Posted on

Senior Business Consultant (Medicaid Vendor Management) at HCSC

 
 

This position has the opportunity to work from home 2 days a week

Job Purpose


The Senior Business Consultant is responsible for driving Medicaid divisional strategies for the following areas: financial performance, operational performance and compliance. She or he will lead major, complex, and strategic cross-divisional and enterprise-wide projects from inception to completion. Some specific responsibilities include project management and process improvement.


Required Job Qualifications


Bachelor’s Degree and 4 years of experience in business analysis, process improvement, project management, business operations or relevant health care industry experience

3 years of experience in project management, business analysis, process improvement, strategic planning, product administration or other relevant healthcare function
Experience communicating with senior management from multiple divisions
Experience developing and delivering executive presentations, written analysis, financial analysis and other business process & control documentation.
Problem resolution experience and skills.
Negotiations skills.
Verbal and written communications skills including establishing working relationships across departments, preparing presentations to senior management, and establishing team environment.
Organizational skills.
Experience managing multiple complex projects successfully.
Detail oriented.
PC proficiency to include MS Office products and VISIO

Preferred Job Qualifications


Medicaid business experience or other healthcare regulatory experience (ideal)

Experience supervising project teams/personnel (internal teams and external vendors)
1 – 2 years vendor management experience

#LI-LI1


#LI-Hybrid


*CA


HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.


Requirements:

Expertise Government Programs Job Type Full-Time Regular Location IL – Downers Grove, IL – Chicago, IL – Naperville

 
 

Clipped from: https://www.themuse.com/jobs/hcsc/senior-business-consultant-medicaid-vendor-management?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

RN, Field Case Manager, Medicaid Western Kentucky Region, Kentucky

 
 

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.

Location Requirement

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

Description

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

Required Qualifications

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

Additional Requirements/Adherence:


Work Style:

Combination remote work at home and onsite member field visits

Locations:

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

Hours:

Monday through Friday 8:00 AM to 6:00 PM Eastern Time

Travel:

Must be willing to travel 25% to meet with members.

Humana’s Driver Safety Program:

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

TB Screening:

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

Preferred Qualifications

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.

Additional Information:


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


Schedule:

8 hour shift

License/Certification:

RN in the state of Kentucky without restrictions (Preferred)

Work Location: Multiple Locations

 
 

Clipped from: https://jobs.kron4.com/jobs/rn-field-case-manager-medicaid-western-kentucky-region-kentucky/670368059-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Eligibility Specialist – Medicaid Eligibility, Chapel Hill, North Carolina

 
 

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
Performs technical work in obtaining Medicaid/Social Security (SSI) insurance coverage for indigent patients to expedite reimbursement for medical services. Positions take the patient through the entire Medicaid application process from application to award or denial. Positions have authority to represent the Health Care System at each of the four levels of appeals when applications are denied.

Responsibilities:
1. Obtains detailed personal, financial and asset information to determine if patient qualifies for one of ten Medicaid/SSI programs. Completes or assists the patient with completion of Medicaid application. Explains the programs and advises patients of methods to become eligible by rearranging finances and assets. Follows through with applicants to obtain accurate and complete information within strict timeframes. Positions must have substantive knowledge of various rules and regulations governing the ten Medicaid programs. Interprets and applies frequent changes in program regulations to expedite applications.
2. Reviews denials from Medicaid/SSI and researches denial information with patients. Advocates for patient coverage with local and state Medicaid offices to obtain reversal of initial denial. Abstracts information, prepares appeals and represents UNC Health Care System in appeal hearings at local, state (Division of Medical Assistance), Office of Administrative Hearings, and state court to present supportive evidence for patient’s denial reversal
 

Other Information

Education Requirements:

Associate’s degree in an appropriate discipline (or equivalent combination of education, training and experience).
Licensure/Certification Requirements:
No licensure or certification required.
Professional Experience Requirements:
If an Associate’s degree: Two (2) years of experience in a social services or healthcare organization.
If a High School diploma or GED: Four (4) years of experience in a social services or healthcare organization.
Knowledge/Skills/and Abilities Requirements:
Analytical, Customer Service, Direct Patient/Family Interaction/ Hospital/Healthcare Experience, Interpersonal, Report Preparation, Strong Written and Verbal Communication skills.
 

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services
 

Organization Unit: Medicaid Eligibility

Work Type: Full Time
 

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

 
 

Clipped from: https://jobs.yourcentralvalley.com/jobs/eligibility-specialist-medicaid-eligibility-chapel-hill-north-carolina/670731605-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 

Posted on

RN, Field Case Manager, Medicaid Western Kentucky Region, Fulton, Kentucky

 
 

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.

Location Requirement

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

Description

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

Required Qualifications

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

Additional Requirements/Adherence:


Work Style:

Combination remote work at home and onsite member field visits

Locations:

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

Hours:

Monday through Friday 8:00 AM to 6:00 PM Eastern Time

Travel:

Must be willing to travel 25% to meet with members.

Humana’s Driver Safety Program:

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

TB Screening:

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

Preferred Qualifications

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.

Additional Information:


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


Schedule:

8 hour shift

License/Certification:

RN in the state of Kentucky without restrictions (Preferred)

Work Location: Multiple Locations

 
 

Clipped from: https://jobs.wavy.com/jobs/rn-field-case-manager-medicaid-western-kentucky-region-fulton-kentucky/670374543-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Advisory Services/Project Management Analyst (Medicaid), Princeton, New Jersey

 
 

  • Position Description :

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

About the opportunity:We currently have openings for Advisory Services/Project Management Analysts with a strong interest in project management in our Medicaid project area. This role blends management, research, and technical assistance. As such, we are seeking prospective employees with a passion for project management and an interest in improving government operations and health care delivery. In particular, we are looking for individuals who can support current and emerging work across any number of areas related to monitoring and improving Medicaid programs such as: Medicaid managed care programs, value-based purchasing and alternative payment models, long-term services and supports, measures of delivery and quality of services for beneficiaries, data analytics, and outcomes of innovative programs and policies. Advisory services analysts work on a variety of projects spanning policy and programmatic areas and are likely to be connected to 2-3 projects at a time. These projects range from data analytics to program evaluation to implementation support. Candidates do not need to have experience in all of these areas but should have experience in at least one of them.


Across all projects, Advisory Services/Project Management Analysts are expected to: Provide the direction and organization needed to help keep Medicaid projects on time and on budget and facilitate communications across and between internal and external stakeholders. Conduct project management activities, such as helping project directors plan, manage, and close out complex projects and designing, implementing, and monitoring tools and processes to help organize data and manage teams. Perform complex analyses of projects to monitor and evaluate project performance and progress, including monitoring project costs, assessing earned value, and overseeing subcontractors. Develop and maintain project collaboration tools, including Microsoft Project schedules, SharePoint websites, Jira trackers, and Excel spreadsheets. Provide technical assistance to state and federal health agencies or healthcare providers by designing webinars or responding to questions from stakeholders. Draft client memos, technical documentation, proposals and other contractual deliverables, such as chapters for reports, case studies, and/or data dictionaries.

  • Position Requirements :

Masters degree in public policy, public administration, business, or related field; or commensurate experience in operations or management-oriented positions Strong management skills, including ability to monitor costs on multimillion-dollar contracts, mentor staff, and oversee small teams to complete work within tight timelines without compromising on quality. Strong organizational skills and high level of attention to detail; flexibility to manage multiple priorities, sometimes simultaneously, under deadlines. Excellent oral and written communication skills, for example the ability to write clear and concise technical documentation, and to communicate with clients diplomatically. Strong analytic and problem-solving skills, and ability to apply critical and creative thinking to identify solutions and respond to client requests in situations where guidance is unclear or absent. Professional experience in a similar field or position Interest in improving and researching Medicaid and other government programs, and/or providing technical assistance to health care entities. Some travel may be required

Desired Skills and Experience: Work experience with a state or federal agency, a foundation, or health care. program is highly desirable, as is prior experience working with Medicaid data. Knowledge of quantitative and/or qualitative research methods. Experience with management tools, such as Microsoft Project and Jira. Certifications demonstrating management proficiency and expertise, such as Project Management Professional (PMP) or Lean Six Sigma Experience engaging a range of client stakeholders by applying a variety of approaches (such as human-centered design). Experience bridging between business owners and technical staff Basic knowledge of software development lifecycles, and agile development.


Please submit a cover letter and your resume along with a work product that demonstrates analytic skills and reflects independent analysis and writing, such as a capstone project, analytic report, or a management plan (nothing company confidential, please).Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on the project. If you are assigned to such a project, you will be required to obtain the requisite security clearance.


This position is open in the following cities and states; however, we are all currently working from home and provide the support and flexibility needed to work from home. We ask the candidates to identify their preferred location for when we return to working in-person.


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


This position offers an anticipated annual base salary range of $60,000-$95,000.This position may be eligible for a discretionary bonus based on company and individual performance.


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


We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

 

Clipped from: https://jobs.wgno.com/jobs/advisory-services-project-management-analyst-medicaid-princeton-new-jersey/670275804-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Outpatient Medicaid Eligibility Representative, Cleveland, Ohio

 
 

Description:

Days: Monday – Friday

Shifts: 8:00am – 4:30pm (With a half hour lunch) and 2 company paid 15 min breaks

Hourly: Compensation is based on experience and will range from $13.50- $14.50

Bonus Potential: Average commissions range from $0-$300 per month after 90 days

Full Benefits after 90 days: Medical, Dental, Vision, Life Insurance, 401(k), PTO

 
 

No one wakes up in the morning and says, “Today I want to go to the hospital”. We are here to help when the unexpected happens. Hospital Referral Services (HRS) Insurance Representative will help patient’s via phone to see what assistance programs the uninsured or underinsured may be eligible to receive.
We are looking for self-motivated professional to add to our growing team. If helping people is something you enjoy, this may be the right job for you. HRS’s team of experts helps guide patients through the Medicaid process so the patient can focus on recovery.

 
 

  • Screen/Interview patients for insurance eligibility in outbound dialer environment
  • Research and respond to all medical billing inquiries or requests to obtain account resolution.
  • Provide thorough, efficient, and accurate documentation in required systems for each work activity.
  • Review open accounts to determine, take appropriate actions, distribute, and follow-up on all requests submitted.
  • The Outpatient Medicaid Eligibility Representative is responsible for meeting goals and quality standards through efficient and accurate work activities.
  • Knowledge, understanding, and compliance with all applicable Federal, State, and Local laws and regulations.
  • Make recommendations to implement improved processes.
  • The Outpatient Medicaid Eligibility Representative will perform other duties as assigned by management.

 
 

Requirements:

  • 1-3 years Dialer call center environment – (minimum of 60 calls daily)
  • 1-3 years of previous healthcare eligibility experience
  • Intermediate knowledge and understanding of insurance/patient billing and collections.
  • Ability to maintain the highest level of confidentiality, customer service, and knowledge of HIPAA.
  • Proficient personal computer skills including Microsoft Office – able to type at least 40 WPM
  • The Outpatient Medicaid Eligibility Representative must have the ability to multi-task and have good time management skills.
  • High School Diploma or GED – (Associate’s degree preferred)

Training for the Outpatient Medicaid Eligibility Representative:

  • In office training will include HIPAA regulations, Revenue Group procedures, Medicaid eligibility, role-playing, client systems and procedures.
  • In office floor training: This will include observation of veteran representatives and supervised calls.

Clipped from: https://jobs.yourcentralvalley.com/jobs/outpatient-medicaid-eligibility-representative-cleveland-ohio/670608171-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Medicaid Program Advisor (Data Integration) – Healthcare Job in New York, NY at Public Consulting Group

 
 

Overview

Staffing Solutions Organization LLC (SSO), a wholly owned subsidiary of Public Consulting Group, is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve


Responsibilities


Program Advisor – Data Integration in Albany, New York (Item 1267)


Position Summary:


 

  • The incumbent will be responsible for supporting and enhancing existing and emerging technologies and systems within the Bureau of Systems and Informatics
  • The Bureau is responsible for multiple systems in support of assessing and analyzing the healthcare ecosystem in New York State, as well as supporting analytics and linking needs of the NYS Medicaid program
  • These systems include the states All Payer Database, SPARCS, Data Quality solutions, Master Data Management solutions, Provider Directory, COVID response support systems, and more
  • The incumbent will analyze data from a variety of data sources; analyze programmatic needs; suggest and develop efficient solutions to leverage technologies to support reaching program objectives; track and monitor program systems performance; evaluate and improve data quality and master data management deployments; raise concerns and suggestions to management team relative to SLA compliance, user experience, and systems operations; facilitate the integration of user and submitter experiences into programmatic operations and change management processes; support improving user and submitter experience in alignment with program objectives; and document business needs and existing processes to support implementing technology solutions

Responsibilities:

 

  • Developing and implementing improvements in data quality and master data management solutions in support of larger data enterprise including linking patient populations in Medicaid and Medicare programs
  • Analyzing information in support of linking across data sources, performing analytics across data sources such as Medicaid Managed Care and Medicare final action data, and integrating/synthesizing multiple data sources into a cohesive data set, store, or model
  • Tracking, monitoring, and suggesting/developing improvements on system data flow and load processes, and raising to management team concerns or areas for improvement
  • Providing technical and analytical advisement and support to user and submitter community for systems managed by the Bureau including working with Medicaid partners on best practices and use of Provider Directory data in support of the Medicaid program
  • Developing and improving solutions utilizing structured and unstructured data, relational database management systems (RDBMS), SQL, R, JSON, Python, Informatica, or similar technologies and languages
  • Performing a variety of ETL activities including mapping data, loading or transferring data, and automation tasks
  • Using APIs in support of data interfacing and integration such as linking validated providers sets with Medicaid Providers accepting new patients
  • Scripting with task automation and systems management tools such as PowerShell, Cron, or similar scripting languages
  • Strong ability in technical writing to document operational activities and workflows

Qualifications

Education / Education:


 

  • Bachelor’s degree with at least 8 years of professional experience
  • Strong computer skills, excellent organizational and communication skills, ability to work independently and as a member of a team
  • Must be a United States Citizen or a Permanent Resident of the United States in order to be considered

*Employees must follow established work schedules. The usual work schedule is 40 hours per week, Monday through Friday. Normal work hours are 8:00 a.m. to 4:30 p.m. unless otherwise specified by the supervisor, this includes a half hour unpaid lunch break. Total work hours must equal 40 hours per week.

All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an e-Verify participant.


#LI-remote


EEO Statement


Clipped from: https://www.ziprecruiter.com/c/Public-Consulting-Group/Job/Medicaid-Program-Advisor-(Data-Integration)-Healthcare/-in-New-York,NY?jid=7a8448b0df3e4d9a&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Medicaid Redesign Analyst 1(Trainee 1/Trainee 2) – 99373 | New York State Department of Health

 
 

Duties Description This incumbent will function as a financial analyst within the Bureau of Global Cap, Rebates, and Supplemental Programs within OHIP’s Division of Finance and Rate Setting (DFRS) in the tracking, analyzing, and forecasting of the Medicaid Global Cap.


The Medicaid Global Cap is comprised of payments to plans and providers to cover medical services for 7 million Medicaid recipients and is projected to total a net $22.3 billion in FY 2022 ($55.7 billion prior to offsets).


Further Duties Include


The incumbent will perform analysis to identify trends and potential efficiencies within Medicaid. The incumbent will also interact and collaborate with rate setting, fiscal management, and program staff within the Department as well as other state agencies that interact with the Medicaid program. Further, the incumbent will often be tasked with developing deliverables and occasionally presenting materials with executive staff in the Bureau.


  • Establish annual Medicaid program spending targets;
  • Track, analyze, and project program spending, offsets, and enrollment on a monthly basis;
  • Process and review provider’s early release payment requests;
  • Project revenue and spending of the Essential Plan;
  • Organize Medicaid data, analyses, and policies (State, Federal, Local) for executive staff review and recordkeeping;
  • Prepare State Plan Amendments (SPAs) and State Regulations;
  • Work collaboratively with the Division of the Budget (DOB) and consultants on the Medicaid Forecast;
  • Review, track, and process provider rate packages; and
  • Prepare quarterly Legislative mandated Medicaid Global Cap and Medicaid Drug Cap reports.


Minimum Qualifications Permanent transfer candidates: Current Department of Health (DOH) employee with permanent or contingent-permanent status as a Medicaid Redesign Analyst 1 (G18). Public Candidates: Active list candidate on the New York State Department of Civil Service’s Professional Career Opportunities (PCO) eligible list with a score of 100 OR qualified 55B/C candidate in possession of a Bachelor’s or higher degree.


Preferred Qualifications


Critical thinking skills, analytical skills using Microsoft Excel, ability to solve problems independently. Professional work experience should include policy, projections and trend analysis. The candidate must also have the ability to interact and collaborate with other staff with the Department of Health as well as Other State Agencies.

 
 

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-redesign-analyst-1-trainee-1-trainee-2-99373-at-new-york-state-department-of-health-3182475553/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Medicaid Health Equity Dir (WA) at Elevance Health in Seattle, Washington

 
 

Description

Medicaid Health Equity Director

Location: Seattle, WA


The Medicaid Health Equity Director is responsible for assisting state Health Plan community and stakeholder engagement experience, while applying application of science-based quality improvement methods to reduce health disparities.


Primary duties may include, but are not limited to: assist with the strategic design, implementation, and evaluation of health equity efforts in the context of the population health initiatives; inform decision-making around best payer practices related to disparity reductions, including the provision of health equity and social determinant of health resources and research to leadership and programmatic areas; inform decision-making regarding best payer practices related to disparity reductions, including providing Health Plan teams with relevant and applicable resources and research and ensuring that the perspectives of members with disparate outcomes are incorporated into the tailoring of intervention strategies; collaborate with the Health Plan analytics team to ensure the Health Plan collects and meaningfully uses race, ethnicity, and language data to identify disparities; coordinate and collaborate with members, providers, local and state government, community-based organizations, and other entities to impact health disparities at a population level; and ensure that efforts addressed at improving health equity, reducing disparities, and improving cultural competence are designed collaboratively with other entities to have a collective impact for the population.


Requires a BA/BS degree and 5+ years of experience, preferably in public health, social/human services, social work, public policy, health care, education, community development, or justice; or any combination of education and experience, which would provide an equivalent background.

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.

Clipped from: https://www.disabledperson.com/jobs/46093063-medicaid-health-equity-dir-wa?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Medicaid Sales Rep, Community Plan, Syracuse, New York – WRIC Jobs

 
 

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That’s why you’ll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life’s best work.(sm)

UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. If you’re ready to help write the history of UnitedHealth Group and improve the lives of others, you can do it with UnitedHealthcare Community & State. We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all – it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

If you are located in Onondaga County, NY you will have the flexibility to telecommute* as you take on some tough challenges.

*This is a 40hr work week schedule*

*Outside/field sales role*

Primary Responsibilities:

  • Interact and meet with eligible individuals at their homes and/or various sites throughout the community/service area to enroll them into UnitedHealthcare government programs
  • Maintain high level of collaboration between UnitedHealth Group and community-based partners and other state and government agencies in the New York area
  • Perform community marketing and outreach to promote UnitedHealthcare government programs
  • Offer ongoing member education and member servicing
  • Maintain accurate records for reporting purposes
  • Meet monthly targets for applications received

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • 1+ years of experience in a direct sales, social service, community, or customer service position
  • Proficient in MS Office (Outlook, Word, Excel, Power Point, Teams)
  • Valid driver’s license, good driving history, reliable transportation, and current automobile insurance
  • Ability to travel locally up to 100% of time within assigned sales territories in this NY market area
  • Work Monday – Friday core business hours, nights & weekends, and overtime, as required
  • Live in/within commutable distance to Onondaga County NY
  • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance

Preferred Qualifications:

  • Certified Application Counselor (CAC) certification
  • Previous business to business B2B sales or marketing experience
  • Proven experience in strategic planning, sales strategies and/or retention
  • Experience giving professional presentations to all levels of organization including executive leadership
  • Experience with enrollment in Medicaid/Essential Plan/Child Health Plus products
  • Experience working with communities of all different ethnicities, cultural backgrounds, diverse populations and/or underserved communities
  • Established professional relationships with non-profits, community sources CBO’s, religious/faith-based organizations FBO’s in designated sales territory
  • Familiar with enrollment and eligibility in New York’s public health insurance programs
  • Bilingual

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with UnitedHealthcare. Let’s talk about opportunity. Start with a Fortune 5 organization that’s serving more than 85 million people already and building the industry’s singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they’re found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that’s second to none. This is no small opportunity. It’s where you can do your life’s best work.(sm)

.All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Clipped from: https://jobs.wric.com/jobs/medicaid-sales-rep-community-plan-syracuse-new-york/664166491-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic