Category: Curator- Job Hunter

Clipped from: https://www.glassdoor.com/job-listing/advisory-services-analyst-medicaid-mathematica-JV_IC1138213_KO0,34_KE35,46.htm?jl=1007897954643&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Position Description:


 

Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding using data science and analytics. Our work yields actionable information to guide decisions in wide-ranging policy areas, from health, education, early childhood, and family support to nutrition, employment, disability, and international development. Mathematica offers our employees competitive salaries, and a comprehensive benefits package, as well as the advantages of being 100 percent employee owned. As an employee stock owner, you will experience financial benefits of ESOP holdings that have increased in tandem with the company’s growth and financial strength. You will also be part of an independent, employee-owned firm that is able to define and further our mission, enhance our quality and accountability, and steadily grow our financial strength. Learn more about our benefits here: https://www.mathematica.org/career-opportunities/benefits-at-a-glance.

 
 

Mathematica is searching for analysts with experience in Medicaid policy and programs at either the state or federal level. In particular, we are looking for individuals who can support current and emerging work across any number of areas related to monitoring and improving Medicaid programs such as: Medicaid managed care programs, value-based purchasing and alternative payment models, long-term services and supports, measures of delivery and quality of services for beneficiaries, data analytics, and outcomes of innovative programs and policies. Additionally, Medicaid analysts will work on or support project management, change management, and business development. Medicaid analysts work on a variety of projects spanning policy and programmatic areas. These projects range from data analytics to program evaluation and implementation support. Candidates do not need to have experience in all of these areas but should have substantial experience in at least one of them.

Medicaid analysts will likely be connected to 2-3 projects at a time, with many projects requiring team leadership and direct-client contact. Across all projects, Medicaid analysts are expected to:

• Lead or participate actively and thoughtfully in multidisciplinary teams to implement and monitor policy and programs, drawing on your past experience with Medicaid programs
  
• Apply rigorous analytic thinking to the collection and interpretation of quantitative and/or qualitative data, including analysis of Medicaid administrative data, managed care data, and site visits or telephone interviews with state and federal officials, health plan representatives, and providers
  
• Bring creative ideas to the development of proposals for new projects
  
• Provide the direction and organization needed to help keep projects on time and on budget and facilitate communications across and between internal and external stakeholders
  
• Contribute to the growth, expertise, and institutional knowledge of staff working in the Medicaid area
  

Specific project or new business development activities may include:

• Conducting research projects on topics related to state and federal Medicaid policy
  
• Providing technical assistance to federal and state Medicaid stakeholders
  
• Assisting with quantitative analyses using Medicaid enrollment, claims/encounter, financial and program data to support program monitoring, improvement, or evaluation
  
• Developing technical specifications, user manuals, and other documentation to support the implementation of reporting systems and analytic tools
  
• Authoring client memos, technical assistance tools, issue briefs, chapters of analytic reports, and webinar presentations
  

Position Requirements:


 

Qualifications:

• Master’s degree or equivalent in data analytics, public policy, economics, statistics, public health, behavioral or social sciences, or a related field, and at least 3 years of experience working in health policy or health research, with a substantial portion of that time focused on some aspect of the Medicaid program at the state or federal level; or a bachelor’s degree and at least 7 years of state or federal Medicaid experience.
  
• Strong foundation in quantitative and/or qualitative methods and a broad understanding of Medicaid program and policy issues
  
• Excellent written and oral communication skills, including an ability to write clear and concise policy and/or technical memos and documents for diverse stakeholder audiences including program administrators and policymakers
  
• Demonstrated ability to lead tasks or deliverables and coordinate the work of multidisciplinary teams
  
• Strong organizational skills and high level of attention to detail; flexibility to manage multiple priorities, sometimes simultaneously, under deadlines
  

To apply, please submit a cover letter, resume, transcripts (unofficial are acceptable), and contact information for three references. Please also provide a writing sample that demonstrates policy analysis or program operation and monitoring skills, and reflects independent analysis and writing, such as a white paper or decision memo. You will also be asked to provide your desired salary range during the application process.

Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on a project. If you are assigned to such a project, you will be required to obtain the requisite security clearance.

Available Locations: Princeton, NJ; Washington, DC; Cambridge, MA; Woodlawn, MD; Ann Arbor, MI; Oakland, CA; Chicago, IL; Remote

This position offers an anticipated annual base salary range of $70,000 – $95,000. This position may be eligible for a discretionary bonus based on individual and company performance.

In accordance with Executive Order 14042 and its implementing guidelines, all Mathematica employees must provide documentation that they have been fully vaccinated or obtain an accommodation through Human Resources by providing documentation from a licensed health care provider that they are unable to be vaccinated against COVID-19 because of a disability (which would include medical conditions) or provide an attestation that they are entitled to an accommodation because of a sincerely held religious belief, practice, or observance.

Clipped from: https://www.ziprecruiter.com/c/004-Humana-Insurance-Company/Job/RN,-Clinical-Educator-Louisiana-Medicaid/-in-Winnfield,LA?jid=d20df71f70c256c4&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description

Humana Healthy Horizons in Louisiana is seeking a RN, Clinical Educator (Nursing Educator 2) who will plan, direct, coordinate, evaluate, develop, and/or deliver trainings and education programs for professional nursing, social work, and nonclinical personnel. The RN, Clinical Educator (Nursing Educator 2) work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The RN, Clinical Educator (Nursing Educator 2) develops educational goals and plans for new associate orientation, ongoing training, and professional development in virtual and in person instructor-led trainings. Training programs may include, but not be limited to, Care Management, Utilization Management, and/or Compliance throughout Humana Healthy Horizons organization supporting Louisiana Medicaid.

• Selects appropriate training materials.
  
• Creates an environment that is conducive to learning and exchanging information, engages the learner, and produces the desired outcomes.
  
• Monitors training personnel records to ensure that associates have met all company training requirements for company, quality, and regulatory compliance.
  
• Analyzes course evaluations in order to judge effectiveness of training sessions, develops new training based upon identified needs, and implements suggestions for improvements.
  
• Evaluates the relevance of online resources to complement the facilitated experience in the fields as appropriate.
  
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
  
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
  
• Follows established guidelines/procedures.
  

               
 

Required Qualifications

• Must reside in the state of Louisiana.
  
• Unrestricted Registered Nurse (RN) license in the state of Louisiana.
  
• Minimum two (2) years of work experience in training and learning development.
  
• Experience in the development of educational materials.
  
• Understanding of curriculum design and adult learning principles.
  
• Proficiency in Microsoft Office applications including Outlook, PowerPoint, Word and Excel.
  
• Strong presentation skills in presenting virtually and in person.
  
• Strong collaboration and communication skills.
  
• Experience working with multiple layers of leadership within an organization.
  
• 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 in Business, Health Administration or a related field.
  
• Experience using a wide variety of training tools to effectively facilitate to a wide audience.
  
• Experience managing projects or processes.
  

Additional Information

• Travel: Up to 10% to Humana Healthy Horizons locations in Metairie or Baton Rouge, LA for team engagement and meetings.
  
• Typical Workdays/Hours: Monday – Friday; 8:00am – 5:00pm CST.
  

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

Clipped from: https://jobs.smartrecruiters.com/CNSI1/743999849158791-senior-healthcare-federal-reporting-specialist-medicaid-remote-u-s-?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Company Description

CNSI delivers a broad range of health information technology enterprise solutions and customizable products to a diverse base of state and federal agencies. We align, build, and manage innovative, high-quality, cost-effective solutions that help customers achieve their mission, enhance business performance, reduce costs, and improve health for over 51 million Americans.

Job Description

Summary:

The Senior Healthcare Federal Reporting Specialist – Medicaid is responsible for analyzing business problems, identifying gaps, and developing solutions involving complex information systems under no supervision relates to CMS reporting requirements for Medicaid, Claims, Benefits Administration, Member Eligibility, Provider Enrollment, Prior Authorization, Third Party Liability (TPL) and Contracts Managed Care. This role involves managing requirement scope, determining appropriate methods on potential assignments, and serving as a bridge between information technology teams and the client through all project phases, providing day-to-day direction on State program activities.

Job Responsibilities:

• Provides Medicaid and Children’s Health Insurance Program (CHIP) expertise and guidance as it relates to Expenditures Reports, Federal Compliance Reports, Management, Analysis and Reporting Subsystem (MARS), Surveillance and Utilization Review Subsystem (SURS) reports
  
• Analyzes user requirements and client business needs, leveraging expert opinion and expertise
  
• Share use cases to data analysts for profiling, review results, and infer compliance to Medicaid / CMS processes and guidelines
  
• Acts as the requirements subject matter expert and supports requirements change management
  
• Works with customers on presenting technical solutions for complex business functionalities
  
• Understand the overall system architecture and cross-functional integration
  
• Demonstrates in-depth knowledge of business analysis to ensure high quality
  
• Communicates issues and risks to the manager or direct supervisor and assists in developing solutions
  

The selected candidate will be able to work remotely in the U.S. with up to 50% travel for client and team meetings, and trainings.  Candidate located in the Atlanta, Georgia area preferred.

Qualifications

Required Experience/Skills:

• Bachelors’ Degree with 7+ years of healthcare data analysis experience and writing business requirements OR Master’s Degree with 5+ years of healthcare data analysis experience and writing business requirements.
  
• 4+ years of experience in working with State Medicaid and CHIP agencies.
  
• 3+ years of experience working with PERM, T-MSIS, CMS Federal Reporting, or similar projects.
  
• 2+ years of experience in HEDIS, CHIPRA, or similar quality metrics.
  
• In-depth knowledge of CMS reporting requirements for Medicaid.
  
• In-depth understanding of FFS, Managed Care claim adjudication processes from enrollment to funding/finance.
  
• Knowledge of the Affordable Care Act and eligibility.
  
• Able to perform complex data analysis using SQL, Excel against data warehouses utilizing large datasets.
  

 Preferred Experience/Skills:

• Strong knowledge and proficiency in SQL.
  
• Knowledge of the Quality-of-Care program.
  
• Knowledge of data integration and software enhancements/planning.
  

Additional Information

About Us:

At CNSI, we strive to be the market leader and most trusted partner for innovative and transformative technology-enabled solutions that improve health outcomes and reduce costs. We’re passionate about helping our clients improve the health and well-being of individuals and families. We succeed when our clients succeed.

Innovation and commitment to our mission are core to our DNA. And through our shared values, we foster an environment of inclusion, empowerment, accountability, and fun! You will be offered a competitive compensation and benefits package.

CNSI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status, or any other status protected by applicable federal, state, or local law. We are proud of our diversity and encourage all qualified applicants to apply.

Kindly inquire during the interview process if this position is subject to President Biden’s Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors, requiring you to be vaccinated by December 8, 2021.

Clipped from: https://www.ziprecruiter.com/c/SeniorBridge/Job/Manager,-Care-Management-(Behavioral-Health)-Louisiana-Medicaid/-in-Many,LA?jid=c3c578e341921443&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description

Humana Healthy Horizons in Louisiana is seeking a Manager, Care Management (Behavior Health) who will lead our behavioral health care management operations and staff to ensure timely and culturally-competent delivery of care, services, and supports in compliance with Louisiana Department of Health (LDH) contractual requirements and industry best practices.

Responsibilities

Essential Functions and Responsibilities:

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

               
 

Required Qualifications

• 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: Physicians (Psychiatrists), 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.
  
• Must reside in the state of Louisiana.
  
• Minimum Five (5) years’ experience working in the healthcare setting.
  
• Minimum two (2) years of management/supervisory experience.
  
• Minimum one (1) year of work experience in the behavior health field.
  
• Experience in case management.
  
• Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
  
• Ability to work independently under general instructions and with a team.
  
• This role is considered patient facing and is a part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
  
• This role is a 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 least100,000/300,000/100,000limits.
  
• 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

• 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.
  

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

Clipped from: https://www.careerbuilder.com/job/J3S0BW65MWQ7HH78SB9?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

List of Jobs and Events

 
 

Sr. Project Manager – Medicaid

Aetna Inc. Washington, DC Full-Time

Job Description

This role is remote and may sit anywhere in the US.

This role:

* Supports Business Development team with strong project management skills and technical knowledge of products and systems with a Medicaid background.
* Manages significant product initiatives, and cultivates relationships with internal and external constituencies.
* Leverages in-depth knowledge and understanding of products across functions and market segments in directing the development and implementation of new initiatives
* Directs, evaluates, and provides requirements/specifications for use of appropriate business processes and systems to support initiatives.
* Seeks and maintains comprehensive understanding of internal and external environmental influences and competitive pressures to develop and enhance portfolio.
* Establish and manage large (or significant) cross-functional development work groups.
* Anticipate resource needs, set priorities, establish accountabilities, define roles/responsibilities, and manage relationships to secure necessary resources not under direct control.

Pay Range

The typical pay range for this role is:

Minimum: 75,400

Maximum: 158,300

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

Required Qualifications

6+ years of related experience.

Extensive knowledge of Medicaid Managed Care.

Experience leading cross-functional project management initiatives.

Advanced communication/presentation skills.

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

Experience working in market pursuit preferred, but not required.

Education

BA/BS or equivalent experience

Business Overview

Bring your heart to CVS Health

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

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

We strive to promote and sustain a culture of diversity, inclusion and belonging every day.

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

Recommended Skills

• Business Development
  
• Business Processes
  
• Communication
  
• Market Segmentation
  
• Medicaid
  
• Medicaid Managed Care
  

Clipped from: https://www.linkedin.com/jobs/view/director-medicaid-at-regence-blueshield-3151242883/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Director of Medicaid

 
 

Oregon, Washington, Utah and Idaho (remote work available in these states)

 
 

Primary Job Purpose

 
 

The Director of Medicaid is the voice of Medicaid internally and externally reporting to the SVP, Government Programs. The Director of Medicaid is accountable for the Profit and Loss of the line of business. This leader is responsible for the strategy, business cases development and implementation of Medicaid in one or all of our four states. This includes overall performance of the market Medicaid line of business program, a focus on financial performance and membership growth. Oversees all aspects of market Medicaid programs, state contracting arrangements, product development, compliance with State and Federal Policies and requirements and partnerships with other divisions. Strategically builds, manages and sustains external business relationships, particularly with state and local regulators. Accountable for product development, administrative processes, interdepartmental communication and regulatory requirements. Develops an annual strategic plan and updates executive leadership on strategic issues/development, business performance and progress against objectives. Demonstrated passion and creativity in developing models of care serving low-income vulnerable populations.

 
 

General Functions And Outcomes

 
 

The position is responsible for the customer experience, achieving membership growth targets, overseeing & developing the Medicaid product portfolio and developing/executing market Medicaid strategy based on state and CMS requirements, national standards and alignment with overall national and market strategy. This position incorporates care delivery requirements into strategy and develops a strong partnership with the medical group and health plan delivery system.

 
 

Normally To Be Proficient In The Competencies Listed Above

 
 

Minimum 10 years of relevant experience in a Medicaid managed care organization. Minimum 7 years of management experience. Minimum 5 years in product line management to special populations. Bachelor’s degree or 4 years relevant experience.

 
 

Minimum Requirements

 
 

The Director, Medicaid must have a strong background working with Medicaid and/or Special Populations and unique health care needs. Must be a decisive, results-oriented leader of people, be able to work in a highly matrixed environment and have strong collaborative skills. Additional competencies include:

 
 

• Understanding of state and federal Medicaid framework and regulatory requirements
  
• Excellent negotiation skills, verbal/written communication skills
  
• Strong analytical and strategic planning skills
  
• Excellent public presentation skills
  
• Strong persuasive and interpersonal skills
  
• Product and Program development skills
  
• Knowledgeable of Medicaid health care delivery systems
  
• Knowledgeable of current trends in care management and industry related to care delivery to Medicaid population
  
• Demonstrated ability to build effective partnerships and influence others who may have different perspectives
  

 
 

FTE’s Supervised

 
 

1-5 direct reports

 
 

15-20 total

 
 

Work Environment

 
 

Work is primarily performed remotely

 
 

Travel may be required, locally or out of state

 
 

May be required to work outside normal hours

 
 

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We’ve been here for members for 100 years. Regence is a nonprofithealth care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largesthealth insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

 
 

If you’re seeking a career focused on making the health care experience simpler, better, and more affordable for people and their families, consider joining our team at Cambia Health Solutions. Cambia is a total health solutions company that is deeply rooted in a 100-year legacy of transforming the industry and the way people experience health care. We had our beginnings in the logging communities of the Pacific Northwest as innovators in helping workers afford health care. That pioneering spirit has kept us at the forefront as we build new avenues to improve access to and quality of health care for the future. Cambia is committed to delivering a seamless, personalized health care experience for the next 100 years.

 
 

This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.

 
 

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

 
 

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

Clipped from: https://www.governmentjobs.com/careers/utah/jobs/3539246/health-program-representative?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description

 
 

Seeking candidate with excellent customer service skills AND medical program experience to join the Medicaid Bureau of Managed Health Care.  

To provide education to Medicaid and CHIP members regarding their benefits and support members with their health/dental plan enrollments.  Education is completed statewide by phone and group orientations are held throughout Davis, Salt Lake, Utah and Weber counties.  Tobacco cessation phone education and follow-up is provided for pregnant Medicaid members.  The job requires continual login to Avaya phone system to answer calls from members and providers for plan selections and changes, access to care issues, billing problems, 1095-B inquiries, MyBenefits registration and eligibility issues, and a variety of other issues.  

Preference may be given for the following.

• MMCS, MMIS, and eRep experience
  
• Software proficiency- Word, Excel, PowerPoint, Google Calendar
  
• Medicaid and Chip program knowledge
  
• Excellent Phone Skills- Avaya experience
  
• Bachelor’s Degree
  
•  
• For more information on the program, please click HERE.
  

Why work for the Utah Department of Health?  In addition to the rich benefits the State of Utah offers, the department offers:

• UTA Eco Pass, at a discounted rate
  
• On-site Fitness Center, for a minimal membership fee
  
• Teleworking opportunities
  
• On-site day care center with First Steps Day Care – contact for rates and availability, 801-538-6996.
  

If offered this position, your employment will be contingent upon passing a background check and review.  There will be no cost to you for this check.  This check will include fingerprinting, which will be available at various UDOH locations for your convenience. Fingerprinting will be completed prior to your first day of employment .  You may review the policy by clicking HERE.
(Download PDF reader)
 

Example of Duties

• Provides clients with information concerning rights, options, benefits, services, goals and expectations.
  
• Analyzes, summarizes and/or reviews data; reports findings, interprets results and/or makes recommendations.
  
• Ensures compliance with applicable federal and/or state laws, regulations, and/or agency rules, standards and guidelines, etc.
  
• Receives, researches and responds to incoming questions or complaints; provides information, explains policy and procedures, and/or facilitates a resolution.
  
• Decides upon the need for additional data, information, etc, and authorizes the means necessary to obtain the required information.
  
• Refers client/inmate/patient to other available services to meet needs where appropriate.
  
• Enters data into a computer system and retrieves, corrects, or deletes previously entered data.
  
• Counsels clients and prospective clients; screens referrals, provides community outreach.
  
• Reviews and/or inspects work for quality, accuracy, and completeness.
  

Typical Qualifications

(includes knowledge, skills, and abilities required upon entry into position and trainable after entry into position)

• Medicaid program(s) knowledge
  
• community resources and Medicaid services
  
• communicate information and ideas clearly, and concisely, in writing; read and understand information presented in writing
  
• use logic to analyze or identify underlying principles, reasons, or facts associated with information or data to draw conclusions
  
• speak clearly, concisely and effectively; listen to, and understand, information and ideas as presented verbally
  
• applicable laws, rules, regulations and/or policies and procedures
  
• research methods, techniques, and/or sources of information
  
• use automated software applications
  

Supplemental Information

Working Conditions

• Risks found in the typical office setting, which is adequately lighted, heated and ventilated, e.g., safe use of office equipment, avoiding trips and falls, observing fire regulations, etc.
  
• Standard Schedule: Monday-Friday, 8:00 am – 5:00 pm
  

Physical Requirements

• Typically, the employee may sit comfortably to perform the work; however, there may be some walking; standing; bending; carrying light items; driving an automobile, etc. Special physical demands are not required to perform the work.
  

Benefits:
The State of Utah offers eligible employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program. Please click the following link for a detailed information page: Benefits. To access a Total Compensation Calculator in Excel format click HERE.

FMLA General Notice: 
English
(Download PDF reader) (right click + open link in new tab)
Español
(Download PDF reader) (clic derecho + abrir en una pestaña nueva?)

 
 

 
 

Humana Inc. Birmingham, AL

director public policy medicaid health advocacy public policy regulatory healthcare corporate affairs enterprise people trade team

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Job InformationHumanaDirector of State Public PolicyinBirminghamAlabamaDescriptionHumana is an $80 billion (Fortune 41) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.Against that backdrop, we are seeking a talented professional to join our team as Director, State Public Policy. This role resides within the Corporate Affairs Department and will serve as an expert in state public payer, Medicaid and Duals public policy while working with subject matter experts and business units within the Humana enterprise including our Retail, Provider, Healthcare Services, and Humana Pharmacy Solutions (HPS) business units.You will be an instrumental part of Corporate Affairs at Humana by assisting in the development of Humana’s public policy positions for our public payer businesses with an emphasis on Medicaid, Medicare Supplement, state retiree, Duals policy, and future state public health programs. This will require you to engage across the company to analyze public policy, develop positions, and draft deliverables supporting Humana business strategy.We are open as to where this position can be located, but cities in Kentucky, Florida, Illinois, Ohio, Texas, Wisconsin, or Washington D.C. would be ideal.ResponsibilitiesUnder direction of the Vice President of Strategy and State Affairs, and with input from enterprise subject matter experts, analyze, draft, and develop state public payer policy positions to support the enterprise’s priorities.Performs necessary research and analyses to support enterprise positions and priorities.Provides regulatory guidance, general issue management and strategic stakeholder engagement support to Corporate Affairs and business leaders.Develops and maintains an archive of legislative and regulatory analyses, policy briefs, reports, position statements, and other materials pertinent to Humana’s public payer policy and advocacy work.Works closely with Humana Medicare, Medicaid and other lines of business to develop value propositions, white papers and other advocacy materials which support state business development opportunities.Drafts and communicates concise and clear descriptions/analyses/summaries of key issues to Corporate Affairs and Humana businesses.Monitors state Medicaid trends. Contributes policy expertise to state-level advocacy efforts on public payer issues including Medicaid expansion, an extension of Medicaid managed care to new populations and programs, integration of the Duals population and state initiatives that affect the role of managed care in Medicaid programs.Acts as an interface between Humana and national advocacy, trade associations, and public policy organizations; assists in the management of policy consultants; develops external stakeholder outreach strategies.Maintains current awareness and analyzes/compares trends, positions, and issues promoted by other companies, trade, and advocacy organizations active on Medicaid-related issues.Assists in the preparation and drafting of testimony, regulatory comments, and position statements sent to legislative and regulatory bodies and other interested parties concerning legislation, policies, published reports, regulations, and statutes governing Medicaid, long-term services and supports (LTSS), and other waiver programs.Key Candidate QualificationsThe successful candidate will have extensive experience (typically 8 years) in health policy – preferably as a Medicaid, State legislative or executive branch staffer or equivalent experience in Medicaid policy, trade group, law firm, or policy organization. This person will also have strong knowledge of state health administrative/regulatory/licensure rules and guidance as well as state health policy. Key to success will be a proven track record of applied analysis, research, and resource development supporting healthcare policy, and translating information from diverse resources into actionable policy documents for use in an advocacy setting or otherwise. A Bachelor’s degree is required, preferably in health/public policy, economics or health care administration, although a Master’s degree will be a strong plus.In addition to the above, the following professional qualifications and personal attributes are also sought:Prefer demonstrated, strong relationships with policy makers and thought leaders in the state public policy arena.Ability to work in cross-functional teams (matrix environment) including interfacing with business executives to develop and align policy/advocacy positioning with strategic business goals.Prefer an academic background in policy, public affairs, business, or a clinical profession.Solid understanding of relevant policy and regulatory issues and ability to translate complex issues in clear, concise manner to business leaders and advocacy team (technical and non-technical audiences)A passion for the development of innovative, high quality government healthcare programsExperience working in a matrixed organization, with proven ability to work collaboratively through various departments and functional areas, promoting a culture of proactive teamwork.Strong conceptual and creative thinker with an ability to identify trends and interrelationshipsExcellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences internally and externally.Strong creative problem-solving, negotiation, and multi-tasking skills in time-sensitive settings.Highly-developed interpersonal skills with ability to build strong working relationships, internally and externally.Ability to meet clearly stated expectations and take responsibility for achieving resultsWe will require full COVID vaccination 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.Scheduled Weekly Hours40

 
 

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The FP&A Manager position will lead the new business development process by providing financial support and modeling for all Request for Proposals (RFP) and Request for Information (RFI), as well as support active health plan business estimated at $14B annual revenue. This position would also support the Business Development team pursuit of $9B annual revenue by preparing and presenting financial proformas to Medicaid leadership. This position will also manage the Capital Investment Process, as well as the Strategic Planning Process for all Medicaid markets in the segment. Other activities that would be included in this role, would be managing the 3rd party vendor requests, cost benefit analysis, return on investment (ROI), and net present value (NPV) calculations. A Candidate should have proven communication skills, as he/she will be expected to present to the Corporate Executives as well as Medicaid’s CEO, CFO, VP of Actuary, VP of Business Development, and RFP Leadership team.


 

• Leads the Capital Investment Process and Strategic Planning Process including all Financial Models, Merger and Acquisition assumptions, Business inputs & Growth targets for all the Medicaid Markets in the segment.
  

– Provides support for the Financial Validation of All Business Cases – Cost, Benefit, Return on Investment (ROI), and Net Present Value (NPV) calculations.

• Leads the Financial Support and Modelling for all Requests for Proposals (RFP) and Requests for Information (RFI).
  
• Responds to all State Specific Requests on Medicaid Market & General and Administrative requests (G&A).
  
• Performs external competitive analysis along with preparing strategic growth financial proformas for leadership review and decision making.
  
• Manage all 3rd party vendor requests and approvals for all of Medicaid including 16 states’ health plans and all corporate shared service areas.
  

Pay Range
The typical pay range for this role is:
Minimum: 60,300
Maximum: 126,600


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


Required Qualifications
7+ years’ professional accounting/finance experience with business development and performing advanced financial modeling and analysis


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

• Capital Budgeting experience
  
• Advanced degree in Business and/or FSA/CPA
  
• Healthcare industry experience
  
• Government knowledge
  
• The ideal candidate will be a strategic and critical thinker who is highly adaptable and comfortable operating in a changing environment.
  
• Strong communication (verbal, written, presentation) and collaboration skills
  
• High level of proficiency using Excel, Access, and PowerPoint.
  
• Strong analytical, organizational, and problem-solving skills with the ability to multitask while meeting tight deadlines
  

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Location: Company:

 
 

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) (https://ethics.la.gov/boardprocedures.aspx?type=advisory%20opinion)
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

 
 

 
 

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