Category: Curator- Job Hunter

 
 

 
 

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

Join Aetna’s Medicaid Actuarial team for an exciting opportunity to work on strategic projects and other business-critical functions. This position will support Medicaid-wide analyses and reporting as part of the Medicaid Strat team.The role will work with Medicaid Plan actuaries to identify opportunities for new or refined analyses that are relevant to multiple markets, standardization of current Plan-level reporting, and automation of existing Medicaid team reporting.This position will work closely with other Actuarial team members, our Medicaid Health Plans, Medicaid Finance, MEU, and other parties. This role provides the opportunity to build the skills necessary to become a well-rounded actuary.- Support actuarial functions by applying quantitative skills and analytical methods to well defined projects.- Take ownership of assigned projects within pre-established overall deadlines.- Use strong technical skills in a functional manner anddemonstrate fundamental business and product knowledge.- Clearly articulate analysis to multiple parties.#AetnaActuary

Required Qualifications

• Existing proficiency with Microsoft Excel and SQL.- Demonstrated analytical and computing skills.- Demonstrated initiative and perseverance.- Excellent oral and written communications skills.

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

• We are looking for individuals that have demonstrated progress towards achieving their ASA designation. – 1 to 3 years related work experience in the Actuarial field; experience with Medicaid preferred but not a requirement.- Demonstrated experience in model building and optimization is a plus.

Education

• A Bachelor’s degree with a strong math background is required.

Business Overview

Bring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

 
 

 This position is open. This job was posted on Fri May 27 2022 and expires on Sun Jun 26 2022.

Tasks

• Inform investment decisions by analyzing financial information to forecast business, industry, or economic conditions.
• Prepare plans of action for investment, using financial analyses.
• Evaluate and compare the relative quality of various securities in a given industry.
• Recommend investments and investment timing to companies, investment firm staff, or the public.
• Present oral or written reports on general economic trends, individual corporations, and entire industries.
• Monitor fundamental economic, industrial, and corporate developments by analyzing information from financial publications and services, investment banking firms, government agencies, trade publications, company sources, or personal interviews.
• Interpret data on price, yield, stability, future investment-risk trends, economic influences, and other factors affecting investment programs.
• Purchase investments for companies in accordance with company policy.
• Monitor developments in the fields of industrial technology, business, finance, and economic theory.
• Draw charts and graphs, using computer spreadsheets, to illustrate technical reports.
• Determine the prices at which securities should be syndicated and offered to the public.
• Collaborate with investment bankers to attract new corporate clients to securities firms.
• Conduct financial analyses related to investments in green construction or green retrofitting projects.
• Forecast or analyze financial costs associated with climate change or other environmental factors, such as clean water supply and demand.
• Identify potential financial investments that are environmentally sound, considering issues such as carbon emissions and biodiversity.
• Determine the financial viability of alternative energy generation or fuel production systems, based on power source or feedstock quality, financing costs, potential revenue, and total project costs.
• Evaluate financial viability and potential environmental benefits of cleantech innovations to secure capital investments from sources such as venture capital firms and government green fund grants.
• Research and recommend environmentally-related financial products, such as energy futures, water rights, carbon credits, government environmental funds, and cleantech industry funds and company stocks.

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.
• Monitoring – Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
• Complex Problem Solving – Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
• 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.

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.
• Computers and Electronics – Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
• Mathematics – Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
• English Language – Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
• Law and Government – Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.
• Communications and Media – Knowledge of media production, communication, and dissemination techniques and methods. This includes alternative ways to inform and entertain via written, oral, and visual media.

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

Chicago, IL, and others

Founded

1963

CEO

Larry J. Merlo

Website

Visit Website

Total job postings in the past

 
 

Clipped from: https://lensa.com/analyst-actuarial-medicaid-jobs/chicago/jd/0c7ab98b11a4400fe8de70ae73f4942e?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

The Medicaid Specialist is responsible for the timely and accurate completion and review of Medicaid Pending applications to ensure all required documentation is made available and gathered for timely processing to the County. Further is responsible to ensure that policy and procedures in the business office are followed in accordance with current applicable Federal, State and local standards, guidelines and regulations. Ensures that all information uploaded into the billing software is accurate and completed promptly.
 

• Works one on one with residents, responsible parties, and families to ensure the Medicaid Application process starts within 24-48 hours of admission for any admission that will become Medicaid Pending. Secures authorizations to represent as applicable.
• Educates residents, responsible parties, families in the Medicaid Process and communicates documents required to complete the Medicaid Application.
• Informs Business Office Manager promptly if there is no cooperation or a delay in cooperation from a resident, responsible party, family in the Medicaid Application Process
• Ensures complete confidentiality of financial, HIPAA protected information of residents
• Responsible for the completion of the Options package for Aging and Adult Services for the clinical approval of Medicaid.
• Responsible for the tracking and ensuring the MA51 is returned from the physician timely. Further is responsible for ensuring the MA51 and the PASSAR match as it may result in a clinical denial.
• Responsible to forward the OBRA letter with the Medicaid application if the resident tis deemed a Target admission by the Commonwealth of Pennsylvania and an Options request is not needed. Responsible for obtaining such documentation from the Social Services or Admissions Department.
• On a daily basis will call residents, responsible parties, families and financial institutions and other affected agencies and financial institutions to assist in attempting to obtain a large number verification that is needed by the Commonwealth of Pennsylvania to secure a Medicaid Grant
• Responsible for ensuring Spousal cases include the additional information required by the County to ensure a timely processes and approval of a Medicaid Application.
• Responsible to ensure the resident and or responsible party or family member understands and signs the Patient Liability which is due on a monthly basis
• Responsible to ensure that Direct Deposit if secured. Reports to the Business Office Manager if there is no compliance and a Rep Payee is secured for Social Security
• Responsible to complete the Rep Payee Application and ensuring the Rep Payee Application is completed promptly and accurately
• Responsible to keep and update the Medicaid Pending log on a daily basis
• Works collaboratively with the applicable County office to ensure they have all required documentation
• Responsible to attend face to face interviews at the County Assistance Office in order to secure a grant if families are uncooperative or unable to attend
• Responsible for ensuring the County Assistance Office is in receipt of all verifications.
• Responsible for ensuring that when the Medicaid Grant is obtained the appropriate persons (third party biller, BOM and RNAC) are notified.
• Responsible for ALL active in-house Medicaid resident’s yearly recertifications.
• Comply with Health Insurance Portability and Accountability Act (HIPAA) regulations
• Must be an active participant in the facility’s Quality Assurance/Performance Improvement (QAPI) program and Performance Improvement Project (PIP) and carry out roles and responsibilities as assigned. Must attend trainings for QAPI, follow policies and procedures in support of QAPI efforts, and support QAPI initiatives and findings. Must also report potential or actual non-compliance issues to the facility’s QAPI committee.
• Perform other reasonable duties as assigned by supervisor.
   

Required Qualifications
 

• Must have two years of work experience in Long Term Care.
• Must be efficient, maintain confidentiality, exhibit good judgment, and have the ability to speak and write effectively.
• Must possess good communication and people skills.
• Must be knowledgeable of all Medicaid legal regulations, guidelines and best practices.
• Must understand the basics of working in the business office and importance of following established processes.
• Must possess an aptitude for problem solving.
• Employment is contingent on completion of all pre-employment screenings inclusive of criminal background check and Medicaid Exclusion Screening, both indicating negative results.
   

Benefits
 

• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid vacation time
• Paid Sick time
• Professional development assistance
• Tuition reimbursement
• Vision insurance

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-specialist-ft-at-premier-healthcare-llc-3096695020?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Reporting to the Senior Vice President, National Medicaid and the MAS VPof MSBD, the Market Medicaid line of business leader is responsible for the overall performance of the market Medicaid line of business program, with a focus on financial performance and membership growth. Oversees all aspects of market Medicaid programs, state contracting arrangements, product development, compliance with State and Federal Policies and requirements, and partnerships with market [Permanente] and Administration. Strategically builds, manages and sustains external business relationships, particularly with state and local regulators. Accountable for product development, administrative processes, interdepartmental communication, and regulatory requirements. Develops an annual strategic plan and updates market and National Executive Sponsorship on strategic issues/development, business performance, and progress against objectives. Demonstrated passion and creativity in developing models of care serving low income vulnerable populations.

Essential Responsibilities:

• Position the market as the leader for quality, care delivery for high need vulnerable populations. The position is responsible for customer experience, achieving membership growth targets, overseeing the Medicaid product portfolio (TANF, ABD, LTSS and Adult Expansion), and developing/executing market Medicaid strategy based on state and CMS requirements, national standards and alignment with overall national and market strategy. This position incorporates care delivery requirements into strategy and develops a strong partnership with medical group and health plan delivery system operations and quality.
• Demonstrated strategic thinking with ability to balance long-term direction with need for immediate impact and results. Maintain awareness of the competitive landscape and market trends. Develop capacity to identify new business opportunities for the market to expand its Medicaid footprint. Recognize industry trends and Identify initiatives for market to demonstrate innovation, which could take the form of creative partnerships, marketing, member retention, care delivery or delivery system improvements, or participation in innovative projects managed by the federal government, community or provider partners.
• Ensure market Medicaid plans adhere to national guidance and are aligned with market business strategies, goals and initiatives and lead development of annual market Medicaid membership targets with market forecasting lead. Participate in market forums to ensure alignment of Medicaid strategies with market business plans and assure full integration of Medicaid where applicable; participate in other market forums and serve as the market voice of Medicaid. Serve as principal contact within the region for Medicaid and interface regularly with market executives (MSBD, CFO, HManage the relationship and activities with functional areas as business, regulatory, operations, legal and IT.
• Market Medicaid Operations
• Manage the relationship and activities with functional areas as business, regulatory, operations, legal and IT. Oversee and coordinate the validation and submission of state required reports and work in collaboration with NMER for timely, accurate and complete submission of encounter data. Coordinate resources so that they leverage/align with other initiatives through the organization. In conjunction with National Medicaid implement market geographic and product line Medicaid expansions. Set key performance metrics and ensure that the Medicaid line of business is well-served and drive continuous improvement initiatives related to Medicaid.
• Stakeholder Outreach
• Represent KP with state regulators, departments and representatives as well as local health departments and community-based organizations. Proactively anticipate and respond to state and federal initiatives which impact Medicaid. Manage contractual arrangements with the states, local Departments of Health, and providers including, but not limited to, transportation providers, School Based Health Centers, Federally Qualified Health Centers and CSBs.
• Medicaid compliance and regulatory
• Maintain a deep understanding of state and CMS Medicaid regulations, collaborate with National Medicaid Compliance to ensure all market functions are aware of and compliant with state and CMS Medicaid requirements. Identify market compliance risks and escalate issues as necessary to market and national Medicaid compliance and line of business leaders. Lead State Medicaid audits. Accountable for market remediation of compliance risks with market functional leaders, as needed.
• Financial Accountability, State Medicaid Capitation and Rate Development
• Accountable for the market Medicaid line of business P&L and department budget. Coordinate the market development of rate development templates for annual capitation rates. In conjunction with Actuarial services and Finance represent the market in capitation rate negotiations. Identify revenue and expense opportunities for increased state reimbursement and internal, fiscal improvement opportunities.
• Lead and develop market Medicaid LOB staff
• Ensure market line of business structure is designed to achieve desired outcomes based upon best practices. Hire, onboard, develop and coach market Medicaid staff to sustain a strong and diverse talented team and advance Medicaid performance. Provide opportunities for market staff to learn about the national Medicaid line of business and functional areas to contribute to building their expertise and expand their view of the business line. Ensure leadership succession plans are in place so that key positions can be backfilled with appropriate talent.

Basic Qualifications:

Experience

• Minimum ten (10) years of relevant experience in a Medicaid managed care organization.
• Minimum seven (7) years of management experience.
• Minimum five (5) years in product line management to special populations.

Education

• Bachelors degree or four (4) years relevant experience.
• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• N/A

Additional Requirements:

• Strong background working with Medicaid and/or Special Populations and unique health care needs.
• Understanding of state and federal Medicaid framework and regulatory requirements
• Excellent negotiation skills, verbal/written communication skills.
• Strong analytical and strategic planning skills.
• Excellent public presentation skills.
• Strong persuasive and interpersonal skills.
• Knowledgeable of Medicaid health care delivery systems
• Knowledgeable of current trends in care management an industry related to care delivery to Medicaid population.
• Demonstrated ability to build effective partnerships and influence others who may have different perspectives.
• Must be a decisive, results-oriented manager or people. Must excel in developing a highly focused, cohesive team of professionals who are comfortable working in a team environment.
• Demonstrated ability to work in a highly matrixed environment.
• Strong collaborative and team skills.

Preferred Qualifications:

• Twelve (12) years of relevant experience in a Medicaid managed care organization preferred.

 
 

Clipped from: https://jobs.kdvr.com/jobs/senior-director-medicaid-market-mid-atlantic-california-city-california/604848529-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Healthcare Business Analyst – Consultant Level – Medicaid/Medicare experience – Remote

The Company

We continuously seek exceptional associates when recruiting new employees. We pride ourselves on having extensive experience working with clients in all major markets. Cognizant’s delivery model is infused with a distinct culture of high customer happiness. We consistently deliver positive relationships, cost reductions and business results. Are you ready to be a change-maker? At Cognizant, we believe those who challenge the way they work today will own the way tomorrow. When was the last time you felt proud about your work?

About Cognizant Consulting

Cognizant Consulting combines deep domain expertise with advanced technology thinking to help global 2000 companies worldwide accelerate their digital journeys. By orchestrating capabilities across strategy, design, IT and industry /functional knowledge, we help, clients solve their toughest business-technology challenges at speed and scale, and lead in today’s dynamic digital age — while planning for whatever tomorrow brings. We do this by applying a keen understanding of the uniquely human aspirations, behaviours and needs of our clients’ customers and employees to first envision and specify, and then deliver and extend modern digital solutions that enable leading players to differentiate and ultimately separate from the competition. Learn more by visiting us at

Job Description:

Conduct workshops with business and IS stakeholders and create Business Requirements documents and process flows and have experience delivering in agile methodology
Provide project leadership and direction on one or more projects while maintaining a high-quality level of service. Ensure quality on all deliverables.
Manage delivery dates, resourcing and schedules
Facilitate project execution by providing support in project-level issue resolution and management of scope
Help build, lead, and develop team of onshore/offshore consultants
Deeply understand their client’s business challenges, and provide thought leadership in addressing these issues
Work proactively to bring the best of Cognizant expertise to their client(s)
Project/Program management experience

In addition to the above:

Prior project experience in Medicaid/Medicare/Care Management
Minimum 2-4 years’ experience in management consulting with a management and/or technology consulting firm

Our strength is built on our ability to work together. Our diverse set of backgrounds offer different perspectives and new ways of thinking. It encourages lively discussions, inspires thought leadership, and helps us build better solutions for our clients. We want someone who thrives in this setting and is inspired to construct meaningful solutions through true collaboration.

If you are comfortable with ambiguity, excited by change, and excel through autonomy, we would love to hear from you!

Cognizant is an Equal Opportunity Employer M/F/D/V

Cognizant is recognized as a Military Friendly Employer and is a coalition member of the Veteran Jobs Mission. Our Cognizant Veterans Network Assists Veterans in building and growing a career at Cognizant that allows them to demonstrate the leadership, loyalty, integrity, and dedication to excellence instilled in them through participation in military service

Cogniz+ant will only consider applicants for this position whom are legally authorized to work in the United States without company sponsorship (H-1B, L-1B, L-1A, etc.)

 
 

Clipped from: https://jobs.fox2now.com/jobs/healthcare-business-analyst-consultant-level-medicaid-medicare-experience-remote-teaneck-new-jersey/604875581-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Are you looking to make an immediate impact where you can help our clients solve their business challenges? Deloitte’s Core Business Operations (CBO) portfolio operates at the center of our client’s business. By joining our team, you could help C-suite and program leaders transform their organization and accelerate mission execution through emerging and disruptive technologies, innovative business models, retooled program operations and industry-driven solutions.

Work you’ll do
 

• Serve as a senior team leader on project engagements and lead the development and growth of the practice in support of state and federal government agencies, primarily on Medicaid related issues.
• Lead client service delivery, sales and marketing, and management of engagement teams
• Work to broaden relationships at the most senior levels within current and potential state and local healthcare clients and to translate this into new business opportunities.
• Work closely with the practice to win additional consulting work with the existing accounts and to acquire new accounts.
• Provide thought leadership expertise, such as leading the development of complex, market-valued intellectual capital, leverage business network for contacts in target market to generate leads and brings ideas on innovative ways to identify and pursue new cross-functional sales opportunities, where appropriate, lead development of the sales pursuit strategy and assembles and effectively manages the sales pursuit plan and work to successfully close the sale and generates enthusiasm in potential clients about working with the Firm.
• Lead engagement teams and support the development of more junior colleagues, plan for the long-term, cross-functional impact of decisions,, delegate appropriate level of decision making; helping team to make reasonable decisions and understand difficult decisions, leads engagement work planning, scoping, and budget development in line with engagement strategy and deliverables and provide overall engagement management, including work plan, issue resolution, and close management of scope change.
   

The team

Deloitte’s Government and Public Services (GPS) practice – our people, ideas, technology and outcomes-is designed for impact. Serving federal, state, & local government clients as well as public higher education institutions, our team of over 15,000+ professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise.

Deloitte’s Health Technology offering transforms the way the Healthcare IT market embraces modernization and modularization. Using our deep health, government, and technology consulting experience, our team strategically advises on design as well as implements and deploys solutions. In order to help clients reduce costs, improve health outcomes, and respond to public health crises, our Health Technology practice addresses critical health agency issues including: claims management, electronic health records, health information exchanges, health analytics, and health case management.

With more than 40 years of experience in assisting state health and human services agencies in nearly every state, Deloitte understands how delivery works-and how it can work better. Our state health team offers industry-leading insights, solutions, and business practices to help state health agencies solve their most difficult challenges, ranging from modernization of eligibility determination systems and compliance with Federal Health Insurance Exchange requirements to innovative Medicaid tools and services that can help states serve their constituents more effectively. Deloitte helps state Medicaid agencies design and implement initiatives that improve upon the management of their health programs, overall financial performance, and health outcomes.

Qualifications

Required:
 

• 10+ years of healthcare experience working either with State Health and Human Services agency or with a Health plan or Consulting company serving Healthcare clients.
• 6+ years of experience supporting Medicaid programs, working on Medicaid related issues including Medicaid managed care, value-based purchasing, Medicaid enterprise solutions, quality measurement and analytics and fee for service operations.
• 6+ years in leading operations and business teams.
• 6+ years of business development experience (pre-sales, proposal, and RFP experience
• Experience leading teams and managing client/executive relationships
• Bachelor’s degree
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
• Willingness to travel at least 25% to 50%

 
 

Clipped from: https://www.linkedin.com/jobs/view/senior-medicaid-transformation-business-leader-at-deloitte-3088253706?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Clipped from: https://phf.tbe.taleo.net/phf01/ats/careers/v2/viewRequisition?org=CBIZ&cws=66&rid=13171

Exempt/Non-Exempt:

Exempt

Scheduled Hours Per Week:

40

Myers and Stauffer LC (MSLC) is a national Certified Public Accounting (CPA) and consulting firm with more than four and a half decades of experience working exclusively for state and federal agencies.  In addition to our work on behalf of all 50 states, we have provided health and human services audit, investigative, and consulting services to many federal agencies, including the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control & Prevention (CDC), the Office of the Inspector General, the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), and other health and human services branches.

At Myers and Stauffer you will have a career that is rewarding on every level of the organization. We are committed to providing our employees with:

• Professional growth and development opportunities
• Educational opportunities leading to certifications
• A diverse, dynamic, and challenging work environment
• Strong leadership, communication, and feedback
• A well-balanced lifestyle that includes personal and family time in addition to professional and networking opportunities
• Creative and innovative solutions to challenges facing our government clients

MSLC is seeking an experienced, senior-level business development/sales professional to help increase market share in the federal government health sector.  The Business Development Director is a new position and will be a core member of our business development team responsible for driving new business within the federal government market segment. The ideal candidate will have a proven track record of identifying and winning business opportunities within federal agencies, particularly Department of Health and Human Services Agencies, Department of Veteran’s Affairs, and Department of Defense, among others.

Essential Functions:

• Focus on identifying, developing, and leading federal business development opportunities within the federal government health sector.
• Develop detailed and actionable account plans that achieve growth targets.
• Develop, maintain, and expand productive relationships with Government decision-makers, project and program managers, and contracting officers.
• Identify opportunities through agency research, 3rd party market intelligence tools, client and partner networks.
• Coordinate meetings with customers, competitors, clients, partner firms, and service delivery teams to develop market insight on requirements, acquisition strategy, acquisition timing, and contract vehicle choices.
• Meet regularly with the service delivery teams to identify account challenges and help them find and win organic growth through mods, increased scope, and innovation.
• Participate as a key resource for federal government Sources Sought, Request for Information (RFIs), and Request for Proposal or Quote (RFP/RFQ) responses in conjunction with MSLC’s Marketing Team.
• Ensure the capture team’s strategy, themes, solution, and discriminators are reflected in the proposal.
• Provide pertinent market and competitive information to the organization.
• Support ad-hoc projects in coordination with upper-level management.

Requirements:

• Bachelor’s Degree required.
• Established network of contacts in applicable federal agencies.
• Demonstrated track record of designing and executing successful Business Development and Capture strategies that has led to profitable revenue growth with HHS, VA, DoD, DHS, and other agencies.
• Ten or more years of related recent business development/capture experience.
• Experience creating teaming agreements, managing vendor relationships, maintaining service level agreements, and operating successful contractor teaming arrangements.
• Excellent communication skills (both verbal and written) and highly effective interpersonal skills in order to carry-out daily interactions with technical leaders and business executives within the firm, affiliate corporation, and with customers, industry and subcontractors.
• Demonstrated working knowledge of the Federal Acquisition Regulations (FAR).
• Ability to use automated tools such as Microsoft Office to present ideas, information, and reports.
• Comfortable with all remote work and video conferencing platforms.
• Ability to travel as required.

 

 
 

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position PurposeConduct analysis, pricing and risk assessment to estimate financial outcomes. Provide expertise and technical support in matters related to the successful and financially sounds operations of the company’s health plan businesses.

In this Manager, Actuarial Services role, you will
 

• Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes.
• Negotiate capitation rates with State agencies
• Oversee health plan experience, identify trends and recommend improvements
• Research and identify new business opportunities
• Work with Health Plans to ensure soundness of capitation rates
• Work with State agencies to assess impact of program/policy changes
   

Our Comprehensive Benefits Package
 

• Flexible work solutions including remote options, hybrid work schedules and dress flexibility
• Competitive pay
• Paid Time Off including paid holidays
• Health insurance coverage for you and dependents
• 401(k) and stock purchase plans
• Tuition reimbursement and best-in-class training and development
   

Education/Experience
 

• Bachelor’s degree or equivalent experience.
• 5+ years of actuarial experience.
• License/Certification Fellow or Associate of the Society of Actuaries (or equivalent international certification). Member of American Academy of Actuaries (or equivalent international membership).
   

Within our actuarial department, your talents and skills will be challenged, recognized and rewarded. We are a pay-for-performance environment that promotes employees based on talent and contribution. In order to maintain our tremendous growth in this space, our over 400 member Actuarial team is growing. Located across the country, this team uses
 

• Technical skills to build leading edge models, predict outcomes and assess future impacts
• Business skills to develop strategy with senior leadership
• Personal skills to interact with state, federal and private employer customers
• Management skills to organize cross department projects
   

Areas of focus within our Actuarial Department includes Medicare / Medicaid / Marketplace / Commercial / Risk Adjustment / Reserving / Actuarial Analytics / Value-Based Care / Actuarial Reporting / Health Policy

About Us

Centene Corporation, a FORTUNE 25 company, is the leading national healthcare enterprise committed to helping people live healthier lives. We are revolutionizing the world of healthcare through digital transformation. Our world class teams use collective innovation to turn visions into action and challenge what is possible. We are an industry leader with a local focus and a global vison
 

• Listed on FORTUNE magazine’s World’s Most Admired Companies List for 2nd consecutive year.
• Ranked No.2 on the FORTUNE 500 Measure Up Initiative, a new benchmark to identify companies building inclusive and fair workplaces.
• National footprint in all 50 states, serving 1 in 15 individuals in the U.S.
   

Clipped from: https://www.linkedin.com/jobs/view/manager-actuarial-services-medicaid-at-centene-corporation-3088253281?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description
Job Summary
Responsible for continuous quality improvements regarding member engagement and member retention. Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the development/maintenance of Member Materials.

Knowledge/Skills/Abilities
• Serves as an advocate for members to resolve issues and complaints. Works with enrollees and providers to facilitate the provision of Medicaid benefits and ensure enrollee’s rights are upheld. Helps enrollees understand their rights and benefits in working through the system.
• Investigates and resolves access and cultural sensitivity issues identified by HMO staff, State staff, providers, advocate organizations, subcontractors and enrollees.
• Monitors all formal and informal grievances with Grievance personnel to identify trends or problem areas of access and care delivery. Assists enrollees in the grievance process at the HMO and State levels and monitors outcomes.
• Provides timely written responses to inquiries; prepares written analyses of advocacy issues; and assists with documentation preparation for appeals, fair hearings or other formal/informal dispute resolution process.
• Provides ongoing training and educational materials to HMO and relevant subcontractor employees and providers as needed.
• Works in collaboration with the Care Management department to help resolve member issues/concerns, ensure that trends are identified and solutions outlined.
• Provides information, guidance and assistance, over the phone or in person, to members with disabilities or BC+ who call for help related to their HMO participation. Analyzes internal HMO system functions that affect enrollee access to medical care and quality of care.
• Serves as a resource for Molina staff and members regarding community agencies, services and referrals for special needs, Medicaid in general, or other related needs.
• Participates in the Statewide Advocacy Program for Managed Care including working with the State External Advocate, Enrollment Specialist and Ombudsmen on issues of access to medical care, quality of care, enrollment and disenrollment.
• Participates in HMO internal Quality Assurance and Improvement Committees to ensure services to enrollees are provided in accordance with all State/HMO requirements..

Job Qualifications

Required Education
Bachelor’s Degree in Social Work, Human Services or related field.
Required Experience
3-5 years experience working with the Medicaid population, preferably in an HMO or MCO setting, with experience in working with disabled, underserved and/or disadvantaged populations.
Preferred Education
Graduate Degree in Social Work, Human Services or related field.
Preferred Experience
5+ years

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

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

Clipped from: https://jobs.myfox8.com/jobs/senior-member-engagement-specialist-st-george-ut-central-utah/604262246-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Found in: Lensa US Premium – 21 hours ago

Montebello, United States Anthem, Inc Full time

Description

SHIFT: Day Job

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?

This position requires that you live within the State of California.

The Program Director is responsible for the development and ongoing management of one or more external client facing programs that are multi-state, multi-function and multi-year in scope. Program directors typically support business strategies through an integrated portfolio of external client facing programs, projects and initiatives.

How you will make an impact:

Primary duties may include, but are not limited to:

• Represent Health Plan on special projects and growth initiatives that result in performance improvements.
  
• Enhance relationships with local elected officials and local stakeholders.
  
• Serve as liaison with County Health and Human Services Agency and County Behavioral Health Departments
  
• Prepare and monitor reporting of activities for submission to Regulatory & Compliance departments.
  
• Build and maintain provider relationships, support local and community health collaborative initiatives, and serve on managed care related committees.
  
• Develop and deliver highly engaging visual presentations on program performance and projects/initiatives to external and internal leaders.
  
• Provides subject matter expertise in response to day to day business issues; researches applicable subject matter practices; and remains aware of industry trends.
  
• Develops documentation to support meeting presentations and the tracking and reporting of the programs success.
  
• Provides day to day support and leadership to program managers
  
• Program directors typically manage external client facing programs that require managing activities and resources of multiple departments or business areas of the organization.
  

Qualifications

Requirements:

• Requires a BA/BS and minimum of 10 years experience in external client facing program management, business development, relationship building, complex business processes, strategic and business planning; or any combination of education and experience, which would provide an equivalent background.
  
• Resident of the State of California
  

Preferred skills and qualifications:

• MBA preferred.
  

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

The health of our associates and communities is a top priority for 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 accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance

REQNUMBER: PS72268

 
 

 
 

Clipped from: https://us.trabajo.org/job-835-20220519-96253873679581c3fc83c11922bab3ee?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Testing Manager (Medicaid / MMIS)
 

Location: Remote

About Us:

Known for “Delighting the Client” through performance, innovation and an employee-centric culture, S2Tech is a fast-growing IT consulting company serving clients in over a quarter of the United States. We are widely recognized as a leading provider of both technical and business services in support of Health and Human Services related projects. Feel free to learn more at www.s2tech.com.

Why S2Tech?:

• Stable privately-owned company with a strong reputation for building long-term client relationships through the delivery of consistent value-based service
  
• 25 year history of providing IT and Business services to private customers and government programs throughout the United States
  
• Expansive client portfolio and active projects – employees benefit from innovative project exposure and in-house skill development training/courses  
  
• Corporate culture that emphasizes the importance of family and promotes healthy work-life balance
  
• Offer competitive pay and a range of benefits including:
  

 
 

• Medical / Dental / Vision Insurance – insurance premium assistance provided
  
• Additional Insurance (Life, Disability, etc.)
  
• Paid Time Off (Vacation & Sick Leave)
  
• 401(k) Retirement Savings Plan & Health Savings Account
  
• Various training courses to promote continuous learning
  
• Corporate Wellness Program
  
• Be part of a company that gives back through its non-profit organization, Fortune Fund, which was launched in 2001. The goal of the Fortune Fund is to close the rural/urban divide by ensuring children in rural communities in India and the United States understand the importance of education & are aware of professional career opportunities allowing them to link their professional & educational goals
  

Responsibilities:

• Develop and manage the quality management solutions on a Medicaid Management Information System (MMIS) program
  
• Coordinate testing efforts across all MMIS modules
  
• Use prior Medicaid Management Information System (MMIS) domain knowledge to develop testing methodologies, test estimations, test scheduling, and test results
  
• Create and document comprehensive test scenarios while understanding the system-wide impact to all relational systems and software applications
  
• Conduct testing scenarios within various application systems and sub-modules; document, review, and track results; and assist in remediation
  
• Demonstrate test results to project stakeholders
  
• Coordinate defect management
  
• Provide training/support for users, stakeholders, and contractors
  

Qualifications:

• Bachelor’s degree in Computer Science, Information Systems, or another similar STEM (Science, Technology, Engineering and Mathematics) discipline
  
• Previous experience working as a Testing Manager on large-scale projects
  
• Must have a minimum of six (6) years of experience with planning and executing all phases of system testing – unit testing, system testing, integration testing, user acceptance testing, regression testing, and performance testing
  
• Experience with and expertise in selection and use of automated test tools and other testing-related tools
  
• Experience managing test teams comprising individuals from multiple organizations
  
• Must have previous experience working on Medicaid Management Information System (MMIS) projects
  
• Must possess a strong understanding of the Medicaid Management Information System (MMIS) and other healthcare programs
  
• Strong analytical and problem-solving skills
  
• Excellent communication skills (oral/written) and the ability to interact with multiple teams in a diverse setting encompassing both technical and non-technical users
  
• Must be willing to work independently or as part of a team in an energetic, team-oriented environment managing systems of varying size and complexity with a fast turn-around time
  

S2Tech is committed to hiring and retaining a diverse workforce. We are an equal opportunity employer making decisions without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or any other protected class.

 
 

Clipped from: https://www.monster.com/job-openings/testing-manager-medicaid-mmis–e2cce9b6-fb70-4588-9f3a-12707c80f06a?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic