Clipped from: https://www.learn4good.com/jobs/southfield/michigan/healthcare/1564043203/e/

Position:  Chief Operating Officer, Medicaid – Michigan
Job Description

Aetna Better Health of Michigan is seeking an experienced Chief Operating Officer (COO) for its managed Medicaid business. The ideal leader is strategic, committed to developing employees, and relentless in pursuing change that is best for the organization and its customers. On a daily basis, the COO is responsible for overseeing all operational activities of various Plan functional areas through direct and indirect reporting lines to:
Claims, Provider Services, Information Technology, Grievance and Appeals, Member Services, Configuration, Contracting, Enrollment and supporting functional areas. The COO will assist the Plan CEO in the successful growth and performance of the Plan. The COO also interfaces, collaborates, and works cooperatively with corporate office functional leaders and centralized shared services business departments. The individual needs a deep understanding of claims, value-based contracts, TPL/COB, and Pharmacy.

The ideal candidate will have extensive knowledge of government programs such as Medicaid, Medicare, uding government affairs, legal, and an in-depth compliance background. The individual must understand how compliance and quality programs (NCQA and HEDIS) affect the Plan. The candidate needs to be proficient on credentialing, provider relations (internal and external), network development (ensuring adequacy and mix) and how that affects the provider experience.

The candidate will need a high acumen on the marketing of Medicaid, effective member and provider communications, the mission imperative on community programs and the interaction of SDOH (housing, employment, CHW, peer specialists, and nutrition). They should have a working knowledge of the interaction between physical and behavioral health, and the outstanding characteristics of behavioral health in taking care of the Medicaid population.

The COO is a valued leader in the organization and an extension of the CEO both within the Plan and externally with the regulatory agencies Michigan Department of Health and Human Services (MDHHS) and other state departments.

Required Qualifications – 10+ years work experience that reflects a proven track record of proficiency in the Medicaid managed care operational competencies noted.

– Proven ability to work collaboratively across many teams, prioritize demands from those teams, synthesize information received, and generate meaningful conclusions.

– Proven ability to conceive innovative ideas or solutions to meet client’s requirements.

– The individual must be able to build a climate of trust and respect with regulators, prospective and existing clients, and our internal growth partners such as health services, service operations, and finance/actuarial personnel.

– Proven leadership and negotiation skills – must have demonstrated leadership with meaningful initiatives such as: business process optimization, enterprise business project management/consulting, financial strategic planning and analysis, mergers and acquisitions, risk management.

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 See above.

Education Bachelor’s degree or equivalent.

Business Overview Bring your heart to CVS Health Every one of us th 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 er – our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart viors support this purpose. We want everyone who works th to feel em 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, r personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation,…

Clipped from: https://www.glassdoor.com/job-listing/senior-project-manager-medicaid-implementation-humana-JV_IC1154429_KO0,46_KE47,53.htm?jl=1008186769905&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Humana is seeking a Senior Project Manager to manage a specific defined business area within Humana, Corporate Medicaid Implementation Team. The Medicaid Implementation Senior Project Manager functions as a project manager with the Corporate Medicaid Implementation Team providing a consistent approach to planning, executing, managing, and implementing Medicaid State programs.

Responsibilities

The Senior Project manager leverages industry-leading best practices and utilizes a framework for program management to provide a common set of tools and templates to drive State Medicaid Implementations to success and ultimately deliver on Humana’s strategic objectives. The Senior Project Manager oversees day-to-day implementation activities, escalates risks in the implementation oversight structure, facilitates communication across value streams, and acts as the main point of contact with the State.

Typical role responsibilities, but not limited to:

• Plans, organize, monitor, and oversee complex projects; manages full project life cycle
  
• Monitors the creation of all project deliverables to ensure adherence to quality standards
  
• Defines the Statement of Work and Specifications for the requested Medicaid Contract/RFP.
  
• Ensures that projects and programs are proceeding according to scope, schedule, budget and quality standards.
  
• Provides on-site leadership for project team by building and motivating team members to meet project goals
  
• Provides leadership and effectively communicate project status to all stakeholders and external agencies
  

Required Qualifications

• Bachelor’s Degree + 2 plus years of project management experience (business operations/people focused preferred)
  

OR

• 5+ years of project management work experience (business operations/people focused preferred)
  

Preferred Qualifications

• 2+ years of leadership experience in a matrixed environment.
  
• Knowledge of Systems Development Life Cycle, Waterfall, and Agile Development Methodologies.
  
• Experience in business operations.
  
• Possess a solid understanding of operations, technology, communications and processes.
  
• Proficiency in Microsoft Office programs.
  
• Experience working in Medicaid implementation.
  
• Six Sigma and / or Project Management Institute certification.
  

Additional Information

• Travel: Infrequent, possible travel throughout the year to various states
  
• Work Days/Hours: Monday – Friday; 9-5pm Eastern Time Zone
  

Work-At-Home Requirements

• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
  
• 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
  

COVID Policy

• 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.
  

#LI-AM

Scheduled Weekly Hours

40

Clipped from: https://www.linkedin.com/jobs/view/medicaid-business-analyst-at-my3tech-3298425552/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Hello Associates,


position : Business Analyst- MEDICAID


Location : REMOTE


Duration : Long Term


Position # 1: Business Analyst with Testing Experience

• Minimum of 6 years working experience working as a BA in IT application implementations or systems support
  
• Must have 4 or more years of experience working with Medicaid Systems Implementation or Support and Medicaid Program Experience
  
• Medicaid Expansion project experience is highly preferred
  
• Minimum of 3 years working experience with creating Test Cases or Test Scenarios
  
• Minimum of 4 years working Experience with performing System and/or User Acceptance Testing
  
• At least 3 years of business analysis and data analysis related experience within IT system development project(s).
  
• Experience with TFS, JIRA or other similar requirements management tools.
  
• Ability to write clearly and concisely, and to communicate effectively and interact professionally with a diverse group including users, peers, managers, and subject matter experts.
  
• Broad knowledge of business analysis techniques for creating requirements and certifying software acceptance.
  
• Broad technical knowledge and experience supporting wide range of applications, data processes and technologies
  
• Strong familiarity with security standards and working with PII and PHI data.
  
• Proven understanding and knowledge of software development life cycle (SDLC).
  
• Ability to develop and maintain effective relationships with management, end users, project team members, and vendors.
  
• Excellent customer service skills.
  
• Ability to manage time, to set priorities, and to work under time constraints.
  
• Excellent oral and written communication and presentation skills.
  
• Proficient in using Microsoft Office suite, Visio, MS Project, other project management and collaboration tools.
  
• Excellent problem-solving skills.
  
• Ability to work both independently and collaboratively.
  

Clipped from: https://www.adzuna.com/details/3561011602?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

The Department of Social Services is seeking highly motivated, dependable professionals with advanced communication and exceptional customer service skills to work as Income Maintenance Caseworkers to determine eligibility for various State programs….Maintenance, Worker, Customer Service, Skills, Retail

 
 

 
 

Job Title: Case Manager for the Medicaid Waiver Service Program – Elderly and Disabled Waiver.

Job Location: Office in Alabaster – Agency serves Central Region (Blount, Chilton, Shelby, St Clair, and Walker counties)

Case load Areas– Ccaseloads available – Walker and Blount County

Job Status: Full-time – Exempt

Summary: Case Managers serve Medicaid eligible clients who would otherwise require nursing home care and are at risk for nursing home placement. The Medicaid Waiver Service (MWS) program aims for clients to remain in their own home and delay/avoid institutionalization by locating, coordinating, and monitoring services. *NCQA accredited program.

Essential Duties and Responsibilities include the following:

• Conduct Case Management services for clients on the MWS Elderly and Disable Waiver in the FamCare software system through monthly home visits.
  
• Caseload is up to 40 elderly, disabled clients, and or disabled children using the medical social work model. Hiring Case Managers for caseloads in the Walker and Blount Counties.
  
• Monitor the service delivery of the Care Plan and complete Assessments.
  
• Update data entry pertaining to medication, doctor appointments, durable medical equipment, and diagnosis data in real-time during home visits.
  
• Assist clients to develop Smart Goals.
  

 
 

• Completes transitions tracking, documents medication, doctor changes/appointments, and tracks critical incidents.
  
• Write effective documentation narratives.
  

Education and Experience:

Bachelor’s Degree in social work, psychology, or related field. Experience in social work, especially the geriatric population is desired.

Relevant Knowledge:

Possess experience in MS Office, ability to learn new software, and general office procedures.

Ability to communicate clearly and effectively, both verbally and in writing.

Time management and organizational skills.

Additional Requirements:

· Possess a valid driver’s license.

· Must maintain automobile 100/300/100 liability insurance; TB Skin Testing upon hire.

Benefits: State of Alabama Retirement; State of Alabama Local Government Health Insurance (BCBS); and other benefits.

How to Apply: Email cover letter, resume, three references, and salary requirements.

Work Remotely

• Possible with Supervisor’s clearance.
  

Job Type: Full-time

Pay: From $19.23 per hour

Benefits:

• Dental insurance
  
• Flexible schedule
  
• Health insurance
  
• Retirement plan
  

Schedule:

• Monday to Friday
  

COVID-19 considerations:
M4A follows CDC guidelines.

Education:

• Bachelor’s (Preferred)
  

Work Location: One location

 
 

Clipped from: https://www.glassdoor.com/job-listing/medicaid-waiver-case-manager-middle-alabama-area-agency-on-aging-JV_IC1127424_KO0,28_KE29,64.htm?jl=1008165764793&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Medicare/Medicaid Program Implementation Advisor Remote US

Company name
Humana Inc.

Location
Birmingham, AL, United States

Employment Type
Full-Time

Industry
Project Management

Job Information

Humana

Medicare/Medicaid Program Implementation Advisor (Remote US)

in

Birmingham

Alabama

Description

Humana’s Enterprise Shared Services organization is seeking an outstanding cross-functional program leader to join its Business Management team. This team is focused on program/project management of large-scale, cross functional initiatives to support new State Medicaid Implementations as well as integration of acquired entities into Humana.

Responsibilities

We are looking for an influencer and organizer who thrives in an environment of complexity and can seamlessly connect strategy to execution. Must be high energy but easygoing, love collaboration, lead change, and have outstanding leadership presence.

The Medicaid/Medicare Program Implementation Advisor you will work side by side with leaders and associates within teams across the Consumer and Provider Services and Solutions Organization (CPSS), the Medicaid & Duals Organization and the Corporate Mergers & Acquisitions Organization. You will manage all aspects of a program, from start to finish, so that it is completed on time and compliant with all federal/state requirements.

Key Role Functions

Drive planning and execution of new State Medicaid Implementation and/or Acquisitions

Mobilize and lead a large global cross-functional team through all project phases including execution, go live and retrospective

Responsible for the plan of record and ensure all work streams are well defined, planned, and resourced to deliver per the overall launch timeline

Support and empower the team to identify milestones, handle dependencies and risks, track deliverables and remove blockers

Drive and maintain senior leadership engagement and alignment, facilitating and supporting key decisions

Implement standard methodologies (e.g. for planning, program, and project management) and help drive adoption of them throughout the organization

Implement program & change management frameworks, processes, and templates ‘right-sized’ for speed, scale, and seamless implementation to support the project/program life cycle

Develop strong collaborative relationships as a trusted advisor for key partner teams (e.g. Retail Contact Center, Membership Plan Services, Resolutions, Provider Contact Center, Information Technology, and Medicaid/Medicare leadership teams) to ensure successful execution

Required Qualifications

Bachelor’s degree and/or equivalent work experience

10 years’ experience in program/project management role in a customer-centric environment

5 years’ experience in health care operations industry

Expert knowledge of program and project management. Knows the tools (e.g. strategic frameworks, change management, dependency management, risk management, amazing communication) and when to use them, when not to use them, and when it’s time to build new ones

Outstanding influencer who is great at connecting the dots and able to lead and influence enterprise wide, cross functional teams

Strength in positions of leadership. Able to mobilize, inspire, and lead teams without direct authority and manage conflicting stakeholder interests effectively

Ability to contribute consistently and positively in a fast-paced, ever-changing environment. Remain flexible and calm in the face of uncertainty and ambiguity

Strong collaboration skills-leading execution across teams, influencing across organizations, and experience working across all levels

Comfortable working with, presenting to, and facilitating decisions among senior executives based on evolving priorities

Strong business acumen and ability to comfortably dive into any area of the business, develop a deep understanding, and shape execution plans

Advanced proficiency in Microsoft applications including Outlook, Teams, SharePoint, Project, PowerPoint, Excel and Visio

Ability to travel up to 15%

Preferred Qualifications

Possess solid understanding of how organization capabilities interrelate across CPSS departments

PMP certification

Additional Requirements

Covid-19 Vaccine Requirement

We will require full COVID vaccination (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html#vaccinated) for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.

If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.

Work at Home/Remote Requirements

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

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

Potential Travel

Based on current guidance from the CDC, local and state governments, and Humana leadership related to the coronavirus (COVID-19) outbreak have extended travel restrictions until further notice. The policy will be reassessed as the situation warrants. Once these restrictions are lifted this role could have the potential for up to 15% travel depending on business needs.

Scheduled Weekly Hours

40

 
 

Clipped from: https://www.employmentcrossing.com/job/id-6e4a4e5c5bbba413ad1fb6749a3ba50c?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Details

MEDICAID ANALYST 1-3

This listing closes on 10/12/2022 at 11:59 PM Central Time (US & Canada).

Salary

$2,309.00 – $4,453.00 Monthly

Location

Shreveport, LA

Job Type

Classified

Department

LDH-Medical Vendor Administration

Job Number

MVA/PJ/163686

Closing date and time

10/12/2022 at 11:59 PM Central Time (US & Canada)

• Description
  
• Benefits
  
• Questions
  

Supplemental Information

This position is located within the Louisiana Department of Health / Medical Vendor Administration / Eligibility Field Operations / Caddo Parish
 
 Announcement Number: MVA/PJ/163686
 Cost Center: 305-2050408
 Position Number(s): 76400, 172413, 50592973,76441 & 56341 
 
This vacancy is being announced as a Classified position and may be filled as a Probationary appointment or Promotional appointment of a current permanent classified LDH employee.
 
No Civil Service test score is required in order to be considered for this vacancy.
 
 

Working Job Description: 

The Medicaid Analyst (MA) is a position responsible for acquiring extensive knowledge of Medicaid policy and procedures and using same to make timely and accurate Medicaid eligibility determinations. The MA is responsible for providing eligibility assistance to members and applicants in the manner of their choosing which may be electronic, by mail, by email, in person, or most often by phone. This position requires competency of web-based programs. Work conditions are a combination of sedentary work on a computer and assistance to members by phone in a call-center format. The ideal candidate is an individual who works independently, is detail-oriented, has excellent customer service skills, can perform routine activities, is attentive to deadlines, and is a team player. Medicaid eligibility is fundamental to the overall Medicaid program, and mastery of eligibility policy and procedure may provide a path for career growth in the health insurance field.
 
As part of a Career Progression Group, vacancies may be filled from this recruitment as a Medicaid Analyst 1,2 or 3 depending on the level of experience of the selected applicant(s).  The maximum salary for the Medicaid Analyst 3 is $70,117.  Please refer to the ‘Job Specifications’ tab located at the top of the LA Careers ‘Current Job Opportunities’ page of the Civil Service website for specific information on salary ranges, minimum qualifications and job concepts for each level. 
 
To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.
 
*Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.*
 
A resume upload will NOT populate your information into your application. Work experience left off your electronic application or only included in an attached resume is not eligible to receive credit
 
For further information about this vacancy contact:
 Paula Jackson
 paula.jackson@la.gov
 LDH/HUMAN RESOURCES
 BATON ROUGE, LA 70821
 225 342-6477
   
This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.      

Qualifications

MINIMUM QUALIFICATIONS:

A baccalaureate degree.

 
 

SUBSTITUTIONS:
Six years of full-time work experience in any field may be substituted for the required baccalaureate degree.

Candidates without a baccalaureate degree may combine work experience and college credit to substitute for the baccalaureate degree as follows:

A maximum of 120 semester hours may be combined with experience to substitute for the baccalaureate degree.

30 to 59 semester hours credit will substitute for one year of experience towards the baccalaureate degree.
60 to 89 semester hours credit will substitute for two years of experience towards the baccalaureate degree.
90 to 119 semester hours credit will substitute for three years of experience towards the baccalaureate degree.
120 or more semester hours credit will substitute for four years of experience towards the baccalaureate degree.

College credit earned without obtaining a baccalaureate degree will substitute for a maximum of four years full-time work experience towards the baccalaureate degree. Candidates with 120 or more semester hours of credit, but without a degree, must also have at least two years of full-time work experience tosubstitute for the baccalaureate degree.

NOTE:
Any college hours or degree must be from a school accredited by one of the following regional accrediting bodies: the Middle States Commission on Higher Education; the New England Association of Schools and Colleges; the Higher Learning Commission; the Northwest Commission on Colleges and Universities; the Southern Association of Colleges and Schools; and the Western Association of Schools and Colleges.

 
 

NOTE:

An applicant may be required to possess a valid Louisiana driver’s license at time of appointment.

Job Concepts

FUNCTION OF WORK:

To make initial and continuing determination, under close supervision, as to clients’ eligibility for all Medicaid programs.

 
 

LEVEL OF WORK:

Entry.

 
 

SUPERVISION RECEIVED:

Medicaid Analysts typically report to a Medicaid Analyst Supervisor. May receive supervision from higher level personnel.

 
 

SUPERVISION EXERCISED:

None.

 
 

LOCATION OF WORK:

Department of Health and Hospitals, Medical Vendor Administration.

 
 

JOB DISTINCTIONS:

Differs from Medicaid Analyst 2 by the presence of close supervision and the absence of independent action.

Examples of Work

EXAMPLES BELOW ARE A BRIEF SAMPLE OF COMMON DUTIES ASSOCIATED WITH THIS JOB TITLE. NOT ALL POSSIBLE TASKS ARE INCLUDED.

 
 

Under close supervision, the entry level Medicaid Analyst learns to perform the following duties:

 
 

Conducts interviews with clients and makes other necessary collateral contacts for verification in determining eligibility for Medicaid Programs.

 
 

Examines application packets for timeliness, completeness, and appropriateness prior to authorization of reimbursement.

 
 

Makes decisions on complex eligibility factors and determines level of benefits for federal and state funded programs as a result of the rolldown procedure.

 
 

Interprets and applies complex federal, state, and agency policies for each program.

 
 

Conducts special investigations and compiles reports concerning fraud and location of absent parents.

 
 

Counsels and refers potentially eligible recipients or applicants to other agencies.

 
 

Contacts individuals, companies, businesses, local, state and federal agencies as needed to obtain or to verify information. 

 
 

Records findings, recommendations, and services provided; completes case record forms and necessary correspondence in connection with assigned cases.

Benefits

Louisiana State Government represents a wide variety of career options and offers an outstanding opportunity to “make a difference” through public service. With an array of career opportunities in every major metropolitan center and in many rural areas, state employment provides an outstanding option to begin or continue your career. As a state employee, you will earn competitive pay, choose from a variety of benefits and have access to a great professional development program.

Flexible Working Arrangements – The flexibility of our system allows agencies to implement flexible working arrangements through the use of alternative work schedules, telecommuting and other flexibilities. These arrangements vary between hiring agencies.

Professional Development – The Comprehensive Public Training Program (CPTP) is the state-funded training program for state employees. Through CPTP, agencies are offered management development and supervisory training, and general application classes on topics as diverse as writing skills and computer software usage.

Insurance Coverage – Employees can choose one of several health insurance programs ranging from an HMO to the State’s own Group Benefits Insurance program. The State of Louisiana pays a portion of the cost for group health and life insurance. Dental and vision coverage are also available. More information can be found at https://info.groupbenefits.org/

Deferred Compensation – As a supplemental retirement savings plan for employees, the State offers a Deferred Compensation Plan for tax deferred savings.

Holidays and Leave – State employees receive the following paid holidays each year: New Year’s Day, Martin Luther King, Jr. Day, Mardi Gras, Good Friday, Memorial Day, Independence Day, Labor Day, Veteran’s Day, Thanksgiving Day and Christmas Day. Additional holidays may be proclaimed by the Governor. State employees earn sick and annual leave which can be accumulated and saved for future use. Your accrual rate increases as your years of service increase.

Retirement – State of Louisiana employees are eligible to participate in various retirement systems (based on the type of appointment and agency for which an employee works).  These retirement systems provide retirement allowances and other benefits for state officers and employees and their beneficiaries. State retirement systems may include (but are not limited to): Louisiana State Employees Retirement System (www.lasersonline.org), Teacher’s Retirement System of Louisiana (www.trsl.org), Louisiana School Employees’ Retirement System (www.lsers.net), among others. LASERS has provided this video to give you more detailed information about their system.

01

Please reflect on the following statement and choose the response that best describes your skill level. “I am a highly organized person”

• Very untrue of me
  
• Untrue of me
  
• Somewhat true of me
  
• True of me
  
• Very true of me
  

02

Please reflect on the following statement and choose the response that best describes your skill level. “I am detailed-orientated and regularly check my work for accuracy”

• Very untrue of me
  
• Untrue of me
  
• Somewhat true of me
  
• True of me
  
• Very true of me
  

03

Please reflect on the following statement and choose the response that best describes your skill level. “When faced with a challenge or barrier, I analyze the details of a complex situation or question in order to discover solutions.”

• Very untrue of me
  
• Untrue of me
  
• Somewhat true of me
  
• True of me
  
• Very true of me
  

04

Reflect on the following statement and choose the response that best describes your skill level. “I am skilled at learning computer software programs and systems.”

• Very untrue of me
  
• Untrue of me
  
• Somewhat true of me
  
• True of me
  
• Very true of me
  

* Required Question

Agency State of Louisiana Phone (866) 783-5462 Website http://agency.governmentjobs.com/louisiana/default.cfm

Address For agency contact information, please refer to
the supplemental information above.
Louisiana State Civil Service, Louisiana, 70802

 
 

Clipped from: https://www.governmentjobs.com/jobs/3736731-0/medicaid-analyst-1-3?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Plaats: Remote, US

Categorieën: Call Center

Vacature ID: 2022-68768

 

Call Center Representatives Needed

Interested in supporting Medicaid providers?

Conduent has immediate remote openings

$15/HR & Great Benefits

Summary:

Call Center Customer Service Representative. This is a great opportunity to learn Medicaid provider support and the medical billing and claims process for third parties and healthcare providers regarding Medicare Claims.

What you get:

• Full-time employment with benefits
  
• Hourly rate of $15/hour starting on day one.
  
• Standard scheduled. 8am – 5pm Monday through Friday and then Saturdays 9am to 2pm.
  
• Substantial Call Center & Customer Service Training
  
• Great Work Environment with Career growth
  

People who succeed in this role have:

• Positive and energetic attitude.
  
• Ability to communicate clearly and confidently.
  
• Ability to multi-task and manage time effectively.
  
• Attention to detail, grammar, and spelling accuracy.
  
• Must type 25 wpm or more to qualify
  

Responsibilities:

• Using a computerized system, responds to Kentucky Medicaid provider inquiries in a call center environment using standard scripts and procedures.
  
• Gathers information, assesses caller needs, research and resolves inquiries and documents calls.
  
• Provides clear and concise information regarding eligibility, claim status and provider enrollment status.
  
• Follows documented policies and procedures including call handling and escalations.
  
• Overall acts as an advocate for the Medicaid Provider to ensure their needs are met.
  

Additional Duties as Assigned:

• Verify documentation and images.
  
• Attend scheduled staff meetings.
  
• Complete required assigned training.
  
• Track daily task for quality review.
  

Preferred Experience:

• One of year medical insurance or medical office experience.
  
• Computer system experience with data entry and database documentation knowledge.
  
• Call center or professional office experience.
  

Requirements

• Must be at least 18 years of age or older.
  
• Must have a high school diploma or general education degree (GED).
  
• Must be eligible to work in the United States.
  
• Must be able to clear a criminal background check and drug test
  
• Limited physical requirements: Typical office environment. Phone and keyboard for periods of time.
  

Join a rapidly growing customer service organization that can support your career goals and Apply Today!

This is a great opportunity to learn and be a part of the growing medical support community. Conduent offers benefits and advancement opportunities. Come join us and help support our Medicaid providers!

At Conduent, we value the health and safety of our associates, their families and our community. For US applicants while we DO NOT require vaccinations for most of our jobs, we DO require that you provide us with your vaccination status, where legally permissible. Providing this information is a requirement of your employment at Conduent. This does not disqualify you from this position.

 
 

Clipped from: https://jobs.conduent.com/nl/job-nl/16432714/call-center-medicaid-support-work-from-home-for-the-state-of-kentucky-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

FIND YOUR FUTURE

We’re excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.

Work from Home

Monday-Friday

#CompanyCulture

Our Benefits Include:

• Free Health, Vision, and Dental Insurance for the employee and their family
  
• Company Provided Life Insurance
  
• Company Provided Short-Term and Long-Term Disability, and Extended Leave
  
• Workplace Flexibility
  
• Employee Assistance Program
  
• Educational Assistance
  
• 401k Match
  
• Adoption Assistance
  
• Wellness program and Nutrition Benefits
  
• Generous Paid Time Off
  
• Paid Holidays
  
• Free Virtual Wellness Classes
  
• Volunteer Opportunities and a community focus
  

Overview

The RN Case Manager (CM) is responsible for helping members achieve a level of well-being, to avoid preventative hospital admissions or readmissions. The CM will perform telephonic outreach to members, physicians, or other care givers to develop a plan of care for the member who needs CM services. The CM will perform case management functions using a member-centric, collaborative process to optimize the wellness and functional capability of members, using available resources to promote quality cost-effective outcomes. The Case Manager applies the guiding principles for case management practice to include assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet a member’s comprehensive health needs. The CM will adhere to regulatory and compliance requirements, adhere to department productivity and quality metrics, and provide exceptional customer service to all internal and external customers.

Qualifications

• Current, active, unrestricted, and registered nursing (RN) license required. Bachelor’s degree preferred.
  
• Case Management Certification (CCM) required. Candidates without CCM certification are required to obtain it within 2 years of commencing employment.
  
• Two (2) years of case management or clinical experience in an acute medical/surgical/critical care and/or ambulatory setting required.
  
• Proficient computer and Windows skills required, including MS Office.
  
• Previous clinical experience in a managed care setting as a case/care manager preferred.
  
• Clinical knowledge of the health and social needs for the population served.
  
• Demonstrated ability to identify barriers to a successful case management path.
  
• Ability to interact effectively and professionally with internal and external customers.
  
• Excellent critical thinking and time management skills.
  
• Excellent written, verbal, and interpersonal communication skills with demonstrated and proven ability to provide exceptional customer service to external and internal customers; excellent customer service skills to include telephonic interviewing of members; motivational interviewing skills a plus.
  
• Demonstrated transferable knowledge, skill, and ability to complete job duties independently and proficiently.
  
• Flexibility in work schedules and assignments required.
  
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
  

Essential Accountabilities

• Assesses the patient’s broad spectrum of immediate and long-term needs through evaluation of the patient’s social and medical history. Develop a plan of care with providers of care and patients, to identified population along the continuum of care; allied health professionals must stay within their scope of practice.
  
• Provide ongoing assessment and documentation to monitor member’s response to the plan of care; revises as needed based on changes in the member’s condition, lack of response to the care plan, preference changes, transitions across settings, and barriers to care and services. Measures and reports outcomes that demonstrate the efficacy, quality, and cost-effectiveness of case management interventions to achieve goals.
  
• Conduct comprehensive assessments of the member’s health and psychosocial needs; includes health literacy, cultural, clinical and laboratory data, claims history, contract and benefit language, related state and federal regulations, established clinical guidelines, and recent literature or research as appropriate to ensure valid case management decisions.
  
• Facilitate communication and coordination between members of the healthcare team; facilitate safe transition of care along the healthcare continuum.
  
• Ability to identify cases that would benefit from alternative care through assessment and evaluation of the patient’s needs, as well as available resources.
  
• Apply appropriate medical policies to evaluate the medical necessity, appropriateness and efficient use of healthcare services, procedures, and facilities across the continuum of care.
  
• Identify and review high-risk cases to ensure members are transitioned to the appropriate care.
  
• Document the patient’s plan of care in a timely manner.
  
• Employ evidence-based guidelines and other self-management resources to maximize the member’s health, wellness, safety, adaptation, and self-care.
  
• Understand case management concepts such as roles, philosophies, principles, liability, and confidentiality issues. Apply these concepts in developing appropriate plan of care and goals based on the needs of the patient.
  
• Improve outcomes by utilizing adherence guidelines, standardized tools, and proven processes to measure a member’s understanding and acceptance of the care plan, his/her willingness to change, and his/her support to maintain health behavior change.
  
• Ensure compliance with regulatory standards as indicated; adhere to applicable local, state, and federal laws, as well as employer policies, governing all aspects of case management practice, including member privacy and confidentiality rights.
  
• Actively participates in project teams and medical management initiatives as needed.
  
• Assist in the orientation of associates as needed.
  

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via their Career Worklet.

Clipped from: https://jobs.localjobnetwork.com/job/detail/69772116/RN-Case-Manager-Medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description

Reporting to the Vice President of Business Solutions in US Services Segment—and working collaboratively with the senior leadership team across Maximus—this is an opportunity to build the solutions that will usher in the next wave of healthcare, human services, and public health services for millions of people across the country.

You will be responsible for providing overall solution vision, strategy, and execution for key pieces of solutions across the Medicaid Enterprise Systems market. You will be the go-to subject matter expert for the people, process and technology components of your specific market area supporting business development, operations and technology partners with ensuring Maximus has the best solution in the market for our customers.

The Sr. Director, Business Solutions is the owner and advocate for user experiences, product features, and solution partnerships at Maximus. You will work closely with our Business Development organization, Business Operations, and Technology Teams to build strong customer value propositions into our solutions and proposals.

Job Summary

Essential Duties and Responsibilities:

Drive client-specific solution architecture, solution development, and communication in a complex technology environment of Maximus and non-Maximus technologies.

– Work with solution architectures and pursuit teams to define operational service and product functionality solutions for new business opportunities.

– Interface with business developers, account managers, competency managers, and executive management throughout all phases of solution development.

– Participate in solution selling activities to ensure that marketing plans align with sales and launch plans.

– Assist and support activities to reduce gaps or inconsistencies in solutions, architectural design, deliverables, benefits, and messaging.

– Become a respected subject matter expert in one of Maximus’s key solution areas. Perform demonstrations and discuss product strategy and roadmaps in the context of market, technology and regulatory trends.

Minimum Requirements:

– Bachelor’s Degree

– 12+ years of experience

– Hands on experience with a multitude of healthcare and Medicaid business and technical services in commercial or government environments across all phases of the program lifecycle.

– Experience in MMIS (Medicaid Management Information System) delivery/operations, product management, implementations, account management, or similar.

– Creative thinking, problem solving, planning, time-management, communication, and organization skills to balance and prioritize work.

Education and Experience Requirements

• MES/MMIS experience in the business or technical operations across various MITA business areas such as: Member, provider, claims and centralized business services.
  
• Knowledge of Digital Health and Health and Human Services market preferred.
  
• Collaborative and organizationally aware.
  
• Ability to communicate, influence, and persuade business and technology leaders and peers. 
  
• Understands business process management, workflow and integration methods/tools.
  
• Comfortable, experienced, and accomplished at working with business executives and able to push back in a professional and diplomatic manner.
  
• Ability to travel is required.
  

MAXIMUS Introduction

Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit

https://www.maximus.com.

EEO Statement

EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

Maximus compensation is based on various factors including but not limited to a candidate’s education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus’s total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation shall be commensurate with job duties and relevant work experience. An applicant’s salary history will not be used in determining compensation.

 
 

Clipped from: https://maximus.jobs.net/en-US/job/sr-director-medicaid-enterprise-solutions/J3S0QV5X5CQ6B33Z1QJ?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic