Category: Curator- Job Hunter

 
 

Department: Iowa Medicaid Services

Location: Des Moines, IA

Paygrade: E13

 
 

Job Title

Manager Operations

 
 

Job Summary

The Operations Manager provides guidance, leadership, planning, and reporting to the assigned business unit. This position ensures the assigned business unit is administering the organizations contracts with the best possible service while maintaining contract expectations and within budget constraints and optimizing staffing levels.

 
 

Key Performance Indicators

• Provides team oversight and direction
• Meets contract obligations
• Promotes efficiency

 
 

Essential Functions

Key Duties/Responsibilities/Accountabilities

• Coaches and develops staff by encouraging growth and ensuring staff are meeting performance expectations
• Ensures the organization meets all contractual expectations
• Manages budgets and works to meet requirements with available funding
• Ensures responsiveness to audit findings and implements timely changes as appropriate
• Ensures strong internal controls and compliance programs within responsible operations
• Initiates process improvements and technology implementation
• Initiates disciplinary action when performance does not meet expectations
• Leads by example by promoting teamwork, recognition, and leadership while demonstrating the company values
• May provide guidance on evaluating the circumstances of cases related to suspected fraud to support potential investigations and fraud prevention procedures
• Assist in organizational and corporate growth opportunities
• Responds to and implements changes in a flexible, positive manner
• Participates as the area subject-matter expert during business development activities as needed

 
 

Non-Essential Duties and Functions

• Other duties as assigned

 
 

Minimum Qualifications

• Bachelor’s degree in Business Administration, Management, or closely related field or equivalent work experience as determined by HR
• 4 years’ experience managing staff
• Knowledge of management theories and practices
• Understands computer information systems
• Knowledge of basic accounting practices
• KEY PERSONNEL REQUIREMENTS:
• 4 years’ experience managing claims processing operations and personnel for a Medicaid state entity, fiscal agent or private sector health care payor
• 2 years’ MMIS experience

 
 

Preferred Qualifications

Above requirements and the following:

• Bachelor’s degree in Business Administration or Management
• 5 years’ experience managing staff
• Strong written and oral communication skills
• Ability to motivate and manage a large group of people
• Ability to direct and maintain a productive and conducive working environment
• Ability to coordinate activities among co-workers
• Ability to develop problem solving skills within staff
• Strong analytical skills

 
 

Environment and Cognitive/Physical Demands

• Office Environment
• Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
• Requires prolonged sitting and telephone use
• Requires the use of office equipment such as computer terminals, telephones, copiers, and printers
• Infrequent lifting to 15 pounds
• Infrequent stooping

 
 

Segregation of Duties

Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.

 
 

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

 
 

Total Rewards Package:

Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.

 
 

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian’s prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

 
 

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.

 
 

Other Information

Noridian is a Federal Contractor required to comply with the Executive Order 14042 and the guidance released by the Safer Federal Workforce Task Force. This Order requires us to ensure all employees working on covered contracts are vaccinated against COVID-19 unless approved for an accommodation due to a medical condition or a sincerely held religious belief. All candidates must be fully vaccinated upon their start date or have an approved accommodation. To request an accommodation, please contact our Human Resources department at noridianhr@noridian.com.

 
 

As of December 7, 2021 the nationwide Federal Mandate has been put on hold. At this time, candidates would not be required to be vaccinated or have an approved accommodation, however if the Executive Order 14042 / Federal Mandate is deemed Legal by court rulings, candidates and employees would need to comply.

 
 

Clipped from: https://www.linkedin.com/jobs/view/manager-operations-iowa-medicaid-at-noridian-healthcare-solutions-llc-3128396021/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

How To Apply

• Do not apply online*. Please send application materials directly to Sarah Truckle at sarah.truckle@vermont.gov.
  
  

Overview


The Vermont Agency of Human Services is seeking qualified candidates for the State Medicaid Director position to oversee the Vermont Medicaid program. Vermont Medicaid is administered through several departments within the Agency of Human Services: the Department of Health Access serves as the State’s Medicaid managed care entity; the Department of Health oversees programs for alcohol and substance use disorders and for children with special health needs; the Department of Mental Health and Department of Disabilities, Aging, and Independent Living oversee Vermont’s Home and Community-Based Services; and the Department for Children and Families administers Medicaid-funded programs for individuals in foster care, receiving targeted case management, and early invention services. The Department of Corrections is also housed in the Agency of Human Services and strong coordination of services in and out of facilities is a priority of the Medicaid program.


Description


This position will set and lead strategic priorities for Vermont Medicaid. This will require close coordination and partnership with the departments within the Agency of Human Services.


The Principal Duties Of The Position Include

• Directing strategic initiatives such as improving managed care oversight; sister state agency partnership and restructuring; advancing population health and strategies to improve social factors that contribute to health; and promoting health equity, diversity and inclusion.
• Engaging a wide range of stakeholders including executive branch leadership, the legislature, provider groups and trade associations on topics such as significant program initiatives, budget and policy expectations, and enforcement of Medicaid requirements and federal/state mandates across departments.
• Ensuring effective staff management, including oversight of Medicaid activities and priorities across departments.
• Directing and evaluating programs and services, including budget and finance alignment, working with federal partners, overseeing activities associated with general operations and compliance, and empowering teams to work outside functional siloes and maintain active relationships across the organization to contribute to larger agency goals.
• Oversee the Agency’s $1.7B Medicaid budget crossing all six departments.
• Set and lead strategic priorities for Vermont Medicaid in addition to serving as the Agency’s primary point of contact with the CMS.
  
  

The ideal candidate has strong business acumen and political savvy and is skilled at:

• Developing, directing, and delegating others
• Leadership and personnel management
• Leading innovation and strategic planning
• Developing vision and purpose
• Communicating vision internally and externally
• Communicating effectively to internal and external audiences
• Managing conflict and negotiating key issues
• Leading innovation and managing change
• Technical learning (understanding complex Medicaid rules/systems)
  
  

Compensation


Compensation for this position is commensurate with experience.


Equal Opportunity Statement The State of Vermont celebrates diversity, and is committed to providing an environment of mutual respect and meaningful inclusion that represents a variety of backgrounds, perspectives, and skills. The State does not discriminate in employment on the basis of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, membership in an employee organization, family medical history or genetic information, or family or parental status. The State’s employment decisions are merit-based. Retaliatory adverse employment actions by the State are forbidden.

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-director-at-state-of-vermont-3127283217/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview:

The primary goal of the Care Manager is to optimize members’ health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the member’s needs, environment, providers, support system and optimization of services available to them. Care Manager is expected to assess and evaluate member’s needs, be a creative, efficient and resourceful problem solver. In collaboration with the members’ care team, a plan of care with individualized goals and interventions is developed, implemented and outcomes evaluated.

Job Description

• Address member’s problems and needs: clinical, psychosocial, financial, environmental
• Provide services to members of varying age, risk level, clinical scenario, culture, financial means, social support, and motivation
• Engage members in a collaborative relationship, empowering them to self-manage their physical, psychosocial and environmental health to improve and maintain lifelong well being
• Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices
• Participate in interdisciplinary rounds
• Ensure plans of care have individualized goals and interventions
• Communicate plan of care to Primary Care Physician
• Address gaps in care with the member and provider
• Address members social determinants of health issues
• Link members to available resources
• Provide care management support during Transitions of Care
• Ensure member/caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers
• Train member on relevant chronic diseases, preventive care, medication management (medication reconciliation and adherence), home safety, etc.
• Provide Complex care management including but not limited to; ensuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports
• Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options
• Employ critical thinking and judgment when dealing with unplanned issues 
• Maintain knowledge of Chronic Conditions and use job aids as a guidance
• Maintain accurate, comprehensive and current clinical and non-clinical documentation in DCMS, the Care Management System
• Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation process
• Maintain professional competencies as a Care Manager
• Other duties as assigned by Manager

Minimum Qualifications

• Background: Registered Nurse, Bachelor’s Degree in Nursing required
• An equivalent combination of training, educational background, and experience in related fields such as hospital, home care, ambulatory setting and educational disciplines. Prior experience in Care Management in a health care and/or Managed Care setting preferred
• Proficiency with computers navigating in multiple systems and web- based applications
• Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
• Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
• Time management and organizational skills
• Strong problem-solving skills
• Ability to prioritize and manage changing priorities under pressure
• Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.
• Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required
• If needed, ability to travel within the MetroPlus service area to participate in facility visits, community events, home visits or other community meetings, including conferences.  
• Registered Nurse or LMSW/LCSW with current NYS license

 
 

 
 

Clipped from: https://jobs.fox59.com/jobs/care-manager-medicaid-new-york/626341573-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview:

The primary goal of the Care Manager is to optimize members’ health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the member’s needs, environment, providers, support system and optimization of services available to them. Care Manager is expected to assess and evaluate member’s needs, be a creative, efficient and resourceful problem solver. In collaboration with the members’ care team, a plan of care with individualized goals and interventions is developed, implemented and outcomes evaluated.

Job Description

• Address member’s problems and needs: clinical, psychosocial, financial, environmental
• Provide services to members of varying age, risk level, clinical scenario, culture, financial means, social support, and motivation
• Engage members in a collaborative relationship, empowering them to self-manage their physical, psychosocial and environmental health to improve and maintain lifelong well being
• Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices
• Participate in interdisciplinary rounds
• Ensure plans of care have individualized goals and interventions
• Communicate plan of care to Primary Care Physician
• Address gaps in care with the member and provider
• Address members social determinants of health issues
• Link members to available resources
• Provide care management support during Transitions of Care
• Ensure member/caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers
• Train member on relevant chronic diseases, preventive care, medication management (medication reconciliation and adherence), home safety, etc.
• Provide Complex care management including but not limited to; ensuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports
• Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options
• Employ critical thinking and judgment when dealing with unplanned issues 
• Maintain knowledge of Chronic Conditions and use job aids as a guidance
• Maintain accurate, comprehensive and current clinical and non-clinical documentation in DCMS, the Care Management System
• Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation process
• Maintain professional competencies as a Care Manager
• Other duties as assigned by Manager

Minimum Qualifications

• Background: Registered Nurse, Bachelor’s Degree in Nursing required
• An equivalent combination of training, educational background, and experience in related fields such as hospital, home care, ambulatory setting and educational disciplines. Prior experience in Care Management in a health care and/or Managed Care setting preferred
• Proficiency with computers navigating in multiple systems and web- based applications
• Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
• Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
• Time management and organizational skills
• Strong problem-solving skills
• Ability to prioritize and manage changing priorities under pressure
• Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.
• Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required
• If needed, ability to travel within the MetroPlus service area to participate in facility visits, community events, home visits or other community meetings, including conferences.  
• Registered Nurse or LMSW/LCSW with current NYS license

 
 

Clipped from: https://jobs.wgntv.com/jobs/care-manager-rn-medicaid-new-haven-connecticut/626341597-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

* Position Description*:
Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding using data science and analytics. Mathematica offers our employees competitive salaries, and a comprehensive benefits package, as well as the advantages of being 100 percent employee owned. As an employee stock owner, you will experience financial benefits of ESOP holdings that have increased in tandem with the company’s growth and financial strength. You will also be part of an independent, employee-owned firm that is able to define and further our mission, enhance our quality and accountability, and steadily grow our financial strength. Read more about our benefits here:
Mathematica is searching for a dedicated professional with experience successfully improving state health and Medicaid programs through data including Medicaid, commercial, and Medicare. Experience with or interest in analyzing additional data sources that are correlated with health outcomes, such as social determinants data, is appreciated but not required. In particular, we are looking for an individual who can apply analytic thinking to support current and emerging work across any number of areas related to state health such as: all-payer claims databases, health outcomes measurement, program or policy evaluations, data analysis, advisory services, and alternate payment models.
Duties of the position:
* Lead or participate actively and thoughtfully in multidisciplinary teams to implement, monitor, and advise on state policy and programs.
* Provide the energy, direction, and organization needed to help keep projects on time and on budget and facilitate communications across and between internal and external stakeholders.
* Author client memos, technical assistance tools, issue briefs, chapters of analytic reports, and webinar presentations.
* Conduct research that applies impartial data collection, analysis, and reporting using quantitative techniques.
* Lead and help develop proposals for new research projects.
* Represent the company’s expertise through various mechanisms, such as publications, conferences, technical communications, and testimony.
* Contribute to the growth, expertise, and institutional knowledge of other state health and Medicaid staff.
* Position Requirements*:
* At least three years of experience working in state health policy or health research, with a substantial portion of that time at a state agency
* Masters or doctoral degree, or equivalent experience in data analytics, public health, public policy, economics, behavioral or social sciences, or other relevant disciplines
* Experience with all-payer claims databases and health care outcome measures highly preferred
* Experience and interest in programming in statistical software such as R or Stata is appreciated but not required
* Strong foundation in quantitative research methods and a broad understanding of health care and health policy issues in the United States
* Excellent written and oral communication skills, including an ability to explain observations and findings to diverse stakeholder audiences including program administrators and policymakers
* Demonstrated ability to provide task leadership and coordinate the work of multidisciplinary teams
* Strong organizational skills and high level of attention to detail; flexibility to lead and manage multiple priorities, sometimes simultaneously, under deadlines
* Ability to work well in teams
Start date are flexible and may range between spring and summer 2022. Applications will be reviewed on a rolling basis starting in February 2022.
Please submit a cover letter, CV and writing sample that demonstrates your analytic abilities and expertise in health.
This position offers an anticipated annual base salary of $85,000-$140,000. This position may be eligible for a discretionary bonus based on company and individual performance.
Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearances a condition of working on projects. If you work on such a project, you will be required to obtain the requisite security clearance.
Available Locations: Ann Arbor, MI; Cambridge, MA; Princeton, NJ; Oakland, CA; Washington, DC; Chicago, IL; Seattle, WA; Woodlawn, MD
All Mathematica staff are working remotely right now, but job opportunities are posted with our regular office locations in mind.
In accordance with Executive Order 14042 and its implementing guidelines, all Mathematica employees must provide documentation that they have been fully vaccinated or obtain an accommodation through Human Resources by providing documentation from a licensed health care provider that they are unable to be vaccinated against COVID-19 because of a disability (which would include medical conditions) or provide an attestation that they are entitled to an accommodation because of a sincerely held religious belief, practice, or observance.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

 
 

Clipped from: https://tarta.ai/j/pg56SIABCr2uuunQ5gtc-researcher-state-health-and-medicaid-in-ann-arbor-michigan-at-mathematica?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Medicaid, MMIS, Healthcare, EA, Sparx, TOGAF

Contract W2, Contract Independent

Depends on Experience

Travel not required

Job Description

Info-Matrix Corporation is currently seeking an experienced Business Architect to join our team. The Business Architect creates enterprise architecture artifacts such as business and technical capability models, defines and documents standard patterns for solutioning, formalizes application and technology standards, and provides architectural governance during solution delivery as needed. Ideal candidates will possess previous experience with/exposure to Sparx EA and possess Healthcare industry exposure. Essential duties and responsibilities include the following:

• Works independently in order to deliver enterprise architecture artifacts such as Business and Technical Reference Models, architecture solution patterns, Business/Technology Capability Roadmaps, and Architecture Review Board related process documents.
• Contributes to the refinement of evolving enterprise architecture standards, principles, and solutioning patterns.
• Documents solution architecture blueprints for assigned projects.
• Contributes to the architectural assessment of complex application and technology components.
• Provides in-depth technical and systems consultation to internal clients and technical management to maintain project alignment with Enterprise Architecture and the Overall program goals and objectives.
• Maintains currency with the latest technology trends and digital best practices.

Qualifications

• MUST possess Medicaid experience (deal-breaker)
• 10+ years of information technology systems design and planning experience in systems, applications, or architecture. Must also have at least five years of leadership experience
• Extensive technical skills and comprehensive knowledge and understanding of an entire line of business or infrastructure sub-domain.
• Excellent verbal, written, and interpersonal communication skills.
• Experience in formal Architectural methodologies preferably TOGAF
• Experience with SOA and API Integration architectures and patterns
• Experience with Data Integration patterns and solutions
• Experience with microservices, containers, and container orchestration technologies and principles and best practices
• Experience with public cloud PaaS capabilities (like Serverless development) from either Amazon AWS or Microsoft Azure
• Experience in defining and maintaining target enterprise architectures with Sparx Enterprise Architect modeling software.
• Experience with UML, BPMN, or Archimate modeling notations
• Experience in designing and implementing HA architectures and systems
• Ability to interact with all levels of an organization
• Ability to influence across all organizational levels, particularly engineering and development teams
• Ability to manage or facilitate analysis of current systems, problem identification, and resolution

Preferred Experience:

• Sparx Enterprise Architect modeling software

 
 

• Formal Training in established Enterprise Architecture methodology with certification a bonus

Education: Bachelor’s Degree in Computer Science, Computer Engineering, Systems Engineering, or a related technical field.

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Dice Id : 10118034

Position Id : 7469063

Originally Posted : 21 hours ago

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Clipped from: https://www.dice.com/jobs/detail/87f3eeb487bd2b4d9d93fad1d9260016?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 

Alexandria, Virginia

Posted: 15-Jun-22

Location: Washington , D.C.

Type: Full Time

Salary: 115k-125k

Categories:

Health

Position Location: Washington D.C. with Hybrid Work Schedule, Requiring 3-Days of In-Office Presence           

 Who we are

Since 1981, Families USA Foundation has been a leading national voice for health care consumers.  Through our long-standing relationships of consumer leaders, advocates, and partner organizations across all 50 states and the District of Columbia, we have remained steadfast in our mission – Dedicated to the achievement of high-quality, affordable healthcare and improved health for all.  We advance our mission through public policy analysis, advocacy, and collaboration with partners to promote a patient-and community-centered health system.

Your Role

We are looking for a Director of Medicaid Initiatives to provide strategic leadership and support for Families USA’s Medicaid policy and advocacy projects. Central job responsibilities include providing expert Medicaid policy analysis and strategy, leading policy advocacy at both the federal and state level and developing Medicaid policy recommendations for the organization related to the Health Policy team’s areas of focus and projects. Collaborate with other departments to develop and implement strategies and tactics to advance Medicaid policy recommendations in these areas, including development efforts.  This person will work in close collaboration with the senior leadership team and will also serve as a spokesperson for the organization around Medicaid work.

Main responsibilities include:

• Direct and develop effective organizational strategies related to Medicaid.
• Manage multiple Medicaid-related grants and associated deliverables.
• Oversee regular coalition meetings.
• Conduct or direct the completion of activities necessary to execute Medicaid related strategies, including anticipating next steps from Congress or target states.
• Respond to changing political dynamics and maintain focus on the Medicaid program and the organization’s efforts to sustain a strong Medicaid program at the federal and state levels.
• Stay abreast of, track, and analyze Medicaid related news reports, scholarly studies, articles, and state and federal program changes, legislation, bills, and regulations.
• Prepare high-quality memoranda, regulatory comments, issue briefs, reports, white papers, legislative language, grant proposals, and other materials.
• Collaborate with Strategic Partnerships, Federal Relations, and Communications teams on a broad range of written products and research, including proposals, blogs, research studies, issue briefs, and regulatory comments to implement organizational strategy.
• Establish thought leadership in broader health policy community.
• Maintain positive relationships with funders and external stakeholders and confer with internal and external colleagues about events to refine our position and determine our best response.
• Represent Families USA at external meetings and conferences.
• Participate in the planning of the health policy workshop programming at the Families USA’s annual Health Action conference.
• Serve as a reviewer of draft documents and ensure that written products are of high quality. Fact-check and quality control written content.
• Supervise staff, subject to the current table of organization, including assigning and supervising work, providing feedback, helping staff set long-term goals and monitoring progress, facilitating weekly check-ins, providing opportunities for enrichment through external opportunities and internal meeting participation, and providing mentorship and professional development.

 Your Experience

Undergraduate degree in public health, public policy or related field.  8 – 10 years’ experience with high-level content knowledge, knowledge of and experience with federal and/or state-level policy-making processes (both legislative and administrative). Experience representing an organization with media, federal and state regulators, state and national partners, funders, including ability to speak in public.

 
 

Applicant should possess the specific knowledge, skills and abilities outlined below:

• Significant experience in health policy with demonstrated understanding of public programs and the health system, with a focus on Medicaid.
• Successful record of collaboration and planning and leading projects within a non-profit environment.
• Highly motivated team player who contributes to an atmosphere in which people collaborate enthusiastically and effectively to produce results.
• Exceptional oral, writing, presentation, organizational, interpersonal, network and leadership skills.
• Capacity to handle multiple competing priorities – including developing and executing project plans and ability to work under pressure and meet deadlines.
• Strong policy analysis and research skills.
• Ability to work collaboratively and effectively across the organization.
• Ability to communicate complex policies ideas simply, both verbally and in writing, with an understanding of how messages will be received by different audiences.
• Ability to engage staff, coalition partners and funders.

Our Workplace

We offer a dynamic, empowering, and collaborative work environment that allows staff to reach their full potential. We provide an extremely attractive total compensation package, including competitive salary, hybrid work schedule: 3 days in office/2 optional WFH days, medical, dental, vision, disability and life, 403(b) retirement matching plan, 3+ weeks’ vacation, ten (10) Federal holidays and our offices are closed between Christmas Eve and New Year’s Day and many more exciting benefit programs.  Salary will be commensurate with experience, our salary range for this role is $115K – $125K.

Families USA’s Core Values

We are committed to providing the best possible climate for maximum development and achievement for all employees. In order to maintain an atmosphere where goals can be accomplished, we attempt to provide a comfortable and progressive workplace. Our practice is to treat each employee as an individual.  We seek to develop an inclusive culture of teamwork which is reflected in our core values:

RESPECT – We value and support each other in ways that bring our best work forward.

EQUITY – We embrace our differences knowing they allow us to accomplish our most effective work.

COLLABORATION – We optimize our collective resources, skills and experiences to carry out our mission and maximize our impact.

EXCELLENCE – We strive to do our best work to increase our organizational impact and improve the lives of the people we serve through our mission.

ACCOUNTABILITY – We embrace practices that build trust, reduce individual and collective stress, and enable us to work more effectively and efficiently.

TRANSPARENCY – We communicate clearly and proactively to gain insight into our priorities, make informed decisions, and encourage camaraderie.

 How to Apply

We encourage all qualified candidates to apply online at Families USA’s Career Site and include in your application: your cover letter, resume and writing sample.  Families USA is an Equal Employment Opportunity employer. We are committed to equal employment opportunity.  We do not discriminate against employees or applicants for employment without regard to race, color, national origin, sex, sexual orientation, marital status, religion, age, disability, gender identity or expression, personal appearance, family responsibilities, political affiliation, results of genetic testing, or service in the military.

 
 

Clipped from: https://careerhq.asaecenter.org/jobs/16969975/director-of-medicaid-initiatives?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

R-259007


Description


Humana’s Louisiana Medicaid BH Medical Director will oversee our behavioral health (BH) clinical program for Louisiana Medicaid plan members. They will collaborate closely with the Chief Medical Officer (CMO) to integrate the day-to-day administration and strategic management of behavioral and physical health services, including utilization management (UM), quality improvement, and value-based payment programs. The BH Medical Director will be based in Louisiana and will also lead the development of new products and services in Humana’s Medicaid BH delivery model.


Responsibilities


Essential Functions and Responsibilities

• Lead major clinical and quality management components of Humana’s BH services
• Oversee, monitor, and assist with the management of psychopharmacology pharmacy benefits manager (PBM) activities, including the establishment of Prior Authorization, clinical appropriateness of use, and step therapy requirements for the use of stimulants and antipsychotics for all Enrollees under the age of eighteen (18); consultations and clinical guidance for contracted Primary Care Providers (PCPs) treating behavioral health‐related concerns not requiring referral to behavioral health specialists;
• Develop comprehensive care programs for the management of youth and adult behavioral health concerns typically treated by PCPs, such as ADHD and depression;
• Develop targeted education and training for contracted PCPs to screen for mental health and substance use disorders using evidence‐based tools (e.g., AUDIT‐C, PHQ‐9 and GAD‐7), perform diagnostic assessments, provide counseling and prescribe pharmacotherapy when indicated, and build collaborative care models in their practices;
• Coordinate with the Medical Director to integrate the administration and management of behavioral and physical health services;
• Oversee, monitor and assist with effective implementation of the Quality Management (QM) program; and work closely with the Utilization Management (UM) of services and associated Appeals related to children and youth and adults with mental illness and/or substance use disorders (SUD)
• Lead BH policy development in Louisiana, driving implementation, oversight, and accountability for both Humana internal and external stakeholders
• Adhere to and comply with federal and state laws and programmatic requirements
• Collaborate with provider relations personnel to ensure high-quality and appropriate care delivered through the BH provider network
• Establish and maintain relationships with providers, advocates, and other key Louisiana stakeholders by maintaining open and ongoing communications; represent Humana at public forums and engagement opportunities
• Maintain compliance with BH-related contract requirements and attend oversight committee meetings to ensure appropriate procedures are adhered to within Humana and within care delivery
• Collaborate closely with corporate and local population health teams in developing programs and strategies to address BH needs at a population health level
  
  

Required Education, Certification, & Experience Qualifications

• Physician with a current, unencumbered Louisiana-license as a physician
• Board-certified in psychiatry
• At least three (3) years of training in a medical specialty
• Knowledge of the managed care industry
• Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, UM, discharge planning and/or home health or rehab
  
  

Preferred Experience Qualifications

• Five (5) years or more clinical experience working in BH
• Familiarity with Louisiana-based BH organizations
• Medicaid Managed Care clinical or behavioral health leadership experience
  
  

Additional Information


For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.


If Progressed To Offer, You Will Be Required To

• Provide proof of full vaccination or commit to testing protocols OR  
• Provide proof of applicable exemption including any required supporting documentation
   

Medical, religious, state and remote-only work exemptions are available.


Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.


#physiciancareers


Scheduled Weekly Hours


40

 
 

Clipped from: https://www.linkedin.com/jobs/view/behavioral-health-medical-director-louisiana-medicaid-at-humana-3093109576/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

The New Jersey Office of the State Comptroller (OSC) is an independent office created to bring greater efficiency and transparency to the operation of all levels of New Jersey government. The Office of the State Comptroller seeks a Statistician to work in the Statistics Unit for the Medicaid Fraud Division.

 
 

The primary responsibility of this unit is to select random samples from Medicaid claims data for auditors and investigators, to analyze and validate the results of the audits and investigations, and to perform extrapolations that determine final overpayment amounts for recovery. Additionally, this unit is

responsible for maintaining and improving the sampling and extrapolation policy, as well as defending any and all challenges that arise during cases.

 
 

Responsibilities:

 
 

* Set up and run reports as requested by the other units within the Medicaid Fraud Division.

* Select valid samples and perform extrapolations using appropriate internal protocols.

* Peer review work of other statisticians.

* As needed, assist in defending challenges to sampling and extrapolation used.

* Conduct research into sampling and extrapolation techniques utilized by federal and state entities.

* Help maintain, update and improve sampling and extrapolation policies and procedures.

* Track all case outcomes and provide monthly updates.

* Perform additional tasks necessary to validate and support MFD work product.

 
 

Requirements:

* Bachelor’s Degree in Statistics from an accredited college or university; Master’s degree in Statistics may be substitute for one (1) year of experience.

* Experience involving the review and analysis of complex data sets, the selection of random samples, and the extrapolation of sample results.

* Advanced abilities using statistics software (R) and Microsoft Office applications (Excel, Access).

* Excellent communication and writing skills.

* Capable of learning advanced concepts and applying them while working independently.

* Highly adaptable, flexible, and able to collaborate with all levels of staff.

* Detail-oriented to complete job responsibilities in accordance with specifications.

* Strong organizational skills to meet deadlines.

 
 

Candidates may be administered a skills test (in R and Excel) at or prior to interview.

 
 

Interested candidates should submit a cover letter, resume, writing sample and three (3) references to:

 
 

Paola Belardo

Office of the State Comptroller

P.O. Box 024

Trenton, NJ 08625

careers@

 
 

Only candidates who send their cover letter, resume, writing sample and references to the address or e-mail above will be considered.

 
 

PLEASE DO NOT APPLY THROUGH THE EASY APPLY OPTION.RESIDENCY REQUIREMENT

 
 

RESIDENCY REQUIREMENT: Pursuant to N.J.S.A. 52:14-7 (L. 2011, Chapter 70), also known as the New Jersey First Act, all new public employees are required to obtain principal residence in the State of New Jersey within one (1) year of employment.

 
 

New Jersey is an Equal Opportunity Employer

 
 

Clipped from: https://jobs.cbs4indy.com/jobs/statistician-medicaid-fraud-division-trenton-new-jersey/625571906-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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Clipped from: https://jobs.cbs4indy.com/jobs/jobs-like-senior-analyst-medicaid-government-pricing-pennington-new-jersey/sv-625568035_2/?expired=1&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic