Clipped from: https://www.salary.com/job/blue-cross-blue-shield-of-az/credentialing-coordinator-medicaid/j202205141421296917571?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Blue Cross Blue Shield of AZ

 
 

 Bapchule, AZ Full Time

Job Posting for Credentialing Coordinator – Medicaid at Blue Cross Blue Shield of AZ

Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. Internal Use Only: GEN 12-14 PURPOSE OF THE JOB The Credentialing Coordinator facilitates the accurate and efficient Credentialing and Recredentialing of Medicaid Business Segment providers in alignment with State, Federal, and NCQA standards. QUALIFICATIONS REQUIRED QUALIFICATIONS Required Work Experience 2 years of experience in a healthcare field 2 years of experience in provider credentialing Required Education High-School Diploma or GED in general field of study Required Licenses N/A Required Certifications N/A PREFERRED QUALIFICATIONS Preferred Work Experience 2 years of experience in a healthcare field, preferably within a credentialing/recredentialing environment and knowledge of national accreditation and/or regulatory standards Preferred Education Associate’s Degree in general field of study Preferred Licenses N/A Preferred Certifications Certified Provider Credentialing Specialist (CPCS) ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES Ensure timely and accurate processing of credentialing and recredentialing for both individual practitioners and organizations Coordinate Credentialing Committee meeting, including preparing the agenda and documenting meeting minutes Identify and communicate agenda items for Credentialing Committee to immediate leader Facilitate prompt coordination with the Credentialing Verification Organization (CVO) and monitor Work in Progress file Promptly address incoming files for processing Review and maintain all applications for accuracy and completeness Accurately and efficiently data enter primary source verification data into the credentialing database Input credentialing decisions and dates into the credentialing database Generate and mail approval letters to participating providers Identify missing or erroneous information from the provider’s application, and communicate with the provider to obtain Coordinate with Network Services and/or other internal departments on follow-up items needed to complete the credentialing process Communicate with Network Services and/or other internal departments regarding status of provider and organizational credentialing Maintain ongoing participation in cross-training activities Provide recommendations and feedback regarding process improvements and/or standardization practices Actively participate in staff meetings, team huddles, and one-on-one meetings Engage in team building activities Perform all other duties as assigned The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements COMPETENCIES REQUIRED COMPETENCIES Required Job Skills Verbal and written communication skills Maintains confidentiality according to policy Effectively communicate with internal and external customers via telephone and email Accurately receive information through oral communication Accurately review data and figures both in hard copy and electronic formats Accurately sort through data and think through issues in a time‐pressured environment Accurately learn and retain new information, knowledge, and skills Efficiently manage multiple tasks, with varying degrees of priority, at the same time Required Professional Competencies Ability to think critically Strong attention to detail Excellent organizational skills Outstanding interpersonal skills, ability to establish a trusting rapport with individuals at all levels Maintain a calm and collected presence while addressing the concerns from an internal and external customer Required Leadership Experience and Competencies N/A PREFERRED COMPETENCIES Preferred Job Skills Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan credentialing preferred Preferred Professional Competencies N/A Preferred Leadership Experience and Competencies N/A CORPORATE RESPONSIBILITIES Comply with BCBSAZ corporate and departmental policies and procedures, including, but not limited to Code Blue, Compliance, HIPAA, Computer Responsibility, Accreditation Standards, Attendance, Staff Qualifications and Quality Management Accountabilities. Our Commitment BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group. Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

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Clipped from: https://jobs.wreg.com/jobs/research-analyst-sardinia-ohio/732439462-2/?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:* Research GDIT is searching for dynamic Research Analyst to join our growing team. You will support an exciting new program focused Identifying Vulnerabilities in Medicaid, Medicaid and the Marketplace enrollment and eligibility and compliance. The role will allow you to utilize advanced research Responsibilitie*.

s* + Conduct research in a wide variety of policy and coverage areas to assess potential risk and vulnerabilities in federal healthcare programs. + Work with team to assess risk, develop mitigation strategies, and document and present findings to customer. + Synthesize complex policy and regulatory guidance to develop recommendations, both written and verbal, to present to senior leadership.

+ Within a case management system, comprehensively document in detail all identify vulnerabilities and provide recommendations to CMS. + Lead risk assessment teams to execute against the SOW and meet/exceed customer needs. Coordinate activities to ensure timeline and quality standards are met.

+ Identify needs for the team including training or SME support. + Senior-level resources with strong policy, regulatory, and research background will result in thorough and accurate risk assessment outcomes Required Skills:* + Bachelor’s degree and 2+ years of Medicare, Medicaid and/or Marketplace experience and policy/research (or equivalent combination of education and experience) + Proficient in computer skills, eg Microsoft Office-Word, Excel.Desired Skills:* + Bachelor’s degree or equivalency in regulatory or policy/research experience + Highly organized, ability to multi-task and meet deadlines + Strong inter-personal and communications skills, both written and oral + Ability to conceptualize, solve problems and draw conclusions \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://jobs.bigcountryhomepage.com/jobs/senior-quality-compliance-nurse-professional-medicaid-pdsa-dmaic-rn-license-oh-springfield-ohio/733006435-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

The Senior Quality Compliance Nurse Professional is an integral part of the Ohio Quality Improvement Department. This role will collaborate with internal and external customers to complete fast-paced and time sensitive projects Responsibilities* The Senior Quality Compliance Nurse Professional will partner with The Ohio Department of Medicaid and other Managed Care Organizations to meet benchmarks, goals and deliverables for Quality Improvement clinical and non-clinical performance projects.

This role is expected to research, gather information and analyze data in an expedited timeframe and use QI tools and templates to report out in cross-functional workgroups/subgroups using the tenants of QI Science. This position will also require leading internal and external workgroups for the collaborative as directed. The Senior Quality Compliance Nurse Professional works independently, sometimes in ambiguous situations, and work may be performed with minimal direction.

The position will have additional responsibilities based on business needs.Required*.Qualifications:* + Bachelor’s degree or 4 + years of relevant experience + Must be RN in the state of Ohio with an active and unrestricted license + Knowledge of quality and process improvement approaches (PDSA, DMAIC, etc.) + Previous managed care Medicaid experience + Demonstrated management experience and ability to partner with senior leadership on strategic initiatives + Demonstrated ability to manage multiple projects and meet deadlines specifically in DMAIC and PDSA style reporting and analysis + Experience presenting information to internal and external stakeholders + Experience with Microsoft Office Suite +.

WAH requirements* : Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required +.COVID VACCINATION* : 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:* + CPHQ + Six Sigma + Previous experience with QI Science and methodologies (IHI) + Project Management knowledge and skills + Proficiency in verbal and written communication to senior and executive leadership + Strong organizational skills and ability to manage multiple or competing priorities + Strong analytical and problem-solving skills.Additional information* +.
Schedule:* Monday to Friday from 8 am to 5 pm.

Open for Flexible Start and Stop times. +.Training:* Remote learning, 30-90 days self-paced and some class training +.Work Location (Address): Remote OH* +.% Travel: 20%* \\.

Scheduled Weekly Hours* 40 Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources’source=Humana_Website..

Clipped from: https://www.linkedin.com/jobs/view/senior-compliance-analyst-medicare-medicaid-remote-at-highmark-wholecare-3303765805/?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?


Yes


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.glassdoor.com/job-listing/medicaid-waiver-case-managers-and-personal-choices-counselors-south-alabama-regional-planning-commission-JV_IC1127676_KO0,61_KE62,104.htm?jl=1008185956479&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Positions available within Area Agency on Aging of the South Alabama Regional Planning Commission are open for the Elderly & Disabled Medicaid Waiver Program serving Mobile, Baldwin and Escambia counties. Positions are available for both case managers, and for personal choice counselors for persons who choose to self-direct their in-home care by hiring their own workers. The positions requires a minimum of a Bachelor’s degree or RN, valid driver’s license, home visitation; good keyboarding, computer and organizational skill. Experience working with elderly and disabled individuals or prior experience performing in-home visitation, and knowledge of community resources is preferred. Both full time and part-time positions are available. Full time positions include state retirement, health, dental, life and disability benefits. Applicants must be residents of Mobile, Baldwin or Escambia County or are relocating to these Alabama counties. Email resume to bevans at sarpc.org by November 4, 2022.

Job Type: Full-time

Pay: $35,000.00 – $55,000.00 per year

Benefits:

• Dental insurance
  
• Health insurance
  
• Life insurance
  
• Paid time off
  
• Retirement plan
  
• Vision insurance
  

Medical specialties:

• Geriatrics
  
• Pediatrics
  

Schedule:

• 8 hour shift
  

Ability to commute/relocate:

• Mobile, AL 36602: Reliably commute or planning to relocate before starting work (Required)
  

Education:

• Bachelor’s (Required)
  

Experience:

• Senior care: 1 year (Required)
  
• Social work: 1 year (Preferred)
  

License/Certification:

• Driver’s License (Required)
  
• RN License (Preferred)
  

Work Location: Hybrid remote in Mobile, AL 36602

Clipped from: https://thelearningcommunity.com/

Job description

Medicaid Enrollment Specialist
Senior Process Associate

In the role of process associate, you will execute transactions as per prescribed guidelines and timelines, reviews and validates the inputs from the other team members, support your manager in training activities, daily operations reviews and help in escalation resolution with the objective to meet service level agreement targets for the specific process within the guidelines, policies and norms of Infosys.

Responsibilities may include but are not limited to:

· Performs processes to resolve the following eligibility exceptions within the required State/Regulatory timeframes:
enrollment file errors, ID card generation errors, PCP assignments and 834 enrollment files to vendor/third party administrators.

· Process COB eligibility through proper application to ensure accurate information is represented in company enrollment system

· Assists with the support of the newborn enrollment functions, to include call center, claims, and encounter requests for verification and updates, PCP assignment activity, enrollment record error reports, enrollment/disenrollment activity and Mass Member Moves.

· As needed is available to support special projects

· Assist to maintain integrity of eligibility tasks.

· External phone call with other health insurances to determine primary payer.

· Prioritizes daily, weekly and monthly job tasks to support regulatory requirements and service level agreements.

· Displays imitative to complete assigned tasks timely and accurately and balances workload to assist peers and Supervisor.

· Provides knowledgeable response to internal and external inquiries regarding eligibility, ID cards, selection of primary, care provider, and state enrollment transactions.

· Reconciles eligibility with State Agencies using varied methods. Tracks and documents all transactions with State Agencies.

Location for this position is Phoenix, AZ.

Qualifications
Basic

• High School Diploma or GED Equivalent
  
• At least 1 year of related work experience
  

Preferred

• Excellent interpersonal and communication skills to deal effectively with all necessary levels within and outside the organization.
  
• Demonstrates analytical and innovative excellence for current state and future state challenges at both the strategic and tactical level.
  
• Strong organizational skills and superior attention to detail. Strong decision maker.
  
• Ability to review documents for accuracy, completeness, and compliance; compile data and information for reports; compose letters and memoranda.
  
• Ability to gather and research data (i.e., statutes, regulations, articles).
  

Note: Applicants for employment in the U.S. must possess work authorization which does not require sponsorship by the employer for a visa (H1B or otherwise).

The job entails sitting as well as working at a computer for extended periods of time. Should be able to communicate by telephone, email, or face to face.

About Us
Infosys BPM, the business process management subsidiary of Infosys (NYSE: INFY), provides end-to-end transformative services for its clients across the globe. The company’s integrated IT and BPM solutions approach enables it to unlock business value across industries and service lines, and address business challenges for its clients. Utilizing innovative business excellence frameworks, ongoing productivity improvements, process reengineering, automation, and cutting-edge technology platforms, Infosys BPM enables its clients to achieve their cost reduction objectives, improve process efficiencies, enhance effectiveness, and deliver superior customer experience.

Infosys BPM has 32 delivery centers in 16 countries spread across 6 continents, with more than 38000 employees from over 80 nationalities, as of Nov 2019.

The company has been consistently ranked among the leading BPM companies globally and has received over 60 awards and recognitions in the last 5 years, from key industry bodies and associations like the Outsourcing Center, SSON, and GSA, among others. Infosys BPM also has very robust people practices, as substantiated by the various HR-specific awards it has won over the years. The company has consistently been ranked among the top employers of choice, on the basis of its industry leading HR best practices. The company’s senior leaders contribute widely to industry forums as BPM strategists.

EOE/Minority/Female/Veteran/Disabled/Sexual Orientation/Gender Identity/National Origin

Job Type: Full-time

Salary: $20.00 – $21.00 per hour

Schedule:

• 8 hour shift
  

Experience:

• Customer service: 1 year (Preferred)
  

Work Location: One location

Clipped from: https://www.linkedin.com/jobs/view/social-science-research-analyst-at-centers-for-medicare-medicaid-services-3296398008/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

At CMS, we believe that at the core of our organization are the employees that carry out the Agency’s vision of advancing health equity, expanding coverage, and improving health outcomes.

 
 

About the role:

 
 

As a Social Science Research Analyst, you will serve as a research expert and team leader and member who will plan, implement, evaluate, and oversee market research using social marketing and communication techniques.

 
 

What you’ll do:

 
 

• Lead the developments, drafts, or reviews and manages the implementation of diverse research methodologies.
  
• Interpret qualitative and quantitative data and findings.
  
• Independently design, research, and interpret findings for planning and evaluation using quantitative and qualitative methodologies.
  
• Represent the agency at briefings and other meetings regarding the justification and approval of specific projects.
  
• Develop clearly written and concise issue papers, presentations, and talking points for senior staff.
  

 
 

Where we’re hiring:

 
 

This is a remote position; however, the position reports to a CMS Office on a periodic basis (e.g. 1-2 times per year). Requirements to report to the office will vary and can be discussed at the time of interview. As such, your pay will be based on your home address. For more information on locality and pay scales, please click here. Your worksite must be within the United States and you must adhere to all regulations and policies regarding remote work at CMS and in the federal government, including the signing of a remote work agreement.

 
 

Experience we’re looking for:

 
 

1) Managing or leading large-scale or quick turnaround qualitative or quantitative market research projects to assess and improve health communication materials, strategies, or initiatives.

2) Measuring and assessing target audience characteristics to recommend feasible solutions to health communication issues or to guide the development or refinement of health decision-making support tools.

3) Analyzing qualitative or quantitative data to be included in study reports- issue paper, or presentation materials.

4) Interpreting research findings to formulate actionable recommendations, guide health communications activities, or frame strategic decisions.

 
 

Education Requirement:

 
 

In addition to meeting the qualification requirements, all candidates must have the following educational requirements:

 
 

Degree: behavioral or social science; or related disciplines appropriate to the position.

OR

Combination of education and experience that provided me with knowledge of one or more of the behavioral or social sciences equivalent to a major in the field.

OR

Four (4) years of appropriate experience that demonstrated that I have acquired knowledge of one or more of the behavioral or social sciences equivalent to a major in the field.

 
 

 
 

You MUST apply through USAJOBS to be considered.

 
 

Come see why over 6,000 employees say CMS is their employer of choice! In addition to dynamic and exciting opportunities, CMS offers generous compensation and benefits programs, an outstanding work-life balance, and most important, the opportunity to give back to your community, state and country by making a difference in the lives of Americans everywhere. For more information about careers at CMS, visit: https://go.cms.gov/Careers.

 
 

 
 

Apply by 10/14/22!

Clipped from: https://www.talent.com/view?id=f136ae5ffcc1&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

UnitedHealthcare is a company that’s on the rise. We’re expanding in multiple directions, across borders and, most of all, in the way we think.

Here, innovation isn’t about another gadget, it’s about transforming the health care industry. Ready to make a difference?

Make yourself at home with us and start doing your life’s best work.(sm)

UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

If you’re ready to help write the history of UnitedHealth Group and improve the lives of others, you can do it with UnitedHealthcare Community & State.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time.

It takes a lot of good ideas. Most of all – it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

If you are located within Upstate NY you will have the flexibility to telecommute* as you take on some tough challenges.

This is a 40hr work week schedule

Outside / field sales role

Primary Responsibilities :

• Interact and meet with eligible individuals at their homes and / or various sites throughout the community / service area to enroll them into UnitedHealthcare government programs
  
• Maintain high level of collaboration between UnitedHealth Group and community-based partners and other state and government agencies in the New York area
  
• Perform community marketing and outreach to promote UnitedHealthcare government programs
  
• Offer ongoing member education and member servicing
  
• Maintain accurate records for reporting purposes
  
• Meet monthly targets for applications received
  

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 :

• 1+ years of experience in a direct sales, social service, community, or customer service position
  
• Proficient in MS Office (Outlook, Word, Excel, Power Point, Teams)
  
• Valid driver’s license and good driving history
  
• Reliable transportation and current automobile insurance
  
• Ability to travel locally up to 100% of time within Buffalo, NY market area
  
• Work Monday – Friday core business hours, nights & weekends, and overtime, as required
  
• Live in / within commutable distance to Buffalo, NY
  
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements.
  

UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance.

Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications :

• Bachelor’s or Master’s degree
  
• Certified Application Counselor (CAC) certification
  
• Previous business to business B2B sales or marketing experience
  
• Proven experience in strategic planning, sales strategies and / or retention
  
• Experience giving professional presentations to all levels of organization including executive leadership
  
• Experience with enrollment in Medicaid / Essential Plan / Child Health Plus products
  
• Experience working with communities of all different ethnicities, cultural backgrounds, diverse populations and / or underserved communities
  
• Established professional relationships with non-profits, community sources CBO s, religious / faith-based organizations FBO s in designated sales territory
  
• Familiar with enrollment and eligibility in New York’s public health insurance programs
  
• Bilingual
  

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 at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That’s why you’ll find some of the most amazingly talented people in health care here.

We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high-risk pregnancy.

Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us.

Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most.

This is the place to do your life’s best work.(sm)

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

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.

Clipped from: https://jobs.cw39.com/jobs/medicaid-specialist-pittsburgh-pennsylvania/732422341-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description

 

ProMedica Senior Care, formerly HCR ManorCare, provides a range of services, including skilled nursing care, assisted living, post-acute medical and rehabilitation care, hospice care, home health care and rehabilitation therapy.

 
 

The Medicaid Specialist assists patients in the skilled nursing centers secure Medicaid benefits.

 
 

In return for your expertise, you’ll enjoy excellent training, industry-leading benefits and unlimited opportunities to learn and grow. Be a part of the team leading the nation in healthcare.

Location

4073 – ProMedica Skilled Nursing and Rehabilitation – Pittsburgh, PA

Educational Requirements

High School plus additional training leading to an Associate’s Degree in Business or Social Services.

Position Requirements

 

Three to twelve months with knowledge of medicaid rules and regulations.

Job Specific Details:

 

FT

 
 

M-F

 
 

8am-4:30pm

 
 

Clipped from: https://jobs.azahcccs.gov/title-nurse-case-manager/job/20648235?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

AHCCCS

Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.

AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

Nurse Case Manager

Division of Fee for Service Management
 

Job Location:

801 E Jefferson St, Phoenix, AZ 85034 

Posting Details:

Open until filled: 1st review of resumes on 10/07/22

Salary: $60,000 to $71,032.42 
 

Grade: 22
 

This position is eligible for part-time/full-time remote work (including virtual office arrangement). Must reside in the State of Arizona. 

Job Summary:

The Division of Fee for Service Management (DFSM) is looking for a highly motivated individual to join our team as a Nurse Case Manager. This position will provide monitoring and technical assistance to ensure compliance with contractual, regulatory, and statutory obligations for FFS members’ physical/acute care services and behavioral health needs. Monitor over and under utilization, conduct reviews, provide oversight and technical assistance, gather, plan, organize and evaluate information from multiple sources, including utilization data, case file reviews and audits. Coordinate care with external and internal stakeholders as needed, make referrals as necessary, participate in clinical staffing as needed, serve as a resource for medically necessary covered services.

Major duties and responsibilities include but are not limited to:
? Provide care management for clinically complex members in collaboration with internal and external stakeholders as needed, make referrals as necessary, participate in clinical staffing as needed, serve as a FFS health plan subject matter expert.
? Review clinical documentation to monitor, evaluate and authorize healthcare services. Review for medical necessity, appropriateness of services, quality of care, and compliance with contractual State and Federal obligations governing the provision of covered behavioral and physical healthcare services.
? Obtain, review, analyze, and discuss report and data findings in order to identify, monitor, and evaluate specialized intervention strategies and outcomes for member populations, including SMI, and TRBHA.
? Collaborate with AHCCCS providers including SMI clinic, TRBHA, Medical Home or other treatment team members in order to provide technical assistance, training, & consultation on AHCCCS requirements and/or expectations to ensure compliance with the contractual, regulatory, & statutory obligations for covered services.
? Assist in the development of policies and procedures as required for delivery of covered behavioral health services.

Knowledge, Skills & Abilities (KSAs):

Knowledge:
? Care Management/Case Management concepts, principles, and strategies.
? Interpret clinical information and assess implications for treatment.
? familiarity with American Indian Tribes programs and policy.

Skills:
? Strong interpersonal skills in working with people of diverse cultures and socioeconomic backgrounds.
? Organizational skills to coordinate, monitor and report on multiple cases simultaneously.
? Documentation and reporting of data and trends.

Abilities:
? Ability to read, interpret, and apply complex rules and regulations.
? Independent decision making yet knowing when to elevate the decision.
? Problem solving identification, evaluation, and imitation of appropriate action, nursing, and case management assessment.

Qualifications:

Minimum:
? Possession of a current license to practice as a registered nurse in the State of Arizona and three (3) year of relevant experience.

Preferred:
? Certified Case Manager.
 

Pre-Employment Requirements:

* Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
* Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
* Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.

Benefits:

Among the many benefits of a career with the State of Arizona, there are:
* 10 paid holidays per year
* Paid Vacation and Sick time off (13 and 12 days per year respectively) – start earning it your 1st day (prorated for part-time employees)
* A top-ranked retirement program with lifetime pension benefits
* A robust and affordable insurance plan, including medical, dental, life, and disability insurance
* Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
* RideShare and Public Transit Subsidy
* A variety of learning and career development opportunities
* Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office)

By providing the option of a full-time or part-time virtual/remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement:

Lifetime Pension Benefit Program
* Administered through the Arizona State Retirement System (ASRS)
* Defined benefit plan that provides for life-long income upon retirement.
* Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
* Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program
* Voluntary participation.
* Program administered through Nationwide.
* Tax-deferred retirement investments through payroll deductions.

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.