Category: Curator- Job Hunter

 
 

Position Title: Medicaid Risk Adjustment Analyst

Contract: 1 year contract with potential for Full Time Hire

Location: REMOTE, must live in California or Hawaii

 
 

Position Purpose:

Our large healthcare client’s team needs help from an experienced Medicaid Risk Adjustment Analyst. They are looking for someone to help them extract data and designing models to predict future expenditures of enrollees based on diagnosis codes reported on claims and encounters.

 
 

Candidate Experience Requirements:

• 4+ years of risk adjustment experience – preferably coming from a previous risk adjustment position in healthcare
• SAS developer with over 3 years of experience
• Previous experience working with Medicaid

 
 

Candidate Experience Nice to Have:

• CDPS Rx modeling experience
• SharePoint and/or Power BI experience

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-risk-adjustment-analyst-at-medasource-3137936172/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Blue Cross Blue Shield of AZ

 
 

 Glendale Luke Afb, AZ Full Time

Job Posting for Clinical Trainer (Medicaid) at Blue Cross Blue Shield of AZ

Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. This remote work opportunity requires residency, and work to be performed, within the State of Arizona. PURPOSE OF THE JOB This position serves as BCBSAZ’s Clinical Trainer and is responsible for the researching, writing and the delivery of behavioral health and integrated care trainings for Providers, community members, stake holders and community partners. This position serves all contracted Providers in all lines of business (RBHA/ACC) in direct partnership with BCBS, the Medicaid Business Segment Clinical Team, AHCCCS and Arizona Workforce Development Alliance. This position is responsible for the delivery of required behavioral health and integrated care trainings throughout the network. REQUIRED QUALIFICATIONS 1. Required Work Experience · At least three (3) years’ practice and training-related experience 2. Required Education · Master’s degree in Behavioral Health field 3. Required Licenses · Independent license such as LPC, LCSW, LMFT, or LISAC · A valid Arizona driver license with an acceptable driving record 4. Required Certifications · N/A PREFERRED QUALIFICATIONS 1. Preferred Work Experience · N/A 2. Preferred Education · N/A 3. Preferred Licenses · N/A 4. Preferred Certifications · N/A ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES Develop and create trainings based upon behavioral health evidenced based theories and integrated care interventions for all levels of Providers (Peer, BHP, BHT, PCPs, etc.) Provide beginner level, experienced and master level trainings for all levels of Providers and attendees Provide professional development and skill-based training for licensed therapists and psychologists contracted with BCBS, Medicaid Business Segment and community partners Provide behavioral health training for community members and tribal members throughout Northern Arizona Provide training on the Children’s System of Care required trainings and other Health Plan required trainings Consults with organizational leaders, QM, and workgroups to develop and respond to training needs and requests Simultaneously manages multiple, complex training projects Posts and manages clinically sponsored trainings Develops and conducts follow-up assessments to determine training needs in the network Uses formal instructional design methodology to develop and support sophisticated, complex and/or enterprise-wide, competency-based training, skills, and educational tools for the network Incorporates feedback gathered from participants and other relevant audiences to improve training, processes, and products Serves as a curriculum/course development lead in partnership with subject matter experts internally and externally to BCBSAZ Perform all other duties as assigned The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements REQUIRED COMPETENCIES 1. Required Job Skills · Experience using Microsoft Office products, Video recording/editing software, Webinar based platforms (i.e., Zoom), Relias Learning Management System, Eventbrite, WordPress Website functions · Plan large scale events/conferences · Ability to prioritize work · Ability to communicate effectively both verbally and in writing · Knowledge of the behavioral health and health care integration 2. Required Professional Competencies · N/A 3. Required Leadership Experience and Competencies · N/A PREFERRED COMPETENCIES 1. Preferred Job Skills · N/A 2. Preferred Professional Competencies · N/A 3. Preferred Leadership Experience and Competencies · N/A Our Commitment BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group. Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

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Clipped from: https://www.salary.com/job/blue-cross-blue-shield-of-az/clinical-trainer-medicaid/j202206221219148603968?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

JOB DESCRIPTION

 
 

Job Summary

 
 

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

 
 

KNOWLEDGE/SKILLS/ABILITIES

 
 

 
 

• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member’s health or psychosocial wellness, and triggers identified in the assessment.

 
 

• Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member’s support network to address the member needs and goals.

 
 

• Conducts face-to-face or home visits as required.

 
 

• Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly.

 
 

• Maintains ongoing member case load for regular outreach and management.

 
 

• Promotes integration of services for members including behavioral health care and long term services and supports/home and community to enhance the continuity of care for Molina members.

 
 

• Facilitates interdisciplinary care team meetings and informal ICT collaboration.

 
 

• Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.

 
 

• Assesses for barriers to care, provides care coordination and assistance to member to address concerns.

 
 

• 25- 40% local travel required.

 
 

• RNs provide consultation, recommendations and education as appropriate to non-RN case managers.

 
 

• RNs are assigned cases with members who have complex medical conditions and medication regimens

 
 

• RNs conduct medication reconciliation when needed.

 
 

 
 

JOB QUALIFICATIONS

 
 

Required Education

 
 

Graduate from an Accredited School of Nursing. Bachelor’s Degree in Nursing preferred.

 
 

Required Experience

 
 

1-3 years in case management, disease management, managed care or medical or behavioral health settings.

 
 

Required License, Certification, Association

 
 

Active, unrestricted RN or LPN license in good standing in the state of WA.

 
 

Must have valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation.

 
 

Must have familiarity with King County and available resources.

 
 

Preferred Education

 
 

Bachelor’s Degree in Nursing

 
 

Preferred Experience

 
 

3-5 years in case management, disease management, managed care or medical or behavioral health settings.

 
 

Preferred License, Certification, Association

 
 

Active, unrestricted Certified Case Manager (CCM)

 
 

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

 
 

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

 
 

Clipped from: https://jobs.cbs4indy.com/jobs/field-remote-medicaid-care-coordinator-rn-lpn-indianola-washington/633415473-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Found in: S US – 19 hours ago

Sacramento, United States KPMG Full time

The KPMG Advisory practice is currently our fastest growing practice. We are seeing tremendous client demand, and looking forward we don’t anticipate that slowing down. In this ever-changing market environment, our professionals must be adaptable and thrive in a collaborative, team-driven culture. At KPMG, our people are our number one priority. With a wealth of learning and career development opportunities, a world-class training facility and leading market tools, we make sure our people continue to grow both professionally and personally. If you’re looking for a firm with a strong team connection where you can be your whole self, have an impact, advance your skills, deepen your experiences, and have the flexibility and access to constantly find new areas of inspiration and expand your capabilities, then consider a career in Advisory.

KPMG is currently seeking a Director State and Local CA Medicaid in Customer & Operations for our Consulting practice.

Responsibilities:

Manage and deliver large, complex public services and state/local government engagements that identify, design and implement creative business and technology services for Medicaid government clientsDevelop and execute methodologies and solutions specific to the public sector and state/local government industry coupled with proven experience with Medicaid and MMIS modernization, with preference for prior work with large Medicaid programs in the western United StatesHandle engagement risk, project economics, planning and budgeting, account receivables and definition of deliverable content to help to ensure buy-in of proposed solutions from top management levelsDevelop and maintain relationships with many senior managements at state/local government agencies, positioning self and the firm for opportunities to generate new businessEvaluate projects from a technical stance, helping to ensure that the development methods used are correct and practical; evaluate risks related to requirements management, business process definition, testing processes, internal controls, project communications, training and organizational change managementManage the day-to-day interactions with client managers

Qualifications:

Minimum ten years of recent experience in the Health and Human Services Medicaid solution delivery market, working for a commercial off-the-shelf (COTS) solution provider or consulting organization with a minimum of eight years of experience managing large, complex technology projects on the scale of a State Medicaid Maintenance Management Information System (MMIS) solution along with proven experience with Medicaid and MMIS modernizationBachelor’s degree of technical sciences or information systems from an accredited university or collegePrior experience and has served in a team supervisory role on at least one MMIS implementation and one MMIS M&O engagement such as Program Manager, Module Project Manager, Solution Architect, Technical Solution Lead, or Quality/Testing ManagerDemonstrated experience leading teams of more than twenty staff, including staff from diverse organizations to successfully implement and operate technology-based solutions; experience and relationships with states in the western United States preferredHands-on experience with the Center for Medicare and Medicaid Services (CMS) Medicaid Information Technology Architecture (MITA), Medicaid Certification Lifecycle, associated toolkit and CMS checklistsCapable of presenting Medicaid topics to large, varied audiences in either written or verbal presentation format and experience in working on customer proposals or deal capture teams in the State Medicaid marketTravel may be up to 80-100%

Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future
KPMG LLP (the U.S. member firm of KPMG International) offers a comprehensive compensation and benefits package. KPMG is an affirmative action-equal opportunity employer. KPMG complies with all applicable federal, state and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other category protected by applicable federal, state or local laws. The attached link contains further information regarding the firm’s compliance with federal, state and local recruitment and hiring laws. No phone calls or agencies please.

At KPMG, any partner or employee must be fully vaccinated or test negative for COVID-19 in order to go to any KPMG office, client site or KPMG event. In some circumstances, individuals who are not fully vaccinated may also be required to have a reasonable accommodation to not be fully vaccinated for COVID-19.

 
 

 
 

Clipped from: https://us.trabajo.org/job-1373-20220622-cd6fafeca4692e500a78006f26a52913?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 has responsibilities as the local market health plan compliance officer and is an individual contributor.

 
 

Primary Responsibilities:

 
 

• Be able to manage a compliance program with an understanding of complex or dual products

 
 

• Engages in high risk/complex remediation strategy & resolution and promote compliance with applicable laws and contractual obligations for various Medicaid products

 
 

• Collaborate with a team that conducts product-specific legal research and monitors changes to requirements to mitigate risks and achieve compliance

 
 

• Interpret complex, technical, professional, regulatory or legal information and publications distilling into actions as needed

 
 

• Collaborate with other legal, regulatory affairs, and compliance professionals cross-functionally to ensure regulatory and contractual requirements are met

 
 

• Investigate identified compliance matters, including corrective action and mitigation

 
 

 
 

This role requires a unique ability to develop relationships, analyze information and influence multiple stakeholders to increase engagement and get the needed results. You will be working in a matrixed environment with multiple groups while ensuring that resources are used effectively to mitigate risks and achieve compliance.

 
 

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 or equivalent work experience

 
 

• 3+ years of experience in a role directly managing key aspects of a compliance program

 
 

• 3+ years of experience working in a government, legal, healthcare, managed care and/or health insurance environment in a regulatory, privacy or compliance role

 
 

• Experience managing teams, major program initiatives or working with regulatory agencies

 
 

• Broad knowledge and experience in: Ability to navigate and influence a complex matrixed environment across UHC, Optum and other delegated entities and drive to resolution

 
 

• 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:

 
 

 
 

• Advanced Degree (JD or Master’s)

 
 

• Professional certification (Certified in Healthcare Compliance – CHC or similar)

 
 

• 5+ years of Healthcare industry or Healthcare related industry experience and government programs

 
 

• Experience with managed care and/or government programs

 
 

• Experience in a strategic role, ideally leading and/or implementing a comprehensive compliance program

 
 

• Solid skills in: goal(s) setting and works independently to achieve them. Pushes self and others to reach milestones

 
 

• Excellent skills in: verbal and written communication; problem solving

 
 

• Demonstrates advanced writing/presentation skills. Easily shifts style based on audience

 
 

• Demonstrated ability to: make decisions even when information is limited or unclear

 
 

• Demonstrated ability to: Adept at understanding and resolving complex concepts and situations presented by the business environment; ability to assess complex problems and recommend the appropriate compliance solutions

 
 

• Other: Ability to effectively deal with ambiguity – can effectively cope with change, can shift gears comfortably, can decide and act without having the total picture, comfortably handles risk and uncertainty in a manner consistent with UnitedHealth Groups core values, culture and common language of leadership

 
 

 
 

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)

 
 

Clipped from: https://jobs.whnt.com/jobs/compliance-officer-nebraska-medicaid-health-plan-lincoln-nebraska/634044384-2/?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 has responsibilities as the local market health plan compliance officer and is an individual contributor.

 
 

Primary Responsibilities:

 
 

 
 

• Be able to manage a compliance program with an understanding of complex or dual products

 
 

• Engages in high risk/complex remediation strategy & resolution and promote compliance with applicable laws and contractual obligations for various Medicaid products

 
 

• Collaborate with a team that conducts product-specific legal research and monitors changes to requirements to mitigate risks and achieve compliance

 
 

• Interpret complex, technical, professional, regulatory or legal information and publications distilling into actions as needed

 
 

• Collaborate with other legal, regulatory affairs, and compliance professionals cross-functionally to ensure regulatory and contractual requirements are met

 
 

• Investigate identified compliance matters, including corrective action and mitigation

 
 

 
 

This role requires a unique ability to develop relationships, analyze information and influence multiple stakeholders to increase engagement and get the needed results. You will be working in a matrixed environment with multiple groups while ensuring that resources are used effectively to mitigate risks and achieve compliance.

 
 

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 or equivalent work experience

 
 

• 3+ years of experience in a role directly managing key aspects of a compliance program

 
 

• 3+ years of experience working in a government, legal, healthcare, managed care and/or health insurance environment in a regulatory, privacy or compliance role

 
 

• Experience managing teams, major program initiatives or working with regulatory agencies

 
 

• Broad knowledge and experience in: Ability to navigate and influence a complex matrixed environment across UHC, Optum and other delegated entities and drive to resolution

 
 

• 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:

 
 

 
 

• Advanced Degree (JD or Master’s)

 
 

• Professional certification (Certified in Healthcare Compliance – CHC or similar)

 
 

• 5+ years of Healthcare industry or Healthcare related industry experience and government programs

 
 

• Experience with managed care and/or government programs

 
 

• Experience in a strategic role, ideally leading and/or implementing a comprehensive compliance program

 
 

• Solid skills in: goal(s) setting and works independently to achieve them. Pushes self and others to reach milestones

 
 

• Excellent skills in: verbal and written communication; problem solving

 
 

• Demonstrates advanced writing/presentation skills. Easily shifts style based on audience

 
 

• Demonstrated ability to: make decisions even when information is limited or unclear

 
 

• Demonstrated ability to: Adept at understanding and resolving complex concepts and situations presented by the business environment; ability to assess complex problems and recommend the appropriate compliance solutions

 
 

• Other: Ability to effectively deal with ambiguity – can effectively cope with change, can shift gears comfortably, can decide and act without having the total picture, comfortably handles risk and uncertainty in a manner consistent with UnitedHealth Groups core values, culture and common language of leadership

 
 

 
 

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)

 
 

Clipped from: https://jobs.cbs4indy.com/jobs/compliance-officer-nebraska-medicaid-health-plan-grand-island-nebraska/634044395-2/?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.

Clipped from: https://jobs.wfla.com/jobs/medicaid-project-management-specialist-program-coordinator-illinois/633826875-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Position Title: Medicaid Risk Adjustment Analyst

Contract: 1 year contract with potential for Full Time Hire

Location: REMOTE, must live in California or Hawaii

 
 

Position Purpose:

Our large healthcare client’s team needs help from an experienced Medicaid Risk Adjustment Analyst. They are looking for someone to help them extract data and designing models to predict future expenditures of enrollees based on diagnosis codes reported on claims and encounters.

 
 

Candidate Experience Requirements:

• 4+ years of risk adjustment experience – preferably coming from a previous risk adjustment position in healthcare
• SAS developer with over 3 years of experience
• Previous experience working with Medicaid

 
 

Candidate Experience Nice to Have:

• CDPS Rx modeling experience
• SharePoint and/or Power BI experience

 
 

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-risk-adjustment-analyst-at-medasource-3137936172/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

What You’ll Do


In a few words…


Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning.


There’s something to be said of things that bounce back, return like boomerangs, or hop out graves and come back to life. Some call it resilience, but we like to think of that as a karmic rebate. At Abarca, we handle lots of different rebates, most of which are not karmic at all (unless you count the rebate powers of our Manager of Rebates Operations, as karmic). As the ultimate master of rebates, you stand at the top of the highest tower in Abarca overseeing the everyday (or night) duties pertaining to financial rebates (in other words, the blood that keeps you and your minions alive). Your superhuman attention to detail and strategic eternal mind supervises all aspects of the manufacturer’s rebates world, system capabilities, billing, reconciliation, and allocation of payments for Medicaid clients. You can see it all! In addition, you’re responsible for designing, structuring, and reporting rebate analytical information. Sorry, but there is no escaping the reports, not even for the Nosferatu.


The fundamentals for the job…

• Oversee the rebates billing process to manufacturer companies related to pharmacy and medical claims for Medicaid Drug Rebates Program (MDRP) and supplemental rebates;
• Provide guidance to Rebate Analysts and support manufacturers with problems related to invoicing, payment allocation, reconciliations, adjustments, and disputes management;
• Track and prioritize rebate activities on an ongoing basis (We could have just written this one, but we like to elaborate.)
• Assist with assessing and communicating critical information for maintenance of the rebate system, including contract amendments and other changes that impact the rebate process. (Unfortunately, your telepathic communication skills won’t work in this case.)
• Oversight reporting for customer, internal use, state, and federal requirements;
• Develop and maintain policy and procedure documentation, quality control integration, process improvement, and compliance oversight;
• Build and maintain expert level knowledge of rebate-related business requirements including contractual service level agreements
• Coordinate cross-functional activities with the Technology Department and other areas on Rebate System Improvements, and ensure data reporting and operation efficiency;
• Identify and analyze performance trends and provide management with recommendations
• Provide support in generating and analyzing medical claims billing and interest invoices;
• Help with the preparation of monthly management reports, accompanying schedules, worksheets, and narratives, and quarterly and annual regulatory filings
• Lend a hand with special projects and provide support on all company audits related to rebate processes (Don’t worry, you’ll get to keep at least one hand.)
  
  

What You’re Made Of


The
bold
requirements…

• Bachelor or master’s degree in Accounting, Finance, Business, or related field (In lieu of a degree, equivalent relevant work experience may be considered.)
• 5+ years of relevant work experience in with Drug Rebates Management or related field
• Previous experience leading cross-functional initiatives or project management
• Experience in the healthcare industry, claims processing, Federal Medicaid Drug Rebates Program (MDRP), Supplemental Rebates for Medical and Pharmacy claims processing, 340B and/or COB claims
• You should be a self-starter with unabated interpersonal skills
• Strong analytical skills with a proven track record of completing analytical tasks or problem solving (How’s your Wordle game?)
• Your Microsoft Office Suite skills (Word, Excel, PowerPoint, and Outlook) are Queen of the Damned level and you surf (the internet) better than Kelly Slater.
• You must be able to communicate effectively (read, write, speak, meme, be offended, rant out loud and telepathically, etc.) in English.
  
  

Nice to have… (Like a fresh stash of blood at twilight. I mean, you can go without breakfast, but really, it’s nicer with.)

• Experience in data systems such as Tableau, SQL, or Rebates
• If you can speak Spanish, we could tell you how much we appreciate you in two languages.
  
  

Physical requirements…
 

• Must be able to access and navigate each department at the organization’s facilities. (Feel free to float around, turn into a bat, or become mist and move creepily around, it’s up to you.)
• Sedentary work that primarily involves sitting/standing (Except when you’re navigating departments, of course.)
  
  

That something extra we´d love to see…
 

• Assertive: You know you’re good at stuff and charge with confidence, trusting that the path you have chosen is the correct one. Your ability to listen to other’s ideas and learn from them is a rare strength.
• Driven: You go from 0 to 60 in less than 5 seconds with just a slight push of your pedal. Your juggling skills are impressive, and you never miss a deadline. You compare and compete, striving to excel at everything. Your legs could be dead halfway through a marathon and you would still finish the race because not finishing is simply NOT an option. (A bit unfair, considering you have superpowers and don’t age.)
• Team Builder / Team Player: You are the little dots on the Lego pieces. Thanks to you the pieces come together and stay together so the team can make amazing things.
• Negotiator: Your communication and negotiation tactics are sharp. You’re the type of person that can talk their way out of anything. The FBI calls YOU when they need a negotiator. (Those mind controlling powers were the selling point of vampirism, weren’t they?)
• Strategic: You’ve played every strategy game out there. Your mother claims you were born with a chessboard instead of a placenta attached to your umbilical cord and this could well be true. You’re always 3 steps ahead of the game quickly spotting relevant patterns and issues. You are a hunter after all.
• Solution seeker: You’re attracted to problems like a moth to a flame. But unlike, the moth, problems make you stronger. They drive your motivation, and you don’t stop until you find the best possible solution. Fixer-upper? Bring it!
  
  

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. “Applicant must be a United States’ citizen. Abarca Health LLC does not this time currently sponsor employment visas”

All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of gender, race/ethnicity, gender identity, sexual orientation, protected veteran status, disability, or other protected group status.

Clipped from: https://www.linkedin.com/jobs/view/medicaid-rebates-manager-at-abarca-health-3138289171/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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HumanaNew Orleans, LA

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• Humana Healthy Horizons in Louisiana is seeking an Associate Director, Utilization Management Nursing who will use clinical knowledge, communication skills, and independent critical thinking skills to provide the best and most appropriate treatment, care or services for members.
• He/she will lead teams of nurses and behavioral health professionals responsible for utilization management.
• The Associate Director, Utilization Management Nursing requires a solid understanding of how organization capabilities interrelate across department(s).
• They will coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
• Serves as a liaison between Humana and the State regarding Prior Authorization reviews, prepayment retrospective reviews, and any additional utilization management functions.
• + Coordinates with the Clinical Leadership team to ensure all utilization reviews are in compliance with the terms of the Medicaid contract.
• + Provide supervision and daily guidance to prior authorization team members ensuring that the service provided meets or exceeds clinical and procedural and Louisiana Department of Health (LDH) standards.
• + Ensure adoption and consistent application of appropriate medical necessity criteria.
• + Monitor, analyze, and implement appropriate interventions based on utilization data, including identifying and correcting over- or under-utilization of services.
• + Will directly lead multiple managers and highly specialized professional associates.
• + Oversee inpatient utilization management functions for physical health and behavioral health; ensure that decisions are made in a timely and consistent manner based on clinical criteria and meet timeliness standards+ Develop and implement departmental policies and procedures in accordance with contract changes and/or updates.
• + Maintain compliance with Louisiana Department of Health (LDH), NCQA, Department of Health and Human Services (DHHS), and the Centers for Medicare and Medicaid Services (CMS) guidelines and contractual requirements.
• Must reside in the state of Louisiana.
• Unrestricted Registered Nurse (RN) license in the state of Louisiana.
• + Minimum five (5) years of previous clinical experience in utilization management.
• + Minimum three (3) years of leadership experience.
• + Familiarity with Interqual, MCG and/or ASAM criteria.
• + Comprehensive knowledge of Microsoft Office applications including, PowerPoint Word, Excel, and Outlook.
• + Knowledge of Medicaid regulatory requirements and National Committee for Quality Assurance (NCQA) standards.
• + This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
• + Must have the ability to provide a high speed DSL or cable modem for a home office.
• + A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
• + Satellite and Wireless Internet service is NOT allowed for this role.
• + A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• + Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters.
• Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
• Bachelor’s or Master’s Degree in nursing, public health, health administration, health policy or business.
• + Knowledge of Humana’s internal policies, procedures and systems.
• up to 25% in the state of Louisiana.
• up to 8 Managers/Associates.
• Scheduled Weekly Hours
• Associated topics: assistant director, care manager, cno, lead, line, manager, nurse manager, officer, rgn, supervisor

 
 

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