Category: Curator- Job Hunter

 
 

The Virginia Hospital & Healthcare Association is seeking candidates for a Director of Medicaid Financial Policy at our headquarters in Glen Allen, Virginia. Ideal candidates will possess a working knowledge of Medicaid policy and reimbursement procedures and an understanding of hospital finance, as well as the ability to perform in-depth review and analysis of changes in Medicaid reimbursement policy and the impact on VHHA members. The position involves interpretation of enacted or proposed legislation related to Medicaid and the provider assessments associated with Medicaid expansion. Strong analytical skills, skills in performing financial modeling and strong communication skills required. Must have advanced Excel skills. Must have excellent relationship management abilities.

 
 

This is a full-time position which requires occasional travel within the Richmond metropolitan area and the Commonwealth of Virginia. A bachelor’s degree in Accounting, Finance or Business Administration and practical work experience (minimum of 5 years) in a relevant field is required. Compensation will be commensurate with work experience. VHHA offers a competitive benefits package and incentive plan opportunity.

 
 

VHHA is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, sex, national origin, age, disability, marital status, military service or veteran status, sexual orientation, gender identity, genetic information, pregnancy, childbirth, or related medical conditions, including lactation, political affiliation, or other basis prohibited by federal or state law relating to discrimination in employment.

 
 

Clipped from: https://jobs.wkrg.com/jobs/director-of-medicaid-financial-policy-richmond-virginia/641919158-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic
 

 
 

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: STATE

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://www.monster.com/job-openings/eligibility-specialist-medicaid-eligibility-chapel-hill-nc–b9f1e16c-82ff-47f9-b043-84bceea80c2f?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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: STATE

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://www.snagajob.com/jobs/758454103?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic
 

 
 

UnitedHealthcare is a company that’s on the rise. We’re expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn’t about another gadget, it’s about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life’s best work.(sm)

This position provides leadership for the Community and State Health Plans Medicaid products in their assigned market to support continued growth and innovation. The position is a member of the health plan senior leadership team and will work collaboratively with the CEO, COO and CFO to ensure overall strategies are aligned with the market level business objectives. This position will oversee the Medicaid community agenda and field-based outreach teams to develop market leading provider and community engagement to forge strong external relationships. This position is responsible for forecasting and has accountability in achieving growth (Acquisition and retention) targets. This is an external and internal facing role.

If you are located in Philadelphia, Pennsylvania, you will have the flexibility to telecommute as you take on some tough challenges.

Primary Responsibilities:

 

• Develop and execute and continually update overall strategies for Medicaid product offering to maximize product growth, member retention, innovation and member and provider experience
• Drive smart Growth in membership and market share in designated market by developing solid relationships across segments and departments (Network, marketing, clinical, quality, finance)
• Lead, develop and uphold accountability of Medicaid products forecasting models with complete understanding of Auto assignment algorithms, eligibility requirements, self-select, and involuntary vs voluntary term ratios
• Manage local Medicaid field-based outreach teams and work directly with M&R regional sales leaders to leverage DSNP Outreach strategies and teams across segments
• Must be able to flex strategies to address local market nuances and unique requirements to assure that we are keeping healthcare “local” while maintaining a strong presence in the market
• Partner with local and functional teams to assure appropriate health plan benefit design and value-added services
• Formulate impactful relationships that drive engagement with community-based organizations and faith-based organizations
• Develop and implement provider engagement strategies (including Field-based approaches and face to face visits Providers) in partnership with Network partners that specifically focuses on membership growth and retention and making UHC the insurer of choice for UHC
• Lead and provide oversight for the Field community outreach team that orchestrates member events, potential consumer events, and community-based goodwill and general awareness that make UHC the insurer of choice
• Manage and uphold accountability for marketing, sponsorship and outreach budgets
• Represent the Health Plan at State meetings, community events, and media relations; Assist in developing new county expansions for existing Medicaid; Assist in implementing future product opportunities
• Ensure compliance to health plan State contract for MCO functions entailing Marketing, Communications, Engagement with Community Based Providers and Provider Network and outreach activities.
• Lead and develop top field talent in designated markets, while creating bench strength and opportunities for professional growth within the team
• Develop social determinants program for designated health plans

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:

 

• Bachelor’s degree
• 5+ years of people management experience
• 5+ years of experience in MLTSS
• Experience building analytical skills including experience generating ROI, business case forecasting and growth opportunities
• Managed care experience
• Proven track record developing and deploying market strategies
• Full COVID-19 vaccination is an essential job function 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. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifcations:

 

• Master’s degree (MPA / MBA)
• Active health license
• Familiar with possible Medicaid referral sources (i.e. CBOs, providers, etc.)
• Bi-lingual

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 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)

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.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

 
 

Clipped from: https://www.themuse.com/jobs/unitedhealthgroup/medicaid-growth-leader-philadelphia-pennsylvania?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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

 
 

 
 

Clipped from: https://jobs.whnt.com/jobs/medicaid-project-management-specialist-program-coordinator-illinois/641277218-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

R-283531


Description


The Louisiana Medicaid Market CFO, Director of Financial Planning & Analysis is responsible for P&L oversight and management. The positions’ responsibilities include but are not limited to: budgeting, forecasting, trend analysis and mitigation, rate analysis, contract review, value based risk modeling and state reporting. This Leader will work closely with the Market President, Segment CFO, and State/Association Finance Partners.


Responsibilities


The Director, Financial Planning & Analysis collects, compiles, verifies, and analyzes financial information and economic indicators so that senior management has accurate and timely information for making strategic and operational decisions. Evaluates industry, economic, financial, and market trends to forecast the organization’s short, medium, and long-term financial and competitive position. May involve financial modeling, reporting and budgeting as well. Provides input into functions strategy.

• Provide market specific financial leadership in the state Medicaid Market, developing a deep understanding of Humana’s Medicaid strategy, capabilities, business drivers, data analytics infrastructure, operational processes, metrics and best practices
• Provide overall Market P&L management and leadership with budgets, forecasts, financial analysis, trends, projections and analytics.
• Provide Market leader support reporting out on financial results, long term planning and drive the understanding of financial performance and key drivers
• Responsible for financial analysis, identification of month end financial drivers, and forecasting including headcount planning to ensure compliance with state requirements
• Perform financial impact analysis for new contracts and support negotiations
• Develop Market specific strategic plans and objectives, manage against a five year long term plan and coordinate annual budget targets that meet the short and long term plan objectives
• Responsible for identifying medical cost trends and leadership of medical cost improvement initiatives
• Responsible for the business unit’s contribution to corporate
• Provide leadership regarding rate and pricing development
• Provide leadership and support regarding value based program development and administration
• Ensure compliance with all state regulatory financial reporting and overall state contract management
• Develop and manage meaningful relationships with the state Department of Health partners. Apply keen insight regarding the current Medicaid health care regulatory environment and competitive environment, and how the components of Humana’s business model interrelate to make Humana competitive in the marketplace
• Cultivate internal and external business relationships which will serve as resources of technical knowledge and performance improvement
• Lead and develop staff through all phases from recruitment to training and advancement opportunities
  
  

Required Qualifications

• 5 or more years of healthcare financial experience; including 2 years or more of Medicaid financials
• Experience working in healthcare and strong foundation of healthcare financials
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Bachelor’s Degree
• 5 or more years of technical experience
• 5 or more years of leadership experience
  
  

Additional Information

• Must reside in Louisiana for this role.
• Director level position
  
  

Scheduled Weekly Hours


40


 

 
 

Clipped from: https://www.linkedin.com/jobs/view/louisiana-medicaid-cfo-director-financial-planning-analysis-at-humana-3149576872/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description:

Warbird Consulting Partners is seeking qualified candidates to be considered for a  direct-hire position for Medicare/Medicaid Reimbursement Manager. This is a REMOTE position. The successful candidate will act as a liaison between operational departments, Finance and the Hospital’s outsourced cost reporting consulting group. This person will ensure the hospital system is well-informed on how regulatory and operational changes will impact the Medicare Cost Report. Additional responsibilities include:

• Leading and training other team members in the preparation of Medicare and Medicaid Cost Reports.
• Leading audit efforts for existing facilities and conducting transaction due diligence on potential acquisitions.
• Maintain knowledge of CMS guidelines and best practices.
• Guiding and directing the team during month-end close.

 
 

 
 

Job Requirements:

Required Qualifications & Experience:

• B.S. Degree in Accounting, Business, Healthcare Administration, or other related field.
• Minimum of seven (7) years Cost Report experience, preferably in an Acute Care and/or Long Term Acute Care setting.
• Experience in Cost Report preparation and audit/review.
• Strong knowledge and experience in GAAP accounting principles.
• Excellent communication, and interpersonal skills.
• Must demonstrate strong analytical skills and attention to detail.
• Intermediate skill level with Excel; SQL experience, a plus.

 
 

Warbird is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, religion, national origin, age, disability, veteran status, genetic data, religion or other legally protected status.  E-Verify –  Warbird participates in the  Electronic Employment Eligibility Verification Program.     INDS

 
 

 
 

Clipped from: https://www.monster.com/job-openings/remote-reimbursement-manager-medicare-medicaid-atlanta-ga–03a42fe9-f436-4cc2-adb6-11144548376e?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description

:

The Montana Department of Public Health and Human Services (DPHHS) has an opportunity for a reliable and resourceful Medicaid Program Integrity Compliance Specialist.

Our mission at DPHHS is to improve and protect the health, well-being, and self-reliance of all Montanans throughout every stage of their life. By joining our team, you will have the opportunity to perform meaningful work in public service to our state and its residents. Whether you are joining the workforce or have several years of experience, DPHHS has the opportunity for you!

This position identifies and investigates potential provider fraud, abuse and waste of Montana Medicaid and Healthy Montana Kids (HMK) programs. Duties include reviewing provider billing practices, as well as computer and information systems to investigate medical claims data and compliance with state and federal laws; analyzing data; interviewing providers; determining overpayments or underpayments, etc.

What We Can Offer You

The State of Montana’s comprehensive benefits package includes healthcare coverage, retirement plans, paid vacation, sick leave, and holidays, work/life balance, and eligibility to participate in the Public Service Loan Forgiveness program. Visit the Health Care and Benefits Division for more information at https://benefits.mt.gov/. In addition to employee benefits, there are a wide range of advancement opportunities within the largest state agency in Montana.

Qualifications

:

What You Can Offer Us

• Knowledge of Medicaid rules, medical claims processing, medical terminology and coding principles and practices.
• Knowledge of reviewing, investigation, and research.
• Excellent written and verbal communication skills.
• Analytical and critical thinking skills.
• Ability to operate personal computer and general office equipment as necessary to complete essential functions, including using spreadsheets, word processing, database, email, internet, and other computer programs.
• Meet minimum qualifications: Bachelor’s degree in health sciences, health information, accounting, business, or social sciences related field. Two years’ experience with medical claims, medical coding, or medical review of services. Other combinations of related education and experience may be considered on a case-by-case basis. Preferred coding certification through American Health Information Management Association (AHIMA) or American Academy of Professional Coder (AAPC).

For a copy of the full job description or if you need a reasonable accommodation in the application or hiring process, contact Heidi Greenback at Heidi.greenback@mt.gov.

How to Apply

Submit the following required documents with your application on the State of Montana Careers website. When submitting the required documents, you must check the “relevant document” box to ensure your attachments are uploading correctly to the specific application for this position.

This position will be posted until filled with frequent screening of applications.

 
 

Clipped from: https://b-jobz.com/us/web/jobposting/049639502ef3?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It’s an opportunity to do your life’s best work.(sm)


The Medicaid Contract Specialist is responsible for managing administrative tasks aligned with the Skilled Nursing Facility contracting process, as well as providing internal support. The Medicaid Contract Specialist will create contracts, support critical reviews to ensure demographic, credentialing and contract accuracy prior to submission. The Medicaid Contract Specialist will play an active role through the load and audit process with all applicable contract loading teams, as well as be accountable to review audit results post-installation. The Medicaid Contract Specialist will also be accountable to manage and submit all daily and mass State Rate updates to all applicable contract loading teams on behalf of Network Management.


You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.


Primary Responsibilities:

• Build and maintain relationships with Optum Network Management, Health Plan and contract loading teams to ensure accurate contract set up results are obtained and maintained
• Manage Skilled Nursing Facility (SNF) contracts, including validation of demographics, credentialing, and system accuracy prior to installation in applicable systems
• Coordinate with quality audit team both pre- and post-implementation to ensure accuracy of contract loading and claim payment accuracy based on contract intent
• Minimize contracting and claim rework associated with incorrect SNF contract set up
• Experience with Medicare, Commercial, and Medicaid will be of value in this role
• Any other projects or duties as assigned
• Use pertinent data and facts to identify and solve a range of problems within area of expertise
• Prioritize and organize own work to meet deadlines
• Be a key resource for addressing questions regarding contract language, contract set-up, payment methodology and other processes
• Attention to detail, problem solving, and establishing and maintaining solid business relationships are crucial for success in this role

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:

• 3+ years of experience in a network data management related role in a managed care environment, such as contract loading or provider data analysis
• Experience using NDB, Cosmos, CSP Facets and Emptoris
• Intermediate proficiency with MS Office suite, including Word and Excel

Preferred Qualifications:

• 2+ years of experience working with reporting tools and generating effective reports
• 2+ years of experience with claims processing, resolution, or recovery
• Experience with facility claims processing systems and guidelines
• Medicaid, Medicare and Commercial product knowledge
• Full COVID-19 vaccination is an essential job function 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. Candidates must be able to perform all essential job functions with or without reasonable accommodation
  
  

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 Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)


Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $26.15 to $46.63. The hourly range for Connecticut / Nevada residents is $28.85 to $51.30. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.


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


Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity 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.


Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

 
 

Clipped from: https://www.theladders.com/job/medicaid-contract-specialist-telecommute-unitedhealthgroup-eden-prairie-mn_55899669?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description
The Pharmacist Director – Californa Medicaid develops and leads clinical pharmacy organization and selects and builds a strong team through training, diverse assignments, coaching, risk-taking, empowerment, performance management and other development techniques. The Director is responsible for achieving financial results consistent with KPM objectives and will champion strategic direction and tactical game plans for delivery of pharmaceutical care.

Will improve operational efficency by directing and changing enhancements to business processes, policies, and infra-structure. The Pharmacy Director plans and executes clinical pharmacy budget, participates in and influences external and internal pharmaceutical/health development efforts, and actively supports Aetna sales and on-going customer relations efforts. Required Qualifications – A current, unrestricted clinical license to practice pharmacy in the State of California is required- Candidate must reside within California, ideally near or within the Sacramento market- Degree in Pharmacy; Business degree a plus.

– 3+ years experience in managed care or completion of a managed care pharmacy residency- 5+ years administrative experience- Ability and willingness to travel up to 30% – Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel. COVID Requirements COVID-19 Vaccination Requirement CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment.

Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work. Preferred Qualifications – 5+ years Managed Medicaid Pharmacy Experience- Completion of Accredited Residency Program specific to Medicaid Pharmacy Education B. S. Pharmacy at minimumPharm. D.

preferred Business Overview At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status.

We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities..

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