Category: Curator- Job Hunter

 
 

THIS POSITION MAY BE TELEWORK ELIGIBLE ON A HYBRID BASIS.


About Us


The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. ODM is implementing the next generation of Ohio Medicaid to fulfill its bold, new vision for Ohio’s Medicaid program – focusing on the individual rather than the business of managed care.


The goals of the next generation of Ohio Medicaid are:

• Emphasize a personalized care experience
• Improve care for children and adults with complex behavioral health needs
• Improve wellness and health outcomes
• Support providers in better patient care
• Increase program transparency and accountability
   

What You Will Do At ODM


Office: Data Governance & Analysis


Classification: Health Services Policy Analyst (PN 20047426 & 20099219)


Job Overview


The Ohio Department of Medicaid (ODM) is seeking to fill three analyst positions in its Data Governance & Analysis team. These positions will support the agency as it implements the Next Generation of Managed Care and transforms healthcare delivery in the state into a person-centered enterprise. The two positions available are:


Pharmacy Informatics Analyst (PN 20099219) –

• heavily involved in the implementation of monitoring metrics to be applied to Ohio’s first-in-the-nation approach to Medicaid pharmacy benefits which is the Single Pharmacy Benefit Manager program (SPBM)
• critical to developing best practices that drive improved health outcomes across the state
• assists in communicating data and metrics to a variety of stakeholders as part of our ODM’s Dashboarding Analytics team
• attends meetings to assist in the development of tools, metrics, dashboards, and models to aid policy decision-making
• conducts literature reviews to identify and implement best practices in program oversight
• prepares reports related to state and federal requirements
• familiarity with healthcare or pharmacy data or policy is preferred, but not required
• experience with data visualization is strongly preferred
   

Healthcare Informatics Analyst (PN 20047426) –

• participating as a member of an inter-disciplinary team on monitoring and evaluating managed care organization (MCO) performance related to population health management
• provides analytical support for MCO quality improvement initiatives developed and implemented by ODM
• coordinates with cross-agency partners to develop mechanisms to share and analyze data
• participates in designing technical solutions to meet federal requirements
• provides analytical support for policy makers at ODM related to healthcare process and outcome quality metric development and implementation related to Medicaid fee-for-service and managed care populations
   

The ideal candidates will be familiar with relational databases and demonstrate experience with data analysis. They will be self-directed and enthusiastic about conducting research to enhance program evaluation and oversight. Those from a variety of backgrounds including but not limited to public health, public administration, business administration, information technology, data analytics, sociology, and political science are encouraged to apply.


What’s In It For You


At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:


Medical Coverage

• Quality, affordable, and competitive medical benefits are offered through the Ohio Med PPO plan.
   

Dental, Vision and Basic Life Insurance

• Dental, Vision, and basic life insurance premiums are free after completed eligibility period. Length of eligibility period is dependent on union representation.
   

Time Away From Work and Work/Life Balance

• Paid time off, including vacation, personal, and sick leave
• 11 paid holidays per year
• Childbirth/Adoption leave
   

Ohio Public Employees Retirement System

• OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of their salary towards their retirement. The employer contributes an amount equal to 14% of the employee’s salary. Visit the OPERS website for more information.
  Deferred Compensation
  
  

 
 

• The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.
  Employee Development Funds
  
  

   
   

• The State of Ohio offers a variety of educational and professional development funding that varies based on whether you are a union-exempt employee or a union-represented employee.
  
  

  Completion of graduate core coursework in health services administration, mathematics, statistics, actuarial science, public administration, allied health sciences, nursing, economics or comparable field; 12 mos. trg. or 12 mos. exp. in research methodology, measurement & testing, analysis of variance & survey sampling; 6 mos. trg. or 6 mos. exp. in use of computer programs/applications used for spreadsheets, statistical analysis & graphics presentation & word processing; 1 course or 3 mos. exp. in multiple regression or multivariate analysis.
  
  

• Or completion of undergraduate core coursework & 12 mos. exp. in one of following: health services administration, mathematics, statistics, actuarial science, public administration, allied health sciences, nursing, economics, public health, or comparable field; 12 mos. trg. or 12 mos. exp. in research methodology, measurement & testing, analysis of variance & survey sampling; 6 mos. trg. or 6 mos. exp. in use of computer programs/applications used for spreadsheets, statistical analysis & graphics presentation & word processing; 1 course or 3 mos. exp. in multiple regression or multivariate analysis.
• Or equivalent of Minimum Class Qualifications For Employment noted above.
  
  

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Baylor Scott White HealthOrange, TX

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• The Medical Director will be responsible for managing health plan medical costs and assuring appropriate health care delivery for plans and members.
• They will be responsible for leading the organizations efforts to achieve excellence in healthcare affordability, quality, member experience, and improved population and member outcomes.
• They will serve as a clinical leader for teams dedicated to concurrent review, prior authorization, case management and clinical coverage review.
• – Share the health plan’s passion for evidence-based medicine and be comfortable applying evidence-based guidelines.
• Collaborate with other senior leaders in efforts that enhance the quality of care delivery, improve outcomes, and improve value delivered to our members.
• – The Medical Director can expect to perform the following functions:- Support pre-admission review, utilization management, concurrent and retrospective review process and case management.
• – Provide professional leadership and direction in the utilization/cost management (UM) and clinical quality improvement (QI) of the health plan, as measured by benchmarked UM and QI goals.
• – Work collaboratively as a clinical resource to other plan functions that interface with medical management such as provider relations, member services, benefits, claims management, etc.
• – Ensure members receive safe, effective, equitable, efficient, timely and patient-centered health care services within their health plan benefits.
• – Carry out medical policies at the health plan consistent with NCQA and other regulatory bodies.
• – Participate and/or chair clinical committees and work groups as assigned.
• – Review medical care, medical service, and pharmacy requests against established clinical guidelines and make approval and denial determinations in accordance with evidence-based standards, organizational policies and procedures, and regulatory requirements.
• – Identify potentially unnecessary services and care delivery settings, and recommend alternatives, as appropriate.
• – Review appeals of medical and pharmacy denials against established clinical guidelines and make approval and denial determinations in accordance with evidence-based standards, organizational policies and procedures, and regulatory requirements.
• – Identify opportunities for corrective action plans to address issues and improve plan and network managed care performance.
• – Collaborate with Provider Networks and Medical Director team in creating and maintaining programs that incentivize providers to achieve selected utilization/cost and quality outcomes.
• – Participate in the retrospective review and analysis of plan performance from summary data of paid claims, encounters, authorization logs, compliant and grievance logs, and other sources.
• – Provide periodic written and verbal reports and updates as required in the Quality Management Program description, the Annual QI Work Plan.- Assure plan conformance with legal and regulatory requirements; support NCQA qualification activities, including site visits and response to accrediting and regulatory agency feedback.
• – Participate in risk management, claims administration, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, nutrition service review, provider orientation, credentialing, profiling, etc.
• – Conduct quality improvement and outcomes studies as directed by the state and federal regulatory agencies, the Quality Management Committee, Medical Advisory Committee, Peer Review Committee, and management.
• – Support grievance process, as led by Chief Medical Officers, ensuring a fair outcome for all members.
• – Monitor member and provider satisfaction survey results and implement changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and plan participants.
• – May be asked to chair various health plan committees, such as Quality Management subcommittees on Peer Review or Credentialing.
• – Promote wellness and ensure programs of prevention, education and outreach to members and providers consistent with the company’s Mission, Ambition, and Values- Perform and oversee in-service staff training and education of professional staff.
• – Contribute to the development of strategic planning for existing and expanding business; recommend changes in program content in concurrence with changing markets and technologies.
• – Participate in key marketing activities and presentations, as necessary, to assist the marketing effort.
• REQUIREMENTS – Doctorate Degree Required- 5+ years of experience- Unrestricted License Texas as a Doctor of Medicine or a Doctor of Osteopathy.
• – Certified in a recognized medical specialty as recognized by the American Board of Medical Specialists (ABMS).

 
 

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Summary

 Gainwell is the leading provider of technology services and solutions that are vital to the administration of health and human service programs. We’re a relatively new company, formed in October 2020, but we have been serving state and local clients for decades and have solution offerings in 50 states and territories. We have been serving one of our state clients for over 40 years and several states for more than 20 years!

We are looking for someone with Medicaid and QNXT experience.

Essential Job Functions

• Assists in planning and designing business processes; assists in formulating recommendations to improve and support business activities.
• Assists in analyzing and documenting client’s business requirements and processes; communicates these requirements to technical personnel by constructing basic conceptual data and process models, including data dictionaries and volume estimates.
• Assists in creating basic test scenarios to be used in testing the business applications in order to verify that client requirements are incorporated into the system design.
• Assists in developing and modifying systems requirements documentation to meet client needs.
• Participates in meetings with clients to gather and document requirements and explore potential solutions.
• Executes systems tests from existing test plans. Assists in analyzing test results in various phases.
• Participates in technical reviews and inspections to verify ‘intent of change’ is carried through phase of project.

Basic Qualifications

• Three or more years of business analysis experience
• Experience working with the interface of information technology with functional groups within an organization
• Experience working with business processes and re-engineering in addition to computer programming concepts and basic language
• Experience working with QNXT and SQL
• Experience working on interchange configuration with Medicaid knowledge

 
 

Clipped from: https://jobs.gainwelltechnologies.com/job/Any-city-BA-DDI-QNXT-&-Medicaid-TX-99999/895359400/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Position Purpose:

Perform care coordination function for members with behavioral health and medical concerns

 

• Ensure effective care coordination from one level of care to another.
   
• Work with providers and care teams to provide collaborative care coordination focused on the member’s needs and ensuring the member receives appropriate referrals.
   
• Ensure provider services are delivered without gaps and identify functional deficiencies in care coordination.
   
• Coordinate and monitor community based services for members not covered by Medicaid.
   
• Assist with provision of Medicare & Medicaid coverage and services.
   
• Actively participate on Integrated Care Teams.
   
• Perform health screenings with members to determine care coordination needs or potential for care management referrals.
   

Education/Experience:

Graduate from an Accredited School of Nursing (RN or Practical Nursing), Bachelor’s degree in Social Work, Counseling, Healthcare or related field preferred. A minimum of 3 years of medical or behavioral health or utilization care coordination experience required.

For Arizona Complete Health – Complete Care Plan:
Obstetrics (OB) assignments requires experience in OB (clinical, acute care, community)
Pediatric assignments requires experience in pediatrics (clinical, acute care, community)

For Tailored Plans Carolina Complete Health plan only: Bachelor’s degree required and 3 years of relevant experience.

Clipped from: https://jobs.centene.com/us/en/job/1336378/Integrated-Care-Manager?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description Summary

Medicaid and/or State-Based Exchange experience highly recommended

Job Summary

Essential Duties and Responsibilities:
– Manage overall operations and performance of assigned contracts including P&L, quality and compliance with all terms and conditions along with preparing and analyzing regular performance reports.
– Manage all aspects of the customer relationship for assigned contracts ensuring effective and efficient communication along with addressing and resolving customer complaints.
– Provide leadership and direct supervision to assigned employees, including setting goals, monitoring work performance, coaching and evaluating results to ensure that objectives are met.
– Manage continual process improvement by monitoring, refining, and optimizing workflow and processes with the goal of continuously improving overall effectiveness (efficiency, productivity, and quality).
– Create an entrepreneurial work environment by involvement in developing and hiring superior talent and instilling a culture of accountability, measurability, and discipline without undue bureaucracy.
– Interpret policies, procedures, and goals of the company for subordinates.
– Participate in the development and monitoring of the operational budget related to assigned contracts.
– Work collaboratively and effectively with IT to ensure that product and service applications and technologies are optimized for contract compliance, productivity, and quality performance.
– Maintain primary responsibility for ensuring customer satisfaction, resolving compliance issues, and accountability for profit & loss with assigned contracts and lines of business.
– Act as the primary point of contact for state officials and other outside contacts for the assigned contract.
– Perform other duties, as necessary.

Minimum Requirements:
– Direct and control the activities of a broad functional area through several department managers within the company.
– Has overall control of planning, staffing, budgeting, managing expense priorities, and recommending and implementing changes to methods.
– Work on complex issues where analysis of situations or data requires an in-depth knowledge of the company.
– Participate in corporate development of methods, techniques and evaluation criteria for projects, programs, and people.
– Ensure budgets and schedules meet corporate requirements.
– Regularly interact with executives and/or major customers.
– Interactions frequently involve special skills, such as negotiating with customers or management or attempting to influence senior level leaders regarding matters of significance to the organization.
– Report to Senior Director or VP level.

MAXIMUS Introduction

Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.

EEO Statement

EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

Maximus compensation is based on various factors including but not limited to a candidate’s education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus’s total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation shall be commensurate with job duties and relevant work experience. An applicant’s salary history will not be used in determining compensation.

Clipped from: https://www.snagajob.com/jobs/753934808?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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CareFirst BlueCross BlueShieldWashington, DC Full-time

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• PURPOSE:The Quality of Care Nurse will effectively identify, prioritize and respond to high level grievances, complaints and complaint appeals from the member or member’s authorized representative for the Commercial or Medicare Advantage lines of business.
• The incumbent reviews and interprets the grievance or complaint, medical and dental records, narrative notes, in-patient/office policies and all documentation submitted or collected by the plan pertinent to the issue.
• The incumbent will also understand the merits of legal and accreditation actions.
• ESSENTIAL FUNCTIONS:Reviews all member grievances or complaints and complaint appeals concerning the quality of care provided by facilities or practitioners.
• Contacts members, providers, or other parties involved, as appropriate, verbally and in writing to obtain additional information regarding the complaint.
• Reviews medical and dental claims information and records, and member and provider correspondence to conduct patient care investigations and renders an investigative finding.
• Provides detailed written and/or verbal responses to members, providers, and authorized representatives upon completion of a thorough investigation.
• Responds to follow up questions or concerns with members, providers, and other parties involved in the investigation, as appropriate.
• Prepares training materials and serves as the professional resource for all quality of care complaints and quality of care appeal complaints.
• Conducts or participates in nursing research as appropriate.
• Completes medical research by defining and interpreting medical language, defining and interpreting medical procedures and medical/hospital office policies.
• Assists with the preparation of regulatory reports by detailing and summarizing the merits of legal or accreditation actions.
• QUALIFICATIONS:Education Level:Licenses/Certifications:RN – Registered Nurse – State Licensure And/or Compact State Licensure Practice in MD, DC, VA, WV.Experience: 5 years Clinical experience in direct health care or health insurance payor setting working with quality reporting, or analytics.
• Working knowledge of NCQA standards.
• Bachelor’s degree in Nursing.
• Behavioral Health Experience.
• Knowledge, Skills and Abilities (KSAs)Demonstrates excellent written and oral communication skills along with effective presentation skills.
• Able to provide verbal and written feedback for improvement.
• Must understand the appropriate mode of communication based on the subject matter.
• Computer proficiency and technical aptitude with the ability to utilize MS Office (Excel, Word and Outlook) and web based technology.
• Ability to exercise sound judgment in making critical decisions.
• Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
• Knowledge of patient rights and laws relative to those rights, such as HIPAAAbility to effectively communicate and provide positive customer service to every internal and external customerProficient in standard medical practices and insurance benefit structures with the ability to use them in varied siturationMust 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: DC Medicaid – Enrollment ServiceEqual 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.

 
 

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Found in: Whatjobs US Premium – 2 hours ago

Palm Beach Gardens, United States Amerihealth Caritas Health Plan Full time

Responsibilities:

Under the direction of the Regional President, Florida the Director, Compliance provides strategic direction and leadership for the development and implementation of compliance policy, process and control activities and provides oversight of all operating division compliance, privacy, and regulatory functions, in addition to possessing the following attributes:

* Demonstrates a solid understanding of operational processes and controls and monitors the execution of operational changes required by regulations and guidelines.

* Develops compliance methodologies to test established and newly executed operational processes and controls and monitor effectiveness.

* Proactively identify process gaps, weaknesses and deficiencies and/or business productivity/efficiency opportunities.

* Partners with local and corporate counterparts to develop protocols that support the review and assessment of objectives that ensure compliance with local plan and corporate policies and procedures.

* Develops and monitors metrics and ensures accurate reporting of regional/local compliance information and compliance and FWA issues reported via the compliance hotline.

* Ensure that local compliance related issues and risks are identified, aggregated and reported.

* Directs ad-hoc compliance assessments/research as requested by the local compliance associates.

* Aligns and monitors compliance training and education programs.

* Oversees compliance with the risk management program and regulatory reporting requirements.

The Compliance Lead may directly manage and support the development of highly skilled and knowledgeable associates. Must be able to operate independently with minimal management oversight and be able to manage competing priorities and deadlines that are subject to frequent change. Must possess and exercise excellent professional judgment in all interactions.

Education/Experience:

* Bachelors Degree or equivalent education and ten years of experience in managed health care including experience in the areas of compliance oversight.

* Advanced degree and/or JD preferred

* Certified in Health Care Compliance preferred.

* 5 to 10 years experience in a managed health care environment, including experience in the areas of compliance oversight.

Other Skills:

* Good working knowledge of AmeriHealth Caritas, its affiliates and the managed care industry.

* Demonstrated knowledge of compliance concepts and practices (strategies, control activities, information analysis and reporting and communication)

* Self-motivated with demonstrated project management skills.

* Strong oral and written communication skills.

* Strong facilitation, collaboration and teamwork skills with the ability to build cross-functional partnerships to drive results.

* Strong interpersonal skills.

* Innovative and creative. Able to embrace change and think outside the box.

* Strong problem solving and critical thinking skills.

* Strong analytical and research skills, able to synthesize information to provide practical solutions to accomplish meaningful results.

* Strong organizational skills, with the ability to apply good judgment and resolve ambiguities.

* Acts independently and requires minimal supervision.
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Job Details
Description:

Medicaid Project Management Specialist – Program Coordinator

University of Illinois Systems

Office of Medicaid Innovation – Remote

The Office of Medicaid (OMI) seeks a Medicaid Project Management Specialist to assist the Office of Medicaid Innovation (OMI) with day-to-day management of projects between the University of Illinois System and the Illinois Department of Healthcare and Family Services (HFS). The Healthcare Project Management Specialist will develop their knowledge and experience with project management to support multiple ongoing Project Orders to ensure that the goals and deliverables of the interagency agreements are met.

The University of Illinois is an Equal Opportunity, Affirmative Action employer that recruits and hires qualified candidates without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability or veteran status. For more information, visit

Major Duties and Responsibilities:

Project Management:

Under the supervision of the Associate Director of Project Management, the Project Specialist will:

Provide program knowledge and expertise of procedures, technical specifications, related to Medicaid Project Order activities
Assist in the development and administration of Medicaid programs, and special projects.
Support various aspects of project management, including creating project documents/artifacts, project schedules, leading meetings, managing, and documenting risk register, backlogs, etc.
Support the management of resources, determination, and supervision of staff functions; assists in the recruitment, training, and management of work related to Medicaid Project Orders.
Share and support OMI operating policies and processes.
Participate in departmental objectives and long-range planning.
Assist in the development of management reports, analyses, data aggregation related to unit projects.
Act as a point of contact with University of Illinois departments and HFS

Other duties as assigned

Position Requirements and Qualifications:

Required:

Bachelor’s degree.
One year of experience in project management, Medicaid policy, healthcare, and/or general operations.
Please note, a Master’s Degree in an area consistent with the duties of the position may be substituted for one (1) year of work experience.

Preferred:

Bachelor’s degree in Business, Social Services, Human Resources, Healthcare, or related field.

Knowledge, Skills, and Abilities:

Knowledge of business and management principles involved in strategic planning, resource allocation, and coordination of people and resources
Skill in analyzing information and evaluating results to choose the best solution and solve problems.
Skill in scheduling meetings, program activities, and the work of others.
Skill in oral and written communication
Ability to adjust actions in relation to others’ actions.
Ability to develop goals and plans to prioritize, organize, and accomplish work.
Ability to work independently and exercise judgment to be able to analyze and investigate a variety of questions or problems
Ability to analyze and develop guidelines, procedures, and systems

Environmental Demands:

Travel is required, reliable transportation is needed.

SALARY AND APPOINTMENT INFORMATION

This is a full-time Civil Service Program Coordinator position appointed on a 12 month service basis. The expected start date is as soon as possible after July 5, 2022 Salary is commensurate with experience.

TO APPLY:

Applications must be received by July 5, 2022. Apply for this position by going to . If you have not applied before, you must create your candidate profile at . If you already have a profile, you will be redirected to that existing profile via email notification. To complete the application process:

Step 1) Submit the Staff Vacancy Application.

Step 2) Submit the Voluntary Self-Identification of Disability forms.

Step 3) Upload the following documents:

cover letter
resume (months and years of employment must be included)
names/contact information for three references
OPTIONAL: academic credentials (unofficial transcripts or copy of diploma may be acceptable) Academic credentials are verified at the time of hire.

In order to be considered as a transfer candidate, you must apply for this position by going to . Applications not submitted through this website will not be considered. For further information about this specific position, contact Cass Dockrill at . For questions about the application process, please contact .

University of Illinois faculty, staff and students are required to be fully vaccinated against COVID-19. If you are not able to receive the vaccine for medical or religious reasons, you may seek approval for an exemption in accordance with applicable University processes.

The University of Illinois conducts criminal background checks on all job candidates upon acceptance of a contingent offer. Convictions are not a bar to employment. Other pre-employment assessments may be required, depending on the classification of Civil Service employment.

As a qualifying federal contractor, the University of Illinois System uses E-Verify to verify employment eligibility.

The University of Illinois System requires candidates selected for hire to disclose any documented finding of sexual misconduct or sexual harassment and to authorize inquiries to current and former employers regarding findings of sexual misconduct or sexual harassment. For more information, visit Policy on Consideration of Sexual Misconduct in Prior Employment

The University of Illinois must also comply with applicable federal export control laws and regulations and, as such, reserves the right to employ restricted party screening procedures for applicants.

College Name or Administrative Unit:
System Office
Category:
2-Administrative
Title:
Medicaid Project Management Specialist – Program Coordinator (166789)
Open Date:
06/15/2022
Close Date:
07/05/2022
Organization Name:
Ofc Medicaid Innovation

 
 

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Medicaid Business Development Leader – Remote + 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 : Jun 28, 2022 + Req # : PS74116 Description Build the Possibilities.

Make an extraordinary impact. Responsible for positioning and capture execution of Medicaid health plan procurement and reprocurement opportunities, managing the strategy and preparations for upcoming Medicaid RFP’s;

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 prior to an RFP.

Location : Remote any US location How you will make an impact : + 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 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. Qualifications – External Minimum Requirements : + Requires a BA / BS degree in a related field.
• Minimum 10 years of experience in strategic planning and business development in Medicaid programs; to include leadership / management experience in health care management, marketing products, and managing significant business results;

or any combination of education and experience, which would provide an equivalent background. + Up to 30% travel may be required.

Preferred Skills, Capabilities and Experiences : + MBA, MPH, or MPP. + Proven successful past performance leading capture and proposal activities for significant opportunities ($1B and more).

• Previous P&L and / or business development experience and project management experience in Medicaid managed care setting.
• 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. 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 Worlds Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion.

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Summary

• Our client requires the services of a trainer/content developer to support training implementation of NC FAST Medicaid Transformation Project modules.
• Important Note: Statewide travel up to 25% of the time is required in the performance of the work for this position. Travel may include some evenings and weekend days.
• NOTE: COVID-19 restrictions prohibit travel at this time; however, when restrictions are lifted, this role may be expected to travel as needed to meet the requirements of this position.

Job Description

• The NC Department of Health and Human Services seeks contract resources to assist with the training and implementation of NC Families Accessing Services through Technology (NC FAST).
• The primary purpose of NC FAST Training Developer is to analyze the NC FAST system functionality to develop classroom facilitator-led learning solutions and eLearning courses to support NC FAST implementation.
• This position will work closely with the Training Lead, Training Scripts Writer, Applications Lead and subject matter experts to understand requirements to design training and develop course materials, to develop and maintain Adobe FrameMaker templates and scripts, and to revise training materials for instructional training of adult learners.
• Using this base, this resource will also be responsible for providing effective and creative classroom and virtual facilitation of training for all levels of employees who oversee and administer social services programs that are managed through the NC FAST system.

Skills Required

• Experience in curriculum design and developing training materials for adult learners Required 3 Years
• Understands the social services programs that drive the efforts of the county, regional, and state staff who administer those programs. Required 3 Years
• Research and evaluate the NC FAST case management software in order to translate the software functionality into effective learning materials. Highly desired 3 Years
• Ability to assist with scheduling, preparing for and participating in quality assurance checks on training materials that have been developed. Required 3 Years
• Experience working with training developers, program subject matter experts, technical support and others to assure training materials are effective. Required 3 Years
• Experience in business analysis, MS Office Suite (e.g., MS Word, MS Excel, MS PowerPoint) Required 3 Years
• Experience in Learning Management System (LMS) technology such as Moodle, XML, HTML Required
• 3 Years
• Experience in designing and delivering computer-based training instructional design, with learning program design systems. Required 3 Years
• Experience in software that may include Adobe FrameMaker, Adobe Captivate, Photoshop, Adobe Breeze, Dreamweaver, Visio or other training applications. Required 3 Years
• Experience developing dynamic instructional training materials using interactions and simulations to create interactive, engaging course content. Required 3 Years
• Experience developing interactive media presentations that enhance the online educational experience Required 3 Years
• Experience leading training sessions in a variety of formats that may include in person, virtual and/or webinar. Required 3 Years
• Ability to assist with basic application software and hardware support Highly desired
• Must have strong understanding of internet concepts and web technology Highly desired
• Ability to clearly communicate in oral and written form, and deal effectively with diverse groups to accomplish the objectives. Highly desired
• Experience evaluating student progress and making recommendations for continued training participation curriculum Required 3 Years
• Experience providing feedback on learning providing feedback on learning curriculum and methodology to assure program relevance and user comprehension. Required 3 Years
• Experience with processes to prepare for and conduct classroom training including facility management, course scheduling and student registration. Required 3 Years
• Knowledge of and experience with NC FAST and the Medicaid Program in NC Highly desired 2 Years

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