Category: Curator- Job Hunter

 
 

 
 

About this job

Description

The Project Manager 2 manages all aspects of a project, from start to finish, so that it is completed on time, as requested, and within budget. The Project Manager 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

• Leads in the design, communication, and implementation of the operational plan for completing work initiatives; monitors progress and performance against the project plan; takes action to resolve operational risks and minimize implementation delays.
  
• Identifies, develops, and gathers the resources to complete the project.
  
• Prepares designs and work specifications; develops project schedules, and selecting materials, equipment, project
  

Read more about this job

Apply now

Share this job:

Humana is at the nexus of the innovation taking place within healthcare. Broadly speaking, we are one of the most active participants in the sector. This is an exciting company headquartered in a city with an excellent quality of life!

Oliver
Director, Corporate Development and Venture Capital

 
 

I looked for the opportunity for growth and stability and I found it here.

Barry
Manager, Software Engineering Strategic HR Systems

 
 

Humana has really helped my sense of belonging because I feel part of the team.

Rosemary
Senior Consumer Experience Professional

 
 

I chose to work at Humana because I heard a lot of great things about the company. It’s a very accommodating place and I enjoy working here.

Majenta
Inbound Contact Representative

The best part of this company is the commitment to associates, which naturally leads to commitment to members.

Abigail
Medical Director, Mid-South

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact yourcareer@humana.com for assistance.

Humana Health and Safety Policy
Humana and its subsidiaries will require full vaccination for associates and select contractors who conduct work outside of their home on behalf of Humana. This applies to those who work within our facilities; interact directly with members and patients; attend in-person meetings or trainings; and/or represent Humana at events or volunteer activities. Medical and religious exemptions will be available, and this policy will not supersede state or local laws. Learn more

Humana Security Notice
Humana will never ask, nor require a candidate to provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact yourcareer@humana.com to validate the request.

California Residents
If you are a California resident and would like to review our California Consumer Privacy Act (CCPA) Policy click here:

CA Resident Privacy Policy

 
 

Clipped from: https://careers.humana.com/job/16692947/project-manager-louisiana-medicaid-market-project-manager-2-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Summary This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Offices of Hearings and Inquiries(OHI). As a Health Insurance Specialist, GS-0107-13, you will expected to be thoroughly skilled in reviewing and deciding appeals involving all areas and issues of the exchange eligibility and enrollment process. Responsibilities Keep current with significant changes in program laws, regulations, policy, guidance, and precedents related to assigned areas of responsibilities. Fully research the law, regulations, policy, guidance and precedents related to the facts and the issues of the appeal. Maintain professional contact with other offices within CMS and agencies with responsibilities under the Affordable Care Act, and confer with legal Counsel with CMS and HHS, as appropriate, regarding cases and issues being considered. Request additional information and documentation as necessary to fully develop the facts and the issues involved in the appeal. Prepare written decisions supporting and communicating the appeal determination in accordance with established CMS protocols and procedures. Requirements Conditions of Employment Qualifications ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT. Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration. In order to qualify for the GS-13, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-12 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Conducting or supporting administrative appeals adjudication, which may include hearing scripts, case briefs, hearings and decision drafts; 2) Developing or researching and interpreting statutes, regulations and program policies and procedures; AND 3) Communicating with internal and external stakeholders regarding the appeals process and appeals case adjudication. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Time-in-Grade: To be eligible, current or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying. Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11634642 Education Additional Information Bargaining Unit Position: Yes-American Federation of Government Employees, Local 1923 Tour of Duty: Flexible Recruitment/Relocation Incentive: Not Authorized Financial Disclosure: Not Required To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply. Workplace Flexibility at CMS: CMS offers flexible working arrangements and allows employees the opportunity to participate in telework combined with alternative work schedules at the manager’s discretion. This position may be authorized for telework. Telework eligibility will be discussed during the interview process. The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at www.opm.gov/rif/employeeguides/careertransition.asp.

 
 

Clipped from: https://www.linkedin.com/jobs/view/health-insurance-specialist-at-centers-for-medicare-medicaid-services-3268906431/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Description

Humana Healthy Horizons in Louisiana is seeking a Manager, Utilization Management Nursing who will utilize clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing applies a Person-Centered approach, works within specific guidelines and procedures; applies advanced technical knowledge and clinical criteria to solve moderately complex problems; receives assignments in the form of team and/or department goals and objectives and determines approach, resources, schedules and monitors success of appropriate team or department goals.

Responsibilities

Essential Functions and Responsibilities

• Supervise utilization management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review, prior authorization and referrals to care management.
  
• Oversee, monitor, orient and train staff in the use of standard utilization management criteria including MCG, Interqual, and ASAM.
  
• Lead development of utilization 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 utilization management services, including introducing innovative approaches to utilization management.
  
• Monitor and maintain staffing levels to meet care and service quality objectives.
  
• 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 utilization management programs.
  
• Collect and analyze performance reports on utilization management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
  
• Conducts briefings and area meetings; maintains frequent contact with other managers across the department and the company.
  

Required Qualifications

• Licensed Registered Nurse (RN) in the state of Louisiana with no disciplinary action.
  
• Must reside in the state of Louisiana.
  
• Previous experience in utilization management.
  
• Two (2) or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.
  
• Two (2) years of leadership experience.
  
• Knowledge of Interqual, ASAM and/or Milliman (MCG) criteria.
  
• Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
  
• Ability to work independently under general instructions and with a team.
  
• 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.

• BSN, Bachelor’s degree in health services, healthcare administration, or related field.
  
• Experience working with Medicaid and/or health plan Utilization Management.
  
• Possess subject matter expertise in review of inpatient admission and concurrent reviews requests.
  
• Experience managing staff who review and process prior authorization, inpatient admission reviews and concurrent reviews.
  
• Experience serving Medicaid, TANF, and/or CHIP populations.
  

Additional Information.

• Workstyle: Remote with limited travel.
  
• Travel: Up to 10% to Humana Healthy Horizons locations in Metairie or Baton Rouge, LA
  
• Typical Work Days/Hours: Monday – Friday; 8:00am – 5:00pm CST with potential rotating on-call schedule.
  
• Direct Reports : up to 12 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

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 [ Link removed ] – Click here to apply to RN, Manager, Utilization Management Nursing (Louisiana Medicaid)

Recommended Skills

• Administration
  
• Benchmarking
  
• Business Process Improvement
  
• Certified Nurse Practitioner
  
• Clinical Nursing
  
• Clinical Works
  

 
 

Clipped from: https://www.careerbuilder.com/job/J3P62679GDG5SB730TF?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Department of Health and Human Services (DHHS)
Opening Date: September 2, 2022
Closing Date: September 16, 2022
Job Class Code: 0441
Grade: 20
Salary: $39,395.20 – $52,894.40/year
Position Number:

Agency information:

The Department of Health and Human Services (DHHS) provides supportive, preventive, protective, public health and intervention services that help families and individuals meet their needs. DHHS strives to provide these programs and services while respecting the rights and preferences of individuals and families. The Office of MaineCare Services (OMS) within DHHS administers the state’s Medicaid program, which provides health insurance coverage for low-income families, adults and children so they can access the important health care services they need to be healthy and be a part of the community through work, caring for family, going to school, and more. OMS works collaboratively within DHHS, with other Departments and the Office of the Governor, with MaineCare members, with providers, and with other health care purchasers on statewide healthcare improvement initiatives. OMS is committed to advancing health equity efforts to improve access to care and health outcomes for all low-income Mainers. OMS provides benefit coverage and supports the services that operate in alignment with Department goals, federal mandates and State policy. OMS also provides oversight necessary to ensure accountability and efficient and effective administration.

The Drug Rebate Program is part of the Pharmacy Unit, within OMS. Drug Rebate is a program that includes Centers for Medicare & Medicaid Services (CMS), State Medicaid agencies, and participating drug manufacturers that helps to offset the Federal and State cost of most outpatient prescription drugs dispensed to Medicaid patients.

Job duties:

This position administers the Drug Rebate Program for the State of Maine. Responsibilities include, but are not limited to, submitting drug rebate invoices to participating drug manufacturers. Allocating and reconciling payments from drug manufacturers. Researching and analyzing national drug code (NDC) reports, paid claim information, and drug pricing and packaging information whenever a drug manufacturer disputes invoiced amounts. Negotiating and resolving disputed units with drug manufacturers and pharmacies. You will evaluate and interpret State and Federal statute, rules, and laws to comply with required procedures. Attention to detail is a must, as is the ability to handle a large volume of work and to make decisions independently. Additional duties are described below.

• Provide detailed reports of drug utilization as requested by manufacturers so they may review the data prior to paying a rebate.
  
• Resolve disputes when the manufacturer disputes the invoiced total units. This may require contacting a pharmacy to verify a member’s prescription of what was dispensed.
  
• Review outstanding balances to see if a manufacturer has credits on file or owes a balance.
  
• Provide claim level detail (CLD) reports to support the invoiced amount.
  
• Respond timely to questions from manufacturers.
  
• Request invoice backup from the manufacturer so that a payment may be allocated correctly and reconciled.
  

This position reports to the Pharmacy Operations Manager. This is a full-time position located at 109 Capitol Street, Augusta, Maine. This opportunity allows partial telework with management approval.

Minimum Qualifications:

A Bachelor’s Degree in Accounting, Business Administration or related field and one (1) year of experience in healthcare insurance or a related insurance field. Directly related work experience may be substituted for education requirements on a year-for-year basis.

Preferred experience includes:

• Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low-income populations
  
• Lived experience with Medicaid and/or other health-related social needs common to individuals and families receiving Medicaid coverage
  

The background of well-qualified candidates will demonstrate the following competencies:

 

1. As a Reimbursement Specialist you frequently communicate by phone and in writing with physicians, pharmacists, drug labelers/manufacturers, attorneys, and federal CMS (Centers for Medicare and Medicaid Services). To successfully perform these duties, you will need strong oral and written communication skills. Please tell us about those aspects of your background that demonstrate you have the oral and written communication skills to be successful as a Reimbursement Specialist.
   
2. Reimbursement Specialists are independent and self-directed workers who operate with considerable autonomy in establishing their day-to-day work activities and priorities. Please provide us with examples from your experience that demonstrate you are a self-directed worker capable of successfully performing your duties with minimal supervision.
   
3. Reimbursement Specialists negotiate with drug labelers/manufacturers and federal CMS representatives in order to collect money for disputed payment amounts on drug invoices. Maintain two-way communications with them and use problem-solving techniques in order to negotiate a dispute resolution. Tell us about those experiences that demonstrate you can successfully perform duties requiring considerable research and negotiation skills.
   
4. Drug manufacturers often challenge the Department’s attempt to recover delinquent accounts. As a Reimbursement Specialist, you will analyze quarterly drug rebate invoices for approximately 780 participating drug manufacturers for 4 different rebate programs. You will record and reconcile payments using knowledge of proper accounting principles. Analyze balances after posting payment in order to identify disputes and reasons for disputes. Please tell your experiences that demonstrate effective accounting principles.
   
5. Reimbursement Specialist must have pharmacy knowledge and an understanding of a preferred drug list. They should be able to review pharmacy claims and have an understanding of a pharmacy formulary and/or preferred drug list in order to respond to drug manufacturers. Please tell your experience that demonstrate proficient pharmacy experience.
   

Application Information:

Please submit all documents or files in a PDF or Word format.

For additional information about this position please contact Jan Wright at or by e-mail . To apply, upload a resume and cover letter addressing the five competency areas identified in the above section.

To request a paper application, please contact .

Benefits

No matter where you work across Maine state government, you find employees who embody our state motto-“Dirigo” or “I lead”-as they provide essential services to Mainers every day. We believe in supporting our workforce’s health and wellbeing with a valuable total compensation package, including:

• Work-Life Balance – Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave.
  
• Health Insurance Coverage – The State of Maine pays 85%-100% of employee-only premiums ($10,150.80-$11,345.04 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State.
  

 
 

• Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%. Visit the Office of Employee Health and Wellness for more information about program requirements.
  

 
 

• Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($350.40 annual value).
  

 
 

• Retirement Plan – The State of Maine contributes 13.16%of pay to the Maine Public Employees Retirement System (MainePERS), on behalf of the employee.
  
• Gym Membership Reimbursement – Improve overall health with regular exercise and receive up to $40 per month to offset this expense.
  
• Health and Dependent Care Flexible Spending Accounts – Set aside money pre-tax to help pay for out-of-pocket health care expenses and/or daycare expenses.
  
• Public Service Student Loan Forgiveness – The State of Maine is a qualified employer for this federal program. For more information, visit the Federal Student Aid office.
  
• Living Resources Program – Navigate challenging work and life situations with our employee assistance program.
  

 
 

• Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child-including fathers and adoptive parents-receive four weeks of fully paid parental leave. Additional, unpaid leave may also be available, under the Family and Medical Leave Act.
  
• Voluntary Deferred Compensation – Save additional pre-tax funds for retirement in a MaineSaves 457(b) account through payroll deductions.
  
• Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness.
  

Maine State Government is an Equal Opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees….. click apply for full job details

 

Clipped from: https://jobs.wane.com/jobs/mainecare-reimbursement-specialist-augusta-maine/712244688-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 

 
 

Overview

Director I HCMS -Medicaid Jobs in SeattleWA at Elevance Health

Title: Director I HCMS -Medicaid

Company: Elevance Health

Location: SeattleWA

Job Family: Medical and Clinical
Type: Full time
Date Posted: Sep 14, 2022
Req #: JR22462

Description
Please note: This position supports the State of Washington Medicaid plan. To be considered for the position, you must reside in the state of Washington
Status: Full-time, Salaried with bonus potential, work from home
The Director I HCMS is responsible for managing the utilization and case management process for one or more member product populations of varying medical complexity ensuring the delivery of essential services that address the total healthcare needs of members.

Primary duties may include, but are not limited to:

Implements and manages health care management, utilization, cost, and quality objectives.
Ensures program compliance and identifies opportunities to improve the customer service and quality outcomes.
Oversees the development and execution of medical and case management policies, procedures, and guidelines; assists in developing clinical management guidelines.
Ensures medical management and case management activities are contracted, reviewed, and reported.
Supports quality initiatives and activities including clinical indicators reporting, focus studies, and HEDIS reporting.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Requirements

BA/BS degree in a health care field
8 years clinical experience including prior management experience
Any combination of education and experience which would provide an

equivalent background.

Preferences

RN, LCSW, or LPC
National Committee for Quality Assurance (NCQA) accreditation and

HEDIS reporting experience

MS/MA degree in a health care field or MBA with Health Care concentration
Certified Case Manager

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

Clipped from: https://customercarejob.com/job/director-i-hcms-medicaid/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Clipped from: https://www.careerbuilder.com/job/J3S19B69Z31NQFQ85HX?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description

Humana Healthy Horizons in Louisiana is seeking a Manager, Utilization Management (Behavioral Health) who will utilize clinical skills to support the coordination, documentation, and communication of behavioral health services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health applies a Person-Centered approach, works within specific guidelines and procedures; applies advanced technical knowledge and clinical criteria to solve moderately complex problems; receives assignments in the form of team and/or department goals and objectives and determines approach, resources, schedules and monitors success of appropriate team or department S.M.A.R.T goals.

Responsibilities

Essential Functions and Responsibilities

• Supervise utilization management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review, prior authorization and referrals to care management.
  
• Oversee, monitor, orient and train staff in the use of standard utilization management criteria including ASAM.
  
• Lead development of utilization 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 utilization management services, including introducing innovative approaches to utilization management.
  
• Monitor and maintain staffing levels to meet care and service quality objectives.
  
• 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 behavioral health utilization management programs.
  
• Collect and analyze performance reports on utilization management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
  
• Conducts briefings and area meetings; maintains frequent contact with other managers across the department and the company.
  

Required Qualifications

• Must reside in the state of Louisiana.
  
• Licensed Mental Health Practitioner (LMHP) who is licensed to practice independently in Louisiana and is in compliance with the requirements of one of the following regulated areas: Medical Psychologists, Licensed Psychologists, Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors (LPCs), Licensed Marriage and Family Therapists (LMFTs), Licensed Addiction Counselors (LACs) or Advanced Practice Registered Nurses (APRN) with specialization in adult psychiatric and mental health.
  
• Two (2) or more years of clinical experience working with the behavioral health populations preferably in an acute care, skilled or rehabilitation clinical setting.
  
• Previous experience in utilization management.
  
• Two (2) years of leadership experience.
  
• Knowledge of ASAM, Interqual and/or Milliman (MCG) criteria.
  
• Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
  
• Ability to work independently under general instructions and with a team.
  
• 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.
  
• 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.
  
• 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

• Certified Case Manager (CCM) or willingness to obtain within 2 years of employment.
  
• Experience serving Medicaid, TANF, and/or CHIP populations.
  

Additional Information

• Workstyle: Remote.
  
• Travel: 25% in-state travel.
  
• Direct Reports: up to 12 Associates.
  
• Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov) ([ Link removed ] – Click here to apply to Manager, Utilization Management Behavioral Health – Louisiana Medicaid 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

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 [ Link removed ] – Click here to apply to Manager, Utilization Management Behavioral Health – Louisiana Medicaid

Recommended Skills

• Administration
  
• Behavioral Medicine
  
• Benchmarking
  
• Business Process Improvement
  
• Case Management
  
• Certified Case Manager
  

Clipped from: https://www.internships.com/posting/sam_LjlV4t1o7LACs7Ri5fd_2Aee3XHIhpXjIpkktC_0TrjAKYgr-HRIyg?context=merch&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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- 1 case load in Blount County ; 1 case load in Walker 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 for caseloads in Blount and Walker 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.
  
• Counsel clients and assists to develop Smart Goals.
  

 
 

• Coordinate Medicaid Re-determination, 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:

Knowledge of social work principles and interviewing techniques.

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 Types: Full-time, Part-time, Internship

Pay: From $17.16 per hour

Benefits:

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

Schedule:

• 8 hour shift
  
• Monday to Friday
  

COVID-19 considerations:
M4A follows CDC guidelines.

Education:

• High school or equivalent (Preferred)
  

Work Location: One location

Clipped from: https://careers.mercy.net/job/887051/Policy-Analyst-Medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 

MHAP – Jackson, MS Department MHA Mississippi Health Advocac Category Business Professional Location Jackson, Mississippi, United States Job Id: 887051 Mercy Posted on: 06/26/2022 Type: Full Time Days

Save Job

Apply Now

https://careers.mercy.net/job/887051/Policy-Analyst-Medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic0

Clipped from: https://louisiana.talentify.io/job/medicaid-pre-release-enrollment-coordinator-2-baton-rouge-la-la-louisiana-3712748?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Summary

The MPRE Coordinator 2 position is part of a three-member team that supports Medicaid’s Justice-involved Pre-Release Enrollment Program as well as other justice-involved initiatives undertaken by Medicaid. The Pre-Release Enrollment Program provides Medicaid coverage for the offender population and is a collaborative effort, working with the Louisiana Department of Public Safety & Corrections (DPS&C) and partners with community groups that work with formerly incarcerated persons. A key role of this position will be to advance the monitoring and evaluation of the program. This position is domiciled at the Louisiana Department of Health’s office in Baton Rouge, Louisiana.

Job Description

• Assist the LDH Program Manager in all areas of daily program functions including researching Medicaid eligibility and resolving application issues, ensuring the accuracy of program data, communicating with stakeholders, and periodic program monitoring.

• Work collaboratively with staff of DPS&C’s prison facilities, Medicaid’s managed care plans, and other LDH programs.

• Assist with the coordination, planning and evaluation of Medicaid’s Pre-release Enrollment Program and other justice-involved initiatives

• Assist LDH management with day-to-day tasks and serve as a secondary contact and provide functional back-up support in the unit supervisor’s absence.

• Research multiple databases to resolve individual Medicaid application and enrollment issues for internal and external partners.

• Responsible for data analysis and writing monthly, mid-year and annual reports.

• Represent the department at relevant conferences, regional events and stakeholder meetings. Some in-state travel is expected, including travel to other state offices and correctional facilities.

• Conduct research on topics related to program or target population as needed.

• Assist with the preparation and execution of conference calls, webinars, and meetings.

• Develop and update documentation about the program for internal and external audiences such as operations manuals, reports, white papers, abstracts and fact sheets.

• Facilitate meetings, trainings as needed.

• Assist with data integrity efforts including verifying data accuracy.

• Other tasks as directed.

 
 

Required Qualifications:

• Bachelor’s degree.

• Minimum of 3 years professional experience in Medicaid programs, the justice-involved population, or criminal justice system.

• Minimum 2 years of professional experience with writing business documents such as reports, abstracts and memorandums.

• Minimum of 1 year of professional experience with planning and leading meetings, committees, or coalitions.

• Advanced ability to problem-solve and research between multiple computer systems or databases.

• Proficient in Microsoft Office applications, including Word, Excel, Access and Power Point.

• Strong verbal and written communications skills and ability to communicate concepts to a range of audiences. .

• Must be able to pass a background check and gain admittance to correctional facilities.

 
 

Desired Qualifications:

• Master’s degree in health administration, business administration, information technology, or public health, Juris Doctor or other advanced degree in relevant field.

• Minimum of 3 years professional experience in Medicaid programs, the justice-involved population, or criminal justice system.

• Minimum of 2 years professional experience with data analysis software such as SAS, SQL, R, Python.

• Experience with scholarly journal article writing, submissions and publications.

• Experience with health outcomes/policy research or study/survey design.

 
 

Required Attachment(s)

 
 

Please upload the following documents in the Resume/Cover Letter section.

• Detailed resume listing relevant qualifications and experience;
  
• Cover Letter indicating why you are a good fit for the position and University of Louisiana Systems;
  
• Names and contact information of three references.
  

 
 

Applications that do not include the required uploaded documents may not be considered

Posting Close DateThis position will remain open until filled.

 
 

Note to Applicant:

 
 

Applicants should fully describe their qualifications and experience with specific reference to each of the minimum and preferred qualifications in their cover letter. The search committee will use this information during the initial review of application materials.

References will be contacted at the appropriate phase of the recruitment process.

This position may require a criminal background check to be conducted on the candidate(s) selected for hire.

As part of the hiring process, applicants for positions at the University of New Orleans may be required to demonstrate the ability to perform job-related tasks.

Salary range is $47,000-$57,000

Clipped from: https://www.helpwanted.com/962679f91137402b9af0388ab2ca7dd2-Manager-Enrollment-Benefits-Configuration-Medicaid-job-listings?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

• Home
  
• Job Search
  
• Benefits Manager Jobs
  
• Massachusetts Benefits Manager Jobs
  
• Hopedale Benefits Manager Jobs
  

 
 

Manager, Enrollment & Benefits Configuration – Medicaid

Point32Health

Hopedale, MA 01747

Posted 3 days ago

Apply Now

• Job Type(s)
  

Full Time

• Industry
  

Administrative, Clerical

• Job Description
  

The Manager, Enrollment and Benefits Configuration is responsible for overseeing all department operations pertaining to data entry, maintenance and reconciliation of member data as well as the documentation and configuration of plans and benefits.

Job Description

• Responsible for ensuring the quality, timeliness and compliance of all organizational processes and reporting as they relate to member data and benefit configuration.
  
• Accountable for the enrollment reconciliations for multiple lines of business and is accountable for the premium reconciliation which includes oversight of rate tables, the generation of expected premiums. This role is responsible for the timely reporting of enrollment and premium discrepancies to Government agencies and external business partners.
  
• Participate in the development and implementation of regulatory, corporate and new business initiatives as it relates to member data and/or plan benefits and documentation. This role will initiate and leads cross departmental activities to improve the quality of member data and is responsible for bringing such projects to completion.
  
• Serves as the key enrollment contact externally, with state agencies and has primary responsibility to ensure all required reporting functions are delivered accurately and timely. This position will independently assess business needs and solution options and present proposals for implementation of business process change to meet an evolving business model and regulatory requirements.
  
• Leads and coordinates development, testing and implementation of key department projects and with other departments within Tufts Health Plan, internal staff and external parties.
  
• Represent the Enrollment and Benefit Configuration team on enterprise wide projects such as the annual production of 1099-HC and 1095 forms, the MLR Reimbursement process, audits and compliance initiatives.
  
• Leads the team in the identification, organization and execution of key initiatives, innovation and process improvements for the department
  
• Oversees day-to-day operations to ensure that all member data is entered accurately into the member enrollment, benefit configuration and revenue applications and that incoming requests are processed within the required time frames. Manages accurate and timely processing of enrollment and premium reconciliations to meet state and federal requirements for MassHealth, QHP and the Unify lines of business.
  
• Initiates interdepartmental projects to improve the quality of the member data and staff workflow process. Serves as the business owner and subject matter expert to bring projects to completion. Continually looks for new opportunities to achieve efficiencies.
  
• Leads team members in performing their daily responsibilities: provides feedback and coaching via regular one-on-one meetings; and holds regular staff meetings to provide training and information. As a Manager, this role is also responsible for measuring employee productivity and coaching staff to reach optimal performance and quality; conducting formal performance appraisals; and, when necessary, appropriate disciplinary action in a timely manner and in accordance to Tufts Health Plan Human Resources policies and procedures.
  
• Makes manager-level decisions for the department regarding issues affecting data quality, and trains and delegates accordingly. Trouble-shoots problems related to the file loading processes and other member-related functions, and works with the appropriate resources to get them resolved. Develops and monitors quality reports to identify issues proactively when possible.
  
• Maintains a thorough understanding of the member enrollment, benefit configuration and revenue applications, data integrity and its impact on other parts of the organization. Establishes, builds, and maintains positive working relationships with other Tufts Health Plan departments, including Claims, Medical Management, Marketing, Product Management, Member Services, Pharmacy, Clinical Services, Network Contacting and IT to ensure that all data is processed efficiently and with accuracy.
  
• The person in this position maintains professional growth and development through self-directed learning activities and involvement in professional, civic, and community organizations; encourages a high work ethic within the department by demonstrating appropriate and acceptable behavioral skills; encourages and precipitates a collaborative work environment among team members; and develops benchmarks for best practices related to all major functions.
  
• Participates as team leader and/or team member on special projects as assigned and all other duties as assigned.
  

Requirements

EDUCATION:

1. Bachelors Degree, or equivalent work experience required; Advanced degree preferred in business or related to health care industry.
   

EXPERIENCE:
 

• 5 to 7 years working with operational and technical aspects of managed care required; healthcare experience preferred, particularly in the areas of claims and/or enrollment processing.
   
  
• Supervisory experience required.
  

SKILL REQUIREMENTS:

• Experience with analysis of operational issues and advanced problem solving skills required.
   
  
• Experience using SQL Server or Microsoft Access to create queries is a strong plus.
  
• Proven track records for establishing, building, and maintaining relationships.
  
• Demonstrated verbal, written and presentation skills.
  
• Ability to work collaboratively as a member of cross-functional teams.
  
• Ability to negotiate and resolve differences.
  
• Ability to motivate staff to achieve a high level of performance.
  
• Ability to be flexible and adapt to change as a result of industry and organizational changes.
  
• Ability to streamline and improve operational processes and metrics.
  

What we build together changes our customer’s health for the better. We are looking for talented and innovative people to join our team. Come join us!

Please note: As of January 18, 2022, all employees including remote employees must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

About Us:

Point32Health is a leading health and wellbeing organization, delivering an ever-better health care experience to everyone in our communities. Building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

At Point32Health, were working to reshape the world of health care by pushing past the status quo and delivering even more to the diverse communities we serve: more innovation, more access, more support, and healthier lives. And we want people like you on our side to make it even better.

This job has been posted by TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID:R4714

Apply

Show more jobs like this

Manager, Enrollment & Benefits Configuration – Medicaid jobs in Hopedale, MA

Direction map

Login

We use cookies to personalize your experience on our website. By continuing to use this site, you agree to our cookie policy. Click here to learn more