Category: Curator- Job Hunter

 
 

Location: Company:

 
 

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://www.adzuna.com/details/3395079266?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Summary

Ensures that the contractual, regulatory, and accreditation requirements and objectives of HMSA’s Medicaid Programs are identified and met. Responsible for assisting with and supporting the development, implementation, planning, and oversight of activities related to Medicaid program requirements and objectives as assigned under the direction of the Director, Medicaid Administration and Sr. Manager, Government Programs.

Responsible for assisting with communication and coordination with HMSA departments, subsidiaries, and business associates that support Medicaid Program requirements and objectives and also for participating in the evaluation of their performance. Also responsible for assisting with the management of projects related to enhancing existing capabilities or developing new capabilities for the Medicaid line of business and analysis of business information with emphasis on the identification, development, and use of appropriate data and analytical methods for answering specific business questions related to HMSA’s Medicaid Programs.

Minimum Qualifications

 

1. Bachelor’s (BA) degree and four (4) years of related work experience; or an equivalent combination of education and related work experience.
   
2. Effective verbal and written communication skills
   
3. Demonstrated knowledge of the operation of managed care programs.
   
4. Demonstrated knowledge of Hawaii’s QUEST program or other governmental managed care programs.
   
5. Intermediate knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and Power Point.
   

Duties and Responsibilities

Business Solution Development:

• Develop, maintain and coordinate department user requirements, data reporting and application requirements for projects that affect Medicaid Programs.
  
• Assist with solution design and development.
  
• Participate in and lead teams involved in projects that affect Medicaid programs and collaborate with project leads and team members from other departments.
  
• Communicate and collaborate with appropriate staff to ensure suitability of solutions. Develop effective use of advanced analytical methods and tools to enhance the delivery of solutions to meet business requirements. As required, learn new business concepts and methods applicable to Medicaid Programs projects and initiatives.
  

Business Project Analysis:

• Develop and apply appropriate analytical methods to assigned business projects and tasks.
  
• Thoroughly document all aspects of project requirements, methodology, task schedule, and analytical results including interpretation of results, summary findings, and presentation reports.
  
• Collaborate with staff and management in own and other departments as required to fully understand business scope, business constraints, and business implications of analytical results
  

Program Management:In support of and with assistance from the Director and Sr. Manager, assist with:

• Developing and communicating overall project strategy to ensure that business requirements are fulfilled across all Medicaid Programs activities and projects.
  
• Ensuring that all Medicaid Program required reports, data, and activities are completed and delivered accurately and on time. Managing all aspects of the planning, execution, and closure of such projects.
  
• Evaluating and directing the development of best practices, project standards, procedures, and quality objectives utilizing established project standards, procedures, and quality objectives.
  
• Conducting project kickoff meetings and communicating individual roles and project/program expectations and responsibilities to ensure that all project team members have the tools and training to perform effectively.
  
• Providing leadership to project managers, project and business leads, and other staff who are assigned to work on Medicaid Programs activities and projects.
  
• Developing and maintaining collaborative relationships with Project Stakeholders, Business Relationship Managers, Project Office Managers, and other management and staff as necessary to provide oversight on Medicaid Programs activities and projects.
  
• Identifying and analyzing business needs.
  
• Translating business needs into appropriate and effective solutions.
  
• Monitoring the design and implementation of solutions.
  
• Establishing project baselines and developing project schedules.
  
• Monitoring project milestones, timelines, technical deliverables, resource usage, critical dates, scope, costs, and quality to identify potential risks.
  
• Identifying and tracking project issues and resolutions.
  
• Facilitating the resolution of schedule and project related issues.
  
• Assessing variance from project plans and implement measures to ensure projects remain within scope, time, cost, and quality objectives.
  
• Tracking and reporting project status.
  
• Preparing and presenting project updates to senior management and Executive Steering Committees.
  
• Preparing and presenting business justification for tactical business priorities as required.
  
• Facilitating the evaluation, selection, and contract negotiations for external vendors.
  
• Managing vendor relationships in support of project goals.
  
• Acting as a liaison between Medicaid Programs department, other HMSA Departments, subcontractors, and vendors.
  
• Continuously providing constructive team feedback as is pertinent to Medicaid Programs projects.
  
• Integrating, wherever possible, areas of improvement into the project lifecycle.
  
• Coaching and mentoring less experienced department personnel.
  
• Maintaining content of project websites to facilitate effective communication.
  

Studies and Reports:

• Produce concise, structured, and informative data analytic reports summarizing projects, objectives, methods findings of program significance.
  
• Document issues, background, data, methods, problems and alternatives, and results.
  

Other Duties/Functions:

• Perform all other miscellaneous responsibilities and duties as assigned or directed.
  

Clipped from: https://jobs.wric.com/jobs/senior-business-analyst-medicaid-programs-honolulu-hawaii/683131783-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Location: Company:

 
 

Program Manager – NY Medicaid
– Job Family: Business Support
– Type: Full time
– Date Posted:Aug 10, 2022
– Req #: JR12563
Location:
– New York, New York
– North Carolina, North Carolina
– New Jersey, New Jersey
– Florida, Florida
– Virginia, Virginia
Description
LOCATION: This is a remote from home opportunity. Occasional visits to an Elevance Health office may be required. Residency on the east coast is strongly preferred.
HOURS: General business hours, Monday through Friday.
.
The Program Manager for delegated risk is responsible for the ongoing operational management and oversight of NY GBD delegated risk programs SOMOS and CAIPA. Responsible for the development and ongoing management of one or more multi-year external client facing programs within a business unit. Program managers typically support business strategies through an integrated portfolio of external client facing projects or initiatives. A program manager may have responsibility for a piece of a larger enterprise/regional external client facing program.
.
Primary duties may include, but are not limited to:
– Manages and coordinates the development, approval, implementation and compliance of on-going external client facing programs; develops program budget; ensures program meets its stated objectives; provides subject matter expertise in response to day to day external client facing business issues.
– Researches applicable subject matter practices and remains aware of industry trends.
– Manages external client facing relationships and partners with corporate and regional business areas.
– Coordinates training related to external client facing program; develops program success measures and performs periodic assessments of program success.
.
Required Qualifications
– Requires a BA/BS and minimum of 5 years external client facing experience in program/project management; or any combination of education and experience, which would provide an equivalent background.
.
Preferred Qualifications
– Graduate degree preferred.
– Project management certification preferred.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.
EEO is the Law
Equal Opportunity Employer / Disability / Veteran
Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
– EEO Policy Statement
– EEO is the Law Postero
– EEO Poster Supplement-English Version
– Pay Transparency
– Privacy Notice for California Residents
Elevance Health, Inc. is an E-verify Employer
Need Assistance?
Email us (elevancehealth@icareerhelp.com) or call 1-877-204-7664

 
 

Clipped from: https://www.adzuna.com/details/3395128555?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description

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

Responsibilities

Essential Functions and Responsibilities

• Supervise utilization management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review, prior authorization and referrals to care management.
  
• Oversee, monitor, orient and train staff in the use of standard utilization management criteria including MCG, Interqual, and ASAM.
  
• Lead development of utilization management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.
  
• Collaborate with internal departments, providers, and community partners to support the delivery of high-quality utilization management services, including introducing innovative approaches to utilization management.
  
• Monitor and maintain staffing levels to meet care and service quality objectives.
  
• Conduct timely evaluations of direct reports and provide regular opportunities for professional development.
  
• Influence and assist corporate leadership in strategic planning to improve effectiveness of utilization management programs.
  
• Collect and analyze performance reports on utilization management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
  
• Conducts briefings and area meetings; maintains frequent contact with other managers across the department and the company.
  

               
 

Required Qualifications

• Licensed Registered Nurse (RN) in the state of Louisiana with no disciplinary action.
  
• Must reside in the state of Louisiana.
  
• Previous experience in utilization management.
  
• Two (2) or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting.
  
• Two (2) years of leadership experience.
  
• Knowledge of Interqual, ASAM and/orMilliman (MCG) criteria.
  
• Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
  
• Ability to work independently under general instructions and with a team.
  
• Must have the ability to provide a high speed DSL or cable modem for a home office.
  
• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  
• Satellite and Wireless Internet service is NOT allowed for this role.
  
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  
• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
  

Preferred Qualifications.

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

Additional Information.

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

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

 
 

Clipped from: https://www.ziprecruiter.com/c/004-Humana-Insurance-Company/Job/RN,-Manager,-Utilization-Management-Nursing-(Louisiana-Medicaid)/-in-Coushatta,LA?jid=d7f30fc7264936e6&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Overview


 

Avalon Health Care Management, Inc. is seeking an experienced Medical Biller for a Medicaid Commercial/Hospice Biller!

The general purpose of the Medicaid Biller is processing and collections of billing Utah, Washington, Arizona, Hawaii, and California Medicaid and Hospice Programs. Includes billing State and Medicaid HMO programs.

If you seek to use your mind and your heart to improve lives on a daily basis, come join our team! We offer great challenges, a rewarding career and opportunities for advancement!

Our Benefits include:

• Medical, Dental, Life, Vision, Short Term Disability, Long Term Disability, and Pet insurance.
  
• We offer career advancement courses
  
• Two weeks of PTO
  
• 401K
  

Responsibilities


 

• Review and follow up with the facilities to ensure facility has received authorization to provide services to Medicaid and Hospice patient. Review the TARS, 10A, Award Letters, Managed Medicaid Authorizations.
  
• Ensure all rates are correct within the billing software. Entry of new Medicaid rates as they are published within the various states.
  
• Employee will bill according to the outlined billing schedule as set by the Avalon Corporate Office. Billers will prepare, review, and transmit claims using billing software through electronic and paper claim processing.
  
• Employee will provide claim follow up based on Avalon claim review protocol. Biller will contact Medicaid providers through phone and on-line review of outstanding claims. Follow up process will continue until claims in reduce from outstanding AR. 
  
• Outstanding claims will be researched and reviewed until the AR payer has been relieved. Employee will process refunds and adjustments according to Avalon guidelines.
  
• Employee will collect the payment EOB and process payment as indicated for patients’ dates of service. Payments which are not equal to outstanding AR will be researched and reprocess for refunds, additional payment request, or adjustment needs.
  
• Employee will need to have effective communication with the Medicaid and Hospice payers to resolve outstanding issues. Employee will also need to work effectively with facility personal to resolve issues for billing.
  
• Data entry of ancillary charges within the billing software for month end close.
  
• Completes monthly aging for facilities and attends aging review meetings when necessary.
  
• Update cash spreadsheet for Cash Management Department.
  
• Run collection reports for Cash Management and Operational requests.
  

Qualifications


 

• Associates Degree or equivalent work experience.
  
• Basic understanding of computer technology.
  
• Proficient in Excel. 
  
• Knowledge of and previous experience with payroll taxes and quarter and year-end adjustments.
  
• Minimum of 2 years of billing experience.
  

Avalon Health Care Group is an Equal Opportunity Employer.

#CB

#Talroo

 
 

Clipped from: https://jobs.krqe.com/jobs/medicaid-biller-south-jordan-utah/684060971-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Summary

Ensures that the contractual, regulatory, and accreditation requirements and objectives of HMSA’s Medicaid Programs are identified and met. Responsible for assisting with and supporting the development, implementation, planning, and oversight of activities related to Medicaid program requirements and objectives as assigned under the direction of the Director, Medicaid Administration and Sr. Manager, Government Programs.

Responsible for assisting with communication and coordination with HMSA departments, subsidiaries, and business associates that support Medicaid Program requirements and objectives and also for participating in the evaluation of their performance. Also responsible for assisting with the management of projects related to enhancing existing capabilities or developing new capabilities for the Medicaid line of business and analysis of business information with emphasis on the identification, development, and use of appropriate data and analytical methods for answering specific business questions related to HMSA’s Medicaid Programs.

Minimum Qualifications

 

1. Bachelor’s (BA) degree and four (4) years of related work experience; or an equivalent combination of education and related work experience.
   
2. Effective verbal and written communication skills
   
3. Demonstrated knowledge of the operation of managed care programs.
   
4. Demonstrated knowledge of Hawaii’s QUEST program or other governmental managed care programs.
   
5. Intermediate knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and Power Point.
   

Duties and Responsibilities

Business Solution Development:

• Develop, maintain and coordinate department user requirements, data reporting and application requirements for projects that affect Medicaid Programs.
  
• Assist with solution design and development.
  
• Participate in and lead teams involved in projects that affect Medicaid programs and collaborate with project leads and team members from other departments.
  
• Communicate and collaborate with appropriate staff to ensure suitability of solutions. Develop effective use of advanced analytical methods and tools to enhance the delivery of solutions to meet business requirements. As required, learn new business concepts and methods applicable to Medicaid Programs projects and initiatives.
  

Business Project Analysis:

• Develop and apply appropriate analytical methods to assigned business projects and tasks.
  
• Thoroughly document all aspects of project requirements, methodology, task schedule, and analytical results including interpretation of results, summary findings, and presentation reports.
  
• Collaborate with staff and management in own and other departments as required to fully understand business scope, business constraints, and business implications of analytical results
  

Program Management:In support of and with assistance from the Director and Sr. Manager, assist with:

• Developing and communicating overall project strategy to ensure that business requirements are fulfilled across all Medicaid Programs activities and projects.
  
• Ensuring that all Medicaid Program required reports, data, and activities are completed and delivered accurately and on time. Managing all aspects of the planning, execution, and closure of such projects.
  
• Evaluating and directing the development of best practices, project standards, procedures, and quality objectives utilizing established project standards, procedures, and quality objectives.
  
• Conducting project kickoff meetings and communicating individual roles and project/program expectations and responsibilities to ensure that all project team members have the tools and training to perform effectively.
  
• Providing leadership to project managers, project and business leads, and other staff who are assigned to work on Medicaid Programs activities and projects.
  
• Developing and maintaining collaborative relationships with Project Stakeholders, Business Relationship Managers, Project Office Managers, and other management and staff as necessary to provide oversight on Medicaid Programs activities and projects.
  
• Identifying and analyzing business needs.
  
• Translating business needs into appropriate and effective solutions.
  
• Monitoring the design and implementation of solutions.
  
• Establishing project baselines and developing project schedules.
  
• Monitoring project milestones, timelines, technical deliverables, resource usage, critical dates, scope, costs, and quality to identify potential risks.
  
• Identifying and tracking project issues and resolutions.
  
• Facilitating the resolution of schedule and project related issues.
  
• Assessing variance from project plans and implement measures to ensure projects remain within scope, time, cost, and quality objectives.
  
• Tracking and reporting project status.
  
• Preparing and presenting project updates to senior management and Executive Steering Committees.
  
• Preparing and presenting business justification for tactical business priorities as required.
  
• Facilitating the evaluation, selection, and contract negotiations for external vendors.
  
• Managing vendor relationships in support of project goals.
  
• Acting as a liaison between Medicaid Programs department, other HMSA Departments, subcontractors, and vendors.
  
• Continuously providing constructive team feedback as is pertinent to Medicaid Programs projects.
  
• Integrating, wherever possible, areas of improvement into the project lifecycle.
  
• Coaching and mentoring less experienced department personnel.
  
• Maintaining content of project websites to facilitate effective communication.
  

Studies and Reports:

• Produce concise, structured, and informative data analytic reports summarizing projects, objectives, methods findings of program significance.
  
• Document issues, background, data, methods, problems and alternatives, and results.
  

Other Duties/Functions:

• Perform all other miscellaneous responsibilities and duties as assigned or directed.
  

 
 

Clipped from: https://jobs.arklatexhomepage.com/jobs/senior-business-analyst-medicaid-programs-honolulu-hawaii/669666160-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Location: Company:

 
 

Apply for this job Business Development Capture Director – Medicaid + Location: National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint + Job Family: BUS > Strategy, Planning & Execution + Type: Full time + Date Posted:Jul 27, 2022 + Req #: JR8096 Description Our Government Business Division’s Growth Team is looking for a Business Development Capture Director – Medicaid to join its Business Development and Capture Group. Our Business Development Capture Director is a high-performing individual contributor role responsible for positioning and capture execution of Medicaid health plan procurement and re-procurement opportunities. Responsible for managing the strategy and preparations for upcoming Medicaid RFPs. Partners with Plan Presidents to lead the cross-functional team of health plan leaders and business development to identify gaps, mitigate risks, and develop solutions and strategy in months before an RFP. [This position can work remotely from any US Anthem location] Responsible for positioning and capture execution of Medicaid health plan procurement and re-procurement opportunities. Primary duties may include, but are not limited to: Monitor and evaluate white space opportunities to make go/no-go recommendations to executive leadership. Develop and execute plans for the pursuit and capture of all Medicaid managed care procurement opportunities, including Alliance partnership opportunities. Leads the cross-functional team of Growth Partners, Health Plan leaders, and Alliance partners (as applicable) to develop winning strategies and identify and mitigate risks and opportunities. Participates in bid decisions and develops recommendations for gate reviews. Collaborates with Health Plan Presidents and Health Plan leaders to understand current and emerging customer needs and requirements. Obtains market intelligence and competitive data to develop a market strategy. Participates in all levels of proposal development and draft review, providing active feedback and recommendations for improvement. Provides mentorship and coaching to other members of the broader Business Development team. Requires a BA/BS degree in a related field and a minimum of 10 years of experience in strategic planning and business development in Medicaid programs; or any combination of education and experience, which would provide an equivalent background. Highly preferred experience: -Previous P&L and/or business development experience and project management experience in Medicaid managed care setting. -Experience leading capture and proposal activities for significant opportunities ($1B and more). -Experience in a capture function or executive leadership function for a managed care-based product for state Medicaid agencies. -State Medicaid agency experience or federal agency experience with CMS. -MBA, MPH, or MPP. Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Be part of an Extraordinary Team Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading. We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact? We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contactability@icareerhelp.comfor assistance. EEO is the LawEqual Opportunity Employer / Disability / Veteran Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees. + EEO Policy Statement + EEO is the Law Postero + EEO Poster Supplement-English Version + Pay Transparency + Privacy Notice for California Residents Elevance Health, Inc. is an E-verify Employer Need Assistance?Email us (elevancehealth@icareerhelp.com) or call 1-877-204-7664 Apply for this job

Stats for this job

Salaries

The number of jobs in each salary range for all:

 
 

 
 

Clipped from: https://www.adzuna.com/details/3355218829?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Apply for this job now Location Austin, Texas Job Type Permanent Posted 28 Jul 2022

Job/Position DescriptionThe Medicaid / CHIP IT Management Analyst performs highly advanced (senior-level) professional administrative and IT management analysis. This position serves as a consultative and coordinative lead between programmatic leadership. The person performs a complex evaluation and analysis of project plans, operational activity, and strategic objectives of the program and IT divisions. May supervise the work of others. Works under minimal supervision, with extensive latitude for the use of initiative and independent judgment. Work involves the following: and; Oversees, plans and directs the review and assessment of project plans, timelines, deliverables, and governance structures.and; Develops new or modifies existing program policies, procedures, goals, and objectives. and; Advises management on the progress of readiness of project deliverables and helps determine the priorities, scope, purpose, objectives, timeframes, and resources necessary for these reviews. and; Reviews and evaluates recommendations for improvement and corrective actions necessary to ensure successful system and program policy implementations. and; Reviews technical documents, records and reports; interprets this information to identify alternatives and makes and justifies contractor readiness recommendations. and; Reviews Medicaid IT operational processing and recommends changes to optimize this processing. and; Communicates orally and in writing with all levels of agency and contractor staff. Essential Job FunctionsEJF Perform IT oversight through the review and analysis of system readiness review deliverables including a review of the underlying program policies, procedures, goals and objectives of these deliverables. Determine whether the deliverables meet agency requirements. Review the technical records included in these deliverables to interpret data, identify alternatives, and make recommendations for improvements. Design, evaluate, recommend and approve changes to forms and reports that comprise these deliverables. Recommend whether the quality and completeness of the deliverables is sufficient to recommend implementation readiness and/or deliverable acceptance. (30%) EJF Represent IT equities in readiness meetings and annual deliverable checklist meetings with program partners. Oversee, plan and direct organizational studies of work problems to improve the processes for developing and reviewing these deliverables. Develop timelines for receiving deliverables and track deliverable receipt against these timelines. Provide management reporting showing contractor progress in completing the deliverables and submitting them to the agency. Communicate to contractors, program area staff and IT management if a contractor is not meeting agreed upon timelines for deliverable submission. (30%) EJF Review the IT MCO oversight process and evaluate business and management practices to streamline this process. Develop or modify IT MCO oversight policies, procedures, goals and objectives. (5%) EJF Review agency audit findings for Medicaid systems, provide recommendations for management responses to fulfill audit requirements including both business operations and system changes, and track the progress of remediation activities associated with these audits. Review Medicaid project information associated with the claims administration and enrollment broker contracts. Recommend changes to deliverables or recommend acceptance of these deliverables. Evaluate industry developments and make Copy the URL in the preceding sentence to an Internet Explorer browser to apply to the job directly through the Texas Health and Human Services Career Portal.

Apply for this job now

Details

• Job Reference: 670359394-2
  
• Date Posted: 28 July 2022
  
• Recruiter: Texas State Job Bank
  
• Location: Austin, Texas
  
• Salary: On Application
  
• Sector: I.T. & Communications
  
• Job Type: Permanent
  

 
 

Clipped from: https://jobs.kxan.com/jobs/medicaid-chip-it-management-analyst-austin-texas/670359394-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Hours: Monday – Friday 8 am – 5 pm. Location: Onsite – Helena, MT – Pay: $17/hr. The primary focus of this position is the evaluation, development, implementation and maintenance of a complete, effective internal training, education and communication…Trainer, Instructor, Business Services, Training

 
 

Clipped from: https://www.adzuna.com/details/3355674840?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Resp & Qualifications


COMPANY SUMMARY:


CareFirst, Inc., and its affiliated companies, generally referred to as CareFirst BlueCross BlueShield (CareFirst), is the Mid-Atlantic region’s largest private sector health insurer, serving the healthcare needs of 3.5 million members in Maryland, the District of Columbia, and portions of northern Virginia. The Company offers a comprehensive portfolio of products and services to individuals and groups, as well as state and federal government sponsored plans. With a market share almost three times that of the closest competitor, the company commands 45 percent penetration across the region.


In July 2018, Brian D. Pieninck assumed the role of President and CEO after serving as the company’s COO of Strategic Business Units and IT Division. Under his leadership, the organization completed an extensive review of its operations and clinical programs, resulting in an expansive 3-year strategy to grow and diversify the company’s core business. Along with a 5-year vision to drive the transformation of the healthcare experience across the continuum of its members, partners, and communities, the company has placed a renewed and intentional focus on fostering a mission-based culture, which drives every decision the company makes. The organization employs over 5,600 full-time employees in Maryland, Northern Virginia, the District of Columbia, and West Virginia. CareFirst has earned multiple workplace awards recognizing its leadership in diversity and inclusion, wellness engagement, and creation of a supportive and equitable work environment for all employees.


At CareFirst, you are part of an inspired, collaborative team that is building the healthcare experience we want for our families and our future. Every day, we make a meaningful difference in the communities where we live and work.


We practice empathy, seek to understand, invest in inclusion, demand equity and nurture belonging every day for our employees and the communities we serve. We rely on the rich diversity of our employees’ experiences and backgrounds to achieve our mission. Every year we host a Week of Equity and Action where we deepen our investment and commitment to diversity, equity, and inclusion. During this week thousands of employees engage in workshops and volunteerism with the goal of bettering themselves and our community.

• Women make up around 70% of CareFirst’s employee population, and over 50% identify as BIPOC (Black, Indigenous, and people of color).
  
• We have 9 resource groups that connect employees over shared identities (LGBTQ, veteran status, race, etc.) and passions (climate change, healthy living, leadership development).
  
• Employees are encouraged to give back and volunteer in their communities with their civic engagement hours.
  
  
  

As a not-for-profit, CareFirst regularly ranks among the most philanthropic organizations with $65 million invested in the community in 2020 to improve overall health, and increase the accessibility, affordability, safety, and quality of healthcare throughout its market area. The company’s employees consistently add to this impact by devoting thousands of volunteer hours to numerous community organizations and social causes. The company’s continued efforts to reinvest in community health care programs has repeatedly earned CareFirst regional accolades as a leading corporate philanthropist, including the No. 2 and No. 7 spots on the Baltimore Business Journal and Washington Business Journal’s 2019 list of top corporate givers, respectively.


PURPOSE


Utilizing the population health frameworks provided by NCQA Accreditation, HEDIS and CMS, this position is responsible for delivering culturally appropriate health promotion information to members that helps increase their access & reduce their barriers to preventive care resulting in industry-leading outcomes at a population level. Uses expertise in HEDIS and other technical quality measures and advanced member engagement techniques to ensure improved population health and accreditation results.


Essential Functions

• Conducts member and provider outreach designed to close member gaps in care, documenting such efforts in a manner that allows collaboration with other team members and other member-facing care delivery staff.
  
• Analyzes quality reports and claims data to assess up-to-the-minute member compliance status to a wide variety of quality measures, utilizing this information to improve compliance and member health outcomes.
  
• Collaborates with a variety of in-home & community-based providers to locate non-compliant members, managing member referrals to those providers for a variety of gap-closing quality campaigns. Maintains access to provider reporting of gap-closure outcomes and facilitates the transmission of such information as supplemental data where allowed.
  
• Maintains ongoing subject matter expertise in population health, measurement science, accreditation, and quality improvement. Utilizes the framework of NCQA Accreditation, HEDIS & CMS quality standards to accomplish and document the work products.
  
  
  

Qualifications


Education Level: Bachelor’s Degree in population health, public health, healthcare administration, business administration, health policy, economics, statistics, mathematics, data science, or a related field OR in lieu of a Bachelor’s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.


Experience: 3 years professional experience in a business environment (public health, health insurance, management consulting fields preferred); evidence of progressing levels of responsibility.


Preferred Qualifications

• Previous experience in member and provider engagement to influence behavior change and improved health outcomes.
  
• Certification in Quality or Process Improvement Methods.
  
• Direct experience with accreditation, HEDIS, CAHPS and other quality related activities a healthcare related environment and/or payor organization.
  
• Data analytics experience working with large data sets to answer clinical, operational, or business questions; prior experience with healthcare data expected.
  
  
  

Knowledge, Skills And Abilities (KSAs)

• Ability to engage health care consumer and/or health care providers in outcomes driven assessment, planning and execution of improvement activities.
  
• Expertise in qualitative and quantitative data analyses and presentations.
  
• End-to-end experience designing, developing, and implementing innovative strategies to improve population health.
  
• Ability to conduct advanced analytics using SQL, Python, R, or similar.
  
• Fluent in the use of Microsoft tools including Excel, Word, Power Point and Outlook.
  
• Knowledge of healthcare claims, survey, clinical, and health data.
  
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
  
  
  

Department

Department: MD Medicaid -QUALITY

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

Physical Demands

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

 
 

Clipped from: https://www.linkedin.com/jobs/view/quality-specialist-md-medicaid-at-carefirst-bluecross-blueshield-3059448614/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic