skills
  
• Strong organizational and time management skills
  
• Prior social media work experience, experience with Hootsuite, MailChimp or Canva is a plus but not required
  
• Interest and knowledge of public health and Medicaid is a plus
  

Clipped from: https://www.adzuna.com/details/3759445892?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

LOCATION: This is remote from home opportunity supporting NC Medicaid. Eastern or Central Time zone located candidates are preferred. HOURS: General business hours, Monday through Friday.. Responsible for generating process improvements that bring ab…Improvement, Consultant, Health, Improvement, Process, Operations, Healthcare, Business Services

Clipped from: https://www.glassdoor.com/job-listing/fp-and-a-analyst-medicaid-cvs-health-JV_KO0,25_KE26,36.htm?jl=1008335035939&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Fortune 5 company, CVS Health, has an exciting and challenging opportunity for an FP&A Analyst to join its Medicaid Finance Team


In this role you will be responsible for but not limited to:
 

• Financial Analysis of data such as revenue, and medical costs, to determine trends and make estimates
  
• Completion of monthly Paid Claims Paid Listings for hospitals
  
• Work with hospitals and other agencies on annual settlement calculations
  
• Prepare reporting for Value Based Agreements and participate in calls with Value Based Provider groups
  
• Completion of monthly reports for business partners and Commonwealth of KY
  
• Calculation of month end accruals for settlements and other value based agreements
  
• Monthly reconciliation of revenue received at the member level.
  
• Work on enhancing current processes with automation or other improvements.
  
• Ad hoc reporting for business partners
  

Pay Range
The typical pay range for this role is:
Minimum: 40,560
Maximum: 81,100


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

• 1+ years in financial or accounting experience
  
• 1+ years of excel skills, including macro-writing, pivot tables, and charts/graphs
  
• 6 + months SQL query experience
  

Preferred Qualifications

• Healthcare experience
  
• Python software knowledge a strong plus
  
• Tableau software knowledge a strong plus
  
• Strong attention to detail and ability to trouble-shoot
  
• Medicaid experience
  
• Experience working with large data files and multiple data files
  

Education

• Bachelor’s Degree required
  
• Finance or Accounting Bachelors Degree preferred
  

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

Clipped from: https://www.mendeley.com/careers/job/business-intelligence-lead-medicaid-remote-us-19742926?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

**Description**

The Business Intelligence Lead works projects with a diverse scope and complexity ranging from moderate to substantial regarding Humana’s Medicaid Line of Business.

**Responsibilities**

**Where you Come In**

The Business Intelligence Lead will act as the liaison between Humana’s Medicaid organization and Humana’s Provider Process Network Organization (PPNO). The lead role has ownership and/or oversight of the key deliverables to support Medicaid implementations and is accountable for ensuring PPNO’s alignment with the goals and objectives established.

**What Humana Offers**

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

**Required Qualifications – What it takes to Succeed**

+ Minimum of 4 years of Provider or Medicaid experience

+ Minimum of 2 years of project leadership experience

+ Proven ability to work with and facilitate cross-functional teams

+ Proficiency in understanding Healthcare related data

+ Proficiency in verbal/written communication to senior and executive leadership

+ Proficient in MS Office

+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences

+ * For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.* If progressed to offer, you will be required to:* Provide proof of full vaccination OR* Commit to weekly testing, following all CDC protocols, OR* Provide documentation for a medical or religious exemption consideration.

+ * This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.

**Preferred Qualifications**

+ Experience in creating BI Reports

+ Experience in translating requirements between business, project management and technical projects or programs

**Additional Information – How we Value You**

* Benefits starting day 1 of employment

* Competitive 401k match

* Generous Paid Time Off accrual

* Tuition Reimbursement

* Parent Leave

* Go365 perks for well-being

* Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.

* Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M

**Interview Format**

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone or text and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

**Scheduled Weekly Hours**

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Clipped from: https://www.linkedin.com/jobs/view/medicaid-eligibility-advocate-at-hca-healthcare-3358736688/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description

 
 

Introduction

 
 

Are you looking for a work environment where diversity and inclusion thrive? Submit your application for our Medicaid Eligibility Advocate opening with Parallon today and find out what it truly means to be a part of the HCA Healthcare team.

 
 

Schedule: Monday-Friday 8:00AM-4:30PM

 
 

Benefits

 
 

Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

 
 

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical transportation.
  
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
  
• Fertility and family building benefits through Progyny
  
• Free counseling services and resources for emotional, physical and financial wellbeing
  
• Family support, including adoption assistance, child and elder care resources and consumer discounts
  
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  
• Employee Stock Purchase Plan
  
• Retirement readiness and rollover services and preferred banking partnerships
  
• Education assistance (tuition, student loan, certification support, dependent scholarships)
  
• Colleague recognition program
  
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
  

 
 

Learn More About Employee Benefits

 
 

Note: Eligibility for benefits may vary by location.

 
 

We are seeking a(an) Medicaid Eligibility Advocate for our team to ensure that we continue to provide all patients with high quality, efficient care. Did you get into our industry for these reasons? We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply!

 
 

Job Summary And Qualifications

 
 

The Medicaid Eligibility Advocate is responsible for conduction eligibility screenings, assessment of patient financial requirements, and counseling patients on insurance benefits and co-payments. The Medicaid Eligibility Advocate serves as a liaison between the patient, hospital, and governmental agencies; and is actively involved in all areas of case management.

 
 

In This Role You Will

 
 

• Screen and evaluate patients for existing insurance coverage, federal and state assistance programs, or hospital charity application.
  
• Re-verifies benefits and obtains authorization and/or referral after treatment plan has been discussed, prior to initiation of treatment. Ensures appropriate signatures are obtained on all necessary forms.
  
• Obtain legally relevant medical evidence, physician statements and all other documentation required for eligibility determination.
  
• Complete and file applications. Initiate and maintain proper follow-up with the patient and government agency caseworkers to ensure timely processing and completion of all mandated applications and accompanying documentation.
  
• Ensure all insurance, demographic and eligibility information is obtained and entered into the system accurately. Document progress notes to the patient’s file and the hospital computer system.
  
• Participates in ongoing, comprehensive training programs as required.
  
• Follows policies and procedures to contribute to the efficiency of the office. Covers and assists with other office functions as requested.
  
• Will be required to make field visits as necessary and will need reliable personal transportation readily available.
  

 
 

Qualifications

 
 

• High School Diploma or GED or related experience in lieu.
  
• Associate’s degree preferred
  
• Minimum one year related experience preferred, preferably in healthcare.
  
• Relevant education may substitute experience requirement.
  

 
 

This role requires you to be fully vaccinated for COVID-19 based on local, state and /or federal law or regulations (unless a medical or religious exemption is approved).

 
 

“

 
 

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

 
 

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

 
 

“

 
 

“Across HCA Healthcare’s more than 2,000 sites of care, our nurses and colleagues have a positive impact on patients, communities and healthcare.

 
 

Together, we uplift and elevate our purpose to give people a healthier tomorrow.”- Jane Englebright, PhD, RN CENP, FAAN

 
 

Senior Vice President and Chief Nursing Executive

 
 

If you find this opportunity compelling, we encourage you to apply for our Medicaid Eligibility Advocate opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing apply today!

 
 

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

 
 

This position is incentive eligible.

Clipped from: https://jobs.myarklamiss.com/jobs/medicare-medicaid-trainer-part-time-remote-washington-washington-dc/817154641-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Title upon hire will be Education/Outreach Coordinator.

Part-time Employee/ 16 Hours per Week

Remote

About Us

Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.

At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees’ professional development. Large company perks Small company feel!

We are now seeking an Education/Outreach Coordinator to join our team.

Responsibilities
 

• Assists with beneficiary, provider, and stakeholder outreach and education services.
  
• Prepares and presents training presentations to internal and external individuals.
  
• Serves as a subject matter expert in Medicare and Medicaid to stakeholders.
  
• Provides assistance with the development and submission of fraud alerts and program vulnerability reports to CMS.
  
• Performs quality assurance (QA) by reviewing auditor/investigator case notes.
  
• Assists with preparation of a quarterly newsletter distributed to stakeholders.
  
   
  

Qualifications

Requirements
 

• Bachelor’s degree preferred.
  
• A minimum of 3 years’ experience with Medicare and Medicaid that demonstrates broad knowledge of both programs. Experience with or knowledge of more than one Medicaid program is a plus.
  
• Experience with outreach/coordination with a variety of stakeholders, preparing and delivering training presentations, and acting as subject matter on Medicare and Medicaid.
  
• Prior work experience on a Unified Program Integrity Contractor (UPIC) and/or Zone Program Integrity Contractor (ZPIC) contract is a plus.
  
• Knowledge of or experience with medical review, audits, or investigations is a plus.
  
   
  

IntegrityM is an Equal Opportunity Employer and we do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, and gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Clipped from: https://www.salary.com/job/pacificsource/medicaid-contract-manager/j202212060550227770129?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

PacificSource

 
 

 Vida, OR Full Time

Job Posting for Medicaid Contract Manager at PacificSource

PacificSource is anything but a typical health insurance company. Founded in 1933, we’re an independent, not-for-profit organization that puts our members, and their communities first—across Idaho, Oregon, Montana, and Washington. It’s our 1,700 employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care. So yes, with PacificSource, you get to do great things. In our effort to put members first—more than 500,000 of them—initiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement. Benefits: Flexible telecommute policy, medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account. We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work. Here’s what else we feel good about: A mission with a real sense of shared values Competitive wages and outstanding benefits, including telecommuting Opportunities for learning development and career advancement Organizational leadership style rooted in servant and transformational leadership A commitment to support the communities we serve A belief in the importance of work-life balance PacificSource is an equal opportunity employer and a company that loves helping people. We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that. In 2021 alone we had 240 internal promotions! Top Workplace 2022 for Idaho | Idaho Press Top Workplace 2022 for Oregon and SW Washington | The Oregonian #4 Healthiest Employer of Oregon 2021 | Portland Business Journal Healthy Worksite 2021 | Design Coalition in Montana PacificSource is an equal opportunity employer. Click here to review our AAP Policy Statement. If you have questions about working at PacificSource or need help with your application, please email HR@PacificSource.com. Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age. Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths. Position Overview: This position will manage key Medicaid contracts with external entities, providers, and payers, including the Oregon Health Authority. The Medicaid Contract Manager will advise and coordinate PacificSource activities to ensure contract deliverables are met. Working closely with CCO leadership and other stakeholders, the Medicaid Contract Manager will create contract management plans, schedules, timelines, and oversight/monitoring plans. This role informs project planning and resource deployment both internally and externally to improve PacificSource’s overall Medicaid performance efforts. The Medicaid Contract Manager will serve on critical work groups to monitor contract changes, participate in rule advisory committees, and provide feedback to the Oregon Health Authority, as applicable. This role coordinates internal and external stakeholders, including PacificSource subcontractors, interacts with PacificSource departments, and oversees key contract monitoring activities. Essential Responsibilities: Responsible for oversight, management, development, implementation, and communication of department programs. Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports. Develop annual department budgets. Monitor spending versus the planned budgeted throughout the year and take corrective action where needed. Coordinate business activities by maintaining collaborative partnerships with key departments. Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize dashboards and daily huddles to monitor key performance indicators and identify improvement opportunities. Actively participate as a key team member in Manager/Supervisor meetings. Actively participate in various strategic and internal committees to disseminate information within the organization and represent company philosophy. Develop contract management and project plans to ensure priority Medicaid objectives are consistently accomplished and to escalate quickly when objectives are not being met. As assigned, lead internal work groups to ensure performance of PacificSource’s Medicaid initiatives, with an emphasis on contract deliverables and related initiatives. Participate in external work groups, including rules advisory committees, contract development committees, service integration work groups, and community governance committees, as assigned. Work directly with department leaders to ensure knowledge, priorities, and actions accomplish line of business aims on behalf of PacificSource members and community partners. Align contracting activities in each CCO region and among lines of business. Maintain collaborative partnerships with key PacificSource departments and leaders. Actively participate as a key team member in cross-departmental meetings. Actively participate in internal committees to disseminate information within the organization, representing company philosophy, and ensuring line of business visibility within the community and the organization. Serve as responsible manager for hiring, coaching, staff development, staff corrective action, and termination of any direct reports. Provide feedback, including regular one-on-ones and performance evaluations, for any direct reports. Build/maintain relationships with PacificSource’s Medicaid community governance partners, providers, community leaders, and other external stakeholders. Align PacificSource and community partner interests toward the accomplishment of common, community-level goals. Collaborate to ensure the success of community partners who serve the Medicaid line of business to the extent such partnerships also improve the PacificSource Medicaid performance goals. Assume a supporting role in working with providers, county health departments, the State of Oregon, and other partners. Help to ensure internal PacificSource operations synergize with the core competencies of external community partners, including partners and subcontractors. Improve Medicaid member experience and quality of care by effectively leveraging both PacificSource’s core competencies, and those of its partners, through contract management and project planning. Supporting Responsibilities: Meet department and company performance and attendance expectations. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information. Perform other duties as assigned. SUCCESS PROFILE Work Experience: Minimum of 7 years of experience in the health care industry, managed care, or public health administration. Relevant experience in the following areas: managing large-scale contracts, relationships with regulators and state agencies, interpreting state and federal regulations and guidance, healthcare operations, government relations, and population health improvement. Experience in managing complex contracts and contract/project deliverables, or healthcare compliance is desirable. Demonstrated organizational skills, financial analysis and modeling comprehension, and proven negotiations experience. Demonstrated ability to develop and execute contract management plans and strategies. Education, Certificates, Licenses: Bachelor’s degree or equivalent prior work experience required. Master’s in healthcare administration, Business, or related field strongly desired. Knowledge: Excellent public relations, presentation, and interpersonal skills. Demonstrated successful communication skills, including public presentation, training, meeting facilitation. Maintain high level of knowledge of company products, health reform trends at the federal and state levels, and the insurance industry. Demonstrated skills with the following software: Microsoft Word, PowerPoint, Excel, and Visio. Strong analytical and problem-solving skills. Competencies Building Trust Building a Successful Team Aligning Performance for Success Building Partnerships Customer Focus Continuous Improvement Decision Making Facilitating Change Leveraging Diversity Driving for Results Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 25% of the time, most often to Salem or Portland. Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice open communication at all levels of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community. We encourage creativity, innovation, and the pursuit of excellence. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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HIRING A SENIOR PMP CERTIFIED PM

WHO IS HHS TECHNOLOGY GROUP?

HHS Technology Group is a software and solutions company serving the needs of commercial enterprises and government agencies. We create and deliver purpose-built, modular software products, solutions, custom development, and integration services for modernization and operation of systems that support a wide spectrum of business and government needs.

WHO WE ARE HIRING: SENIOR PROJECT MANAGER (PMI CERTIFIED) WITH STATE GOVERNMENT HEALTHCARE EXPERIENCE

This is a full-time permanent role with exceptional benefits.

WHAT WE OFFER:

Please find all benefits listed here:

• Fully paid premiums on dental, vision, life insurance, and disability insurance.
  
• Generously sponsored Medical Insurance
  
• Generous 401k matching program (100% match up to 6%)
  
• Open PTO policy
  

WHAT HHS TECHNOLOGY GROUP DOES:

HHS Tech Group creates innovative, purpose-built technology products and solutions, resulting in value and positive, quantifiable financial and time saving impacts for our clients and the people they serve. Our vision drives the future in the healthcare insurance domain. HHS Technology Group is expanding. Our growth trajectory is fantastic. We are leveraging data science to create healthcare insurance software to identify data trends which would indicate fraud waste and abuse scenarios as well as third party liability, thusly giving the insurance provider an opportunity to recover erroneously paid claims monies. We specialize in ensuring seamless modernization of monolithic, antiquated systems and leverage data science to give our customers intelligent insight of data trends pertaining to paid insurance claims. HHS Technology Group has become a valued and trusted systems integration partner for several departments within several State Governments. Components of this modular software can be re-purposed or built upon to deliver cloud based technical web services solutions. The intense growth and tremendous financial forecast we are experiencing at HHS Technology Group can largely be attributed to our successes and the high caliber on our delivery teams.

POSITION DESCRIPTION:

HHS Technology Group is excited about expanding and adding an Agile Project Manager to our Professional Services team. This key member of our highly talented team will interface with our valued customers and manage the delivery of complex web-based solutions on schedule and within budget, consistent with HHS Technology Group and State Government guidelines, processes, and contract stipulations.

This highly valued PM will be responsible for implementing complex information and analytics systems in support of State government health and human service programs and play a key role in nurturing State Government client business members and stakeholder relationships.

Strength with both AGILE and PMBOK methods for managing complex technical projects is critical. Proficiency in defining and documenting the following is required:

• Project Management Plan
  
• Project Work Plan in Microsoft .mpp format and in Jira using BigPicture
  
• Change Management Plan
  
• Quality Management Plan
  
• Communication Management Plan
  
• Risk Management Plan
  

Essential Responsibilities:

• Primary responsibility of HHS Tech Group’s Agile Project Managers is to drive and supervise the progress and activities of the Agile team dedicated to implementing complex information technology systems in support of government health and human service programs, often focused on Provider Enrollment and Provider Relations, as well as other modernization and newly built web services digital solutions. Please visit for more information about HHS Technology Group’s product suite.
  
• The successful PM will manage, motivate, mentor, and ensure optimum team efficiency (often in a geographically distributed team scenario); create and maintain detailed work plans and foster a Continuous Integration/Continuous delivery (CI/CD) Agile approach.
  
• This outstanding individual will partner with stakeholders to ensure proper strategy, alignment, integration and visibility whilst managing project scope and continuously analyzing and reviewing iterations and related change management tracking and reporting.
  
• A talented PM easily drives collaboration, consensus, and decision-making with State Government client stakeholders and executive management, while concisely communicating expectations and directives to the technical team.
  
• Extensive experience managing projects that leverage Jira and Jira plug-ins is a requirement.
  
• Manage and proactively escalate project issues, risks, and actions.
  
• Track and Manage budget/actual project financials; project codes, and invoices.
  
• Work with client project manager to ensure understanding of all project activities, schedules and deliverables, act as resource for questions, and manage expectations
  
• Serve as contract manager handling contract-related activities
  
• Maintain and improve client relationships, identify areas to add additional value and organically grow the account, as well as gain a positive reference from the client.
  
• Drive adoption of Agile and foster a culture of knowledge sharing with regular team contributions and content feedback.
  
• On an as needed basis, support the efforts of other groups such as Quality Assurance, Software Development, Training/Consulting, Marketing and Product Development, consistent with delivering quality products and services to our clients and the market.
  

Technical and Professional Qualities include:

• Active PMI Project Management Professional (PMP) Certification and/or PMI-ACP, or CSM
  
• 10+ years of project management experience delivering business value using technology solutions and managing staff in a matrix or direct reporting relationship
  
• 5+ years’ experience performing a lead client facing role in a system integration, ideally large transformational projects.
  
• 5+ years’ experience performing systems development life cycle on an enterprise-wide deployment and/or maintenance and operations
  
• 7+ years’ experience managing multiple priorities/projects including project scope, schedules, quality, change management and project financials
  
• Demonstrated use of project tracking tools (Microsoft Project, ALM tools, Jira, CA Rally)
  
• Experience implementing and integrating COTS products (Commercial-Off-the-Shelf) and managing SAAS delivery efforts
  
• Extensive applied Agile experience, applied Scrum Master experience, and expertise in some or all of the following: Medicaid – MMIS – MECT – Health care – Data warehouse – Analytics – JIRA
  
• State government/public sector experience on IT Projects in health and human services programs (such as Medicaid, MMIS, claims processing, eligibility, HHS analytics, data warehouse, etc)
  
• Proven track record of effective communication skills to lead client, vendor and internal teams through the project lifecycle process and successfully implementing complex IT projects from initiation to closure
  
• Exceptional verbal communication and written documentation using MS Office and other collaborative tools to achieve success is expected.
  

Preferred Technical and Professional Expertise:

• 5+ years of Medicaid, MMIS, Decision Support Systems (DSS), eligibility/enrollment systems, claims process or related experience with a state agency
  
• Experience managing enterprise State-level projects, either having delivered projects to a State or worked in State government delivering healthcare related projects.
  
• Experience in both business and systems architectures
  
• Advanced experience using MS Project including resource and cost loading, resource leveling, and earned value management
  
• Experience with implementation/SDLC methodologies (Agile, waterfall, hybrid and/or iterative)
  
• CMS Certification experience, MECT (Medicaid Enterprise Certification Toolkit), MITA (Medicaid Information Technology Architecture)
  
• HHS Technology Group is a software and solutions company serving the needs of government agencies and public programs. HHS Technology Group delivers purpose-built, modular software products, solutions, and integration services for modernization and operation of systems across a wide spectrum of health and human services programs including Medicaid.
  

Our Software, Discover Your Provider, is a Provider Management solution which encompasses software, integration, and related services to create web-based Provider Eligibility and Enrollment and Provider Management.

https://hhstechgroup.com/products/#discover-your-provider

HHS Technology Group is proud to be one of the elite technology solutions vendors to awarded the NASPO Value Point contract.

HHS Technology Group has formally been awarded as 1 of 6 vendors on the multi-state procurement process organized through NASPO ValuePoint which favorably positions us to be selected for multiple state government initiatives and system implementations.

https://www.naspovaluepoint.org/portfolio/mmis-provider-services-module-2018-2028/hhs-technology-group/

EEO Statement

HHS Technology Group is an equal opportunity employer. All aspects of employment including the decision to hire, promote, discipline, or discharge, will be based on merit, competence, performance, and business needs. We do not discriminate on the basis of race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law.

HHS Technology Group’s competitive Benefits Package includes but is not limited to:

• Fully paid premiums on dental, vision, life insurance, and disability insurance.
  
• Generously sponsored Medical Insurance
  
• Generous 401k matching program (100% match up to 6%)
  
• Open PTO policy
  

HHS Technology Group provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

HHS Technology Group creates software products in the healthcare insurance domain. Our software, Discover your Provider (DyP) and Discover your Data (DyD) ensure seamless modernization of monolithic, antiquated systems and leverages data science to give our customers intelligent insight of data trends pertaining to paid insurance claims. HHS Technology Group has become a valued and trusted systems integration partner for several departments within a number of State Governments. HHS Technology Group’s flagship product, Discover your Provider (DyP) is a provider relations/provider enrollment solution. Components of this modular software can be re-purposed or built upon to deliver cloud based technical web services solutions. The intense growth and tremendous financial forecast we are experiencing at HHS Technology Group can largely be attributed to our successes on these initiatives.