Category: Curator- Job Hunter

Clipped from: https://www.learn4good.com/jobs/oklahoma-city/oklahoma/healthcare/1710598217/e/

Position:  Vice President Oklahoma Medicaid
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is  invested in your future!

Job Summary

This position is responsible for leadership and oversight of the Oklahoma Medicaid program operations directly at HCSC or through subcontractors.  Responsible for serving as direct th Care Authority (OHCA), managing Oklahoma Medicaid operations including profit and loss management and ensuring compliance with terms of the Contract including securing and coordinating resources.  This position is authorized and empowered to represent the MCO regarding all matters pertaining to the Contract prior to such Representation and act as liaison between MCO and the OHCA.

This position also supervises the BCBSOK Medicaid Operations personnel which includes staff that perform state reporting and delegated oversight reporting, compliance activities, medical management oversight, quality management oversight, project management and member services oversight of applicable vendors and directly performed company activities. Leverages matrix relationships with key departments at BCBSOK for network development, provider data, credentialing, IT, finance, actuary, Enterprise Government Programs, marketing and communications, and budget.

Responsibilities

Responsible for leadership, direction and oversight of Oklahoma Medicaid program operations directly at HCSC or through subcontractors.

Ensure compliance with terms of the Contract including securing and coordinating resources necessary for compliance.

Provide oversight, coordination or directly responsible for financial, clinical, IT, quality improvement, reporting, claims processing, member services, and network management. Build and maintain relationships across the company.

Accountable for contract compliance and works under the review of the Oklahoma Health Care Authority. Become familiar and keep abreast of contractual obligations through the OHCA.

Maintain business relationship with state agency personnel and federal agency personnel (as applicable) and serve as the primary point of contact in Oklahoma for those agencies as well as for HCSC Enterprise Government Programs.

Direct project activities related to new or revised regulations.

Develop processes and procedures and coordinate with various internal and external personnel. Responsible for ensuring a robust Medical Policy and Procedure Manual is developed and maintained which includes policies mandated by state and federal agencies as well as policies to guide the running of the business.

Receive and respond to or provide guidance and interpretation of impacted areas for all inquiries and requests made by made by the OHCA related to the Contract and in the time frames specified by OHCA.

icipate in regular OHCA and MCO Executive Director meetings or conference calls.

Make best effort to promptly resolve any issues identified by HCSC, vendors or federal/state agencies that may arise and are related to the Contract.

Meet with OHCA representatives on a periodic or as needed basis to review HCSC’s performance and resolve issues. Includes meeting with OHCA e requested by OHCA if OHCA determines that HCSC is not in compliance with the requirements of the Contract.

Responsible for P & L of the line of business which includes budget, reporting and systems.

Build and maintain relationships with subcontractors.

Ensure direct internal and subcontractor staff are trained on all state, federal and business requirements and meet/exceed goals and initiatives.

Responsible for presentations to upper management and governmental agencies.

Job Requirements:

Bachelor degree.

10 years in a leadership/management position.

10 years health care/managed care experience.

Experience with government contracting.

Knowledge of managed care practices, utilization and care management, accounting, provider networking and member services.

Experience to lead multifunctional business unit.

PC proficiency including Word, Excel and PowerPoint.

Presentation skills.

Verbal and written communications skills including interpersonal skills to interface ls of the organization and represent the company to subcontractors and government agency.

Preferred

Requirements:

Masters Degree.

Experience working with OHCA or Medicaid Populations.

#LI-BP1

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We encourage people of all backgrounds and experiences to apply.

Even if you don’t think you are a perfect fit, apply anyway – you might have qualifications we haven’t even thought of yet.

Are you being referred to one of our roles? If so, ask your connection t our Employee Referral process!

HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer…

Clipped from: https://www.talent.com/view?id=943aa6d577e0&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Overview

Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting.

By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation.

Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success.

The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies.

For more information, please visit www.guidehouse.com.

Responsibilities

We are seeking a Senior Consultant with experience and knowledge of national healthcare reform and its impact on state Medicaid, public health or state and local health and human services programs, including health benefits exchanges, Medicaid expansion, Medicaid managed care, Medicaid program operations, program improvement and state compliance requirements, as well as a strong understanding about various state and local programs and policies across the country.

The successful candidate will :

• Assist state agencies, including Medicaid, Behavioral Health, Developmental and Intellectual Disabilities, State Units on Aging and / or Social / Human Services in the development of strategic plans to support the statewide implementation of healthcare reform
  
• Assist clients in assessing business and technical requirements related to the implementation of healthcare reform, including managed care programs and Accountable Care arrangements
  
• Research and stay abreast of all states’ healthcare reform efforts
  
• Perform data and qualitative research activities to address state research needs
  
• Document and communicate findings and support development of recommendations and follow-up steps to respond to findings
  
• Identify and collaborate with broad range of healthcare stakeholders
  
• Participate in analysis of client-identified issues or problems
  
• Manage projects and engagements of various sizes and durations
  
• Supervise and support the development of staff
  
• Effectively manage client interaction and managing client expectations
  
• Provide subject matter expertise, as requested and appropriate
  
• Help develop business with new clients, as requested
  
• Participate in non-client related firm-building activities
  

Qualifications

• A Bachelor’s degree in business administration (finance or accounting), economics or similar discipline – OR – A Master’s degree in health policy and administration, public policy, public health, social service administration OR equivalent
  
• 2-3 years of previous work experience in the health care industry, preferably in a consulting capacity or consulting firm
  
• Knowledge of state health agencies and healthcare reform, e.g., Medicaid, public health, health insurance, and health reform organizations (legislative, executive, governor’s office
  
• Ability to travel to meet client needs (10-30%) as required
  

Preferred :

• Superior written and oral communication skills
  
• Excellent quantitative analysis skills
  
• A strategic problem solver
  
• Demonstrated ability to self-manage task execution and manage discreet task / project / initiative functions.
  
• Working knowledge of Word, Excel, PowerPoint, and Access as well as the ability to conduct research through use of the internet and other information sources
  
• The ability to work overtime as necessary
  
• Assure high-quality client work product
  

Additional Requirements

• The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
  
• The salary range for this consultant role is $80,000 to $115,000 but may vary based on experience and location
  
• Applicants must be currently authorized to work in the United States for any employer.
  
• No sponsorship is available for this position.
  
• Due to our contractual requirements, to be eligible for this role, you must be fully COVID-19 vaccinated at time of hir e.
  

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation guidehouse.

com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Rewards and Benefits

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include :

• Medical, Rx, Dental & Vision Insurance
  
• Personal and Family Sick Time & Company Paid Holidays
  
• Position may be eligible for a discretionary variable incentive bonus
  
• Parental Leave and Adoption Assistance
  
• 401(k) Retirement Plan
  
• Basic Life & Supplemental Life
  
• Health Savings Account, Dental / Vision & Dependent Care Flexible Spending Accounts
  
• Short-Term & Long-Term Disability
  
• Tuition Reimbursement, Personal Development & Learning Opportunities
  
• Skills Development & Certifications
  
• Employee Referral Program
  
• Corporate Sponsored Events & Community Outreach
  
• Emergency Back-Up Childcare Program
  

Clipped from: https://getwork.com/details/ade8ed6c30a27fec89837a2ca75a8014?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description

Aetna Better Health® Medicaid plans have a proven record as trusted managed care organization partners for 30 years, currently serving approximately 2.8 million members in 16 states. Aetna Inc.’s acquisition by CVS Health (a Fortune 4 company and the nation’s largest retail pharmacy) in 2018 resulted in the creation of a company characterized by innovation with a strong community-based footprint, market reach, financial resources, and name recognition to expand delivery of Medicaid managed care services. Aetna Inc.’s health insurance plans and services include medical, pharmacy, and dental plans; Medicare plans; Medicaid services; Duals programs; behavioral health programs; and programs tailored for foster youth, individuals with serious emotional disturbance, and the justice-involved. We are seeking to hire a Head of the Medicaid Proposal Development team will lead all activities related to the management of RFP responses. These responsibilities include designing and leading an innovative and efficient Proposal Development team that collaborates with subject matter experts across the organization to produce and submit innovative and winning Medicaid proposals. This is a fantastic opportunity to be a part of growth focused Medicaid division passionate about healthcare innovation and integration between CVS and Aetna.

• Full accountability for directing the development, production, and submission of large, highly complex responses to state Medicaid Requests for Proposals (RFP) where revenue and membership growth is generated by winning and retaining strategic contracts through the competitive RFP process. • Works collaboratively with State CEOs, Medical Management, Legal, Compliance, Operations, Actuary, Network, Finance and Implementation to ensure strategic procurement solutions meet Aetna Medicaid’s model of care, are cost-effective, and compliant. • Directs end-to-end continuum of the procurement process, following professionally recognized business processes, to determine gaps, develop solutions, draft the proposal, and obtain executive approval. • Works with Finance and Actuary to submit competitive rates, produce final proposals, and conduct a thorough quality review to ensure submitted proposals are completed with all necessary information required in order to not be disqualified. • Establishes and manages relationships with Senior leaders across the enterprise and with outside consultants.
  

The Role

ED, Head of the Medicaid Proposal Development

• Builds an effective proposal team and process through transformational leadership skills and compelling leadership capabilities. Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions, including employment, termination, performance reviews, salary reviews, and disciplinary actions. Performs other duties as required.
  

REMOTE – working East Coast hours

Pay Range

The typical pay range for this role is:

Minimum: 131,500

Maximum: 289,300

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

Strong knowledge of Medicaid and the public procurement process

• Experience managing a proposal (RFP) team will be highly valued but not required
  
• Possess a strategic mindset with an understanding of what it takes to win and the ability to develop and execute a plan
  
• Strong operational mind, compliance management, strong project management skills
  
• Ability to lead a team to support strategy development, competitive positioning, and differentiation within proposals to drive winning business
  
• Excellent writing and communication skills
  
• Strong problem solving, management skills, leadership skills • Knowledge best practice of RFP database and process will be valued
  
• Familiarity with industry standards and nomenclature for proposal management such as Shipley or other similar training will be valued
  
• Ability to respond to rapidly changing direction and priorities across multiple projects while overseeing team efforts
  
• Align with the Heart at Work Behaviors of CVS Health – Put people first; Join forces; Inspire Trust; Rise to the Challenge; Create
  

Preferred Qualifications

• Advanced Degree
  

Education

• Bachelor’s Degree
  

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.linkedin.com/jobs/view/medicaid-helpline-agent-at-nyc-department-of-social-services-3293971765/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description


The Medicaid Helpline provides information to New Yorkers on enrolling in Medicaid public health insurance. The agency’s Medical Assistance Program helps New Yorkers who qualify enroll in public health insurance programs like Medicaid. The Helpline receives inquiries from providers, hospitals, client representatives, community-based organizations, and others.


Under the supervision of the Team Supervisor, with some latitude for independent judgement, the Medicaid Helpline Agent is responsible for providing information to callers on the Medicaid program and services. The Office of Constituent Services is recruiting for eight (8) Eligibility Specialist II’s to function as a Medicaid Helpline Agents in the DSS Infoline/Helpline call center.


The Medicaid Helpline Agent will:

• Respond to telephone inquiries from the general public and clients by providing information,
  
  
   
  

including but not limited to eligibility criteria, phone numbers, program description and Medicaid


status.

• Screen calls and perform a preliminary assessment of callers needs to determine whether a
  
  
   
  

caller can be serviced by the core information line, or she/he requires additional assistance.

• Utilize the Intranet Quorum (IQ) system to report complaints from the client regarding their case.
  
• Review pertinent data from New York State EMEDNY system in order to substantiate and review
  
  
   
  

eligibility.

• Utilize automated office systems to evaluate applicant documentation and to verify pertinent date;
  
  
   
  

determines the need for additional information.

• Consult with the Team Supervisor as needed on overall problems and if questions arise.
  
• Enter caller information, which generates a letter in the clerical support unit, to be sent with
  
  
   
  

applications, informational and/or pamphlets to the caller or is forwarded to a program area for


action.

• Enter/Update/Retrieve information on an electronic information storage system by operation
  
  
   
  

control consoles/keyboards/other, in order to facilitate clearance/search/verification/other operations.

• Access/update/retrieve information from manual files/sources, in order to facilitate clearance/search
  
  
   
  

/verification/other operations.

• Initiate and/or complete paperwork as required.
  
  
   
  

Minimum Qual Requirements

• Completion of 60 semester credits at an accredited college; or
  
• A four-year high school diploma or its educational equivalent and two years of full-time satisfactory experience in one or more of the following areas; performing the work described below:
  
• Interviewing, gathering information and/or preparing necessary documentation for the purpose of making decisions concerning eligibility for public assistance or unemployment, health benefits, social security, casualty, property or liability insurance, or other similar benefits; or
  
• Performing bookkeeping, bank teller duties, housing office teller duties, purchasing agent, assistant store manager, sales representative responsible for accounts, or customer service representative responsible for making determinations; or
  
• Dealing with social service agencies or aiding individuals in solving housing, social, financial or health problems as a community organization representative; or
  
• A satisfactory combination of education and/or experience equivalent to “1” or “2” above. College education may be substituted for the experience in “2” above on the basis that 30 semester credits from an accredited college may be substituted for each year of required experience. However, all candidates must have at least a four year high school diploma or its educational equivalent.
  
  
   
  

Special Note


Work experience which provides only incidental opportunities to perform the job duties as described in “2a”, “2b” and “2c” above are not acceptable for meeting the minimum qualification requirements. Examples of unacceptable work experience include, but are not limited to, experience as a token clerk, check-out clerk, sales clerk, teacher’s aide, cashier, receptionist or secretary.


Additional Information

• LOAN FORGIVENESS
  
  
   
  

The federal government provides student loan forgiveness through its Public Service Loan Forgiveness Program (PSLF) to all qualifying public service employees. Working with the DSS/HRA/DHS qualifies you as a public service employee and you may be able to take advantage of this program while working full-time and meeting the program’s other requirements.


Please visit the Public Service Loan Forgiveness Program site to view the eligibility requirements:


https://studentaid.ed.gov/sa/repay-loans/forgiveness-cancellation/public-service


In addition, the Human Resources Administration/Department of Social Services offers competitive salaries and the following benefits:


Generous Pension Plans (The New York Employees’ Retirement System);


401(k) and 457 Roth’s Retirement Savings Programs;


U.S. Savings Bonds Flexible Spending Program;


Health Benefits, Dental, Vision Coverage, Prescription Drug Program;


Training and Professional Development;


Opportunity for Scholarship; College Savings Program;


Paid Holidays and Generous Annual Leave;


To Apply

If you are hired provisionally in this title, you must take and pass the Civil Service Exam, when it becomes


available, to be eligible for continued employment.


The exam will open for filing from November 2-22, 2022 and the exam will be available to take starting February 4, 2023.


Click “APPLY NOW” Button.


55-a Program

This position is also open to qualified persons with a disability who are eligible for the 55-a Program. Please indicate at the top of your resume and cover letter that you would like to be considered for the position through the 55-a Program.


Hours/Shift

M-F, 11:00am-7:00pm (Straight Time) No Flextime Available


Work Location

92-31 Union Hall Street, Jamaica, NY 11433


Residency Requirement

New York City residency is generally required within 90 days of appointment. However, City Employees in certain titles who have worked for the City for 2 continuous years may also be eligible to reside in Nassau, Suffolk, Putnam, Westchester, Rockland, or Orange County. To determine if the residency requirement applies to you, please discuss with the agency representative at the time of interview.

Clipped from: https://www.startwire.com/jobs/durham-ct/executive-director-head-proposal-development-medicaid-4131377858?source=seo&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description

Aetna Better Health® Medicaid plans have a proven record as trusted managed care organization partners for 30 years, currently serving approximately 2.8 million members in 16 states. Aetna Inc.s acquisition by CVS Health (a Fortune 4 company and the nations largest retail pharmacy) in 2018 resulted in the creation of a company characterized by innovation with a strong community-based footprint, market reach, financial resources, and name recognition to expand delivery of Medicaid managed care services. Aetna Inc.s health insurance plans and services include medical, pharmacy, and dental plans; Medicare plans; Medicaid services; Duals programs; behavioral health programs; and programs tailored for foster youth, individuals with serious emotional disturbance, and the justice-involved. We are seeking to hire a Head of the Medicaid Proposal Development team will lead all activities related to the management of RFP responses. These responsibilities include designing and leading an innovative and efficient Proposal Development team that collaborates with subject matter experts across the organization to produce and submit innovative and winning Medicaid proposals. This is a fantastic opportunity to be a part of growth focused Medicaid division passionate about healthcare innovation and integration between CVS and Aetna.

Full accountability for directing the development, production, and submission of large, highly complex responses to state Medicaid Requests for Proposals (RFP) where revenue and membership growth is generated by winning and retaining strategic contracts through the competitive RFP process. Works collaboratively with State CEOs, Medical Management, Legal, Compliance, Operations, Actuary, Network, Finance and Implementation to ensure strategic procurement solutions meet Aetna Medicaids model of care, are cost-effective, and compliant. Directs end-to-end continuum of the procurement process, following professionally recognized business processes, to determine gaps, develop solutions, draft the proposal, and obtain executive approval. Works with Finance and Actuary to submit competitive rates, produce final proposals, and conduct a thorough quality review to ensure submitted proposals are completed with all necessary information required in order to not be disqualified. Establishes and manages relationships with Senior leaders across the enterprise and with outside consultants.

The Role

ED, Head of the Medicaid Proposal Development

Builds an effective proposal team and process through transformational leadership skills and compelling leadership capabilities. Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions, including employment, termination, performance reviews, salary reviews, and disciplinary actions. Performs other duties as required.

REMOTE – working East Coast hours

Required Qualifications

Strong knowledge of Medicaid and the public procurement process

Experience managing a proposal (RFP) team will be highly valued but not required

Possess a strategic mindset with an understanding of what it takes to win and the ability to develop and execute a plan

Strong operational mind, compliance management, strong project management skills

Ability to lead a team to support strategy development, competitive positioning, and differentiation within proposals to drive winning business

Excellent writing and communication skills

Strong problem solving, management skills, leadership skills Knowledge best practice of RFP database and process will be valued

Familiarity with industry standards and nomenclature for proposal management such as Shipley or other similar training will be valued

Ability to respond to rapidly changing direction and priorities across multiple projects while overseeing team efforts

Align with the Heart at Work Behaviors of CVS Health Put people first; Join forces; Inspire Trust; Rise to the Challenge; Create

Preferred Qualifications

Advanced Degree

Education

Bachelor’s Degree

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.

Req ID

2282877BR

Clinical Licensure Required

N/A

Job Category

Aetna Better Health

Business Area

Aetna

Job Type (Expected Hours Category)

Full Time

Location – State/City

CT – Work from home

Location code

WFHCT

State

CT

FLSA

Exempt

Requisition Template

Professional

Sourcing Requisition

No

No. of Positions

1

Annual Min

131,500

Annual Max

289,300

Clipped from: https://getwork.com/details/149aa79fa5734683d00a6cc9274a3c2b?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Overview

AIR’s Payer Innovation, Transformation, and Support program area is seeking a Researcher with a strong background in Medicare and Medicaid policy to join AIR’s Health Division. The Researcher will support projects ranging from technical assistance and implementation support to evaluation and analytical support for CMS, states, and foundations.

Candidates hired for the position might initially start working remotely but will eventually have the option to work from one of our offices located in Arlington, VA; Rockville, MD; Austin, TX; Chicago, IL; Chapel Hill, NC or Waltham, MA or continue to work remotely.

About AIR:

Established in 1946, with headquarters in Arlington, Virginia, AIR is a nonpartisan, not-for-profit institution that conducts behavioral and social science research and delivers technical assistance to solve some of the most urgent challenges in the U.S. and around the world. We advance evidence in the areas of education, health, the workforce, human services, and international development to create a better, more equitable world.

AIR’s commitment to diversity goes beyond legal compliance to its full integration in our strategy, operations, and work environment. At AIR, we define diversity broadly, considering everyone’s unique life and community experiences. We believe that embracing diverse perspectives, abilities/disabilities, racial/ethnic and cultural backgrounds, styles, ages, genders, gender identities and expressions, education backgrounds, and life stories drives innovation and employee engagement. Learn more about AIR’s Diversity, Equity, and Inclusion Strategy and hear from our staff by clicking here.

Responsibilities

The responsibilities for the position include:

• Provide research and analytical support and task-level leadership for major contract and grant research, implementation, technical assistance, and evaluation projects.
  
• Support project teams in developing and carrying out the work, manage small teams under the leadership of Senior and Principal Researchers to ensure the timely completion of all deliverables within budget, and with high quality research standards that meet client requirements.
  
• This position will require collaboration within and outside AIR, including with program providers, subject matter experts, as well as federal, state, and local agency officials.
  

Qualifications

Education, Knowledge, and Experience:

• Master’s degree in health administration, MPP, MBA or MPA (with health-related focus/concentrations) with 4+ years of experience in a similar contracted research/consulting firm, Federal or State-level government, or foundation that conducts policy and health services research, or PhD in public policy, economics, psychology, sociology, anthropology, other social science discipline.
  
• At least 2 years of experience working on Medicaid-related research.
  
• Some experience with research on either Medicare or state-based health exchanges is preferred but not required.
  

Skills:

• Experience leading projects and/or tasks that require mixed methods:
  
• Qualitative and quantitative research skills and methods, such as developing interview guides and leading interviews, conducting/analyzing surveys, or abstracting information from documents; analyzing policies, regulations, and agency guidance; calculating and interpreting descriptive statistics, and understanding and interpreting inferential statistic
  
• Writing skills, including conceptualizing, organizing, drafting, and managing written deliverables such as reports, memos, PowerPoint presentations, or other client-facing materials.
  
• AIR is seeking a Researcher who values diversity, equity, and inclusion.
  
• Comfortable working in a virtual/dispersed work environment.
  

Disclosures:

AIR requires all new hires to be fully vaccinated against COVID-19 or receive a legally required exemption from AIR, as a condition of employment. AIR will ask candidates to verify their vaccination status only after a conditional offer of employment is made. Applicants should not provide information about their vaccination status or need for exemption prior to receiving a conditional offer of employment from AIR

Applicants must be currently authorized to work in the U.S. on a full-time basis. Employment-based visa sponsorship (including H-1B sponsorship) is not available for this position. Depending on project work, qualified candidates may need to meet certain residency requirements.

All qualified applicants will receive consideration for employment without discrimination on the basis of age, race, color, religion, sex, gender, gender identity/expression, sexual orientation, national origin, protected veteran status, or disability.

AIR adheres to strict child safeguarding principles. All selected candidates will be expected to adhere to these standards and principles and will therefore undergo rigorous reference and background checks.

Clipped from: https://www.mendeley.com/careers/job/senior-data-analyst-17781392?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 

**Type of Requisition:** Regular

**Clearance Level Must Be Able to Obtain:** None

**Job Family:** Data Analysis

GDIT is searching for Senior Data Analyst to join our growing team. You will support an exciting new program focused on identifying vulnerabilities in Medicaid, Medicare and the Marketplace. The position will focus on reviewing and analyzing publicly available data related to Medicaid, Medicare, and/or Marketplace exchanges. Our work depends on a Senior Data Analyst joining our team to support our customer, Center for Medicare and Medicaid Services (CMS) activities. At GDIT, our people are at the center of everything we do. As a Senior Data Analyst supporting CMS Vulnerability Management Contract. You will be trusted to work on specific technology and data science tools to identify vulnerabilities within CMS’ programs in Medicare, Medicaid, and Marketplace. In this role, a typical day will include:

+ Collaborating with CMS Center for Program Integrity (CPI) to effectively identify and target specific healthcare vulnerabilities to detect and prevent FWA

+ Extract qualitative and quantitative relationships (i.e., patterns, trends) from large amounts of publicly available data using SAS, SQL, R, Python, or other statistical tools

+ Gather and organize information for use in supporting decision-making process

+ Collect, manipulate, analyze, evaluate, and display data using visualization tools

+ Perform data analysis and create data summaries using descriptive statistics

+ Implement open-ended data merges, data analysis plans, and perform complex data manipulation and reporting tasks

+ Develop, write, and present detailed technical solutions to solve open-ended business problems to technical and non-technical audiences

**Required Skills:**

+ Bachelor’s degree and 8+ years related experience (or equivalent combination of education and experience such as a Masters and 6+ or no degree and 12 years)

+ Medicare, Medicaid and/or Healthcare Marketplace experience

+ Superior skills conducting statistical and mathematical modeling and analysis using SAS software

+ Superior skills using SQL for data manipulation purposes

+ Experience developing and presenting solutions to complex, open-ended problems

+ Experience proactively identifying and working collaboratively with stakeholders to resolve data anomalies, data quality, and compliance issues in administrative data

+ Experience matching and merging disparate data sets

+ Experience using MS Excel and PowerPoint for analysis and presentation of results

**Desired Skills:**

+ Experience with fraud detection

+ Experience using data visualization tools such as Tableau

+ Experience conducting health care related research and analytics

+ Superior customer service skills working proactively and collaboratively with federal or state research, compliance, and policy staff and stakeholders to implement and enhance internal and external management reports and public-facing data analysis tools and data sets

+ Superior multi-tasking and organization skills. Must manage multiple simultaneous projects and prioritize assignments and tasks, accordingly, remaining flexible to changing priorities and new initiatives

+ Superior written and verbal skills. Must write succinctly and clearly and explain complex situations in plain English to technical and non-technical audiences

\#CMSVulnerabilityManagement

\#GDITHealthSystems

\#GDITPriority

COVID-19 Vaccination: GDIT does not have a vaccination mandate applicable to all employees. To protect the health and safety of its employees and to comply with customer requirements, however, GDIT may require employees in certain positions to be fully vaccinated against COVID-19. Vaccination requirements will depend on the status of the federal contractor mandate and customer site requirements.

We are GDIT. The people supporting some of the most complex government, defense, and intelligence projects across the country. We deliver. Bringing the expertise needed to understand and advance critical missions. We transform. Shifting the ways clients invest in, integrate, and innovate technology solutions. We ensure today is safe and tomorrow is smarter. We are there. On the ground, beside our clients, in the lab, and everywhere in between. Offering the technology transformations, strategy, and mission services needed to get the job done.

GDIT is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.

Clipped from: https://careers.highmarkhealth.org/explore-jobs/job/j215501-senior-compliance-analyst-medicare-medicaid-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Company :

Highmark Wholecare

Job Description : 

JOB SUMMARY

This job partners with business units to ensure compliance to rules, regulations, policies, and procedures of governmental, contractual, and/or corporate entities.  Provides consultation and analytic support to assigned functional areas.  Continuously monitors regulatory changes, legislative efforts, industry trends, and/or contract changes.

ESSENTIAL RESPONSIBILITIES

• Manage and coordinate compliance related processes.
  
• Monitor governance and compliance of rules, regulations, policies, and procedures and assist with appropriate audits, as applicable.  Contacts may include legislators, consumers, special interest groups, advocacy agencies, CMS and other regulatory bodies such as DPW.
  
• Ensure systems are updated and accurate for compliance. 
  
• Responsible for understanding and applying accreditation and regulatory requirements.  May support Regulatory Compliance department to ensure all state renewals, applications, and annual reports are completed accurately and timely.
  
• Depending on department may be responsible for one of the following:  the delegation oversight of subcontractors when applicable to ensure compliance with health plan standards and policies and regulatory bodies;  performing and providing oversight of the care management delegation functions of multiple vendors through review of annual assessments, monthly performance reporting and analysis of reports to ensure adherence to regulatory and accreditation standards.
  
• Other duties as assigned or requested.
  

QUALIFICATIONS

Minimum

• Bachelor Degree required
  
• 5 or more years of relevant, progressive experience in the area of specialization
  

Preferred

• Master’s Degree preferred
  
• Experience in one or more of the following:  healthcare operations, compliance, auditing, investigations, regulatory accreditation, process improvement, project management and/or managed care operations
  

Knowledge, Skills and Abilities 

• Strong written and oral communication skills.
  
• Strong customer orientation with excellent interpersonal skills, including interview techniques, good judgment, initiative, and discretion in confidential or sensitive matters.
  
• Self-starter with the ability to work under pressure independently and as part of a team.
  
• Superior decision-making abilities under a variety of circumstances and creative thinking and effective risk mitigation abilities.
  
• Strong process improvement and project management skills.
  
• Strong analytical ability.
  
• Demonstrated ability to effectively interact with all levels within the organization.
  
• Proficiency with Microsoft Office software programs and database query tools, and other Internet and Intranet applications and databases.
  

SCOPE OF RESPONSIBILITY  

Does this role supervise/manage other employees?   

No 

WORK ENVIRONMENT

Is Travel Required? 

No  

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-product-strategist-work-from-home-express-scripts-at-express-scripts-3332381847/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description Of Position

 
 

• The Product Management Senior Advisor is responsible for working across Express Scripts Regulated Markets division and cross-functionally to define the overall Medicaid strategy for our current products and capabilities. This individual will closely coordinate with cross-enterprise teams to identify, propose, prioritize and execute projects that drive value to our stakeholders and meet the needs of our client and members. The ideal candidate will have a broad based knowledge of Regulated Markets/PBM, a strategic mindset, and the ability to influence and drive change.
  

 
 

Essential Functions

 
 

• Regularly monitor the competitive market landscape (i.e., market trends, competitor offerings, needs of key stakeholders, etc.). and in partnership with Regulated Markets stakeholders, ensure the team’s strategic direction is properly focused.
  
• Address the specific and unique needs of the various Medicaid markets, identify and introduce products and capability enhancements that drive continued profitable growth, client and customer savings, and better health outcomes.
  
• Collaborate with Regulated Markets and other key Product owners across Evernorth to align strategies to ensure competitive positioning, profitability and responsiveness to market needs.
  
• Effectively maximize key relationships to create synergies, alliances and opportunities.
  
• Partner with team to determine success metrics for products and follow-up with postmortem analysis of product misses, based on stakeholder feedback.
  
• Communicate project statuses, insights, and resulting business recommendations to senior leadership and matrix partners.
  

 
 

Knowledge/Skills And Abilities

 
 

• Bachelor’s or Master’s Degree in business, marketing, operations or related field, at least 5 years of relevant experience in Regulated Markets/Medicaid is strongly preferred.
  
• Experienced influencer and collaborator, working through others, building relationships and leading in a matrix organization.
  
• Strong learning skills and ability to adapt quickly to changing environment.
  
• Comfortable navigating and informing strategy against CMS regulation.
  
• Individual contributor, organized and process oriented.
  
• Exceptional organizational agility skills with a strong understanding of business processes, operations and financials to facilitate execution of initiatives.
  
• Excellent communication and presentation skills with experience communicating with internal and external individuals in various functional areas and at various levels of management.
  
• Proficient in Excel and PowerPoint
  

 
 

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

 
 

For this position, we anticipate offering an annual salary of 101,100 – 168,500 USD / yearly, depending on relevant factors, including experience and geographic location.

 
 

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

 
 

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

 
 

About Cigna

 
 

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

 
 

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

 
 

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

 
 

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

Clipped from: https://www.dice.com/jobs/detail/df0afb3861348099f6eb3d1bbd3b79dc?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Overview

About Public Consulting Group

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 www.publicconsultinggroup.com.

Responsibilities

The Medicaid marketplace is changing, and PCG is at the forefront. We are looking for an experienced Medicaid Consultant to join our team and help lead our growth efforts. Deep Medicaid experience is critical, as well as experience working with the Centers for Medicare and Medicaid Services (CMS) and the new streamlined modular certification (SMC) and outcomes-based certification (OBC). Our ideal Medicaid Consultant will provide oversight and direction for scope, schedule, , quality, , communications, risk, and , stakeholder management activities, all while adding deep Medicaid and Medicaid Enterprise Systems (MES) experience and thought leadership

Specific Responsibilities:
• Demonstrated understanding and knowledge of Medicaid, CMS, SMC/OBC, and MES
• Conduct Medicaid System Assessments
• Help states plan for and execute SMC/OBC activities
• Help lead and provide expert level guidance on various projects
• Ensure planned results are achieved on time
• Work with clients, vendors, team members to establish and achieve project goals
• Address problems through risk management and contingency planning
• Plan, organize, execute, and monitor and control project activities
• Perform project assessments and report on project progress
• Facilitate meetings and present project information
• Identify, document, and/or escalate issues to appropriate levels

Qualifications

Required Skills/Experience:
• Bachelor’s degree or equivalent university degree
• 5+ years experience performing project oversight and assessments for a large enterprise grade information technology initiative
• 4+ years experience performing performance metrics measurements and reporting to management and executive level staff.
• Demonstrated experience working with SMC/OBC
• Demonstrated written and verbal communications skills
• Ability to influence internal and external stakeholders
• Ability to lead/manage others in a matrixed environment
• Proficiency in Microsoft applications (Outlook, Word, Excel, PowerPoint, Visio, Project) and project management tools

#LI-AH1

#D-PCG

#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, or any other 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.