Category: Curator- Job Hunter

Clipped from: https://www.linkedin.com/jobs/view/health-insurance-specialist-program-policy-at-centers-for-medicare-medicaid-services-3382766213/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Duties

 
 

• Evaluate and analyze the impact of new or revised changes to legislation before the Congress pertaining to any CMS program.
  
• Conduct analysis of policy issues and topics by researching background information, the origin of laws, and the intended impact in order to make effective policy recommendations.
  
• Work with the CMS Office of Legislation and related Congressional committees and staff in performing an impact analysis or mark-up of various Congressional options before the committees.
  
• Provide technical assistance, consistent with program expertise and experience, other Federal agencies staff, State agencies and private sector organizations.
  
• Develop and review health care policies and legislation in order to draft related policy documents, regulations, procedures and guidance to states.
  
• Prepare all forms of written correspondence regarding program policy related activities and Medicaid issues to the public, Congressional staff, industry contacts, and State representatives.
  

 
 

Requirements

 
 

Conditions of Employment

 
 

• You must be a U.S. Citizen or National to apply for this position.
  
• You will be subject to a background and suitability investigation.
  
• Time-in-Grade restrictions apply.
  
• This is a remote position; however, the position reports to a CMS Office on a periodic basis. Requirements to report to the office will vary and can be discussed at the time of interview.
  

 
 

Qualifications

 
 

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.


Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.


In order to qualify for the GS-13, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-12 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Conducting analysis of national health insurance program policy issues in order to propose policy modifications; (2) Developing regulations, manuals, program guidelines, program memoranda, policy letters, and/or instructions to communicate health insurance program policies; and (3) Presenting recommendations and conclusions based on analysis and evaluation of health insurance programs that describe feasible options and/or the consequences.


Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.


Time-in-Grade: To be eligible, current or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.


Click The Following Link To View The Occupational Questionnaire


Education


This job does not have an education qualification requirement.


Additional information


Bargaining Unit Position: Yes – American Federation of Government Employees, Local 1923


Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Not Required


To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply.


Remote-Out Positions at CMS: This is a remote position; however, the position reports to a CMS Office on a periodic basis (e.g. 1-2 times per year). Requirements to report to the office will vary and can be discussed at the time of interview. As such, your pay will be based on your home address. For more information on locality and pay scales, please


The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy.

• A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding.
  
  
  

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

Clipped from: https://www.learn4good.com/jobs/springfield/missouri/healthcare/1826647876/e/

Position:  Communications Lead, Insurance Services (Medicare/Medicaid)
** Description*
* ** Responsibilities*
* Humana’s Marketing Organization is seeking a Communications Lead to join the Corporate Communications team. The Communications Lead, Insurance Services is responsible for developing and executing integrated internal communications strategies that enable Humana’s growing Insurance Services business.

The Communications Lead, Insurance Services is responsible for developing and executing integrated internal and executive communications strategies in support of Humana’s largest business – Insurance Services, including our growing Medicare and Medicaid businesses. The individual is a strong strategic advisor who creates end-to-end plans and creative campaigns, giving employees the knowledge and inspiration they need to navigate a complex industry. The Communications Lead helps employees successfully manage transformation and organizational change through engaging communications that create a positive culture and employee experience.

** Key Role Functions**   

+ Create integrated messaging for diverse audiences related to the Insurance Services business to create a positive employee experience

+ Develop messaging and content that advances business priorities within the Insurance Services segment and across the enterprise

+ Partner with cross-functional teams to drive cohesive, consistent communications activities

+ Bring Humana’s strategy to life on new and existing communications channels through impactful storytelling and high-impact messaging

+ Work closely with senior leaders and change sponsors to engage employees during organizational transformation, helping to position changes appropriately and reach segmented internal audiences with relevant information

+ Develop clear and consistent internal communications, creative multimedia content and compelling storytelling packages that promote associate understanding of Humana’s purpose, culture, employee value proposition, and insurance business

+ Build strong alignment with cross-functional colleagues, including other corporate communicators, on internal communications strategies and content prioritization

+ Leverage data, analytics and feedback from stakeholders to inform strategy and decision making

+ Work in close collaboration with external vendors and partners to deliver against communications plans and goals

This is a remote role working anywhere in the U.S. and may require quarterly travel.

** Required

Qualifications *
* + Bachelor’s degree in communications, public relations or related field

+ 8+ years of employee communications or public relations experience with proven expertise in change communications

+ Experience and knowledge of change management principles, methodologies and tools

+ Adept ytics, as well as emerging practices and technologies

+ Self-organized – can independently plan, lead and implement integrated communications projects

+

Ability to work under tight deadlines, multitask and deliver quality work under pressure

+ Exceptional written communications skills and deep experience as a content creator

+ Proactive, flexible and always seeking improvement and positive change

+

Ability to influence

+ Foster an open, inclusive and diverse community at Humana

+ Advanced skills using O365 suite, including Teams and Share Point

** Preferred

Qualifications *
* +

Education or Certification in Organizational Change Management

+ Experience at large, matrixed corporate organization with diverse stakeholder groups

+ Previous experience in project management

** Additional

Qualifications *
* ** Covid-19 Vaccine/Testing Requirement*
* Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask s while in a Humana facility or while working in the field.

** Work te

Requirements *
* + Must ensure designated work area is free from distractions during work hours and virtual meetings

+ Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10×1 (10mbs download x 1mbs upload) for optimal performance of is required

** 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

Clipped from: https://www.learn4good.com/jobs/dover/delaware/government/1806419911/e/

Overview

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, technology, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG employs approximately 2,000 professionals worldwide all committed to delivering solutions that change lives for the better. The firm has extensive experience in all 50 states, Canada, and a growing practice in Europe.

PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit  .

Responsibilities

• Provides subject matter expertise in support of advising clients regarding health policy strategy, development and implementation.
  
• Conducts policy research on behalf of clients and the practice area and drafts formal written positions, policy briefs and recommendations on key policy issues identified.
  
• Analyzes relevant legislative and regulatory matters and keeps up-to-date with government policy discussions in related areas.
  
• Drafts technical documents including legislation, regulations, guidance, Medicaid State Plan Amendments and waivers.
  
• Identifies and supports client implementation of strategies for developing, advancing, communicating and operationalizing agreed-upon policy decisions.
  
• Liaises and consults with relevant colleagues and stakeholders in the conduct of policy work.
  
• Assists with planning and implementing stakeholder engagement on behalf of clients.
  
• Establishes good working relationship with local, state, federal and private service agencies.
  
• Uses existing client networks to provide a perspective on future business.
  
• As appropriate, assist project leads with coordination of strategic planning, project reporting, and technical activities.
  
• Writes articles and policy briefs to disseminate public health findings and evidence based best practices.
  
• Other tasks as to be determined by PCG management.
  

Qualifications

Education:

Bachelor’s degree required. Master’s degree or professional equivalent highly preferred

Experience:

5+ years’ experience in healthcare and policy advising with progressively increasing level of leadership responsibility. Experience in working for e government is preferred.

Required skills:

 

• Subject Matter expertise related to Health and Human Services; specific expertise in the Medicaid program, CHIP and related authorities preferred.
  
• Strong leadership, assertiveness and interpersonal skills.
  
• Outstanding verbal and written communication skills.
  
• Must be tactical in delivering project tasks under tight deadlines, with the ability to keep the big picture in mind  a strategic perspective.
  
• Demonstrated ability to manage multiple deliverables in a cross-functional capacity.
  
• Self-starter, assertive, enthusiastic and has the political savvy to get things done, yet maintain a likeable presence.
  
  Ability to deal with adversity and differing opinions.
  

#LI-remote

EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications.

We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, r status protected under federal, state, or local law.

PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

>

Job Location s
US

Posted Date
5 days ago
(11/17/2022 12:08 PM)

Job 2022-8827

# of Openings
1

Category
Other

Type
Regular Full-Time

Practice Area
Health Services

Public Consulting Group is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, protected veteran status, or status as a qualified individual with a disability. VEVRAA Federal Contractor.

Clipped from: https://www.recruit.net/job/manager-jobs/D7595B9E424403E1?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description
Manager, Medicaid Plan Marketing
Territory: Bronx County and Manhattan County
Develops objectives, policies, and programs for marketing activity related membership growth, retention, acquisitions, and business initiatives.
Primary duties may include, but are not limited to:
– Develops short and long term marketing and retention strategies and objectives.
– Directs and coordinates activities of the business if Initiative to assure alignment with corporate goals.
– Researches and evaluates competitive activity.
– Develops and implements an effective tracking mechanism for daily, weekly, monthly, and yearly activities and productivity.
– Develops and conducts office and field rep training methods.
– Oversees the quality control process and procedures.
– Ensures compliance with state and municipal laws, rules, and guidelines for marketing and outreach.
– Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Minimum Qualifications
Requires a BA/BS degree in a related field and a minimum of 7 years of related experience, including at least 3 years of leadership experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications
MBA preferred
Familiarity and experience in working with providers and reviewing membership reports to increase growth
Experience with MS Office and SalesForce
Strong analytical skills
Strong written and presentation skills
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $104,544 to $156,816
Locations: Colorado; Nevada, Jersey City, NJ; New York City, NY; Ithica, 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.
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.

Clipped from: https://us.bebee.com/job/20221201-3e4faa8c751b7aa73e5b2e6794a4a215?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Found in: beBee S2 US – 19 hours ago

 
 

Description

Starting Date: 1/1/2023

Service Area:
Case Manager will be serving Jefferson and surrounding Indiana counties . This position requires working remotely from your home office and travel within your service area. This is NOT a fully remote position. You must live within the service area to be considered for this position.

Job Summary:
Case Managers support individuals participating in a Medicaid waiver program.

The CM will ensure they have access to services available on the waiver, other Medicaid state plan services as well as providing additional resources within their community.

A primary role in this position is one of advocacy for the individuals we serve.

Responsibilities and Duties:

Following a person-centered process; Annual Planning; Quarterly Monitoring face to face; Maintaining and managing all electronic records; Facilitating interdisciplinary team and other meetings; Completing/maintaining each individuals waiver budget; Monitoring service delivery and utilization; Ensuring individuals health and welfare; Maintaining/Building relationships with individuals, families, guardians, providers.

Skills:

Ability to plan, organize, manage time, and work productively in a virtual environment under minimal supervision to provide timely and quality service delivery for Individuals; intermediate level of technology skill; strong oral and written communication skills; team facilitation; critical thinking; quality orientation; attention to detail; and team collaboration.

Work

Schedule:
Monday- Friday 8-4:30 forty hour work week.

At times it will be necessary to flex schedule to accommodate a later afternoon meeting for working parents and school aged individuals.

Knowledge/

Experience:

Bachelor’s degree in Psychology, Social Work, Counseling, Nursing, Special Education, Rehabilitation, Gerontology, or another field of study with one year of direct work experience with persons with intellectual disabilities.

Plus, one year of experience working with individuals with intellectual disabilities.

Required:
Authorization to access State of Indiana’s operating systems. CPR certification, current and valid driver’s license. Ability to pass a thorough background screen. CM must have a dedicated home office space where Protected Health Information cannot be accessed by others. They are required to have all furnishings for a home office- internet, phone, computer, and ability to print. They will need reliable transportation. Ability to physically enter Individual’s homes and other community settings.

Preferred:
Previous case management experience; experience in team facilitation; and experience working from home. Experience with Aged & Disabled Waiver, Tramatic Brain Injury Waiver, Family Support Waiver or Community Integration Habilitation Waiver.

Benefits:
Medical, dental and vision; 401K; 15 days paid vacation plus paid holidays; iPad with a hot spot. Salary ranges are based on level of experience and ability to meet quality expectations for caseload.

Connections Case Management understands that our mission values and objectives will be best supported in your role as case manager by providing support to our case managers in the same manner.

Connections understands that employees are more than just case managers. They have families and lives outside of their professional careers. Our company values the health and well-being of our employees.

We understand that if we provide supports that allow our employees to have a quality life at work and home, via a good income and personal time away from work responsibilities, the return will be in quality supports for those they have on their caseload.

Everyone in the company has a caseload.

Each case manager is part of a smaller, regionally based team of 3-6 people which allows for direct quality support and monitoring by a supervisor.

Additionally, your role as case manager is supported with an open and accessible team concept.

Because Connections serves all 92 counties in Indiana, employees are encouraged to use all forums to connect with colleagues and utilize a team approach to case management.

For more information about Connections Case Management please visit us at where you can also download an application. Please also look us up on social media and check out our reviews on Glassdoor

Job Type:
Full-time

Pay:
$40,000.00 – $50,000.00 per year

Benefits:
401(k)
Dental insurance
Flexible schedule
Health insurance
Paid time off
Parental leave
Vision insurance

Schedule:
8 hour shift
Day shift
Monday to Friday

COVID-19 considerations:

To keep our individuals and case managers safe we follow all CDC and IDOH protocols as well as local health department guidelines.

Education:
Bachelor’s (Required)

Experience:
Case management: 1 year (Preferred)

License/Certification:
Driver’s License (Required)

Willingness to travel:
50% (Required)

Work Location:
On the road

Clipped from: https://www.adzuna.com/details/3734407813?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Location: Company:

 
 

Description
Humana’s Oklahoma Medicaid BH Medical Director will oversee our behavioral health (BH) clinical program for Oklahoma Medicaid plan members. They will collaborate closely with the Chief Medical Officer (CMO) to integrate the day-to-day administration and strategic management of behavioral and physical health services, including utilization management (UM), quality improvement, and value-based payment programs. The BH Medical Director will be based in Oklahoma and will also lead the development of new products and services in Humana’s Medicaid BH delivery model
Responsibilities
Essential Functions and Responsibilities
– Lead major clinical and quality management components of Humana’s BH services
– Oversee, monitor, and assist with the management of the establishment of Prior Authorization, clinical appropriateness of use, and step therapy requirements for the use of stimulants and antipsychotics for all Enrollees under the age of eighteen (18); consultations and clinical guidance for contracted Primary Care Providers (PCPs) treating behavioral health-related concerns not requiring referral to behavioral health specialists;
– Develop comprehensive care programs for the management of youth and adult behavioral health concerns typically treated by PCPs, such as ADHD and depression;
– Develop targeted education and training for contracted PCPs to screen for mental health and substance use disorders using evidence-based tools (e.g., AUDIT-C, PHQ-9 and GAD-7), perform diagnostic assessments, provide counseling and prescribe pharmacotherapy when indicated, and build collaborative care models in their practices;
– Coordinate with the Medical Director to integrate the administration and management of behavioral and physical health services;
– Oversee, monitor and assist with effective implementation of the Quality Management (QM) program; and work closely with the Utilization Management (UM) of services and associated Appeals related to children and youth and adults with mental illness and/or substance use disorders (SUD)
– Lead BH policy development in Oklahoma, driving implementation, oversight, and accountability for both Humana internal and external stakeholders
– Adhere to and comply with federal and state laws and programmatic requirements
– Collaborate with provider relations personnel to ensure high-quality and appropriate care delivered through the BH provider network
– Establish and maintain relationships with providers, advocates, and other key Oklahoma stakeholders by maintaining open and ongoing communications; represent Humana at public forums and engagement opportunities
– Maintain compliance with BH-related contract requirements and attend oversight committee meetings to ensure appropriate procedures are adhered to within Humana and within care delivery
– Collaborate closely with corporate and local population health teams in developing programs and strategies to address BH needs at a population health level
Required Education, Certification, & Experience Qualifications
– Physician with a current, unencumbered Oklahoma-license as a physician
– Board-certified in psychiatry
– At least three (3) years of training in a medical specialty
– Knowledge of the managed care industry
– Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, UM, discharge planning and/or home health or rehab
Preferred Experience Qualifications
– Five (5) years or more clinical experience working in BH
– Familiarity with Oklahoma-based BH organizations
– Medicaid Managed Care clinical or behavioral health leadership experience
Additional Information
Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.
#physiciancareers
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://getwork.com/details/560240faed2597975b77ff2722eaaec9?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description

Humana Healthy Horizons in Ohio is seeking a Care Guide/Care Guide Plus (Care Coach 1) who will assess and evaluate member’s needs and requirements to achieve and/or maintain optimal wellness state. The Care Guide serves as a single point of contact for care coordination for members who are not assigned to a Care Coordination Entity (CCE), OhioRISE Plan, and/or CME involvement and short-term care coordination needs are identified. The Care Guide Plus serves as a single point of contact at the MCO for care coordination when there is Care Coordination Entity (CCE), OhioRISE Plan, and/or CME involvement and short-term care coordination needs are identified. Connects members to CCEs, the OhioRISE Plan, or MCO Care Management if the member’s needs indicate a higher level of coordination.

Responsibilities

This position employs a variety of strategies, approaches, and techniques to manage a member’s health issues.

• Identifies and resolves barriers that hinder effective care.
  
• Ensures member is progressing towards desired outcomes by continuously monitoring care through use of assessment, data, and conversations with member/member representative.
  
• Assesses and evaluates member’s needs via telephonic and face to face assessments and evaluations, to coordinate services and address member short term needs.
  
• Assures completion of an HRA or other assessments.
  
• Assists members to remediate immediate and acute gaps in care and access.
  
• Assists members with filing grievances and appeals.
  
• Provides information to members related to MCO requirements, services, and benefits.
  
• Provides members with information and/or referrals to community resources.
  
• Coordinates services, and monitoring and evaluating the care coordination plan against the member’s personal goals and identified needs.
  
• Guides members/families towards resources appropriate for their care.
  
• Services are driven by facilitating interactions with other payer sources, providers, interdisciplinary teams, and others involved in the member’s care as appropriate.
  
• Work assignments are often straightforward and of moderate complexity.
  
• Makes decisions regarding own work approach/priorities and follows direction.
  
• Understands own work area professional concepts/standards, regulations, strategies, and operating standards.
  
• Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.
  

Required Qualifications

• Must reside in Ohio.
  
• Must be able to travel 50% within the state of Ohio to meet with members.
  
• Minimum one (1) year of care coordination experience.
  
• Minimum one year intermediate or better of working knowledge using Microsoft Office Programs specifically Teams, Excel, Powerpoint, Outlook and Word, with the ability to troubleshoot and resolve general technical difficulties.
  
• Strong understanding and respect of all cultures and demographic diversity.
  
• Exceptional interpersonal skills with the ability to quickly build rapport.
  
• Strong written and verbal communication skills.
  
• Strong advocate for members at all levels of care.
  
• This role is considered patient facing and is a part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
  
• This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
  
• Must have the ability to provide a high speed DSL or cable modem for a home office.
  
• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  
• Satellite and Wireless Internet service is NOT allowed for this role.
  
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  
• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
  

Preferred Qualifications:

• Bachelor’s degree in Social Work, Sociology, Psychology, Gerontology or related field.
  
• Community Health Worker Certification.
  
• Prior experience with Medicaid, Medicare or dual eligible populations.
  
• Experience with health promotion, coaching and wellness.
  
• In home assessment and care coordination experience.
  
• Knowledge of community health and social service agencies and additional community resources.
  
• Previous experience with electronic case note documentation and experience with documenting in multiple computer applications/systems.
  
• Bilingual (Spanish, Somali or other) Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in assessed languages.
  

Additional Information

• Work Style: Remote with travel to see members (see below for Travel information).
  
• Workdays/Hours: Monday – Friday; 8:00 AM to 5:00 PM Eastern Time, over-time may be requested to meet business needs.
  
• Travel: 50% travel within state to meet members and to Humana Healthy Horizons office location in Dublin, OH for staff meetings and training. Leader will discuss during the interview.
  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Clipped from: https://www.linkedin.com/jobs/view/state-local-outreach-manager-medicaid-remote-at-american-cancer-society-3342193943/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Position Description

• This is a remote position that can be home-based anywhere in Alabama, Florida, Georgia, Mississippi, North Carolina, or South Carolina. ***
  
  
  

Job Summary


Under the guidance and supervision of the Sr. Outreach Manager, Medicaid, this position will work with state coalitions and partners to continue to grow and improve the patient story collection strategies and collaborate on communication strategies for the media and public for the Medicaid Covers US project. This position is part of a Project team charged with leveraging the assets and capabilities of ACS CAN to shift and reframe the perceptions of the role the Medicaid program in providing access to care for cancer patients, survivors, those with chronic diseases and those at risk with cancer and chronic diseases. The Medicaid State and Local Outreach Manager will help maintain and grow a Medicaid story bank, providing a valuable asset for ACS CAN’s work to demonstrate the role of the Medicaid program in providing low-income families and individuals access to care. The Medicaid State and Local Outreach Manager will work in close collaboration with the Medicaid Covers US project team, including the: Project Director, Medicaid State and Local Campaign Manager, project team, ACS CAN’s national and field advocacy staff, including grassroots, media advocacy staff, and policy team.


This position will also work with staff across the country in different issue areas to help build an ACS CAN wide story bank through training, support, and technical assistance in identifying, interviewing and engaging storytellers. This position will engage in strategic conversations with state staff to best identify opportunities to highlight the stories of people with lived experiences in order to better educate and advocate for ACS CAN’s mission priorities. A primary focus area for this position will be working with state coalitions and partners to expand and deepen new and existing partnerships with organizations of color in the South, particularly organizations and institutions led by and serving Black communities. In consultation with the Sr. Outreach Manager, the Medicaid State and Local Outreach Manager would develop new and existing relationships with Black-led organizations and institutions, such as with HBCUs in the South and build on existing relationships with Black Greek Life organizations (the Divine 9) that are already engaged in cancer related advocacy. The person in this role will work in close collaboration with the Medicaid Covers US project team, including the: Senior Director, Sr. Medicaid State and Local Campaign Managers, project team, ACS CAN’s national and field advocacy staff, including grassroots, media advocacy staff, and policy team.


This position will also support administrative functions related to this partnership development, including support for the contracts process, storytelling logistics such as consent forms and coordinating storyteller films, grants and funder reporting, and other duties as needed.


This is a grant-funded position, with time-limited funding.


Major Responsibilities

• Identifying and interviewing storytellers, writing their stories, with an emphasis on collecting stories from HBCU staff, faculty, and students and connections made with Black Greek Life and other HBCU affinity organizations at all levels (students, alumni) while building lasting relationships with them, and identifying ways to engage them in ACS CAN and Medicaid Covers US work.
  
• In collaboration with the Medicaid Covers US project team and media advocacy staff:
  
• Assist in the development and successful execution of a plan for identifying and collecting diverse stories from those that access health care through the Medicaid program within the target states of the project; (2) Support execution of a media plan to leverage these stories through various media channels; (3) Identify, collect, produce and deploy stories in a story sharing campaign focused on Medicaid.
  
• Working with the Project team, ACS CAN national and field advocacy staff and others as appropriate, build relationships with national, state and local organizations who can contribute to the campaign’s story-collection efforts with an emphasis on relevant HBCU professional schools and engaging and deploying participants as volunteers where appropriate.
  
• Building, tracking, and executing a sustainable stream of story leads from internal sources, including but not limited to the National Cancer Information Center, social media, and volunteers nation-wide.
  
• Assisting in the implementation of a nation-wide story bank by helping state-based staff collect and track their volunteer stories.
  
• Keeping in touch with storytellers from across the country to help them stay engaged and identifying opportunities for them to share their stories.
  
• Assist with strategizing with state teams on story identification and collection and helping with storyteller interviews. Coordinating development and rollout of a Medicaid expansion and race equity training module for use in schools of public health, social work, nursing, and medical schools in project states, including HBCUs.
  
• Working with the Project team, ACS CAN national and field advocacy staff and others as appropriate, build relationships with national, state and local organizations who can contribute to the campaign’s outreach efforts. Partnership development will focus on local, state and regional strategies in Southern states as well as diversifying project partners and reach of the campaign into communities disproportionately impacted
  
• Co-design and execute events in targeted states/communities in collaboration with project partners.
  
• Establish and maintain collaborations and partnerships with other organizations and community influencers in Southern states to forward assigned campaign objectives. Coordinate campaign activities with grassroots and community-based project partners, as well as with regional and national ACS CAN grassroots teams.
  
• Participate in state coalition strategy calls as appropriate to support and contribute to outreach strategies
  
• Collaborate with State and Local Campaigns team on execution and follow through on partner contracts, evaluating progress on contract work, and contribution to written and verbal reporting on activities as requested.
  
• Other duties as assigned.
  
  
  

Position Requirements


FORMAL KNOWLEDGE

• Preferred BS, BA degree with demonstrated campaign/legislative and or communications experience in public health, sociology, public policy, health equity, or another related field.
  
• Minimum of 5 years of public health or non-profit operational and project and budget management experience.
  
• Exceptional writing and editing skills, as well as the ability to adopt the style, tone, and voice accordingly when documenting people’s stories.
  
• Well-organized and detail oriented.
  
• Highly collaborative style.
  
• Ability to establish and maintain effective working relationships with many different stakeholders and constituencies.
  
• Ability to multi-task and can be flexible in performing tasks as priorities will change from time to time depending upon program changes.
  
• Strong interpersonal skills.
  
  
  

SPECIALIZED TRAINING OR KNOWLEDGE

• Experience producing content for the web, as well as channel-specific knowledge (blog, Facebook, Twitter, etc.).
  
• Knowledge of programs and initiatives available to individuals and families with low incomes.
  
• Experience working with individuals and families with low incomes.
  
• Experience creating and executing communications and/or campaign/legislative plans.
  
• Experience creating and managing diverse coalitions.
  
• Understanding of public policy and health insurance/Medicaid coverage.
  
• Graphic design skills are a plus.
  
  
  

Competencies/Skills

• Campaign and media and communications strategic, development, production and management skills with the ability to respond to changing circumstances/priorities.
  
• Demonstrated ability to work with coalitions and groups together to deliver results.
  
• Ability to manage internal and external collaborations.
  
• Strong verbal and written communication skills.
  
• Ability to handle difficult situations involving difficult people.
  
• Ability to handle multiple planned and unplanned projects, roles, and responsibilities.
  
• Persistent attention to detail, while maintaining an overall view of the situation.
  
• Self-motivated and able to work with limited supervision.
  
• Demonstrated work ethic, integrity and professional conduct.
  
• Consistent ability to set and deliver against a work plan in a fast-paced environment.
  
• Ability to communicate with volunteers, staff, and constituencies from multiple organizations, and to provide strategic guidance in a collaborative, consultative, and positive manner.
  
• Information research, analysis, and evaluation skills.
  
  
  

SPECIAL MENTAL OR PHYSICAL DEMANDS

• Ability to travel (by car and/or airplane) frequently.
  
• Ability to complete work deliverables while traveling.
  
• Ability to juggle multiple initiatives at the same time.
  
  
  

The American Cancer Society has adopted a vaccination policy that requires all staff, regardless of position or work location, to be fully vaccinated against COVID-19 (except where prohibited by state law).


ACS CAN provides staff a generous paid time off policy; medical, dental, retirement benefits, wellness programs, and professional development programs to enhance staff skills. Further details on our benefits can be found on our careers site at: jobs.cancer.org/benefits. We are a proud equal opportunity employer.

Clipped from: https://hirelifescience.com/career/117892/Senior-Associate-Government-Contracts-Medicaid-New-Jersey-Nj-Plainsboro

About the Department

At Novo Nordisk, our Strategy, Finance, and Operations team works to provide strategic direction to the company, ensuring that everything we do is viable and built to last. Overseeing and safeguarding Novo Nordisk’s short and long-term planning, the Strategy, Finance and Operations team works closely with the business across the organization to develop strategies and business plans, monitor industry trends, and provide operating recommendations. We regulate accounting, uphold workplace safety, manage our supply chain and sampling, support technology, provide commercial insights & analytics, maintain our facilities and assure the integrity and completeness of all business transactions. At Novo Nordisk, you will have the opportunity to build a life-changing career in a global business environment. We encourage our employees to make the most of their talent. And we reward hard work and dedication with the opportunity for continuous learning and personal development. Are you ready to realize your potential?

The Position


Responsible for processing and reconciling the Medicaid rebate claims utilizing the Model N Medicaid System. Regularly coordinates with State Medicaid agencies, contract administrators and assists with analyses on resolutions. Ensures Novo Nordisk Inc (NNI) compliance with the Medicaid Drug Rebate Program (MDRP).

Relationships

Reports to an Associate Director manager in Government Contracts – Medicaid. Internal relationships include Government Contracts, Pricing, Pricing, Contract Operations & Reimbursement and general finance. External relationships include Centers for Medicaid and Medicare Services (CMS), State Medicaid agencies and Pharmacy Benefit Administrators.

Essential Functions
 

• Data Analysis and Medicaid Reporting
  

 
 

• Attends Financial Planning &Analysis (FP&A) forecasting meetings and provides guidance to FP&A Department on potential future Medicaid events that could impact rebate forecasting
  
• Analyzes and ensures accuracy of state rebate formatted data for each level of processing
  
• Assists management in Government Compliance regarding pricing and reporting issues as required
  
• Prepares and provides standard Medicaid rebate reports to field and home office management. These reports include state utilization trending, claim receipt status, reconciliation of state invoice and ad-hoc reporting
  
• Prepares Medicaid data analyses to explain variances between rebate periods
  
• Reviews and analyzes contract terms and conditions; ensures data in the Model N Medicaid system reflects the current contract terms for accurate processing
  
• Medicaid Rebates
  

 
 

• Acts as company liaison, negotiating with state Medicaid agencies and Pharmacy Benefit Administrators regarding dispute resolution with a third party Consultant
  
• Assists internal & external customers with inquiries relating to Medicaid payments, dispute and contracts
  
• Builds and maintains relationships with internal stakeholders to build an understanding of business objectives
  
• Coordinates Medicaid claim data entry with third party vendor
  
• Coordinates Medicaid disputes with third party dispute vendor and provides periodic reporting to Senior Management.
  
• Develops and distributes quarterly analysis of Medicaid Rebate Liability
  
• Ensures compliance with all state mandated due dates by avoiding interest penalties at all times
  
• Ensures that all dispute inquires and claim level details received from the States are submitted to dispute resolution consultant in a timely manner
  
• Maintains knowledge in operation of Model N Medicaid Rebate Processing system
  
• Prepares/reviews quarterly Federal Medicaid, ADAP, SPAP (State Programs), and Supplemental Invoices; prepares/reviews prior quarter adjustments as necessary
  
• Responsible for the timely and accurate payments of all Federal and State Medicaid Rebate claims
  
• Reviews state utilization data for reasonableness and quantifies and accounts for Medicaid dispute exposure
  
• Serves as point of contact for all State Medicaid customers regarding rebate payment inquiries
  
• Stays up-to-date and applies knowledge of the Medicaid Rebate legislation to all Federal and individual State programs
  

 
 

• Systems Maintenance/Contract Administration
  

 
 

• Assists internal and external customers with inquiries relating to Medicaid payments, dispute resolution and contract inquiries
  
• Coordinates the implementation of Medicaid system enhancements and testing
  
• Coordinates with Accounts Payable and IT regarding SAP interface check requests and wire transfers
  
• Formats incoming claims data from Medicaid contract customers; ensures rebate claims data is in proper format
  
• Maintains up-to-date knowledge of Model N Medicaid system and coordinates with IT and Model N tech support as necessary
  
• Processes, reviews and validates all Medicaid rebate claims, ensuring all payments are made within the required timeframes, as stated in the contractual agreements
  
• Utilizes DNA Software for State Preferred Drug Lists and dispute analysis
  

Qualifications

 

• A Bachelor’s degree required; relevant experience may be substituted for degree when appropriate
  
• 3 years relevant experience preferred with at least 1 year required
  
• Ability to interact with various departments and levels internally and externally
  
• Ability to work independently
  
• Advanced PC skills required
  
• Experience with Government Pricing Medicaid rebate system preferred (Model N)
  
• Intermediate skills in Access and Showcase Query preferred
  
• Intermediate skills in Microsoft Excel required
  
• Knowledge of Medicaid Drug Rebate Program desirable
  
• Strong analytical, quantitative, and qualitative analysis skills required
  
• Strong attention to detail required
  
• Strong organization and prioritization skills required
  

We commit to an inclusive recruitment process and equality of opportunity for all our job applicants.

At Novo Nordisk we recognize that it is no longer good enough to aspire to be the best company in the world. We need to aspire to be the best company for the world and we know that this is only possible with talented employees with diverse perspectives, backgrounds and cultures. We are therefore committed to creating an inclusive culture that celebrates the diversity of our employees, the patients we serve and communities we operate in. Together, we’re life changing.

Novo Nordisk is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, gender identity, sexual orientation, national origin, disability, protected veteran status or any other characteristic protected by local, state or federal laws, rules or regulations.

Novo Nordisk requires all new hires to be fully vaccinated against COVID-19 prior to the first date of employment. As required by applicable law, Novo Nordisk will consider requests for reasonable accommodation.

If you are interested in applying to Novo Nordisk and need special assistance or an accommodation to apply, please call us at 1-855-411-5290. This contact is for accommodation requests only and cannot be used to inquire about the status of applications.

Clipped from: https://www.glassdoor.com/job-listing/case-manager-rn-medicaid-molina-healthcare-JV_IC1134737_KO0,24_KE25,42.htm?jl=1008221028529&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

JOB DESCRIPTION

Case Manager (RN) – Medicaid

For this position we are seeking a (RN) Registered Nurse who lives in MICHIGAN and must be licensed for the state of MICHIGAN. We cannot accept out of state licensure.

This is a telephonic case manager role, managing our Medicaid and Marketplace population

WORK SCHEDULE: Monday thru Friday 8:30AM to 5:00PM /

This is a Remote position, but will require the flexibility to go into Troy, MI location for meetings and training

Home office with internet connectivity of high speed required.

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

KNOWLEDGE/SKILLS/ABILITIES

Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member’s health or psychosocial wellness, and triggers identified in the assessment.

Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member’s support network to address the member needs and goals.

Conducts face-to-face or home visits as required.

Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

Maintains ongoing member case load for regular outreach and management.

Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for Molina members.

Facilitates interdisciplinary care team meetings and informal ICT collaboration.

Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.

Assesses for barriers to care, provides care coordination and assistance to member to address concerns.

25- 40% local travel required.

RNs provide consultation, recommendations and education as appropriate to non-RN case managers.

RNs are assigned cases with members who have complex medical conditions and medication regimens

RNs conduct medication reconciliation when needed.

JOB QUALIFICATIONS

Required Education

Graduate from an Accredited School of Nursing. Bachelor’s Degree in Nursing preferred.

Required Experience

1-3 years in case management, disease management, managed care or medical or behavioral health settings.

Required License, Certification, Association

Active, unrestricted State Registered Nursing (RN) license in good standing.

Must have valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education

Bachelor’s Degree in Nursing

Preferred Experience

3-5 years in case management, disease management, managed care or medical or behavioral health settings.

Preferred License, Certification, Association

Active, unrestricted Certified Case Manager (CCM)

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $26.41 – $51.49 an hour*

 

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.