Category: Curator- Job Hunter

 
 

• Humana • Sandy, UT 84090
  

Job #2188429090

•  
• Description
  

Humana Healthy Horizons is seeking a Technology Solutions Lead who will devise an effective strategy for executing and delivering on IT business initiatives. The Technology Solutions Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Technology Solutions Lead acts as a liaison and collaborates with the Medicaid business and functional stakeholders to identify and deliver strategic enablement solutions.

• Provides oversight of the project portfolio and associated budget, ensuring projects remain operationally sound and that resources are prioritized and managed appropriately.
  
• Leads and manages the project portfolio meetings, support strategic planning, and partner with business to ensure all products are delivered on time and within budget.
  
• Operates the project intake and review process (e.g., prioritization, backlog management, resource assignment, etc.).
  
• Oversees the annual project prioritization and budgeting process working with Corporate, IT, and Market leaders as appropriate.
  
• Provides portfolio-level status updates to leadership (e.g., project health, capabilities delivered, funding, etc.).
  
• Collaborates with leadership and key stakeholders to ensure processes, operating tools and templates, etc. are optimized to support operations and advance business objectives. Facilitate decision-making by providing leadership with data and analysis.
  
• Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision.
  
• Uses independent judgment requiring analysis of variable factors and determining the best course of action.
  

Required Qualifications

• Bachelor’s degree in Business, Information Technology, OR a related field OR equivalent work experience.
  
• 3 or more years of project leadership experience.
  
• 3 or more years’ experience problem solving and consultation within complex environments and facilitating cross-functional teams’ efforts.
  
• Demonstrated ability to run large scale, highly visible programs with responsibility for multiple project teams.
  
• Extensive knowledge in Systems Development Life Cycle, Waterfall, and Agile Development Methodologies.
  
• Solid understanding of operations, technology, communications and processes.
  
• Strong influencing and process implementation skills.
  
• Ability to communicate effectively and deliver presentations to senior leaders.
  
• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health screening questionnaire.
  
• Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
  
• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
  
• Satellite and Wireless Internet service is NOT allowed for this role.
  
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  

Preferred Qualifications

• Master’s Degree of Business Administration, Computer Science, or a related field.
  
• 2 or more years’ experience in IT business analysis, including artifacts development.
  
• Advanced experience leading special projects and producing metrics, measurements, and trend reports.
  
• Experience with QuickBase.
  

Additional Information

• Travel: up to 20%.
  
• Work Days/Hours: Monday – Friday; Eastern Standard Time (EST) Zone and Central Standard Time (CST) Zone.
  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

 
 

 
 

Clipped from: https://www.nexxt.com/jobs/technology-solutions-lead-medicaid-remote-us-sandy-ut-2188429090-job.html?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic&aff=2ED44C72-8FD2-4B5D-BC54-2F623E88BE26&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Found in: Appcast US Premium – 6 hours ago

Basking Ridge, United States Torrent Pharma Inc. Full time

Torrent Pharma Inc. is a multi-billion dollar company leading the way across the globe within the Biotech and Pharmaceutical industry. With a significant presence in over 40 countries, Torrent Pharma Inc. is looking to continue expanding its US base further. We are seeking a qualified Government Pricing/Medicaid Analyst to join our Finance Team in Basking Ridge, NJ.

JOB DESCRIPTION

This role will report into and will work collaboratively with the Head of the Government Pricing group, to ensure the company’s compliance with various government regulations. This employee would oversee the company’s Monthly and Quarterly AMP calculations and compliance with CMS and other various state/ federal government regulations related to Government pricing and Medicaid reimbursement.

The individual will be responsible for assisting the Company’s Manager in the overall management and facilitation of our government programs (Medicaid and 340B) and executing Government Price calculations (AMP, etc.). The individual will also be responsible for processing Medicaid rebate claims submitted by State agencies.

The ideal candidate is a someone, who has successfully managed government programs and calculated government pricing. This position requires building relationships with internal business partners, collaborating to deliver results, hitting key milestones, improving effectiveness, and delivering a high quality and focus on compliance.

Key Responsibilities:

· Manage key activities related to the Company’s government programs (Medicaid and 340B, and anticipated new Government Reporting Relationships as the company expands).

· Execute the calculations of government prices (AMP etc.) URA and as referenced above “anticipated” additional prices types such as ASP, NonFAMP, Best Price etc..

· Create and maintain work instructions and SOP processes for Government Pricing.

· Prepare Monthly and Quarterly variance commentary on fluctuations for government prices and Medicaid rebate amounts.

· Ensure compliance with contracting policies and procedures.

· Provide assistance and support in process improvements, projects and tasks as needed.

· Processing of State rebates.

· On an as needed basis, provide input to update and, as new regulations are either on the horizon or have passed, assist in the creation of new policies and procedures to reflect these changes

· Achieve all reporting deadlines and coordination of all government filings

· Work closely with other departments in the analyses of government filings

· Analysis of internally assigned customer classes of trade Provide assistance in the development of guidance on the impact of Federal or State agency pricing decisions on Government reporting/calculations

· Keep current with all Government Reporting regulations as they impact the Company Provide ad hoc analysis on various special projects as they arise Participate in other government activity as required

Additionally, as the regulatory landscape is rapidly changing, this position will require the ongoing analysis of new government regulations as they relate to reporting obligations. This individual will be encouraged to identify opportunities for process improvements and efficiencies.

Qualifications:

· Bachelor’s degree in Business, Finance, Accounting or related degree. CPA or MBA a plus.

· Government pricing experience in the pharmaceutical industry preferred. Excellent organizational and follow up skills. Strong problem solving and analytical skills.

· Strong computer skills, including Advanced Excel, Power Point and MS Access experience.

· Excellent written and oral communication skills. Ability to interact well with internal/external parties, including Sales, Rebates, Finance, IT, and Government Agencies

· Self-motivated and goal oriented with the ability to drive process change and meet deadlines with minimal assistance or guidance Working knowledge of OTC systems such as Vistex, Revitas, Model N or iContracts.

· Auditing, Compliance and Accounting experience

 
 

Clipped from: https://us.trabajo.org/job-972-20220520-1fb054fad1d5f5b8ada6820c888501d4?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description

DescriptionHCR ManorCare provides a range of services, including skilled nursing care, assisted living, post-acute medical and rehabilitation care, hospice care, home health care and rehabilitation therapy.The Medicaid Specialist assists patients in the skilled nursing centers secure Medicaid benefits.In return for your expertise, you’ll enjoy excellent training, industry-leading benefits and unlimited opportunities to learn and grow.  Be a part of the team leading the nation in healthcare.Location556 – ProMedica Skilled Nursing and Rehabilitation – Chambersburg, PAEducational RequirementsHigh School plus additional training leading to an Associate’s Degree in Business or Social Services.Position RequirementsThree to twelve months with knowledge of medicaid rules and regulations. Job Specific Details:Medicaid experience required.Willingness to work well with others.

 
 

 
 

Clipped from: https://b-jobz.com/us/web/jobposting/073a30953a51?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

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?

Build the Possibilities. Make an extraordinary impact.

Anthem’s Medicaid Proposal Development Team is looking for a Director of Writing for Proposal Development to join its team.   This people leader will lead our internal writing team and editors.  S/he also staffs and manages our live proposal work with external writers to supplement our internal writing staff.  S/he is also responsible for the completion and quality of our Medicaid Proposal writing, tracking performance, and maintaining our core content library.

[This position can work remotely from any US Anthem office]

How you will make an impact:

Responsible for directing and conducting activities related to the development of the Medicaid proposal process, to include strategic messaging and writing and/or support of effective and efficient development of responses to Requests for Proposal(s) to expand the Medicaid business in both new and existing markets. Primary duties may include, but are not limited to: Incorporates evaluation of the market and customer values and develops win themes and tactics to ensure messages are evident in the response and the Company is well-positioned to win the business. Considers the competitive environment, customer goals, objectives, and the RFP requirements in the development of strategies to deliver the Company’s messages effectively and timely. Leads and manages the writing team which includes both internal and external resources and/or leads the development of proposal tools and processes to ensure they are consistent with win themes, style guide, and other presentational tactics, as identified in the RFP Response and Leadership Strategy processes (to include issues management, document production and assessment of the proposal to drive a complete, fully compliant and effective proposal response). Hires, trains, coaches, counsels, and evaluates the performance of direct reports.

Qualifications

BA/BS degree and a minimum of 7 years of related experience including at least 5 years of leadership experience; or any combination of education and experience, which would provide an equivalent background.

Highly preferred skills and experience:

-Former proposal writing experience, preferably on Medicaid Health plan proposals

-People management experience

 
 

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 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. 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 race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/8968963-director-writing-for-medicaid-proposal-development?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Johnson & Johnson Health Care Systems, part of the Johnson & Johnson family of companies, is recruiting for a TEAM LEAD MEDICAID REBATES, Government Rebate Operations (GRO), to be located in Piscataway, NJ.

Johnson & Johnson Health Care Systems Inc. (JJHCS) provides contracting, supply chain, business services, and strategic solutions to customers and commercial intermediaries of U.S.-based Johnson & Johnson companies, including hospital systems, health plans, distributors, wholesalers, purchasing organizations, government payer programs, and government healthcare institutions in the U.S. JJHCS also engages with customers to provide streamlined supply chain services for our products that seamlessly integrate with customer operations, address shared evolving market challenges to value-based care, and develop innovative solutions that improve patient care and access.

Acting on behalf of Johnson & Johnson pharmaceutical operating companies, the GRO team is responsible for ensuring efficient and compliant participation in base and supplemental Medicaid, Medicare Part D Coverage Gap Discount Program (CGDP) and state pharmaceutical assistance rebate programs. The GRO team is relied upon to provide oversight on all issues relating to rebate analysis and payments, adjudication of such payments on a timely basis and resolution of any disputes on rebate claims. Additionally, GRO develops and implements agreed upon rebate policies and advises Johnson & Johnson pharmaceutical operating companies on strategic and operational issues pertinent to Federal and state rebate programs.

The selected candidate will:

• Report to Senior Manager, Government Renate Operations Medicaid Rebates.
  
• Supervises base business activities within own sub-team structure, including review of work, ensuring accuracy, timeliness and alignment with guidance documents, SOPs (Standard Operating Procedure) and Work Instructions.
  
• The Team Leader will be responsible for attracting, developing, and retaining talent, support training, and maintain a collaboration environment among employees.
  
• Direct people management responsibilities for 5 direct reports.
  
• Provide leadership oversight to department initiatives and projects.
  
• Expected to be proficient in all transactional processes performed by direct reports and have a thorough understanding of the overall Government Rebate Operations organization.
  
• The Team Leader will monitor team efficiency and effectiveness based on pre-determined organization performance metric.
  
• Analyze multiple types of invoice submissions and administer all rebate payments on behalf of Johnson & Johnson, including analyzing any State resubmissions and price changes, evaluating market and product trends.
  
• Work closely with Johnson & Johnson operating company partners to ensure accurate and timely payments as well as providing vital information in support of financial planning efforts.
  
• Ensure accuracy and completeness of payment packages, claim review, commentary and approval for all analyst payments, per the Medicaid Operational Guidelines.
  
• Identify and implement process improvements to improve operational efficiency.
  
• Utilize various sources of data, state updates and industry knowledge to collectively integrate, evaluate and provide a critical analysis of data/trending.
  
• Develop and cultivate key business partnerships especially with States and third-party agencies.
  
• Stay fully informed of any new regulatory or government rule changes as it relates to states and Medicaid.
  

Qualifications

• A minimum of bachelor’s degree is required.
  
• A minimum of six (6) years overall business experience, along with demonstrated progressive responsibility in finance, business operations, administrative services, and analysis is required.
  
• Experience in Medicaid, Finance, Rebate Management, or Contract Administration is required.
  
• Three years supervisory experience either direct report or dotted line oversight is required.
  
• Experience with workload distribution and monitoring of department timelines required.
  
• Demonstrated ability to influence key stakeholders and decision makers using sound business rationale.
  
• Project management experience required; Lean certification preferred.
  
• Sound business knowledge and experience in relation to contracting and contract compliance processes is required.
  
• The ability to anticipate and communicate the upstream and downstream impacts of process or data changes and provide recommendations for improvement is required.
  
• Strong communication and interpersonal skills are required.
  
• Knowledge and usage of SOPS and WIs is required.
  
• Experience with CORE (or relevant Medicaid contracting/rebate system), Model N and Hewlett Packard Enterprise – Content Manager (HPE) is required.
  

 
 

Clipped from: https://www.myvalleyjobstoday.com/jobs/team-lead-medicaid-rebates-piscataway-new-jersey/597677359-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Found in: Whatjobs US Premium – 5 hours ago

Austin, United States Sellers Dorsey & Associates, LLC Full time

Description/Job Summary

The Technical Writer develops content and proposal responses focused on long term services and supports (LTSS)for Medicaid managed care Request for Proposals (RFP) for Sellers Dorsey’s National Consulting Practice. The National Consulting Practice provides consulting services to a diverse portfolio of clients including Medicaid and Medicare health plans, state and governmental health-related agencies, health care companies and providers, private equity firms, and health-related trade associations. The Technical Writer collaborates with internal and external teams and subject matter experts (SMEs) to develop LTSS proposal responses that are compelling, compliant, and competitive. The Technical Writer facilitates the review and compilation of content and SME feedback during Color Team meetings (e.g., pink team, red team, gold team) for assigned LTSS sections, ensures content conveys appropriate win themes and messages, and incorporates proof and evidence into proposal responses to substantiate our client’s offering.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you tackle challenging and rewarding assignments. Sellers Dorsey offers market-competitive compensation that includes merit increases, paid holidays, Paid Time Off, and medical, dental, vision, short- and long-term disability benefits, 401(k) +match, life insurance, wellness programs, and financial education resources.

Responsibilities/Duties

Provides LTSS proposal writing support on client consulting engagements including:

Participate in procurement strategy sessions to help clients prepare for upcoming RFPs

Work with client’s SMEs to develop proposal content for Medicaid Managed Care procurements

Participate in proposal review process (e.g., pink team, red team, gold team) with client project team

Work with client’s SMEs to refine content throughout proposal review process

Ensures timely delivery of deliverables by establishing and adhering to proposal timelines and proactively engaging and communicating with proposal stakeholders

Provides other writing support and LTSS subject matter expertise on current client engagements:

Works with Sellers Dorsey Directors and staff to develop client deliverables (e.g., white papers, market research reports, strategic plans, presentation materials)

Reviews/edits client deliverables and presentations for internal project teams upon request

Strong writing, organization, critical thinking, problem solving, facilitation, and communication skills with an emphasis on LTSS programs. Adept at handling multiple priorities, prioritizing tasks, and meeting deadlines. Ability to effectively collaborate with others and work in teams.

Required Qualifications

Education and Work Experience:

Bachelor’s degree

5+ years of writing experience with expertise in LTSS programs in a professional business or government setting is required

3+ years of experience in Medicaid or other health care programs is required

Experience meeting deadlines is required

Experience in response preparation for government and commercial procurements is required

Experience or knowledge in Managed Care Organization operations preferred

Skills:

Demonstrated oral and written communication skills (writing exercise and/or samples will be required)

Immaculate attention to detail

Familiarity with the Shipley method

Highly efficient, flexible, and motivated

Proven group presentation and facilitation skills

Excellent analytical and organizational skills

Ability to work independently and in teams

Ability to manage multiple priorities while adhering to timelines and meeting all deadlines

Ability to exercise mature judgment to identify problems and offer solutions

Ability to interact professionally with team members and clients

Proficiency in Word, Excel, and PowerPoint

Able to work evenings and weekends as proposal schedule requires

Ability to travel 15%

Details

Core Behaviors and Competencies:

Build positive relationships within and outside the Firm

Treat clients, strategic partners and fellow employees with respect and professionalism in all interactions

Take ownership for one’s professional development by increasing knowledge, skills and abilities in areas that are critical to the Firm’s success

Collaborate and share knowledge with other Firm staff

Demonstrate formal and ad hoc team leadership in projects, issues or organizations that are critical to achieving the Firm’s strategic goals

Be self-motivated, and be an advocate for one’s abilities and talents, both internally and externally

Key Performance Metrics/Expectations:

Successful completion of deliverables, tasks, projects

Professional development

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Clipped from: https://us.trabajo.org/job-982-20220520-e42077c28cddfcc6d054d81d2f80f9ce?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Title: Senior Medicaid Business Analyst

Duration: 3+ Months

Location: Austin, TX (Locals to Texas only)

Note: Resumes will not be accepted from applicants outside of Texas***

The services to be provided include, but are not limited to the following:

• Analyzes program policies, procedures, and initiatives to determine the impact on business systems and functional areas.
  
• Analyzes and reviews complex project deliverables such as project charters, business user requirements, design documentation, test plans, and risk assessment plans to ensure business requirements are met.
  
• Acts as a Product Owner and liaison between State Staff and Vendors to translate operational and business requirements to vendors.
  
• Reports project statuses to management based on established timelines.
  
• Analyzes and writes User Stories with Acceptance Criteria based on business needs and according to the Agile methodology.
  
• Develops business user test scenarios and participates in systems and user acceptance testing.
  
• Identifies potential project risks and issues and develops mitigation strategies.
  
• Manages schedule for deliverables as established.
  

Minimum Requirements:

• 5 Years of Required Experience in requirements gathering and translating business needs into technical objectives and identifying solutions to satisfy the business need.
  
• 5 Years of Required Experience reporting project status to management including risks, issues, and key decisions.
  
• 5 Years of Required Experience identifying project risks and issues; and developing/implementing mitigation strategies.
  
• 5 Years of Required Experience in effective general written/oral communication, including documenting requirements, deliverables, test scenarios and project status.
  
• 5 Years of Required Experience utilizing business analysis skills and interacting with business end users and technical staff.
  
• 5 Years of Required Experience performing review and approval processes of complex technical user and system requirements written by vendors.
  
• 5 Years of Required Experience with Microsoft Office products (e.g., Word, Excel, etc.).
  
• 5 Years of Required Experience coordinating and developing test strategies and test scenarios.
  
• 5 Years of Required Experience with Microsoft Project or similar project management software.
  
• 5 Years of Required Experience utilizing the Agile methodology or other form of adaptive software development methodology.
  
• 5 Years of Required Experience working in a team environment.
  
• 5 Years of Required Experience with Medicaid systems and processes.
  
• 2 Years of Required Experience in claims processing.
  
• 4 Years of Preferred Knowledge of Texas Medicaid programs.
  
• 2 Years of Preferred Experience with long term care services.
  

 
 

Clipped from: https://www.ziprecruiter.com/c/Hireblazer/Job/Senior-Medicaid-Business-Analyst/-in-Austin,TX?jid=ae3a565eead0e124&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
Performs technical work in obtaining Medicaid/Social Security (SSI) insurance coverage for indigent patients to expedite reimbursement for medical services. Will take the patient through the entire Medicaid application process from application to award or denial. Will have authority to represent the Health Care System at each of the four levels of appeals when applications are denied.

***This position qualifies for a $5,000 commitment incentive, paid over a three (3) year commitment. Payment of $1,500 will be made within the first thirty (30) days of employment. The remaining will be paid after each six (6) month period of work completed. Learn more here:https://jobs.unchealthcare.org/pages/revenue-cycle-commitment-incentive-program***
 

Responsibilities:
1. Obtains detailed personal, financial and asset information to determine if patient qualifies for one of ten Medicaid/SSI programs. Completes or assists the patient with completion of Medicaid application. Explains the programs and advises patients of methods to become eligible by rearranging finances and assets. Follows through with applicants to obtain accurate and complete information within strict timeframes. Positions must have substantive knowledge of various rules and regulations governing the ten Medicaid programs. Interprets and applies frequent changes in program regulations to expedite applications.
2. Reviews denials from Medicaid/SSI and researches denial information with patients. Advocates for patient coverage with local and state Medicaid offices to obtain reversal of initial denial. Abstracts information, prepares appeals and represents UNC Health Care System in appeal hearings at local, state (Division of Medical Assistance), Office of Administrative Hearings, and state court to present supportive evidence for patients denial reversal
 

Other Information

Education Requirements:
● Associate’s degree in an appropriate discipline (or equivalent combination of education, training and experience).
Professional Experience Requirements:
● If an Associate’s degree: Two (2) years of experience in a social services or healthcare organization.
● If a High School diploma or GED: Four (4) years of experience in a social services or healthcare organization.
 

 
 

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services
 

Organization Unit: Medicaid Eligibility 

Work Type: Full Time
 

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Raleigh

Exempt From Overtime: Exempt: No

 
 

 
 

Clipped from: https://www.monster.com/job-openings/eligibility-specialist-medicaid-eligibility-raleigh-nc–5586b999-254d-485e-8d21-c9c7baabd8a3?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 

 
 

Job Description


Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.


**This is a remote based (work from home) role and can be based anywhere in the US.**


Aetna Medicaid is looking for a Medical Director to be part of a centralized team that supports the Medical Management staff ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request. Aetna operates Medicaid managed care plans in sixteen states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia and West Virginia. The Medical Director is a work-at-home position supporting the Aetna Medicaid line of business in these sixteen states, offering a variety of physical and behavioral health programs and services to its membership.


Required Qualifications


 

• 2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.
  
• Active and current state medical license without encumbrances
  
• M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience
  
  
  

COVID Vaccine Required :


Yes


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


 

• Health plan/payor experience.
  
• Electronic medical systems/record experience
  
• Managed Care experience
  
  
  

Education

• Active and current state medical license without encumbrances
  
• M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience
  
  
   
  

Clipped from: https://www.linkedin.com/jobs/view/medical-director-medicaid-at-cvs-health-3077250460/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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Public Consulting GroupConcord, NH

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• Overview About Public Consulting Group Public Consulting Group, Inc. (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives.
  
• Founded in 1986 and headquartered in Boston, Massachusetts, PCG has over 2,500 professionals in more than 60 offices worldwide.
  
• PCG’s Technology Consulting practice offers a full spectrum of quality Information Technology (IT) services to help state and local government agencies at every stage of the IT life cycle.
  
• Through its specialized IT services, PCG’s Technology Consulting team finds cost-effective ways to help agency partners deliver successful IT systems that enhance the lives of the user base.
  
• To learn more, visit Responsibilities Consultant/Analyst will provide a combination of Medicaid and Project Management expertise in monitoring project lifecycle implementations in waterfall, agile and/or hybrid methodologies and providing advisory services on best practices and problem remediation strategies.
  
• The incumbent will assess project status progress and quality in accordance with PMI standards as applied in the context of eligibility systems design, development, implementation, and operations.
  
• The successful candidate will have either state agency or vendor experience with state Medicaid eligibility systems which includes knowledge of eligibility programs and state options.
  
• Experience as an eligibility worker, supervisor, or state eligibility program or operations manager highly preferred.
  
• The Consultant will report to the team leader on project status through participation and observation of DDI activities in the requirements, construction, system integration testing, UAT, and go-live phases of DDi activites.
  
• Will contribute to deliverables and work products delivered by the by the team.
  
• These deliverables and work products will be completed in accordance with our overall strategy, approach, and methodology.
  
• Provides project management and technical expertise on large-scale IT projects
  
• Supports development of all deliverables, status reports and other work products
  
• Supports activities to plan and oversee all project work and develop/manage any potential organizational change management strategies or processes that might be needed
  
• Support the goals and outcomes of the project stakeholders
  
• Support Developing, managing, and updating Project Plan and other project documents (e.g., Communication Plan, Risk Plan, Stakeholder Register, Resource Plan)
  
• Support and or develop, manage, and update the execution of the Project Schedule to ensure project scope and applicable milestones are met
  
• Support or develop and deliver regular status reporting
  
• Identifies, tracks, and manages project risks; including coordination for risk mitigation
  
• Identifies, tracks, and manages project issues; including coordination for issue resolution
  
• Establish a response and track the response to project recommendations (e.g., Quality Assurance (QA) vendor recommendations)
  
• Provide ongoing communication (e.g., email, meetings) to provide project status
  
• Collaborate with the project’s Communication Manager to enhance communication efforts
  
• Review project and related operational processes and provide input for improvement by implementing relevant lean or agile strategies
  
• Conduct Agile Project Management and Organizational Change Management workshops Qualifications Required: •Direct experience with state Medicaid eligibility systems •State agency work experience with Medicaid, SNAP, TANF or other health and human service programs
  
• Self-directed and reports to the Engagement Manager
  
• 3+ years of prior project management experience using both Agile and Waterfall techniques in IT related projects to include operations, infrastructure, and application development projects
  
• Certified Scrum Master or PMI Agile Certified Practitioner certification
  
• QA / IV&V experience preferred
  
• PMI Project Management Professional certification #LI-AH1 #D-PCG #LI-remote EEO Statement Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion.
  
• We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences.
  
• At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications.
  
• We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law.
  
• PCG will not tolerate discrimination or harassment based on any of these characteristics.
  
• PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.
  
• Connect With Public Consulting Group!
  
• Public Consulting Group is an equal opportunity employer.
  
• All qualified applicants receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, protected veteran status, or status as a qualified individual with a disability.
  
• VEVRAA Federal Contractor.
  

 
 

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