Posted on

Director, Medicaid Enrollment (Remote) at Molina Healthcare in Long Bch, California

Clipped from: https://molina-healthcare.talentify.io/job/director-medicaid-enrollment-remote-long-bch-california-molina-healthcare-2016368?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description

Job Summary
Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan’s member and enrollment records, employer’s monthly reports, sending membership cards and materials. Verify enrollment status, make changes to records, research and resolve enrollment system rejections. Address a variety of enrollment questions or concerns received via claims, call tracking, or e-mail. Maintain records in the enrollment database.

Work Location – Remote, within the United States of America

Knowledge/Skills/Abilities

• Holds general oversight of enrollment and premium staff at each plan site within defined region. This may include employee reviews, coaching sessions and disciplinary actions.
• Monitors and enforces compliance with company-wide reconciliation processes.
• Ensures that delivery of enrollment / premium related data is accurate for defined region.
• Subject matter expert for projects and / or new business related to areas of oversight.
• Oversees maintenance of policies and standard operating procedures..


Required Education
Graduate Degree or equivalent combination of education and experience

Required Experience

7-9 years

Preferred Experience

10+ years


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.

Posted on

State of Mississippi Medicaid Operations Leaders, Jackson, Mississippi

Clipped from: https://jobs.myarklamiss.com/jobs/state-of-mississippi-medicaid-operations-leaders-jackson-mississippi/738379501-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Apply for this job now Location Jackson, Mississippi Posted 11 Oct 2022

Summary

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

Your role in our mission

Essential Job Functions

  • Oversees the day-to-day operations of the customer support center operations.
  • Conveys customer feedback to product development staff in order to continuously improve client satisfaction.
  • Manages customer support staff to ensure service level agreements for products and services are met. Schedules staff to adequately handle call volume on any point in time. Monitors progress and number of telephone calls made. Manages personnel activities of staff (i.e., hires, trains, appraises, rewards, motivates, disciplines, recommends termination as necessary, etc.).
  • Manages customer support functional activities for products, and contributes to overall service profitability by efficiently using staff and systems in the customer support area. Improves quality and responsiveness of customer support staff and resources.
  • Contributes to overall service revenue by generating new and creative ideas to sell add-on services. Promotes sales of various service options.

What we are looking for

  • Bachelor’s degree or equivalent combination of education and experience
  • Bachelor’s degree in business management, computer science or related field preferred
  • Nine or more years of customer service or other telephone operations experience
  • Five or more years of leadership or supervisory experience
  • Experience working with the company’s products and systems

What you should expect in this role

Office Environment

Apply for this job now

Details

  • Job Reference: 738379501-2
  • Date Posted: 11 October 2022
  • Recruiter: Gainwell Technologies LLC
  • Location: Jackson, Mississippi
  • Salary: On Application
Posted on

Health Equity Director – WV Medicaid Job South Carolina

Clipped from: https://www.learn4good.com/jobs/online_remote/healthcare/1598756976/e/

LOCATION:

This is a remote from home position with occasional visits to the Charleston office. You must be a resident of WV or be willing to relocate.

.

HOURS:
General business hours, Monday through Friday.

.

TRAVEL:
Approximately 25% travel is required throughout the state, and occasional national travel may be required.

.

This is a very strategic position that is responsible for assisting the state Health Plan community and stakeholder engagement experience, while applying application of science-based quality improvement methods to reduce health disparities.

.

Primary duties may include, but are not limited to:

  • Assist with the strategic design, implementation, and evaluation of health equity efforts in the context of the population health initiatives.
  • Inform decision-making around best payer practices related to disparity reductions, including the provision of health equity and social determinant of health resources and research to leadership and programmatic areas.
  • Inform decision-making regarding best payer practices related to disparity reductions, including providing Health Plan teams with relevant and applicable resources and research and ensuring that the perspectives of members with disparate outcomes are incorporated into the tailoring of intervention strategies.
  • Collaborate with the Health Plan analytics team to ensure the Health Plan collects and meaningfully uses race, ethnicity, and language data to identify disparities.
  • Coordinate and collaborate with members, providers, local and state government, community-based organizations, and other entities to impact health disparities at a population level; and ensure that efforts addressed at improving health equity, reducing disparities, and improving cultural competence are designed collaboratively with other entities to have a collective impact for the population.

.

Required Qualifications

  • Requires a BA/BS degree; ination of education and experience, which would provide an equivalent background.
  • 5+ years of experience, in public health, social/human services, social work, public policy, health care, education, community development, or justice.

.

Preferred

Qualifications

  • MPH or higher is strongly preferred.
  • A background working in public health is strongly preferred.
  • The ability to speak publicly and host a conversation is a must!
  • Previous social service experience/Medicaid familiarity is very helpful.
  • Previous leadership skills, either as a project manager or people leader, is preferred.
  • Ability to work with cross-functional teams is extremely important.
Posted on

Manager, Care Management (Physical Health & Behavioral Health) – Ohio Medicaid – Humana

Clipped from: https://www.ziprecruiter.com/c/004-Humana-Insurance-Company/Job/Manager,-Care-Management-(Physical-Health-&-Behavioral-Health)-Ohio-Medicaid/-in-Dover,OH?jid=5691ba4d736230ee&lvk=6qgI7bX9GeztnmN_EI9JGA.–MehRJ_72-&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description

Humana Healthy Horizons in Ohio is seeking Managers of Care Management (Physical Health & Behavioral Health) who will lead our physical or behavioral health care management operations and staff to ensure timely and culturally-competent delivery of care, services, and supports in compliance with Ohio Department of Medicaid (ODM) contractual requirements and industry best practices.

Responsibilities

Essential Functions and Responsibilities:

  • Supervise care management personnel and oversee all care management functions, including assessment, care planning, and care coordination.
  • Lead development of care management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.
  • Collaborate with internal departments, providers, and community partners to support the delivery of high-quality care management services, including introducing innovative approaches to care coordination.
  • Oversee the processes for comprehensive enrollee assessments to identify their individual needs.
  • Monitor and maintain staffing levels to meet care and service quality objectives.
  • Support orientation and training of staff.
  • Conduct timely evaluations of direct reports and provide regular opportunities for professional development.
  • Influence and assist corporate leadership in strategic planning to improve effectiveness of case and disease management programs for physical health and behavioral health.
  • Collect and analyze performance reports on care management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership

Oversee Care Management staff to ensure the following:

  • Utilize a holistic, enrollee-centric approach to engage and motivate enrollees and their families through recovery and health and wellness programs.
  • Perform clinical intervention through the development of a care plan specific to each enrollee based on clinical judgement, changes in enrollees’ health or psychosocial wellness, and identified triggers.
  • Communicate regularly with enrollees/families, physicians, and facilities/agencies to assure optimal quality patient care and effective operations.
  • Collaborate with relevant internal and external partners to coordinate seamless transitions for enrollees from inpatient settings to community-based services.

               
 

Required Qualifications

  • Must reside in the state of Ohio.
  • Licensed Registered Nurse (RN) or Licensed Behavioral Health Professional (LSW, LISW, LISW-S, LPC, LPCC or LPCC- S) in the state of Ohio, with no disciplinary action.
  • Minimum Five (5) years’ experience working in the healthcare setting.
  • Minimum two (2) years of management/supervisory experience.
  • Experience in physical health case management or behavioral health case management.
  • For Behavioral Health, C.M. Manager Only: Must have a Child and Adolescent Needs & Strengths (CANS) certification or able to obtain one within 60 days of hire.
  • Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
  • Ability to work independently under general instructions and with a team.
  • 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 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 nursing, health administration, or related field.
  • Certified Case Manager (CCM).
  • Bilingual – Fluency in Spanish or Somali.
  • Experience serving Medicaid, TANF, and/or CHIP populations.

Additional Information

  • Typical Work Days/Hours: Monday – Friday; 8:00am – 5:00pm.
  • Travel: Up to 25% in-state travel.
  • Direct Reports: Up to 15 associates.

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

Posted on

Lead, Director, Network Provider Relations (Michigan/Medicaid-Remote) at CVS Health

Clipped from: https://www.themuse.com/jobs/cvshealth/lead-director-network-provider-relations-michiganmedicaidremote-41027a?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description
The Michigan Medicaid Network State Director manages and oversees compliance with our Network responsibilities as provided within the State Medicaid contractual requirements as outlined below:

• This Position will manage separate functions for external provider engagement representatives and internal provider relations representatives to ensure successful Provider Relationships, Network Performance including Clinical and Affordability Targeted Improvements as identified.

• The State Network Director will manage and deploy the Medicaid National Provider Engagement Program through the Local Market Network Engagement Provider Representatives within their respective Leadership
• The State Network Director will manage and direct the internal / external Network Provider Relations staff to ensure “best in class” Provider Relationships
• The State Network Director will assist in the recruitment of new providers as needed and maintain compliance with all network access requirements.
• Develops and implements training programs and educational materials for providers as well as for internal staff and aligns Network functions with Operations and Claims as needed.
• Assist and develop Network Action Plans to ensure Network Compliance with any and/all State Network Compliance requirements

Role/responsibilities

• Manages Local Provider Engagement Team to Deploy National Engagement Model
• Manages Local Provider Relations staff to ensure Market Leading Provider Satisfaction
• Provides direction to operations teams regarding policy and procedures related to claims/providers.
• Facilitates Provider Advisory Group and JOC meetings to work with management to implement changes via coordination with Quality Management to develop appropriate provider Clinical measure improvements and implement those measures in the provider community.
• Oversees the monitoring of executed provider contracts to ensure Network Access meets State requirements.
• Coordinate’s provider information with Member Services and other internal departments as requested.
• Provides service to providers by resolving problems and advising providers of new protocols, policies, and procedures.
• Develops training materials for staff and provider network; oversees staff responsible for initial and ongoing provider in-services and provider education; develops and implements provider satisfaction surveys.
• Participates in Grievance and Appeals meetings, tracks and trends provider grievances, monitors staff for timely compliance;
• Compiles data and staff metrics in order to complete regulatory deliverables; participates in all internal compliance audits and Regulatory reviews.
• Researches, reviews, and prepares response for all governmental, regulatory and quality assurance provider complaints ; timely and continuous reconciliation of provider records; oversees Provider Access and Availability by reviewing Appointment Availability Audits conducted by staff.
• Provides support and maintenance assistance for websites, portals, directories, manuals, and dashboards; plans, coordinates, and conducts provider forums and monthly webinars; develops communications including newsletters, notifications and Fax Blasts.
• Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with Member Services and other internal departments.
• Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions. Monitors staff performance, including weekly staff metrics; coaches and mentors’ staff on performance issues or concerns.
• Promotes and educates providers on cultural competency

Pay Range

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

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.


Required Qualifications

• Minimum of 5 to 7 years recent Managed Care Network experience in Provider Relations & Employee Supervision with 3-5 Years Medicaid Network
• Excellent interpersonal skills and the ability to work with others at all levels
• Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards
• Excellent analytical and problem-solving skills
• Strong communication, negotiation, and presentation skills
• Knowledge of Michigan Medicaid.

COVID Requirements


COVID-19 Vaccination Requirement


CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.


Preferred Qualifications

Master’s degree preferred.

Candidates to reside in applicable State or surrounding State.


Education

• Bachelor’s degree in a closely-related field or an equivalent combination of formal education and recent, related experience.

Business Overview

Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand – with heart at its center – our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Posted on

Medicaid Data Analytic Coach – Senior Consultant, Lorton, Virginia

Clipped from: https://jobs.bigcountryhomepage.com/jobs/medicaid-data-analytic-coach-senior-consultant-lorton-virginia/738210976-2/?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 .


Responsibilities


Guidehouse is seeking a highly motivated, passionate, and detail-oriented Medicaid Data Analytic Coach to support the analysis of State Medicaid data. The ideal candidate will have a strong client service background, acute attention to detail, experience with Medicaid data and analytic tools (e.g., Python, PySpark, R, RStudio) and AWS cloud data architecture.


Job Description/Responsibilities:

  • Collaborates with cross-functional team using data analytics, validation, computational checks, cleansing and standardization processing to identify data quality issues, find root causes, and identify solutions.
  • Utilizes analytical, statistical, and programming skills to collect, analyze, and interpret large data sets.
  • Develops custom data models and algorithms to apply to data sets and determines causes of failed data quality checks.
  • Evaluates the effectiveness and accuracy of new data sources and data gathering techniques.
  • Uses predictive modeling to increase and optimize user experiences, system capabilities, and other business outcomes.
  • Documents analyses, creating summaries and presenting written and verbal results to various stakeholders.
  • Applies subject matter expertise relative to Medicaid data (eligibility, managed care, claims, encounters, financial, etc.) to coach stakeholders on data compliance.
  • Maintains, tracks, and collaborates on multiple distinct user community issues simultaneously; keeping all conversations well documented and ensuring appropriate internal/intra team communications to remediate issues or questions.
  • Develops training materials to conduct coaching sessions.
  • Provides data coaching and technical assistance to State Medicaid representatives to resolve data issues, including working sessions to enable a deeper understanding of requirements.
  • Communicate complex data engineering issues/recommendations to all aspects of users, peers, technical and non-technical community, and internal team members.
  • Participates in continuous improvement activities to improve community satisfaction; collaborates with HCD team, Support Analysts, and Engineers.

Qualifications

Required:

  • Minimum of eight (8) years of experience.
  • A Bachelor’s degree in Computer Science, Information Systems, Engineering, Math, or other related scientific or technical discipline.
  • CMS or Health Care Industry experience.
  • Experience with Python, PySpark, R, RStudio.
  • Experience in AWS cloud data architecture and big data technologies, including EMR, Databricks, Hive, Spark, AWS Glue, Athena, and Redshift.
  • Ability to communicate technical outcomes with a high degree of detail and precision to technical audiences, while at the same time being able to communicate those outcomes to non-technical audiences in an approachable and understandable manner.
  • Exceptional problem-solving abilities, accuracy with work, strong organizational skills, attention to detail and the ability to multi-task while meeting deadlines.

Preferred:

  • Medicaid Data subject matter expertise.
  • Data platform certifications (e.g., Databricks), Coding Certifications (Python, R, etc.) and/or AWS Cloud Certifications.
  • An agile methodologies and iterative mindset; focused on consumer-oriented solutions and communications.
  • Experience applying human centered-design principles during discovery and analysis.
  • Experience with Atlassian Jira/Confluence.

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 for this role will be in the range of $90,000 up to $125,000 commensurate with experience.


Due to our contractual requirements, to be eligible for this role, you must be fully COVID-19 vaccinated at time of hire.


Disclaimer


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- or via email at . 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
Posted on

Lenoir Memorial Hospital GOVERNMENT CLAIMS ANALYST-MEDICAID Job in Kinston, NC

Clipped from: https://www.glassdoor.com/job-listing/government-claims-analyst-medicaid-lenoir-memorial-hospital-JV_IC1138852_KO0,34_KE35,59.htm?jl=1008194284901&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

  • JOB PURPOSE

 
 

Expedites the settlement of Medicaid claims by submitting accurate claims and posting payments in a timely manner.

  • JOB SPECIFICATIONS

 
 

EDUCATION

High school diploma or equivalent required. An Associate Degree in Medical Office Administration, Business or related field may be substituted for the experience requirement.

EXPERIENCE

Minimum 1 to 3 years experience in Medicaid claims processing in a Healthcare environment required. Computer background required. Basic knowledge of State Healthcare Regulations required.

LICENSURE/REGISTRATION/CERTIFICATION

None

Location: Lenoir Memorial Hospital · 9110_Patient Accounting
Schedule: Full time, Days, M-F 8:30am – 5:00pm

Posted on

American Institutes for Research – Senior Researcher – Medicaid – Washington, DC

Clipped from: https://www.careermatch.com/posting/bug_39328593939/?context=merch&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

HomeResearchSenior Researcher – Medicaid

American Institutes for ResearchWashington, DC

Paid Job

16 days ago

Description

Senior Researcher – Medicaid Senior Researcher – Medicaid Washington, DC / Arlington, VA / Austin, TX / Chapel Hill, NC / Chicago, IL / Columbia, MD / Neptune, NJ / Oakland, CA / Rockville, MD / Sacramento, CA …View All View Less Posted Today Job Description Senior Researcher – Medicaid Job Location US-Remote | US-DC | US-VA-Arlington | US-TX-Austin | US-NC-Chapel Hill | US-IL-Chicago | US-MD-Columbia | US-NJ-Neptune | US-CA-Oakland | US-MD-Rockville | US-CA-Sacramento | … Job ID 12356 Job Location United States Category Research Overview AIR’s Payer Innovation, Transformation, and Support program area is seeking a Senior Researcher with a strong background in Medicare and Medicaid policy to join AIR’s Health Division. The Senior 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; Washington, DC; Rockville, MD; Columbia, 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 leadership for major contract and grant research, implementation, technical assistance, and evaluation projects. Conceptualize the vision for the required work, provide support for project teams in developing and carrying out the work, follow sound project management practices 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 7+ 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 with 3+ years of experience in a similar contracted research/consulting firm, Federal or State-level government, or foundation that conducts policy and health services research. At least 4 years of experience working on Medicaid-related research. Experience conducting research on Medicare, state-based health exchanges, or health and human service programs is preferred but not required. Experience leading projects and/or tasks that require mixed methods: Designing and leading evaluations and other types of mixed methods research, including: Qualitative and quantitative data collection and analysis, including interviewing, conducting surveys, calculating or using descriptive and inferential statistics. Using administrative data such as claims or other types of data used to administer large federal or state programs (Medicare, Medicaid, commercial health plan data, drug data, hospital data, TANF, SNAP, etc.) Understanding and analyzing regulatory, sub-regulatory, and guidance materials. Experience with, or exposure to, person-centered approaches and equity frameworks is desirable. Ability to independently conceptualize, organize, draft, revise, and manage written deliverables such as reports, memos, PowerPoint presentations, or other client-facing materials. Skills: Client management leadership skills: Ability to interpret and as needed, clarify, client requests and manage client expectations; ability to manage project scope; ability to translate client asks into operational processes for execution (identifying staff, identifying steps, developing timelines); experience overseeing or guiding teams of more junior staff, including quality assurance. AIR is seeking a Senior 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. #LI-DC1 #LI-Remote All qualified applicants will receive consideration for employment without discrimination on the basis of race, color, religion, sex, gender, gender identity/expression, sexual orientation, national origin, protected veteran status, or disability. Read More Job Summary Company American Institutes for Research Start Date As soon as possible Employment Term and Type Regular, Full Time Required Education Master’s Degree Required Experience 7+ years

 
 

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Posted on

Disclosure Compliance Specialist, Medicaid Job in San Francisco, CA

Clipped from: https://www.adzuna.com/details/3583627475?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Location: Company:

San Francisco, CA

UnitedHealth Group

 
 

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration, and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.(sm)

 
 

Positions in this function are responsible for all activities associated with National Disclosure of Ownership and Control Interest project to process Disclosure Forms for Individual and Entity providers. Includes processing Disclosure Form per Job Aids and entering data into database and ensuring high quality standards are maintained. Reviews work to reduce errors and improve performance.

 
 

Training will be provided in an individual or a group setting for approximately eighty (80) hours to include job shadowing and on the job training/coaching. Ramp-up period is as follows: Week 1: 10 forms per day; Week 2: 15 forms per day; Week 3: 20 forms per day. At the conclusion of the ramp-up period, the Disclosure Compliance Specialist should be able to independently process 20 Individual or Entity Disclosure Forms (including Roster Addendum and Templates) per day with an accuracy rate of 95% or greater.

 
 

Hours: Monday – Friday; 8 hours per day; 7:30AM – 4:00PM; 8:00AM-4:30PM; 8:30AM-5:00PM

 
 

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

 
 

Primary Responsibilities:

 
 

The processing of Disclosure Forms involves the following:

Understanding the purpose of the Disclosure Form as it relates to the state-Medicaid health plans
Understanding the Provider types, i.e. group entity models, and criteria to process the Disclosure Form
Ability to meet a production goal of processing twenty (20) Disclosure Forms/ Records per day with a quality score of 95% or greater
Ability to comprehend and follow workflows as outlined on the Job Aids
Ability to work in multiple databases, i.e. National Disclosure Database, P-LINX, NMDB, SharePoint, to search for and enter required information
Making outbound calls and creating and sending emails and faxes to providers to collect additional information required to meet the criteria for a “Complete/Clean” Disclosure Form
Ability to document activity notes in the National Disclosure Database and Tracking Grids as outlined in the Job Aid
Communicating with providers and or their office staff in a professional manner
Incorporating the UHG Cultural Values into daily work of: Integrity, Compassion, Relationships, Innovation and Performance

 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

 
 

Required Qualifications:

High School Diploma/GED (or higher) OR 2+ year experience in manage care, provider relations, credentialing, healthcare insurance
1+ years of experience in manage care, provider relations, credentialing, or healthcare insurance
Intermediate level of proficiency in Microsoft Word, Outlook, and Adobe

 

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

 
 

Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)

 
 

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 
 

 
 

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $16.00 to $26.88. The salary range for Connecticut / Nevada residents is $16.83 to $29.66. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group 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). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 
 

 
 

 
 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

 
 

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

 
 

 
 

#RPO

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Medicaid Data Analytic Coach – Senior Consultant, Marbury, Maryland

Clipped from: https://jobs.bigcountryhomepage.com/jobs/medicaid-data-analytic-coach-senior-consultant-marbury-maryland/737626374-2/?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

Guidehouse is seeking a highly motivated, passionate, and detail-oriented Medicaid Data Analytic Coach to support the analysis of State Medicaid data. The ideal candidate will have a strong client service background, acute attention to detail, experience with Medicaid data and analytic tools (eg, Python, PySpark, R, RStudio) and AWS cloud data architecture.

Job Description/Responsibilities:

  • Collaborates with cross-functional team using data analytics, validation, computational checks, cleansing and standardization processing to identify data quality issues, find root causes, and identify solutions.
  • Utilizes analytical, statistical, and programming skills to collect, analyze, and interpret large data sets.
  • Develops custom data models and algorithms to apply to data sets and determines causes of failed data quality checks.
  • Evaluates the effectiveness and accuracy of new data sources and data gathering techniques.
  • Uses predictive modeling to increase and optimize user experiences, system capabilities, and other business outcomes.
  • Documents analyses, creating summaries and presenting written and verbal results to various stakeholders.
  • Applies subject matter expertise relative to Medicaid data (eligibility, managed care, claims, encounters, financial, etc.) to coach stakeholders on data compliance.
  • Maintains, tracks, and collaborates on multiple distinct user community issues simultaneously; keeping all conversations well documented and ensuring appropriate internal/intra team communications to remediate issues or questions.
  • Develops training materials to conduct coaching sessions.
  • Provides data coaching and technical assistance to State Medicaid representatives to resolve data issues, including working sessions to enable a deeper understanding of requirements.
  • Communicate complex data engineering issues/recommendations to all aspects of users, peers, technical and non-technical community, and internal team members.
  • Participates in continuous improvement activities to improve community satisfaction; collaborates with HCD team, Support Analysts, and Engineers.

Qualifications

Required:

  • Minimum of eight (8) years of experience.
  • A Bachelor’s degree in Computer Science, Information Systems, Engineering, Math, or other related scientific or technical discipline.
  • CMS or Health Care Industry experience.
  • Experience with Python, PySpark, R, RStudio.
  • Experience in AWS cloud data architecture and big data technologies, including EMR, Databricks, Hive, Spark, AWS Glue, Athena, and Redshift.
  • Ability to communicate technical outcomes with a high degree of detail and precision to technical audiences, while at the same time being able to communicate those outcomes to non-technical audiences in an approachable and understandable manner.
  • Exceptional problem-solving abilities, accuracy with work, strong organizational skills, attention to detail and the ability to multi-task while meeting deadlines.

Preferred:

  • Medicaid Data subject matter expertise.
  • Data platform certifications (eg, Databricks), Coding Certifications (Python, R, etc.) and/or AWS Cloud Certifications.
  • An agile methodologies and iterative mindset; focused on consumer-oriented solutions and communications.
  • Experience applying human centered-design principles during discovery and analysis.
  • Experience with Atlassian Jira/Confluence.

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 for this role will be in the range of $90,000 up to $125,000 commensurate with experience.

Due to our contractual requirements, to be eligible for this role, you must be fully COVID-19 vaccinated at time of hire.

Disclaimer

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 (see below) . 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