Category: Curator- Job Hunter

 
 

SCHEDULE : Full-time

Be part of an extraordinary team

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change.

Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Build the Possibilities. Make an extraordinary impact.

The Medicaid Quality Management Health Plan Director is responsible for driving the development, coordination, communication, and implementation of strategic clinical quality management and improvement program within an assigned health plan.

Responsible for working with the regional head of quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement, NCQA accreditation, and compliance with regulatory agencies and other objectives.

Primary duties may include, but are not limited to :

Works with both internal and external customers to promote understanding of quality management activities and objectives within the company and to prioritize departmental projects according to Anthem corporate, regional, and departmental goals.

Maintains expert knowledge of current industry standards, quality improvement activities, and strong medical management skills.

Serves as a resource for the design and evaluation of process improvement plans / quality improvement plans and ensures they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements.

Collaborates with other leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans, year-round medical record review, and overread processes.

Monitors and reports quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements.

Minimum Requirements

Requires BA / BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and 5 years of progressively responsible experience in a healthcare environment or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences

MS or advanced degree in a healthcare-related field (i.e. nursing, health education) or business is strongly preferred.

Previous experience working with NCQA, and HEDIS preferred.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs, and financial education resources, to name a few.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19.

If you are not vaccinated, your offer will be rescinded unless you provide and Anthem approves a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate.

Anthem will also follow all relevant federal, state, and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 Worlds Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion.

To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require an accommodation to participate in the job application process may contact ability icareerhelp.com for assistance.

REQNUMBER : PS71505

 
 

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Position Description


Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding using data science and analytics. Our work yields actionable information to guide decisions in wide-ranging policy areas, from health, education, early childhood, and family support to nutrition, employment, disability, and international development. Mathematica offers our employees competitive salaries, and a comprehensive benefits package, as well as the advantages of being 100 percent employee owned. As an employee stock owner, you will experience financial benefits of ESOP holdings that have increased in tandem with the 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. Learn more about our benefits here: https://www.mathematica.org/career-opportunities/benefits-at-a-glance.


Mathematica is searching for Medicaid Data Advisory Services Analysts with interest in Medicaid policy and programs at either the state or federal level to support current and emerging data analytics work. Medicaid data analysts will likely be connected to 2-3 projects at a time, with many projects requiring work with multidisciplinary teams and direct-client contact. Projects may span across several policy and programmatic areas: Medicaid managed care programs, value-based purchasing and alternative payment models, long-term services and supports, measures of delivery and quality of services for beneficiaries, and outcomes of innovative programs and policies.


Across All Projects, Medicaid Analysts Are Expected To

• Lead or participate actively and thoughtfully in project teams to implement, monitor, or evaluate policy and programs
• Apply rigorous analytic thinking to the collection, analysis, and interpretation of quantitative data
• Develop expertise in Medicaid data, policy, and programmatic areas
  
  

Specific Project Activities May Include

• Assisting with quantitative analyses using Medicaid enrollment, claims/encounter, financial and program data to support program monitoring, improvement, or evaluation
• Participating in decisions regarding analysis design and methodology
• Reviewing policy, program, and/or data documentation to develop technical specifications for analyses
• Working with developers to compile and analyze data
• Investigating data to identify data quality issues, patterns, or other findings
• Translating analysis findings into actionable information to support clients in making data-driven decisions regarding Medicaid policies and programs
• Providing technical assistance to federal and state Medicaid stakeholders to support the implementation of data collection, monitoring, and reporting programs
• Authoring client memos, technical assistance tools, issue briefs, chapters of analytic reports, user manuals, and webinar presentations summarizing findings
  
  

Position Requirements

• Master’s degree or equivalent in data analytics, public policy, economics, statistics, public health, behavioral or social sciences, or a related field; or a Bachelors degree and equivalent experience
• Experience conducting quantitative analysis work in a health policy or research setting, with experience in Medicaid preferred
• Strong foundation in quantitative methods and a broad understanding of Medicaid program and policy issues.
• Familiarity with Medicaid enrollment, claims, financial, or program data is preferred.
• Excellent written and oral communication skills, including an ability to write clear and concise policy and/or technical memos and documents for diverse stakeholder audiences including program administrators and policymakers
• Demonstrated ability to work on multidisciplinary teams
• Strong organizational skills and high level of attention to detail; flexibility to manage multiple priorities, sometimes simultaneously, under deadlines
  
  

To apply, please submit a cover letter, resume, transcripts (unofficial are acceptable), and contact information for three references. Please also provide a writing sample that demonstrates policy analysis or program operation and monitoring skills, and reflects independent analysis and writing, such as a white paper or decision memo. You will also be asked to provide your desired salary range during the application process.


Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on a project. If you are assigned to such a project, you will be required to obtain the requisite security clearance.


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


This position offers an anticipated annual base salary range of $70,000 – $95,000. This position may be eligible for a discretionary bonus based on individual and company performance.


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


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

 
 

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Department Information


State Of Colorado Residency Required


NOTE: This announcement may be used to fill multiple openings.


The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado’s Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.


We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.


We are looking for a Project Manager I to join our Project Management Division in the Health Information Office!


As part of the State of Colorado, HCPF offers a competitive benefits package:

• PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans
• Medical, Dental, and Vision insurance coverage
• Automatic Short-Term and Optional Long-Term Disability Coverage
• Life and AD&D Insurance
• Flexible Spending Accounts (FSAs)
• Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)
• 10 Paid Holidays Annually and Accrued Annual and Sick Leave
• Accrued Sick Leave for State of Colorado Temporary Employees
• Flexplace and Flextime work arrangements
• Variety of discounts on services and products available through the State of Colorado’s Work-Life Employment Discount Program
• Discounted RTD EcoPass
• Reduced college tuition through CSU Global
• Credit Union of Colorado Membership Eligibility
  
  

The ongoing COVID-19 pandemic has impacted how and where we do our work. During this pandemic, we are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements. Depending on the business need and description of the position, we have options that range from fully remote, hybrid, to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage.


The Health Information Office develops, implements, and maintains the Department’s Health Information Technology (Health IT) and related Information Technology (IT) infrastructure, while coordinating with the Governor’s Office of Information Technology and other stakeholders on HIT and IT projects that impact the Department. Major responsibilities of the Health Information Office include enhancing and maintaining the Department’s health care claims payment system (Medicaid Management Information System or MMIS) and client eligibility system (Colorado Benefits Management System or CBMS) by developing requirements documentation, reviewing detailed system design approaches, proposing systems solutions to program staff and implementing systems solutions to support Department initiatives. In addition to aligning the Department’s infrastructure, this Office creates a foundation for emerging Health IT solutions that will be necessary to implement the Department’s transformational vision for the future of Medicaid.


Enterprise Project Management Office


This work unit of the Enterprise Project Management Office (EPMO) is responsible for the management of projects for the Medicaid Enterprise Systems (MES) and ensuring that project management standards and methodology are followed in line with the Project Management Body of Knowledge (PMBOK). The work unit is responsible for managing projects related to implementing and enhancing the MES. The EPMO project manager ensures processes are followed that are necessary for successfully project design, development, and implementation. The processes include activities such as developing effective and consistent requirements, detailed system design, identifying and resolving project risks and issues, and cost, schedule, and documentation management. The unit forms partnerships with policy staff, programmers, testing staff, as well as business and operations analysts to ensure the Health Information Office (HIO) meets internal and external (i.e., Fiscal Agent, CMS) project deadlines, creates project work plans to track activities, tasks, risks, issues, accomplishments, and schedules.


The work unit also oversees and coordinates projects related to Medicaid Management Information System (MMIS), Colorado Benefits Management System (CBMS), Program Eligibility Application Kit (PEAK), Shared Eligibility System (SES), and Health Information Technology (Health IT) initiatives at the Department of Health Care Policy and Financing (the Department). The work unit coordinates Heath IT initiatives with other State agencies, including coordination with the Governor’s Office, the Office of eHealth Innovation, the Office of Information Technology (OIT), the Department of Public Health and Environment (CDPHE), and the Department of Human Services (CDHS) to maintain a cohesive strategic approach among these agencies. Finally, the work unit is responsible for ensuring current compliance and strategic planning to achieve required compliance with federal regulations (I.e., HIPAA, Medicaid Information Technology Architecture (MITA), Medicaid Enterprise Certification Life Cycle (MECL), MEET), including Advanced Planning Documents (APDs). Description of Job


What You’ll Be Doing


The Project Manager manages and oversees all aspects of the development and implementation of large, highly complex, multi-platform technology initiatives. Typical job functions will include:

• Provides Strategic Project Management support, direction and training to ensure overall success of large, complex initiatives by following and promoting best practices and EPMO standards through the entire Project Lifecycle. Taking projects from original concept through final implementation by defining project scope and objectives, creating the budget, analyzing project requirements and determining best approach to complete project using existing and/or new approaches, developing detailed work plans, schedules, project estimates, resource plans, and status reports, managing the project risks, issues and budget, and developing plans for transition to operations
• Ensure alignment of projects to strategic business goals and project scope, in collaboration with management and project sponsors.
• Plans Resource Management, allocation and monitoring of tasks needed to achieve project goals. Influences and negotiates with Department managers, when necessary, regarding the support of required personnel to ensure project continuity through completion
• Conducts Project Budget planning and monitoring including collaborating on Advanced Planning Documents, budget proposals and providing subsequent budget change recommendations
• Communicates and collaborates to develop, and appropriately execute stakeholder analysis, communication, adoption plans and change strategy
• Coaches, mentors, and motivates project team members and vendors on best practices, processes and encourages positive action, communication and accountability for assigned work
• Proactively manage changes in project scope, identifies potential risks, and devises and executes response plans
• Manages issues and proactively escalate critical issues for immediate resolution effectively demonstrating decision making, issues management and resolution skills
• Collaborate, lead, and facilitate cross functional coordination of projects with teams from within the Department and vendors – managing and monitoring progress, quality, and cost
• Creates and delivers status reports from the project team, troubleshoots problem areas and delivers overall progress reports to senior management
• Conducts project lessons learned assessments and suggests improvements in process or procedures

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights


Minimum Qualifications


Education and Experience:


Bachelor’s degree from an accredited institution in Health Care Administration, Business Administration or a field of study related to the work assignment AND three years of professional experience in healthcare or IT related Project Management, managing complex cross-functional projects.


Substitutions

• A combination of work experience in the occupational field or specialized subject area of the work assigned to the job, which provided the same kind, amount, and level of knowledge acquired in the required education, may be substituted on a year-for-year basis for the bachelor’s degree.
• A master’s or doctorate degree from an accredited college or university in a field of study related to the work assignment may be substituted for the bachelor’s degree and at the agency’s discretion, one or two years of general experience respectively.
   

Preferred Qualifications

• PMP or equivalent Project Management Certification, or the ability to achieve this certification within one year of employment
• Experience in managing multiple large healthcare or IT projects through the full project lifecycle while adhering to challenging cost and schedule constraints
• Strong stakeholder management and communication skills at all levels, with the ability to maintain effective relationships and partnerships with a diverse group of stakeholders
• Strong planning and organizational skills, including the ability to manage multiple projects concurrently
• Vendor management experience
• Proficiency with the Microsoft Office Suite, Project (PWA), SharePoint
• Ability to set and prioritize workload, develop a work plan with tasks, time frames, milestones, resources, and dependencies
• Strong communication skills, verbal and written
• Ability to be self-motivated and self-directed, while possessing the ability to work in a team environment.
  
  

DEFINITION OF PROFESSIONAL EXPERIENCE: Work that involves exercising discretion, analytical skill, judgment, personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor’s or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods.


CONDITIONS OF EMPLOYMENT

• All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.
• Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.
• Effective September 20, 2021, employees will be required to attest to and verify whether or not they are fully vaccinated for COVID-19. Employees who have not been fully vaccinated may be required to submit to serial testing in the future. Upon hire, new employees will have three (3) business days to provide attestation to their status with proof of vaccination. Vaccinated employees must provide proof of vaccination. Note: Fully Vaccinated means two (2) weeks after a second dose in a two-dose series of the COVID-19 vaccine, such as the Pfizer or Moderna vaccine, or two (2) weeks after the single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine, as defined by the most recent State of Colorado’s Public Health Order and current guidance issued by the Colorado Department of Public Health & Environment.
   

Appeal Rights


If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.


An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email (dpa_state.personnelboard@state.co.us), postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed (303.866.5038) within ten (10) calendar days from your receipt of notice or acknowledgement of the department’s action.


For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov; contact the State Personnel Board for assistance at (303) 866-3300; or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director’s Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.


Supplemental Information


How to Apply
(PLEASE READ CAREFULLY)


Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked “SEE RESUME” will not be considered.


Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.


Comparative Analysis Process


The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email. Failure to submit properly completed documents by the closing date will result in your application being rejected.


ADAAA Accommodations: The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.


The Department of Health Care Policy & Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Virginia Miller, at virginia.miller@state.co.us.


The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.

 
 

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Job Brief

Experience in a Provider Services position working directly with Providers in a Managed Care/Health Insurance industry and with Medicaid/Medicare background. Must have Claims, Presentation/Communications skills and solid proven Excel skills.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

Must Live in Michigan to qualify. 

Responsibilities:

The AE I is responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers.  Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations.  AE I maintains in depth understanding of Plan’s contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues.  Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the Plan’s territory in keeping w/ State and Federal contact mandates for all products.   Identifies, contacts and actively solicits qualified providers to participate in Plan at new and existing service areas and products, assuring financial integrity of the Plan is maintained and contract management requirements are adhered to, including language, terms and reimbursement requirements.  Maintains complete understanding of Plan reports and metrics and uses them to evaluate the performance of assigned providers/practices/facilities, determining, communicating and implementing plans for providers to improve performance and measuring ongoing performance.  Uses data to develop and implement methods to improve relationship.  Assists in corrective actions required up to and including termination, following Plan policies and procedures.  Supports the Quality Management department with the credentialing and re-credentialing processes, investigation of member complains and any potential quality issues.  Maintains a functional working knowledge of Facets, including the provider database and routinely relays information about additions, deletions or corrections to the Provider Maintenance Department.  Maintains and delivers accurate, timely activity and metric reports as required.  Identifies and maintains strong partnerships with appropriate internal resources and stakeholders.  

 
 

Education/ Experience:

• Bachelors Degree or equivalent work related experience.
• 1 to 3 years experience in a Provider Services position working with directly with Providers.                    
• 3 to 5 years experience in the Managed Care/Health Insurance industry and with Medicaid/Medicare background.
• Excellent communications skills (written and verbal). Will be expected to present at meeting with executive level personnel.
• Must have Claims experience.
• Required Excel experience.
• Demonstrated strength in working independently, establishing influential relationships internally and externally, meeting and training facilitation skills. Priority setting and problem solving skills critical.

Note:  Presently all of our AmeriHealth Caritas Family of Companies associates are working remotely due to the Pandemic.  This role/department will be transitioning back to the Southfield, Michigan office when it is safe to return.

 
 

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Company Description

CVS Health, the Woonsocket, Rhode Island-based healthcare company, offers clinical, retail pharmacy, specialty pharmacy, pharmacy benefit management, and prescription mail order services in the US, the District of Columbia, and Puerto Rico. CVS’ mission is to provide people assistance on their path to better health, making quality care more affordable, accessible, simple and seamless.The company seeks to attract individuals whose beliefs and behaviors are in alignment with CVS core values of collaboration, innovation, caring, integrity and accountability. The multi-award winning company (e.g. Military Friendly Employer, America’s Top Corporation for Women Business Enterprises) provides opportunities to a diverse work experience that empowers the team for career success. CVS offers a benefits package to its employees, including medical, prescription, dental and vision coverage, a company contribution to a health savings account (HSA), employee stock purchase plan, adoption benefits, life, accident and disability insurance, paid time off, tuition reimbursement, and colleague discount.

Job Description

Job Description

Only candidates that live in or are willing to move to Louisiana will be considered.The Manager of Operations is responsible for leading and managing all hands-on operational aspects and activities of various functional areas within the Plan which may include: Claims, Provider Services, Information Technology, Grievance and Appeals, Member Services, Medical Management and the Medicare and Long Term Care lines of business. Assists the Plan leader in the successful growth and performance of the Plan. The Manager of Operations also interfaces, collaborates and works cooperatively with corporate office functional leaders and centralized business departments.

Required Qualifications

Provides day-to-day leadership and management to a service organization that mirrors the mission and core values of the company. Interfaces with corporate office staff as required.* Responsible for driving the Plan toachieve and surpass performance metrics, profitability, and business goals and objectives.* Responsible for employee compliance with, and measurement and effectiveness of all Business Standards of Practiceincluding Project Management and other processes internal and external. Provides timely, accurate, and complete reports on the operating condition of the Plan. Develops policies and procedures for assigned areas. Ensuring that other impacted areas, as appropriate, review new and changedpolicies.* Assists the Plan leader in collaborative efforts related to the development, communication and implementation of effective growth strategies and processes. May be required to spearhead theimplementation of new programs, services, and preparation of bid and grant proposals.* Collaborates with the Plan management team and others to develop and implement action plans for the operational infrastructure ofsystems, processes, and personnel designed to accommodate the rapid growth objectives of the organization.* Assists in defining marketing andadvertising strategies within State guidelines. Participates in the development and implementation of marketing policies for the Plan, and ensures their compliance with program regulations.* Provides assistance inpreparation and review of budgets and variance reports for assigned areas.* Works cooperatively with Network Development team in the development of the provider network. Acts as “client-care officer” through direct contact with all stakeholders. Serves as a liaison with regulatory and other state administration agencies and communicates activity to CEO and reports back to Plan. * Communicates, Motivates and leads a high performance management team. Attract, recruit, train, develop, coach, and retain staff. Fosters a success-oriented, accountable environment within the Plan.* Ensures that performance evaluations and compensation decisions for employees are not influenced by the financial outcomes of claimsdecisions.* Assures compliance to and consistent application of law, rules and regulations, company policies and procedures for all assigned areas. * Prompt response with a sense of urgency/priority to customer requests.Documented follow through/closure. Assists as assigned or required in performing other duties, assignments and/or responsibilities. **Must have a managed care experience.

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications

10+ years work experience that reflects a proven track record of proficiency in the competencies noted.Ability to work collaboratively across many teams, prioritize demands from those team, synthesize information received, and generate meaningfulconclusions.Ability to conceive innovative ideas or solutions to meet clients requirements.Excellent communication and relationship management skills. Express thoughts in an organized and articulate manner. Listen very effectively and build a climate of trust and respect with prospective and existing clients andthe consulting communityAbility to work closely with client service, operations, and investment personnelProven leadership and negotiation skills.Demonstrated leadership with relevant initiatives: Business process, enterprise business project management/consulting, financial strategicplanning and analysis, mergers and acquisitions, strategic planning, risk management.Recent and related managed health care experience.

Education

Bachelor’s degree required; Master’s degree preferred.

Business Overview

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

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

 This position is open. This job was posted on Wed Jun 01 2022 and expires on Fri Jul 01 2022.

Minimum $58,343

$102,897 average

Maximum $131,709

Tasks

• Direct or coordinate an organization’s financial or budget activities to fund operations, maximize investments, or increase efficiency.
• Appoint department heads or managers and assign or delegate responsibilities to them.
• Analyze operations to evaluate performance of a company or its staff in meeting objectives or to determine areas of potential cost reduction, program improvement, or policy change.
• Direct, plan, or implement policies, objectives, or activities of organizations or businesses to ensure continuing operations, to maximize returns on investments, or to increase productivity.
• Prepare budgets for approval, including those for funding or implementation of programs.
• Confer with board members, organization officials, or staff members to discuss issues, coordinate activities, or resolve problems.
• Implement corrective action plans to solve organizational or departmental problems.
• Direct human resources activities, including the approval of human resource plans or activities, the selection of directors or other high-level staff, or establishment or organization of major departments.
• Establish departmental responsibilities and coordinate functions among departments and sites.
• Preside over or serve on boards of directors, management committees, or other governing boards.
• Negotiate or approve contracts or agreements with suppliers, distributors, federal or state agencies, or other organizational entities.
• Coordinate the development or implementation of budgetary control systems, recordkeeping systems, or other administrative control processes.
• Review reports submitted by staff members to recommend approval or to suggest changes.
• Deliver speeches, write articles, or present information at meetings or conventions to promote services, exchange ideas, or accomplish objectives.
• Interpret and explain policies, rules, regulations, or laws to organizations, government or corporate officials, or individuals.
• Prepare or present reports concerning activities, expenses, budgets, government statutes or rulings, or other items affecting businesses or program services.
• Review and analyze legislation, laws, or public policy and recommend changes to promote or support interests of the general population or special groups.
• Administer programs for selection of sites, construction of buildings, or provision of equipment or supplies.
• Direct or conduct studies or research on issues affecting areas of responsibility.
• Direct or coordinate activities of businesses or departments concerned with production, pricing, sales, or distribution of products.
• Make presentations to legislative or other government committees regarding policies, programs, or budgets.
• Refer major policy matters to elected representatives for final decisions.
• Direct or coordinate activities of businesses involved with buying or selling investment products or financial services.
• Conduct or direct investigations or hearings to resolve complaints or violations of laws or testify at such hearings.
• Direct non-merchandising departments, such as advertising, purchasing, credit, or accounting.
• Prepare bylaws approved by elected officials and ensure that bylaws are enforced.
• Serve as liaisons between organizations, shareholders, and outside organizations.
• Attend and participate in meetings of municipal councils or council committees.
• Represent organizations or promote their objectives at official functions or delegate representatives to do so.
• Organize or approve promotional campaigns.
• Nominate citizens to boards or commissions.

Skills

• Reading Comprehension – Understanding written sentences and paragraphs in work related documents.
• Active Listening – Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
• Writing – Communicating effectively in writing as appropriate for the needs of the audience.
• Speaking – Talking to others to convey information effectively.
• Mathematics – Using mathematics to solve problems.
• Critical Thinking – Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Active Learning – Understanding the implications of new information for both current and future problem-solving and decision-making.
• Learning Strategies – Selecting and using training/instructional methods and procedures appropriate for the situation when learning or teaching new things.
• Monitoring – Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
• Social Perceptiveness – Being aware of others’ reactions and understanding why they react as they do.
• Coordination – Adjusting actions in relation to others’ actions.
• Persuasion – Persuading others to change their minds or behavior.
• Negotiation – Bringing others together and trying to reconcile differences.
• Instructing – Teaching others how to do something.
• Service Orientation – Actively looking for ways to help people.
• Complex Problem Solving – Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
• Operations Analysis – Analyzing needs and product requirements to create a design.
• Judgment and Decision Making – Considering the relative costs and benefits of potential actions to choose the most appropriate one.
• Systems Analysis – Determining how a system should work and how changes in conditions, operations, and the environment will affect outcomes.
• Systems Evaluation – Identifying measures or indicators of system performance and the actions needed to improve or correct performance, relative to the goals of the system.
• Time Management – Managing one’s own time and the time of others.
• Management of Financial Resources – Determining how money will be spent to get the work done, and accounting for these expenditures.
• Management of Material Resources – Obtaining and seeing to the appropriate use of equipment, facilities, and materials needed to do certain work.
• Management of Personnel Resources – Motivating, developing, and directing people as they work, identifying the best people for the job.

Knowledge

• Administration and Management – Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.
• Economics and Accounting – Knowledge of economic and accounting principles and practices, the financial markets, banking and the analysis and reporting of financial data.
• Sales and Marketing – Knowledge of principles and methods for showing, promoting, and selling products or services. This includes marketing strategy and tactics, product demonstration, sales techniques, and sales control systems.
• Customer and Personal Service – Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
• Personnel and Human Resources – Knowledge of principles and procedures for personnel recruitment, selection, training, compensation and benefits, labor relations and negotiation, and personnel information systems.
• Mathematics – Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
• Psychology – Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders.
• Education and Training – Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.
• English Language – Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
• Public Safety and Security – Knowledge of relevant equipment, policies, procedures, and strategies to promote effective local, state, or national security operations for the protection of people, data, property, and institutions.
• Law and Government – Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.

CVS Health

Description

CVS Health, the Woonsocket, Rhode Island-based healthcare company, offers clinical, retail pharmacy, specialty pharmacy, pharmacy benefit management, and prescription mail order services in the US, the District of Columbia, and Puerto Rico. CVS’ mission is to provide people assistance on their path to better health, making quality care more affordable, accessible, simple and seamless.The company seeks to attract individuals whose beliefs and behaviors are in alignment with CVS core values of collaboration, innovation, caring, integrity and accountability. The multi-award winning company (e.g. Military Friendly Employer, America’s Top Corporation for Women Business Enterprises) provides opportunities to a diverse work experience that empowers the team for career success. CVS offers a benefits package to its employees, including medical, prescription, dental and vision coverage, a company contribution to a health savings account (HSA), employee stock purchase plan, adoption benefits, life, accident and disability insurance, paid time off, tuition reimbursement, and colleague discount.

Type

Company – Public

Size

Large

Revenue

Over $10B

Location

Baton Rouge, LA, and others

Industry

General Hospitals, Outpatient Care Centers

Founded

1963

CEO

Larry J. Merlo

Website

Visit Website

Total job postings in the past

Based on 130 job boards, duplications excluded

Current job openings

15%

6 months

1,504%

1 year

5 weeks

Average posting lifetime

Total job posting distribution in the past

Based on 130 job boards, duplications excluded

Job category Distribution 6 months 1 year

 
 

 
 

Clipped from: https://lensa.com/louisiana-medicaid-health-plan-coo-jobs/baton-rouge/jd/54c924bd4f16478bf305dcb2dfada4bf?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

Reporting to the Director of Reporting Systems within Analytics and Reporting Department, the Senior Data and Business Intelligent Developer provides business intelligence support to units within the organization. This individual is responsible for analysis of healthcare data, designing processes for data transformation in SQL Server environment, and developing data visualization in various BI reporting tools such as SSAS, Excel, Tableau, or Power BI.

Qualified candidates must be a self-motivated and technically strong individual with minimum 7 years of experience in SQL Server development and BI reporting tool. The candidate must be proficient in T-SQL, SSIS development and familiar with application development life cycle. Knowledge of Python, C# or R script is a plus. This candidate also must have strong analytical skill and problem-solving skills.

 
 

Clipped from: https://jobs.fox2now.com/jobs/medicaid-team-lead-new-york/609766513-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

The Product Owner is an expert in translating strategy and business needs into product features. They have expert skills with enterprise Medicaid solutions and specifically, the Provider module, along with expert business acumen and communication skills. They lead and drive outcomes for the Provider Management solution delivery initiatives, nurture ideas and solutions to existing customer problems, and work closely with the development team throughout the development process. The Product Owner leads and guides solution outcomes for the entire lifecycle of the initiatives (research, design, development, implementation, and validation). They drive continual process improvement activities, guide engineers and analysts, review UI/UX design, conduct solution demos, and work with project clients, internal stakeholders, leadership, and technical development teams.
Essential Duties and Responsibilities:
• Manage backlogs, translate business needs into epics, features, user stories and tasks, and review work of other product owners providing guidance where needed.
• Conduct and lead data analysis, change impact analysis, investigate issues and defects.
• Lead agile team on sprint deliverables, identifying and implementing process and efficiency improvements.
• Lead sprint planning activities, collaborate with other organizations, Operations, and IT.
• Lead and conduct release activities, demos, acceptance testing.
• Produce feature and release documentation, documents for presentations.
• Collaborates with the business regarding progress and agile metrics. Monitors outcomes, customizes and adds metrics to continuously provide stakeholders with an updated view of the product’s success. Evaluates agile metrics and discusses methodologies to deliver against outcomes. Actively anticipates future needs and utilizes product health metrics to identify improvement opportunities.
• When called upon, works with customers to review releases and adjust development accordingly. Maintains a clear vision on the highest value program backlog items and works closely with the team to reprioritize when needed. Makes trade-offs and negotiates with Product Management based on team capacity to determine the backlog.
• Provide subject matter expertise for additional areas of strategic interest.
• Participate in the creation and communication of the product vision, strategy, and roadmap. Incorporate stakeholder feedback when needed and clearly articulates team backlog items and acceptance criteria to the team. Represent the product in governance meetings.
• Remote position with regular travel to various work sites. Up to 50% travel.
Minimum Requirements:
• Bachelor’s degree from an accredited college or university. A degree in Business, Information Systems, or Public Policy is desirable.
• 5+ years of experience in the Medicaid enterprise systems space (Provider and/or Claims is highly desirable)
• 5+ years of experience documenting business, system, and/or data requirements.
• 3+ years as a Product Owner or in Product Development & Management, Project/Program Management or Strategic Consulting
• 2+ years agile team experience (SAFE preferred) as a product owner, scrum master or analyst.
• Expert interpersonal, verbal, and written communication skills and ability to present complex technical/analytical concepts to customer and executive audiences.
• Able to work independently and lead an agile team.
• Ability to clearly communicate product benefits to educate partners, motivate action, and improve business outcomes.
Preferred Qualifications:
• SAFE certification as Product Owner/Product Manager
• HIPAA EDI Document Standards
• Prior experience working in a transformative/hybrid agile environment
• Understanding of DevOps

Essential Duties and Responsibilities:

– Manage backlogs, translate business needs into epics, features, user stories and tasks, and review work of other product owners providing guidance where needed.

– Conduct and lead data analysis, change impact analysis, investigate issues and defects.

– Lead agile team on sprint deliverables, identifying and implementing process and efficiency improvements.

– Lead sprint planning activities, collaborate with other organizations, Operations, and IT.

– Lead and conduct release activities, demos, acceptance testing.

– Produce feature and release documentation, documents for presentations.

– Provide subject matter expertise for additional SOA PAX areas of strategic interest.

Minimum Requirements:

– Bachelor’s degree from an accredited college or university in Business Analytics, Information Systems, Public Policy, Statistics or other area focused on quantitative analytics or applied mathematics (advanced degree preferred).

– 7+ years of operational Data Analytics experience.
– 7+ years experience documenting business, system, and/or data requirements.
– 5+ years agile team experience (SAFE preferred) as a product owner, scrum master or analyst.
– 5+ years experience creating reports and dashboards using Enterprise analytic tools (Tableau, Power BI, Microstrategy and/or Qlik).
– 3+ years experience with government sponsored health care programs and/or contact center operations.
– Strong SQL skills preferred.
– Expert interpersonal, verbal, and written communication skills and ability to present complex technical/analytical concepts to customer and executive audiences.
– Able to work independently and lead an agile team.
– Ability to clearly communicate data findings to educate partners, motivate action, and improve business outcomes.

Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.
As a large employer and Federal contractor, Maximus is subject to various vaccine mandates across our lines of business. Maximus is committed to complying with any applicable vaccine mandates. The specific vaccine requirements for this position will be outlined throughout the selection process. Individuals who believe they may qualify for a medical or religious accommodation will have the opportunity to apply for an accommodation following an offer of employment.
EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.
Maximus compensation is based on various factors including but not limited to a candidate’s education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus’s total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation shall be commensurate with job duties and relevant work experience. An applicant’s salary history will not be used in determining compensation.

 
 

 
 

Clipped from: https://www.recruit.net/job/product-owner-jobs/2207C3F771FF3863?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Summary

The Senior Analytics Consultant will lead the firm’s design and conducting of complex analyses using the Transformed Medicaid Statistical Information System (T-MSIS) data set to answer priority questions, meet the data analytic needs of our clients and generally advance our mission to improve the health and wellbeing of individuals and communities by making publicly funded health care, and the social services that support it, more accessible, equitable, and effective. With latitude for independent judgment, responsibilities are focused on interpreting and analyzing T-MSIS data and other large health care claims data sets and financial data from health care payers and providers. Additionally, the Senior Analyst will support the firm’s design and conducting of complex analysis using Medicare claims data sets and Medicare beneficiary demographic datasets. The Senior Analytics Consultant will operate in both a team environment and independently, with minimal supervision in a variety of projects to organize and analyze data for patterns, trends, and strategic insights in support of the firm’s consulting engagements. Lastly, the Senior Analytics Consultant will assist with all phases of quantitative research including programming, data management and the interpretation and presentation of results.

Work Performed

• Performs data extraction, uploading data, manipulation, cleaning, quality checking and analysis.
• Designs and conducts data analyses

 
 

• Utilizes the Transformed Medicaid Statistical Information System (T-MSIS) in the Virtual Research Data Center (VRDC).
• Works with other large health care and financial data sets, such as Medicare claims and Medicare beneficiary demographic data sets.
• Interprets findings and prepare materials to clearly communicate analytical summations to management.
• Analyzes and creates reports to summarize data findings for clients
• Processes Medicaid eligibility, encounter and claims data to identify enrollment, utilization, and spending trends in Medicaid across or within states.
• Using eligibility, encounter and claims data, models the fiscal impact of changes to provider payment rates, billing rules, and modifications to service arrays.
• Assists in the development of audience-appropriate reports and presentations to summarize findings from analytical research associated with the tasks.
• All other job duties as assigned.
  
   

Education/Training

Bachelor’s degree in computer science, economics, finance, accounting, public policy, or related field is preferred. Equivalent work experience equivalent will be considered. Master’s degree is ideal.

Experience

A minimum of five years of experience working with health care data. The preferred candidate will have experience with the Transformed Medicaid Statistical Information System (T-MSIS) data set or with the MSIS data previously. Experience with SAS. Intermediate Microsoft Office applications skills including MS Excel, Word, PowerPoint and Access.

Knowledge, Skills And Abilities
 

• Experience in the manipulation and evaluation of large data sets of health care claims, managed care encounters and financial information.
• Experience utilizing eligibility and claims data to provide insight to challenging publicly funded health care problems.
• Knowledge of financial analysis techniques
• Knowledge of health care policy and data.
• Creative problem solving.
• Strong analytical and statistical skills.
• Excellent attention to detail.
• Strong communication skills.
• Superior interpersonal skills.
• Highly organized and able to work under tight deadlines.
• Preferred: Experience using Tableau or PowerBI.
  
   

Work Aids and Equipment Used

Computer, printer, copier, scanner, fax, telephone, web conferencing, Internet, video conferencing.

Working Conditions

Work is sedentary in nature and performed in an office environment. Involves frequent contact with staff and clients. Work may be stressful at times. May require travel at times (:5%).

Physical/Mental Demands

Work requires hand dexterity for office machine operation; stooping, climbing, and bending to files and supplies; mobility to complete errands; stand/sit for up to eight hours each day; ability to communicate clearly when using the telephone; requires sitting, standing, walking, reaching, bending, lifting, and twisting at times; moderate levels of stress. Ability to lift up to 20 pounds at times.

Vaccine Requirement

In accordance with the Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors, Health Management Associates (HMA), has adopted the Federal Contractor COVID-19 Vaccination Policy to comply with the requirements for entities that are assigned to federal contracts/subcontracts, and to safeguard the health of our colleagues and their families; our clients and visitors; and the community at large from COVID-19.

This policy applies to current and future HMA colleagues. Proof of vaccine will be required after an offer of employment is extended and accepted. Employment will be contingent upon the employer receiving proof of being fully vaccinated. Fully vaccinated means receiving two doses of Moderna or Pfizer COVID-19 vaccine, or one dose Johnson& Johnson COVID-19 vaccine.

 
 

Clipped from: https://www.linkedin.com/jobs/view/senior-analytics-consultant-transformed-medicaid-statistical-information-system-t-msis-at-health-management-associates-3032146665?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Direct message the job poster from EVERSANA

 
 

Karen Goldin

Hiring: Supply Chain Data Project Manager, Solution Architect/Learning Management LMS, Product Security Software Engineer, UX/UI Designer,…

THE POSITION:

Today’s customer demand for innovation and higher value is transforming current business processes across all industries. The Senior Consultant role offers the opportunity to work with our industry’s thought leaders and provide consulting services across the life sciences and pharmaceutical industries. As a member of our team, you will be incorporate our extensive methodologies with our client’s needs while leveraging industry best practices to drive tangible results. You will operate as an individual contributor as well as leading engagements, project work streams, stakeholder decision making and mentor junior level consultants to provide superior service to our clients.

 
 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Our people are tasked with delivering excellent business results to their clients. These results are achieved by:

• Manage work efforts and develop quality deliverables in accordance with project scope and client specifications

• Lead meetings and/or workshop sessions for both technical and business personnel

• Ability to adhere to varying system development lifecycle management deliverables

• Interface with client leads and cultivate successful client relationships

• Serve as a subject matter expert in the revenue management domain for Pharmaceutical and Medical Device clients

• Develop and manage a detailed project plan including project communication plans, schedule, roles, scope, risk management and assumptions

• Contribute to the management of project economics and timeline

• Manage 2 or more medium scale projects of significant complexity

• Lead project teams as required with day-to-day tasks including management of offshore team members

• Support delivery by maintaining accurate and timely project reporting

• Anticipate and communicate project risks as well as mitigation solutions and troubleshooting to resolve issues

• Mentor colleagues to contribute to their growth and knowledge in client relationships and domain

• Contribute to the development of EVERSANA intellectual property

• Support business development efforts in expanding business including new or additional revenue opportunities with existing clients

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

 
 

EXPECTIONS OF THE JOB:

• Travel (25-75% to client sites as needed)

• Hours (Full-Time)

 
 

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES:

 
 

• Education: Bachelor’s or Master’s degree

• Experience and/or Training:

o 5-7 years’ experience in an analytical role, preferably in the pharmaceutical or medical device industries

o Strong analytical skills, conceptual thinking, effective time management skills & good communication skills

o Proven ability to successfully manage multiple projects of various complexity simultaneously, prioritize projects, meet deadlines, and operate in a fast-paced work environment

o Proven ability to build rapport while providing superior customer service and maintaining positive relationships with internal teams and client contacts

o Strong organizational, analytical skills and strong attention to detail

o Excellent interpersonal, verbal and written communication skills

o Excellent troubleshooting, problem solving and decision-making skills

o Ability to work well independently and as a team member

o Ability to follow through and successfully execute tasks while adhering to quality standards

o Has the knowledge of best practices and procedures within a particular field, especially Pharma contracting and/or compliance domains, Life Sciences & Finance

o Knowledge of revenue management systems such as Model N and other claim management applications

o Ability to complete time critical processes

o Proficiency in the Microsoft Office Suite, including but not limited to Word, Excel, Access, Project, and Outlook

o Advanced knowledge of Microsoft Excel

o Unrestricted permanent US work authorization

• Technology/Equipment: Model N or SAP Vistex, Excel, Word, PowerPoint, Project

 
 

PREFERRED QUALIFICATIONS:

• Education: Bachelor’s or Master’s degree in a business-related field, Computer Science, Information Technology, or Life Sciences related field

• Experience and/or Training: 4-8 years in Managed Care rebate processing, Medicaid claims processing, chargeback processing and/or distributor rebates processing within a revenue management system such as Model N; Knowledge of or experience with Government Pricing practices and calculation procedures; Knowledge of gross to net practices and procedures

• Technology/Equipment Advanced knowledge of Model N or SAP Vistex, Microsoft PowerPoint, Project, SQL, VBA, JIRA

 
 

 
 

Clipped from: https://www.linkedin.com/jobs/view/managed-care-rebate-processing-medicaid-claims-processing-senior-level-at-eversana-3082142223?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Department of Health And Human Services

Office of Legislation (OL)

COVID-19 Vaccination Requirement

The COVID-19 vaccination requirement for federal employees pursuant to Executive Order 14043 does not currently apply. Some jobs, however, may be subject to agency- or job-specific vaccination requirements, so please review the job announcement for details. Click here for more information.

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Legislation(OL), Medicare Parts A and B Analysis Group .


As a Health Insurance Specialist, GS-0107-12, you will review, analyze and evaluate proposed legislation, regulations and other administrative actions for CMS programs.

Learn more about this agency

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Overview

• Accepting applications

 
 

• Open & closing dates

05/27/2022 to 06/03/2022

• Salary

$89,834 – $116,788 per year

• Pay scale & grade

GS 12

• Help

Location

FEW vacancies in the following location:

• Washington, DC
• Telework eligible

Yes—as determined by the agency policy.

• Travel Required

Not required

• Relocation expenses reimbursed

No

• Appointment type

Permanent

• Work schedule

Full-time

• Service

Competitive

• Promotion potential

12

• Job family (Series)

0107 Health Insurance Administration

• Supervisory status

No

• Security clearance

Not Required

• Drug test

No

• Position sensitivity and risk

Moderate Risk (MR)

• Trust determination process

Credentialing

Suitability/Fitness

• Announcement number

CMS-OL-22-11514299-DE

• Control number

656926900

Videos

 
 

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Duties

• ENTER 1 MAJOR DUTY PER RESPONSIBLITY BOX AND ENTER NO MORE THAN 5 MAJOR DUTIES

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Requirements

Conditions of Employment

• You must be a U.S. Citizen or National to apply for this position.
• You will be subject to a background and suitability investigation.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.


Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.


In order to qualify for the GS-12, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-11 grade level in the Federal government, obtained in either the private or public sector, to include:
(1) Conducting analysis using statutes regarding the Medicare program AND
(2) Producing written documents such as briefing documents, reports, issue papers, or decision memoranda regarding the Medicare
program AND
(3) Briefing management on topics or concerns regarding the Medicare program.


Substitution of Education for Experience: There is no substitution of education to meet the specialized experience requirement at the GS-12 grade level.


Combination of Experience and Education: There is no combination of experience and education to meet the specialized experience requirement at the GS-12 grade level.


Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.


Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11514299

Additional information

Bargaining Unit Position: Yes- American Federation of Government Employees

Tour of Duty: Flexible

Recruitment/Relocation Incentive: Not Authorized

Financial Disclosure: Not Required


Federal agencies may request information regarding the vaccination status of selected applicants for the purposes of implementing other workplace safety protocols, such as protocols related to masking, physical distancing, testing, travel, and quarantine.


Expanded/Maximum Telework Posture: Due to COVID-19, the agency is currently in a maximum telework posture. If selected, you may be expected to telework upon your appointment. As employees are permitted to return to the office, you may be required to report to the duty station listed on this announcement, even if your home/temporary telework site is located outside the local commuting area. Your position may be eligible for workplace flexibilities which may include remote work or telework options, and/or flexible work scheduling. These flexibilities may be requested in accordance with the CMS Master Labor Agreement.


Full-Time Telework Program for CMS Employees: CMS employees currently participating in the Full-Time Telework Program must discuss whether they can remain in the program with the hiring manager. If an employee in this program is selected, the pay will be based on the address on the current telework agreement (normally home address) and will be used as your official duty station for pay purposes. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page.


The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.

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• Help

A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

If you meet the minimum qualifications and education requirements for this position, your application and responses to the online occupational questionnaire will be evaluated under Category Rating and Selection procedures for placement in one of the following categories:

• Best Qualified – for those who are superior in the evaluation criteria
• Well Qualified – for those who excel in the evaluation criteria
• Qualified – for those who only meet the minimum qualification requirements

The Category Rating Process does not add veterans’ preference points or apply the “rule of three” but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans’ preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher).


Once the announcement has closed, your online application, resume, transcripts and CMS required documents will be used to determine if you meet eligibility and qualification requirements listed on this announcement. If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration. Please follow all instructions carefully. Errors or omissions may affect your rating.


Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):

• Analysis
• Health Insurance
• Oral Communication
• Written Communication

lClipped from: https://www.usajobs.gov/job/656926900?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic