Category: Curator- Job Hunter

Clipped from: https://b-jobz.com/us/web/jobposting/069a6c05407e?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description

Position Summary Are you interested in working in a dynamic environment that offers opportunities for professional growth and new responsibilities? Are you interested in helping clients drive transformative healthcare solutions? Are you interested in joining an actuarial practice that is a leading global advisor and implementation partner working with State and Federal governments, health plans, providers, drug and device manufacturers and other organizations around the world? If you are seeking a role that offers you the opportunity to advise Government and Public Services (GPS) clients through critical and complex issues, while allowing you to develop personally and professionally, consider a career in Deloitte’s Actuarial and Insurance Solutions practice. Work you’ll do The Senior Manager will be expected to lead complex client initiatives and engagement teams working on Medicaid related projects. They will support the development and maintenance of strong relationships with senior client leadership. They should help develop the more junior members of the engagement team and deepen their understanding of the political, policy, financial and business aspects of the Medicaid program. Delivery expectations of the Senior Manager includes:•Anticipates client needs based on a strong understanding of the client and its industry and marketplace.•Determines client needs by guiding teams in selecting and applying the most appropriate tools, techniques, and approaches to understand the client’s issues and opportunities.•Integrates recommendations into a total solution for the client that is consistent with the engagement strategy.•Challenges and enhances quality by consistently striving for ways to improve deliverables.•Directs the team to provide exceptional service to the client by responding with a sense of urgency, practicality, accountability, integrity, and respect.•Communicates regularly with client management on a variety of business topics (e.g., trends, innovations, problem-solving discussions)•Demonstrate specific service area/competency and/or industry expertise that resulted in tangible value for the client.Market, Sales, and Communication: The Senior Manager will be expected to broaden relationships at the most senior levels within current and potential state and local healthcare clients and to translate this into new business opportunities. They will work closely with the practice to win additional consulting work with the existing accounts and to acquire new accounts. The teamWith more than 40 years of experience in assisting state health and human services agencies in nearly every state, Deloitte understands how delivery works—and how it can work better. Our state health team offers industry-leading insights, solutions, and business practices to help state health agencies solve their most difficult challenges, ranging from modernization of eligibility determination systems and compliance with Federal Health Insurance Exchange requirements to innovative Medicaid tools and services that can help states serve their constituents more effectively.Deloitte helps state Medicaid agencies design and implement initiatives that improve upon the management of their health programs, overall financial performance, and health outcomes. Our advisory services and solutions focus on four critical areas: policy and program design, analytics, organizational transformation, and ongoing program evaluation. In an environment in which states are being asked to do more with less, Deloitte brings a wealth of knowledge, experience and solutions to help health agencies plan for the future. Qualifications Required: At least 10 years of healthcare experience working either with a state Health and Human Services agency or with a health plan or consulting company serving healthcare clients. Demonstrated experience working on Medicaid related issues including Medicaid managed care, value-based purchasing, 1115 transformation waivers, social determinants for health, managed long term services and supports, home and community based services, physical and behavioral health coordination, Medicaid enterprise solutions, quality measurement and analytics and fee for service operations Track record of leading and growing strong teams of management consultants or other organizational groups, with ability to manage across multiple engagements Outstanding leadership skills, verbal and written communication skills, presentation skills, team working skills and ethical standards. This individual should be looked upon as a role model who instills the pride, values and integrity of Deloitte in their team. Experience supporting Medicaid programs Experience mentoring and coaching others Business development experience (pre-sales, proposal, and RFP experience) Experience leading teams and managing client/executive relationships Willingness to travel at least 25% Proficient PowerPoint, Word, Visio, Access, and Project For individuals assigned and/or hired to work in Colorado, Deloitte is required by law to include a reasonable estimate of the compensation range for this role. This compensation range is specific to the State of Colorado and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and delivery model. We would not anticipate that the individual hired into this role would land at or near the top end of the range, but such a decision will be dependent on the facts and circumstances of each case. A reasonable estimate of the range is $131,000 – $219,000. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.

Clipped from: https://jobs.wvnstv.com/jobs/business-analyst-medicaid-eligibility-enrollment-remote-u.s.-atlanta-georgia/694810618-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

OVERVIEW:

At CNSI, we are innovators, developers, engineers, and architects, who each play a vital role in our mission: Empowering our clients to improve the health and well-being of one in five Americans. If you want to join a company that uses technology to revolutionize healthcare, let s talk!

WHAT WE DO:

CNSI is empowering the delivery of public sector healthcare in claims and encounter processing platforms, provider support solutions, and promoting consumer engagement and interoperability. Our configurable, modular, scalable platform, evoBrix X , powers robust data analytics, risk reduction and regulatory compliance, and fiscal agent operations for our clients.

CNSI’s technology-enabled products and solutions connect consumers, payers, and providers to improve health outcomes for one in five Americans.

CNSI is currently looking for an experienced Business Analyst to join our growing team!

Summary:

As a Business Analyst you are responsible for analyzing business problems, identifying gaps, and developing technical solutions involving complex information systems under no supervision for Medicaid Eligibility and related subsystems. 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; provide day-to-day direction on State program activities.

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.

Responsibilities:

• Works with customers on presenting technical solutions for complex business functionalities
  
• Possesses unwavering commitment to customer service and operational excellence
  
• Provides customer support through leading client demos and presentations
  
• Prioritizes and schedules work assignments based on the project plan, handling multiple tasks across project phases
  
• Creates and modifies Business Process Models
  
• Understands the overall system architecture and cross-functional integration
  
• Demonstrates in-depth knowledge of business analysis relates to Member Eligibility and Enrollment to ensure high quality
  
• Demonstrates advanced expertise and contributes to the Business Analysis practice by publishing technology points of view through the creation of white papers
  
• Possesses in-depth knowledge and is well-versed in multiple functions or capabilities
  
• Uses cases, workflow diagrams, and gap analysis to create and modify requirements documents and design specifications
  
• Analyzes user requirements and client business needs, leveraging expert opinion and expertise
  
• Acts as the requirements subject matter expert and supports requirements change management
  

To learn more about what we are doing, check us out at

Industry Recognition – Press Release:

Required Experience/Skills:

• Bachelor’s degree with 2+ years of business analysis experience OR Master’s degree
  
• 2+ years of experience on large complex project Domain knowledge of Medicare, Medicaid and/or healthcare verticals
  
• Strong knowledge in Medicaid Management Information System (MMIS) around Medicaid Eligibility & Enrollment and related subsystems
  
• Business Analysis Process (SDLC, documentation procedures) experience
  
• High-level of technical and database knowledge
  
• Excellent customer relation skills including presentation and meeting facilitation
  
• Experience facilitating and running JAD requirements design sessions, etc.
  
• Excellent requirements elicitation and validation skills
  
• Strong knowledge and proficiency in SQL
  
• Knowledge of data integration and software enhancements/planning
  

Preferred Experience/Skills:

• Knowledge of Quality-of-Care program
  

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.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

Clipped from: https://www.ziprecruiter.com/c/Embrace-Families/Job/Vice-President-of-Operations,-Medicaid/-in-Maitland,FL?jid=f4a51e9e6faf932b&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

At Embrace Families we believe all kids deserve to grow up in safe, stable and loving homes. As a national leader in child welfare services, we begin by helping Central Florida families overcome the root causes of abuse and neglect through programs that offer case management and other prevention services that keep families together and build a stronger community. When a child can’t remain safely in their home, we partner with local agencies to support them through foster care, adoption, mentoring and beyond to ensure that children in bad situations move toward brighter futures.

Telecommuting/Remote work options available – Hybrid/Mostly Full-Time Remote

Starting salary: [$104,600-$123,428 per year] (dependent on experience)

————————————————————————————————

POSITION OBJECTIVE:

This position will oversee the operations of Integrated Health which is responsible for the provision of Medicaid services to children and families in dependency. The VP is responsible for the contract’s successful implementation & ensuring the operation of Integrated Health is meeting expected outcome measures and adhering to required contract provisions. This position also will ensure that positive relationships with stakeholders are maintained and will serve as the organization’s primary representative with the Agency for Healthcare Administration (AHCA), Sunshine State Health Plan (SSHP), the Department of Children & Families (DCF), and other stakeholders as it relates to this contract. This position is associated with the implementation and management of the Statewide Medicaid Managed Care – Child Welfare Specialty Plan Contract that was awarded by AHCA.

KEY FUNCTIONS:

• Ensures effective & productive working relationships are maintained & serves as the representative of Integrated Health with AHCA, DCF, SSHP, provider groups, community alliances, the Integrated Health Board of Directors, and other stakeholders as needed.
  
• Manage & administer Integrated Health’s statutory & contractual responsibilities with AHCA and SSHP
  
• Oversees any contract monitorings by SSHP and AHCA and coordinates change initiatives and corrective action plans with CBCIH Senior Management and Board of Directors.
  
• Responsible for the financial performance of CBCIH and ensuring alignment with the organizations goals, contract requirements, and the policy decisions of the board.
  
• Oversees the process of policy design in order to ensure Integrated Health is in compliance with Medicaid regulations, statutes and the Specialty Plan.
  

QUALIFICATIONS:

Required:

• Master’s Degree in a related field and 10 years of experience in management of a Managed Care Environment
  
• A minimum of ten years of management/supervisory experience
  
• Knowledge of Medicaid rules & regulations
  

Preferred:

• Experience working with the Department of Children and Families’ and/or the Agency for Health Care Administration.
  
• Experience in Florida’s Child Welfare System.
  
• Current or Former healthcare/ behavioral healthcare licensure
  
• Certified Professional in Healthcare Management (CPHM) and/or Certified Professional in Healthcare Quality (CPHQ)
  

SKILLS:

• Effective leadership, management and planning skills
  
• Excellent interpersonal and communication skills
  
• Ability to define problems, collect data, establish facts and draw valid conclusions
  
• Ability to analyze and implement services, plans and policies
  
• Ability to interact with and maintain high morale among employees
  
• Ability to analyze, integrate and report data
  
• Demonstrate cultural and linguistic competence & sensitivity to population served
  
• Ability to travel
  

SPECIAL CONDITIONS:

• Thorough Background Screening upon hire including FBI, FDLE, Local Law check, Employment Reference check, DMV check, Criminal Records check, Social Security Trace & Drug Screening. FDLE check will be run at least every 5 years.
  
• On-call assignments- Yes
  
• Travel- local: 7% per week, long-distance: 15% per month
  
• Attend at least 15 hours of in-service training annually
  

————————————————————————————————

Embrace Families Values Strong Families and Strong Communities. We believe Every Child deserves a safe, stable, and loving home. We invite you to come on board and help us make that happen.

• We are the lead child welfare agency in Central Florida covering the tri-county area of Orange, Osceola and Seminole counties
  
• We are Innovative and have piloted programs not seen before in this industry – Ask us about our Keys to Independence Program and our work in Texas
  
• We raise awareness with fun and inspiring events such as Dance, Dream, & Inspire, the MANicure Movement, and our Golf Tournament
  
• We partner with organizations throughout the tri-county area to address the specific needs of our children and families at their community level.
  
• Voted one of the Top Places to Work by Orlando Sentinel
  
• A high % of Employee Engagement according to our yearly Gallup survey
  

Embrace Families Values Strong Employees. Our comprehensive pay and benefit package provides a foundation of health, wellness & development supports for you and your family.

• Your benefit eligibility starts on day 1
  
• 100% Employer paid basic life, AD&D and disability benefits
  
• 401(k) with Employer match up to 4% of eligible pay
  
• Paid Time Off accrues starting on day 1 with 27 days (216 hours) per hire year!
  
• 10 paid holidays each year
  
• A broad EAP Program with access to thousands of trainings and lifestyle discounts ranging from professional and personal which cover, mental, physical, and financial well-being
  
• Flexible hybrid work opportunities for most positions
  
• Opportunities for learning, growth, and development
  
• A high % of Employee Engagement according to our yearly Gallup survey
  
• Market based pay scale and an emphasis on recognizing and rewarding staff
  

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Clipped from: https://jobs.pahomepage.com/jobs/program-manager-medicaid-implementation-rockville-maryland/694836025-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

The clinical manager ensures members in the Medicaid programs obtain care and services based on their individual medical, psychosocial and behavioral health needs; while concurrently improving quality, decreasing disparities and identifying cost savings opportunities across the line of business. Responsible for implementing contract and clinical requirements across all KPMAS Medicaid programs and ensures that KPMAS is in compliance with state, federal and member expectations. The clinical manager will implement the organization’s commitment to serving the community through participation in Medicaid programs. The activities described below pertain to KP Medicaid programs in Virginia and Maryland as well as participation in Priority Partners in Maryland.

Essential Responsibilities:

• Clinical Implementation: Identifies newly proposed program clinical changes as per guidance from state regulatory agencies. Analyzes new and existing Maryland and Virginia Medicaid contract and clinical requirements for downstream organizational implications. Develops and builds clinical requirements for cross-functional review, including applicable internal and external partners. Manages and facilitates process development and planning discussions with cross-functional stakeholders. Develops clinical implementation strategies and plans. Maintains relationship with cross-functional partners on an ongoing basis until the scope of work relating to clinical changes is complete. Monitors existing clinical changes in accordance with state regulatory guidelines. Manages relationship with external stakeholders regarding applicable clinical changes. Develop operational workflows and related materials for clinical changes.
  
• Regulatory Analysis: Assist with contract and regulatory interpretation and disseminate regulatory updates to appropriate KPMAS functional areas. Coordinate and draft KP responses to proposed changes to state regulation or Medicaid program changes (i.e., notices of proposed rulemaking or public comment), in collaboration with applicable cross-functional stakeholders.
  
• Communications: Develop periodic communications either organization-wide or to targeted audiences to ensure organizational partners understand current clinical requirements and policies. Disseminate proposed clinical workflows for collaborative approval from cross-functional stakeholders. Maintain KPMAS website for VA and MD Medicaid members. Manage KP Medicaid mailbox, the KP Medicaid SharePoint site, and portal access provided by external quality review organizations including The Delmarva Foundation and HSAG. Maintain functional area and department Medicaid contact list. Manage inquiries to and from the Medicaid Office as posited by functional areas or external stakeholders.
  
• Data Analysis & Other Duties: Run necessary analytics and reports in collaboration with Medicaid Office and IT stakeholders to aid in the deployment of newly developed programs. Other duties as assigned by the Senior Director of Medicaid Operations or Executive Director of Medicaid.
  

Basic Qualifications:

Experience

• Minimum two (2) years of experience in any combination of the following: health care delivery, case management or Medicaid.
  
• Minimum one (1) year of project management experience.
  

Education

• Bachelor’s degree in Nursing OR four (4) years of directly related experience required.
  
• High School Diploma or General Education Development (GED) required.
  

License, Certification, Registration

• N/A
  

Additional Requirements:

• Extensive knowledge of Medicaid health care delivery systems
  
• Extensive knowledge of current trends in care management and industry standards related to care delivery to Medicaid population
  
• Project management experience in health care or managed care setting.
  
• Knowledge of KP MAS or other health care organizations.
  
• Strong background working with Medicaid and/or Special Needs Populations with unique health care needs
  
• Excellent negotiation skills, verbal/written communication skills
  
• Strong analytical and strategic planning skills. Excellent public presentation skills.
  
• Strong persuasive and interpersonal skills.
  
• Demonstrated ability to work in a highly matrixed environment. Strong collaborative and team skills.
  
• Ability to interpret and communicate laws and regulations related to health care and Medicaid
  
• Experience in working with regulatory agencies and managing a large organization’s response to actions.
  
• Experience with budgeting; state and federal compliance; state and federal policies and laws
  
• Experience working within a large multi-disciplinary health care setting
  
• Broad knowledgeable of Medicaid programs and health care delivery systems to support low-income patients.
  
• Broad knowledgeable of current trends in care management and industry standards related to care delivery to Medicaid population
  

Preferred Qualifications:

• Extensive knowledge of Medicaid health care delivery systems.
  
• Extensive knowledge of current trends in care management and industry standards related to care delivery to Medicaid population.
  
• Project management experience in health care or managed care setting.
  
• Masters Degree in Nursing preferred.
  

COMPANY: KAISER

TITLE: Program Manager Medicaid Implementation

LOCATION: Rockville, Maryland

REQNUMBER:

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

Clipped from: https://jobs.pahomepage.com/jobs/senior-business-analyst-medicaid-eligibility-systems-little-rock-arkansas/694810087-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Overview

About Public Consulting Group


Public Consulting Group, Inc. (PCG) is a leading public sectorsolutions implementation and operations improvement firmthat partners with health, education, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has over 2,500 professionals in more than 60 offices worldwide.PCGs Technology Consulting practice offers a full spectrum of quality Information Technology (IT) services to help state and local government agencies at every stage of the IT life cycle.Through its specialized IT services, PCGs Technology Consulting team finds cost-effective ways to help agency partners deliver successful IT systems that enhance the lives of the user base. To learn more, visit

Responsibilities

Consultant/Analyst will provide a combination of Medicaid and Project Management expertise in monitoring project lifecycle implementations in waterfall, agile and/or hybrid methodologies and providing advisory services on best practices and problem remediation strategies. The incumbent will assess project status progress and quality in accordance with PMI standards as applied in the context of eligibility systems design, development, implementation, and operations. The successful candidate will have either state agency or vendor experience with state Medicaid eligibility systems which includes knowledge of eligibility programs and state options. Experience as an eligibility worker, supervisor, or state eligibility program or operations manager highly preferred. The Consultant will report to the team leader on project status through participation and observation of DDI activities in the requirements, construction, system integration testing, UAT, and go-live phases of DDi activites. Will contribute to deliverables and work products delivered by the by the team. These deliverables and work products will be completed in accordance with our overall strategy, approach, and methodology.

Provides project management and technical expertise on large-scale IT projects

Supports development of all deliverables, status reports and other work products

Supports activities to plan and oversee all project work and develop/manage any potential organizational change management strategies or processes that might be needed

Support the goals and outcomes of the project stakeholders

Support Developing, managing, and updating Project Plan and other project documents (e.g., Communication Plan, Risk Plan, Stakeholder Register, Resource Plan)

Support and or develop, manage, and update the execution of the Project Schedule to ensure project scope and applicable milestones are met

Support or develop and deliver regular status reporting

Identifies, tracks, and manages project risks; including coordination for risk mitigation

Identifies, tracks, and manages project issues; including coordination for issue resolution

Establish a response and track the response to project recommendations (e.g., Quality Assurance (QA) vendor recommendations)

Provide ongoing communication (e.g., email, meetings) to provide project status

Collaborate with the projects Communication Manager to enhance communication efforts

Review project and related operational processes and provide input for improvement by implementing relevant lean or agile strategies

Conduct Agile Project Management and Organizational Change Management workshops

Qualifications

Required:

Direct experience with state Medicaid eligibility systems

State agency work experience with Medicaid, SNAP, TANF or other health and human service programs

Self-directed and reports to the Engagement Manager

3+ years of prior project management experience using both Agile and Waterfall techniques in IT related projects to include operations, infrastructure, and application development projects

Demonstrated ability to work directly with diverse business and technical team members in a strong team-oriented environment

Desired:

Certified Scrum Master or PMI Agile Certified Practitioner certification

QA / IV&V experience preferred

PMI Project Management Professional certification

EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employmentregarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programsare based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

>

Job Locations
US-MS-Jackson US US-TX-Austin US-GA-Atlanta US-TN-Nashville

Posted Date
3 months ago
(5/9/2022 7:04 PM)

Job ID
2

# of Openings
1

Category
Consulting

Type
Regular Full-Time

Practice Area
Technology Consulting

EOE including Disability/Protected Veterans. Flowserve will also not discriminate against an applicant or employee for inquiring about, discussing or disclosing their pay or, in certain circumstances, the pay of their co-workers. Pay Transparency Nondiscrimination Provision

If you are a qualified individual with a disability or a disabled veteran, you have the right to request a reasonable accommodation if you are unable or limited in your ability to use or access as result of your disability. You can request a reasonable accommodation by sending an email to . In order to quickly respond to your request, please use the words “Accommodation Request” as your subject line of your email. For more information, read the Accessibility Process.

Clipped from: https://lensa.com/manager-claims-research–resolution-louisiana-medicaid-jobs/monroe/jd/2049c06b72b2a3a0b8594739fcd5eca1?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description

Humana Healthy Horizons in Louisiana is seeking a Manager, Claims Research & Resolution (Claims Administrator) who will be responsible for the administration of a comprehensive claims processing system capable of paying claims in accordance with state and federal requirements for Humana’s Louisiana Medicaid plan. They will oversee every aspect of the claims process, including initial claim payment, claim rework, claim-related inquiries from enrollees and providers, and other functions related to claims, such as billing, enrollment, accounts receivable, and provider data management.

Responsibilities

• Responsible for the day to day operations of claims management and issue resolution staff.
  
• Monitors prior authorization functions and assures that decisions are made in a consistent manner based on clinical criteria and meet timeliness standards.
  
• Develops, implements, and monitors the provision of care coordination, disease management, and case management functions.
  
• Ensures adoption and consistent application of appropriate inpatient and outpatient medical necessity criteria.
  
• Monitors claims administration areas to identify and minimize the impact of irregularities in claims processing.
  
• Identifies claims payment issues and responding to escalation.
  
• Utilizes root-cause analysis to identify claims issues; manage the development and implementation of process improvement projects.
  
• Ensures that appropriate concurrent review and discharge planning of inpatient stays is conducted.
  
• Monitors, analyzes, and implements appropriate interventions based on utilization data, including identifying and correcting over and underutilization of services.
  
• Provides training support and guidance for cost-effective claims review, processing, and service; develops in-house expertise in medical claims coding and support staff’s pursuit of trainings and certifications.
  
• Works closely with the Program Integrity Officer, Claims Cost Management and Claims Processing Organization to develop and implement processes for cost avoidance, minimization of claims overpayments and need for recoupments, coordination of resources, coordination of benefits, and payment recoupment.
  

Required Qualifications

• Must reside in the state of Louisiana.
  
• Bachelors Degree.
  
• Minimum (2) years of claims management experience in the healthcare industry.
  
• Three (3) years of leadership experience.
  
• Experience in claims operation preferably in Medicaid.
  
• Familiarity with medical terminology and ICD-9/ICD-10, CPT, HCPCS
  
• Comprehensive knowledge of Microsoft Office tools such as Word, Excel and PowerPoint.
  
• Proficiency in Visio and Process Map Development.
  
• Thorough understanding of claims adjudication processes.
  
• Proven analytical skills .
  
• Proven ability to develop working relationships within a highly matrixed business environment.
  
• Excellent communication skills, both oral and written
  
• 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 least 100,000/300,000/100,000 limits.
  
• Must have the ability to provide a high speed DSL or cable modem for a home office.
  
• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  
• Satellite and Wireless Internet service is NOT allowed for this role.
  
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  
• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
  

Preferred Qualifications

• Lean, Six Sigma and/or PMP certification.
  
• Experience working with internal claims systems.
  

Additional Information

• Workstyle : Hybrid Home – 3 -4 days/week remotely and 1 – 2 days/week in Humana’s Metairie, LA location.
  
• Travel: up to 10% as requested by business to Louisiana Department of Health (LDH) location.
  
• Direct Reports: Up to 10 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

 This position is open. This job was posted on Fri Aug 26 2022 and expires on Sun Sep 25 2022.

Humana

Description

Louisville, Kentucky-based Humana offers a wide range of insurance products and health and wellness services. Humana is dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Humana associates are at the heart of creating and providing positive healthcare experience for its members. The firm is seeking innovative professionals who are passionate about making a positive change in the lives of others. Humana recruits undergraduate and graduate level students for internships and full-time opportunities, and is devoted to hiring veterans in all areas of its business as well. When joining the team, you will have the chance to benefit from a bunch of incentives including a competitive base pay, medical, dental and vision benefits, life insurance, 401(k), paternity leave, and several other.

Type

Company – Public

Size

Large

Location

Multiple locations

Industry

Insurance Agency & Brokerage Firms

Founded

1961

Website

Visit Website

Total job postings in the past

Based on 130 job boards, duplications excluded

Current job openings

9%

6 months

1,106%

1 year

2 weeks

Average posting lifetime

Total job posting distribution in the past

Based on 130 job boards, duplications excluded

Job category Distribution 6 months 1 year

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Clipped from: https://www.nexxt.com/jobs/market-network-operations-lead-behavioral-health-medicaid-metairie-la-2289615986-job.html?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic&aff=2ED44C72-8FD2-4B5D-BC54-2F623E88BE26&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

• Humana • Metairie, LA 70001
  

Job #2289615986

•  
• Description
  

The Network Operations Lead maintains provider relations to support customer service activities through data integrity management and gathering of provider claims data needed for service operations. The Network Operations Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Network Operations Lead manages provider data for health plans including but not limited to demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manages provider perceived service failures. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Required Qualifications

• Bachelor’s Degree or 3 or more years of provider contracting or physician network development experience
  
• Experience with analyzing, understanding and communicating financial trends
  
• 2 or more years of project leadership experience
  
• Intermediate knowledge of Microsoft Word and Excel
  
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  

Preferred Qualifications

• Experience with credentialing and contract management systems
  
• Working knowledge in the areas of Group Practice Management, Long-Term Acute Care, home health, home infusion, behavioral health, ambulatory surgery, and the outpatient experience
  

Work-At-Home Requirements

• Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
  
• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  
• Satellite and Wireless Internet service is NOT allowed for this role.
  
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
  

Scheduled Weekly Hours

40

Clipped from: https://jobsearcher.com/j/rn-field-case-manager-medicaid-at-humana-in-paducah-ky-ODJZ7QP?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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HumanaPaducah, KY

• The Field Care Manager Nurse 2 assesses and evaluates member’s needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.
  
• This role requires residence in the Western Kentucky Region.
  
• Must reside within the following Counties: Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Livingston, Marshall, McCracken, and Trigg
  
• Collaborate with members of an inter-disciplinary team to meet the needs of the individual and the population
  
• Identify problems or opportunities that would benefit from care coordination
  
• Engage the member and complete a health and psychosocial assessment, taking into account the cultural and linguistic needs of each member
  
• Engage with the member in a variety of settings to establish an effective, professional relationship.
  
• Settings for engagement include but are not limited to; hospital, provider office, community agency, member s home, telephonic or electronic communication
  
• Identify and prioritize the individual s care management needs and goals in collaboration with the member and caregivers
  
• Identify and manage barriers to achievement of care plan goals
  
• Identify and implement effective interventions based on clinical standards and best practices
  
• Maximize the client s health, wellness, safety, adaptation, and self-care through effective care coordination and case management
  
• Educate the member and other stakeholders about treatment options, community resources, insurance benefits, etc.
  
• so that timely and informed decisions can be made
  
• Employ ongoing assessment and documentation to evaluate the member s response to the plan of care
  
• Evaluate client satisfaction through open communication and monitoring of concerns or issues
  
• Collaborate with facility based case managers and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner
  
• Appropriately terminate care coordination services based upon established case closure guidelines
  
• Provide clinical oversight and direction to unlicensed team members as appropriate
  
• Document care coordination activities and member response in a timely manner according to standards of practice and policies regarding professional documentation
  
• Looks for ways to improve the process to make the members experience easier and shares with leadership to make it a standard, repeatable process
  
• Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program
  
• Registered Nurse Licensed in the State of Kentucky without restrictions.
  
• Three to five (3-5) years varied experience in nursing/healthcare fields (discharge planning, case management, care coordination, and/or home/community health experience)
  
• Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
  
• Collaborate with team members to optimize outcomes for members
  
• Strong advocate for members at all levels of care
  
• Strong understanding and respect of all cultures and demographic diversity
  
• Proven track record of demonstrating empathy and compassion for individuals
  
• Exceptional communication and interpersonal skills with the ability to quickly build rapport
  
• Ability to work with minimal supervision within the role and scope
  
• Ability to use a variety of electronic information applications/software programs including electronic medical records
  
• Combination remote work at home and onsite member field visits
  
• Must reside in or within a 50 mile radius of the following Western Kentucky counties: Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Livingston, Marshall, McCracken, and Trigg
  
• Monday through Friday 8:00 AM to 6:00 PM Eastern Time
  
• Must be willing to travel 25% to meet with members.
  
• This role is a part of Humana’s Driver Safety program and therefore requires and individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,00 limits
  
• Valid driver’s license, car insurance, and access to an automobile
  
• 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.
  
• Work at Home Requirement
  
• Internet and Home Office
  
• requirements: Must have the ability to provide a high speed DSL or cable modem for a home office.
  
• Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
  
• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  
• Satellite and Wireless Internet service is NOT allowed for this role.
  
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
  
• Bachelor s of Science in Nursing (BSN) preferred
  
• Five (5) years or more clinical experience is preferred
  
• Three (3) years or more Medicaid and/or Medicare managed care experience is preferred
  
• Certification in Case Management
  
• Bilingual English and Spanish – Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in both languages.
  
• Interview Format *
  
• As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability.
  
• We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
  
• You will be able to respond to the recruiters preferred response method via text, video or voice technologies If you are selected for a screen, you may receive an email correspondence *(please be sure to check your spam or junk folders often to ensure communication isn t missed)
  
• inviting you to participate.
  
• You should anticipate this screen to take about 15 to 30 minutes.
  
• Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
  
• Covid Vaccination Processes: *
  
• 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.
  
• Job Type: Full-time
  
• RN in the state of Kentucky without restrictions (Preferred)
  
• Work Location: Remote
  
• Associated topics: ambulatory, cardiothoracic, care unit, infusion, maternal, neonatal, recovery, surgical, tcu, transitional
  

Stand out and contact Humana directly

Updated 4 hours ago

Clipped from: https://www.linkedin.com/jobs/view/medicaid-senior-manager-at-deloitte-3233215825/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Senior Manager / Specialist Leader, Government and Public Services

Healthcare (Medicaid)


Position Summary


The successful candidate will be a senior member of Deloitte’s Government and Public Services consulting organization in the United States. The candidate will serve as a senior team leader on project engagements and lead the development and growth of the practice in support of state and federal government agencies, primarily on Medicaid related issues.


Deloitte State Healthcare Consulting

With more than 40 years of experience in assisting state health and human services agencies in nearly every state, Deloitte understands how delivery works-and how it can work better. Our state health team offers industry-leading insights, solutions, and business practices to help state health agencies solve their most difficult challenges, ranging from modernization of eligibility determination systems and compliance with Federal Health Insurance Exchange requirements to innovative Medicaid tools and services that can help states serve their constituents more effectively.


Deloitte helps state Medicaid agencies design and implement initiatives that improve upon the management of their health programs, overall financial performance, and health outcomes. Our advisory services and solutions focus on four critical areas: policy and program design, analytics, organizational transformation, and ongoing program evaluation. In an environment in which states are being asked to do more with less, Deloitte brings a wealth of knowledge, experience and solutions to help health agencies plan for the future.


The Role

The Senior Manager will focus on selling and delivering consulting services in support of state Medicaid Directors’ agendas. They will help clients manage forward and transform themselves through a highly complex and ever-changing business environment. Consulting services and solutions would include generating new ideas for clients that will help them in this transformational journey and that generate a positive return on investment (ROI). The work will be rooted in the creation of innovative customer engagements for clients, building and leading a world-class team, and driving the development of thought leadership and offerings to create value for clients. Specific responsibilities and expectations include leading client service delivery, sales and marketing, and management of engagement teams.


Requirements:
 

• At least 10 years of healthcare experience working either with a state Health and Human Services agency or with a health plan or consulting company serving healthcare clients. Demonstrated experience working on Medicaid related issues including Medicaid managed care, value-based purchasing, 1115 transformation waivers, social determinants for health, managed long term services and supports, home and community based services, physical and behavioral health coordination, Medicaid enterprise solutions, quality measurement and analytics and fee for service operations
  
• Track record of leading and growing strong teams of management consultants or other organizational groups, with ability to manage across multiple engagements
  
• Outstanding leadership skills, verbal and written communication skills, presentation skills, team working skills and ethical standards. This individual should be looked upon as a role model who instills the pride, values and integrity of Deloitte in their team.
  
• Experience supporting Medicaid programs
  
• Experience mentoring and coaching others
  
• Business development experience (pre-sales, proposal, and RFP experience)
  
• Experience leading teams and managing client/executive relationships
  
• Willingness to travel at least 25%
  
• Masters Degree Preferred
  
  
  

Qualifications:

• Anticipates client needs based on a strong understanding of the client and its industry and marketplace.
  
• Determines client needs by guiding teams in selecting and applying the most appropriate tools, techniques, and approaches to understand the client’s issues and opportunities.
  
• Integrates recommendations into a total solution for the client that is consistent with the engagement strategy.
  
• Challenges and enhances quality by consistently striving for ways to improve deliverables.
  
• Directs the team to provide exceptional service to the client by responding with a sense of urgency, practicality, accountability, integrity, and respect.
  
• Communicates regularly with client management on a variety of business topics (e.g., trends, innovations, problem-solving discussions)
  
• Demonstrate specific service area/competency and/or industry expertise that resulted in tangible value for the client.
  
• Demonstrates a thorough knowledge of market trends, including opportunities and competitor activities in market assessments.
  
• Contributes to innovative thought leadership expertise, such as leading the development of complex, market-valued intellectual capital.
  
• Leverages their business network for contacts in target market to generate leads and brings ideas on innovative ways to identify and pursue new cross-functional sales opportunities, where appropriate.
  
• Leads development of the sales pursuit strategy and assembles and effectively manages the sales pursuit plan.
  
• Demonstrates the ability to successfully close the sale and generates enthusiasm in potential clients about working with the Firm.
  

Clipped from: https://www.linkedin.com/jobs/view/medicaid-eligibility-specialist-ka-consulting-at-cbiz-mhm-llc-2833135712/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Status Category:

 
 

Full-Time

 
 

Exempt/Non-Exempt:

 
 

Non-Exempt

 
 

Scheduled Hours Per Week:

 
 

40

 
 

Job Code:

 
 

FS200

 
 

With over 100 offices and nearly 6,000 associates in major metropolitan areas and suburban cities throughout the U.S. CBIZ (NYSE: CBZ) delivers top-level financial and employee business services to organizations of all sizes, as well as individual clients, by providing national-caliber expertise combined with highly personalized service delivered at the local level.

 
 

CBIZ has been honored to be the recipient of several national recognitions:

 
 

• 2022 Top Workplaces USA
  
• 2022 Great Place to Work Certification
  
• Top 101 2021 Best and Brightest Companies to Work For in the Nation
  
• 2021 America’s Best Mid-Size Employers
  
• 2021 Best and Brightest Companies in Wellness
  

 
 

CBIZ Benefits & Insurance Services is a division of CBIZ, Inc., providing benefits consulting, HRIS technology, payroll, human capital management, property and casualty, talent and compensation solutions, and retirement & investment solutions to organizations of all sizes. CBIZ is ranked as a Top 20 Largest Broker of U.S. Business (Business Insurance Magazine) and a Top 100 Retirement Plan Adviser (PLANADVISER).

 
 

Essential Functions and Primary Duties:

 
 

• Assisting patients in applying for financial assistance through Medicaid on behalf of our client facility.
  
• Interviewing patients or authorized representatives via phone or in person to gather information to determine eligibility for medical benefits.
  
• Obtaining, verifying, and calculating income and resources to determine client financial eligibility.
  
• Documenting case records using automated systems to form a record for each client.
  
• Following up with applicants to obtain accurate and complete information within strict timeframes.
  
• Completing/following up on all forms related to Medicaid eligibility.
  
• Performing any additional tasks related to the position assigned by the Manager.
  

 
 

Preferred Qualifications:

 
 

• Bachelor’s degree.
  
• Knowledge of Medicaid and Charity Care.
  
• Experience working in a hospital environment.
  
• Ability to speak and read Spanish.
  

 
 

Minimum Qualifications:

 
 

• High school diploma/GED.
  
• Must be ambitious and self-directed in a fast-paced environment and can perform in a high volume, multitasking setting.
  
• Must be trustworthy, professional, detail and goal oriented.
  
• Must have exceptional customer service and excellent verbal/written communication skills.
  
• Must be able to learn and work with Medicaid eligibility regulations.
  

 
 

CBIZ.Jobs Category: Benefits & Insurance

 
 

REASONABLE ACCOMMODATION

 
 

If you are a qualified individual with a disability you may request reasonable accommodation if you are unable or limited in your ability to use or access this site as a result of your disability. You can request a reasonable accommodation by calling 844-558-1414 (toll free) or send an email to

 
 

EQUAL OPPORTUNITY EMPLOYER

 
 

CBIZ is an affirmative action-equal opportunity employer and reviews applications for employment without regard to the applicant’s race, color, religion, national origin, ancestry, age, gender, gender identity, marital status, military status, veteran status, sexual orientation, disability, or medical condition or any other reason prohibited by law. If you would like more information about your EEO rights as an applicant under the law, please visit these following pages