Posted on

Nurse,Quality of Care Review/DC Medicaid Job Washington District of Columbia

 
 

Position:  Nurse, Quality of Care Review (DC Medicaid)
 

Resp &

Qualifications

PURPOSE:

 

The Quality of Care Nurse will effectively identify, prioritize and respond to high level grievances, complaints and complaint appeals from the member or member’s authorized representative for the Commercial or Medicare Advantage lines of business. The incumbent reviews and interprets the grievance or complaint, medical and dental records, narrative notes, in-patient/office policies and all documentation submitted or collected by the plan pertinent to the issue.

The incumbent will also understand the merits of legal and accreditation actions.

ESSENTIAL FUNCTIONS:

 

  • Reviews all member grievances or complaints and complaint appeals concerning the quality of care provided by facilities or practitioners. Contacts members, providers, or other parties involved, as appropriate, verbally and in writing to obtain additional information regarding the complaint. Reviews medical and dental claims information and records, and member and provider correspondence to conduct patient care investigations and renders an investigative finding.
  • Provides detailed written and/or verbal responses to members, providers, and authorized representatives upon completion of a thorough investigation. Responds to follow up questions or concerns with members, providers, and other parties involved in the investigation, as appropriate.
  • Prepares training materials and serves as the professional resource for all quality of care complaints and quality of care appeal complaints.
  • Conducts or participates in nursing research as appropriate. Completes medical research by defining and interpreting medical language, defining and interpreting medical procedures and medical/hospital office policies.
  • Assists with the preparation of regulatory reports by detailing and summarizing the merits of legal or accreditation actions.

QUALIFICATIONS:

 

Education Level:

Licenses/

Certifications:


 

RN – Registered Nurse – State Licensure And/or Compact State Licensure Practice in MD, DC, VA, WV.

Experience:

5 years Clinical experience in direct health care or health insurance payor setting working with quality reporting, or analytics.

Preferred

Qualifications:


 

  • 3 years’ experience in Quality Initiatives, Medical Review, Utilization Management gement or similar Managed Care organization or hospital preferred.
  • Working knowledge of NCQA standards.
  • Bachelor’s degree in Nursing.
  • Behavioral Health Experience.

Knowledge, Skills and Abilities

(KSAs)

  • Demonstrates excellent written and oral communication skills along with effective presentation skills.

    Able to provide verbal and written feedback for improvement. Must understand the appropriate mode of communication based on the subject matter.

  • Computer proficiency and technical aptitude with the ability to utilize MS Office (Excel, Word and Outlook) and web based technology.
  • Ability to exercise sound judgment in making critical decisions.
  • Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
  • Knowledge of patient rights and laws relative to those rights, such as HIPAA
  • Ability to effectively communicate and provide positive customer service to every internal and external customer
  • Proficient in standard medical practices and insurance benefit structures with the ability to use them in varied situration
  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.

    Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Department

Department: DC Medicaid – Enrollment Service

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please  to apply:

Closing Date

Please apply before: 4.16.2022

Federal Disc/Physical Demand

Note:

The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle l controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

#LI-LY1

 
 

Clipped from: https://www.learn4good.com/jobs/washington/district-of-columbia/healthcare/1188681104/e/

Posted on

Behavioral Care Advocate – Idaho Medicaid – Telecommute at UnitedHealth Group

 
 

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It’s an opportunity to do your life’s best work.(sm)

You have high standards. So do we. Here at UnitedHealth Group, this includes offering an innovative new standard for care management. It goes beyond counseling services and verified referrals to programs integrated across the entire continuum of care. That means you’ll have an opportunity to make an impact on a huge scale – as part of an incredible team culture that’s defining the future of behavioral health care.


You’ll enjoy the flexibility to telecommute
from anywhere within the U.S. as you take on some tough challenges.


Primary Responsibilities:


 

  • Oversee outpatient treatment for psychiatric and chemical dependency patients
  • Make patient assessments and determine appropriate levels of care
  • Administer benefits, review treatment plans, and coordinate transitions between various areas of care
  • Review service requests for pre authorizations
  • Obtain information from providers on outpatient requests for treatment

You’ll find the pace fast and the challenges ongoing. We’ll expect you to achieve and document measurable results. You’ll also need to think and act quickly while working with a diverse member population.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.


Required Qualifications:


 

  • Master’s degree in Psychology, Social Work, Counseling or Marriage or Family Counseling; OR Licensed Ph.D.; OR Registered Nurse
  • Professional license in the state of residency
  • 2+ years of experience in behavioral health

Preferred Qualifications:

 

  • Experience working in an environment that required coordinating benefits and utilizing multiple groups and resources for patients
  • Experience working with the Medicaid patient population
  • Outpatient and/or partial hospitalization experience
  • Dual diagnosis experience with mental health and substance abuse
  • Residential/inpatient services experience
  • Microsoft Teams Experience
  • Proficiency with Microsoft Office Suite programs (Word, Outlook, Internet)

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)


Colorado, Connecticut or Nevada Residents Only:
The salary range for Colorado residents is $54,400 to $97,000. The salary range for Connecticut / Nevada residents is $60,000 to $106,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.


All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action 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.


UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

 
 

Clipped from: https://www.themuse.com/jobs/unitedhealthgroup/behavioral-care-advocate-idaho-medicaid-telecommute-f87b29?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Utilization Review Registered Nurse (Medicaid Health Systems Specialist – RN) | Ohio Department of Medicaid

 
 

This position may be telework eligible on a hybrid basis; the selected applicant must complete the initial training period prior to being eligible to telework. All requests to telework are reviewed on a case-by-case basis and must be approved by ODM’s Chief Human Resources Officer.

About Us



The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. ODM is implementing the next generation of Ohio Medicaid to fulfill its bold, new vision for Ohio’s Medicaid program – focusing on the individual rather than the business of managed care.


The goals of the next generation of Ohio Medicaid are:


  • Emphasize a personalized care experience
  • Improve care for children and adults with complex behavioral health needs
  • Improve wellness and health outcomes
  • Support providers in better patient care
  • Increase program transparency and accountability


What You Will Do At ODM


Office: Legal Counsel


Bureau: Program Integrity


Classification: Medicaid Health Systems Specialist/RN (PN 20043106)


Job Overview


The Ohio Department of Medicaid (ODM) is seeking a Registered Nurse (RN) to be a part of our Surveillance/Utilization Review Section (SURS). SURS is charged with helping the agency review utilization of Medicaid services, detect fraud, waste and abuse and recover inappropriate payments to providers. As a Utilization Review RN, your responsibilities will include:


  • Reviewing clinical utilization of Medicaid services
  • Evaluating provider clinical compliance with state and federal Program Integrity rules
  • Evaluating provider medical documentation and billing practices for fraud, waste and abuse
  • Recovering overpayments for medically unnecessary services via administrative procedures and/or referrals to health oversight agencies
  • Responding to provider clinical reconsideration (appeal) requests
  • Consulting on clinical matters with ODM policy units and other state agencies
  • Coordinating clinical Program Integrity efforts with ODM contractors and managed care plans
  • Supporting hospital utilization review contract management
  • Presenting findings from clinical reviews of provider non-compliance
  • Responding to inquiries from the public, consumers, providers and other agencies


Must possess a current & valid license as registered nurse (RN) as issued by Ohio Board of Nursing, pursuant to Sections 4723.03 & 4723.09 of Ohio revised code.


The preferred candidate will take direction and work toward established goals, with high attention to detail and strong communication skills.


What’s In It For You


At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:


Medical Coverage


  • Quality, affordable, and competitive medical benefits are offered through the Ohio Med PPO plan.
     

Dental, Vision and Basic Life Insurance


  • Dental, vision and basic life insurance premiums are free after one year of continuous service.


Time Away From Work and Work/Life Balance


  • Paid time off, including vacation, personal, and sick leave
  • 11 paid holidays per year
  • Childbirth/Adoption leave


Ohio Public Employees Retirement System


  • OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of their salary towards their retirement. The employer contributes an amount equal to 14% of the employee’s salary. Visit the OPERS website for more information.
    Deferred Compensation


 
 

  • The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.
    Current & valid license to practice professional Nursing as a Registered Nurse (i. e., RN) in Ohio as issued by the Board of Nursing pursuant to Sections 4723.03 to 4723.09, inclusive of Ohio Revised Code; additional 24 months of experience in Nursing.


    Training & Development Required to Remain in Classification After Employment: Biennial renewal of license in practice as Registered Nurse per Section 4723.24 of Ohio Revised Code.


    Primary Location


    United States of America-OHIO-Franklin County-Columbus


    Work Locations


    Lazarus 4


    Organization


    Ohio Department of Medicaid


    Classified Indicator


    Classified


    Bargaining Unit / Exempt


    Bargaining Unit


    Schedule


    Full-time


    Work Hours


    8:00 a.m. – 5:00 p.m.


    Compensation


    $30.03/per hour


    Unposting Date


    May 27, 2022, 3:59:00 AM


    Job Function


    Nursing


    Job Level


    Individual Contributor


    Agency Contact Information


    HumanResources@medicaid.ohio.gov

 
 

 
 

Clipped from: https://www.linkedin.com/jobs/view/utilization-review-registered-nurse-medicaid-health-systems-specialist-rn-at-ohio-department-of-medicaid-3066161926/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Business Strategy Plan Director – Medicaid East Region in Raleigh, North Carolina

 
 

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? 

Location:  This is a Work-At-Home Opportunity, preferably from any of the Eastern States:  NY, NJ, MD, IN, KY, TN, GA, NC, SC, FL, and VA.  The selected candidate must be able to commute to the office as needed.

 
 

The Business Strategy Plan Director is responsible for business unit strategic planning and customer insight work. Primary duties may include, but are not limited to:

  • Understands all aspects of the business and partners with executive leadership to define strategy and success criteria for the future.
  • Translates strategy into defined tactics, programs/projects priorities, and timelines and ensures alignment and attainment of enterprise’s strategic plans to turn strategy into reality.
  • Documents strategic priorities such as external environment and reports on customer insight research initiatives.
  • Builds and leverages relationships to provide innovative solutions to complex business problems.
  • Proposes opportunities to improve results based on continuous needs assessment.
  • Responsible for the development implementation and monitoring of line of business planning and project activities.

Qualifications

Minimum Requirements: Requires a BA/BS degree in a related field and a minimum of 10 years of related experience including prior leadership experience and 3 to 5 years of strategic planning; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications, Skills, and Experiences:  Master’s degree preferred. Ability to travel may be required.

 
 

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 World’s 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.

 
 

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/9452830-business-strategy-plan-director-medicaid-east-region?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Analyst, Actuarial – Medicaid in Chicago IL USA – CVS Health

 
 

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.

 
 

Clipped from: https://www.recruit.net/job/analyst-actuarial-jobs/8A42D2300143B0FF?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Director State and Local CA Medicaid

 
 

Job Description

The KPMG Advisory practice is currently our fastest growing practice. We are seeing tremendous client demand, and looking forward we don’t anticipate that slowing down. In this ever-changing market environment, our professionals must be adaptable and thrive in a collaborative, team-driven culture. At KPMG, our people are our number one priority. With a wealth of learning and career development opportunities, a world-class training facility and leading market tools, we make sure our people continue to grow both professionally and personally. If you’re looking for a firm with a strong team connection where you can be your whole self, have an impact, advance your skills, deepen your experiences, and have the flexibility and access to constantly find new areas of inspiration and expand your capabilities, then consider a career in Advisory. KPMG is currently seeking a Director State and Local CA Medicaid in Customer & Operations for our Consulting practice. Responsibilities: Manage and deliver large, complex public services and state/local government engagements that identify, design and implement creative business and technology services for Medicaid government clients Develop and execute methodologies and solutions specific to the public sector and state/local government industry coupled with proven experience with Medicaid and MMIS modernization, with preference for prior work with large Medicaid programs in the western United States Handle engagement risk, project economics, planning and budgeting, account receivables and definition of deliverable content to help to ensure buy-in of proposed solutions from top management levels Develop and maintain relationships with many senior managements at state/local government agencies, positioning self and the firm for opportunities to generate new business Evaluate projects from a technical stance, helping to ensure that the development methods used are correct and practical; evaluate risks related to requirements management, business process definition, testing processes, internal controls, project communications, training and organizational change management Manage the day-to-day interactions with client managers Qualifications: Minimum ten years of recent experience in the Health and Human Services Medicaid solution delivery market, working for a commercial off-the-shelf (COTS) solution provider or consulting organization with a minimum of eight years of experience managing large, complex technology projects on the scale of a State Medicaid Maintenance Management Information System (MMIS) solution along with proven experience with Medicaid and MMIS modernization Bachelor’s degree of technical sciences or information systems from an accredited university or college Prior experience and has served in a team supervisory role on at least one MMIS implementation and one MMIS M&O engagement such as Program Manager, Module Project Manager, Solution Architect, Technical Solution Lead, or Quality/Testing Manager Demonstrated experience leading teams of more than twenty staff, including staff from diverse organizations to successfully implement and operate technology-based solutions; experience and relationships with states in the western United States preferred Hands-on experience with the Center for Medicare and Medicaid Services (CMS) Medicaid Information Technology Architecture (MITA), Medicaid Certification Lifecycle, associated toolkit and CMS checklists Capable of presenting Medicaid topics to large, varied audiences in either written or verbal presentation format and experience in working on customer proposals or deal capture teams in the State Medicaid market Travel may be up to 80-100% Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future KPMG LLP (the U.S. member firm of KPMG International) offers a comprehensive compensation and benefits package. KPMG is an affirmative action-equal opportunity employer. KPMG complies with all applicable federal, state and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other category protected by applicable federal, state or local laws. The attached link contains further information regarding the firm’s compliance with federal, state and local recruitment and hiring laws. No phone calls or agencies please. At KPMG, any partner or employee must be fully vaccinated or test negative for COVID-19 in order to go to any KPMG office, client site or KPMG event. In some circumstances, individuals who are not fully vaccinated may also be required to have a reasonable accommodation to not be fully vaccinated for COVID-19.

 
 

Clipped from: https://b-jobz.com/us/web/jobposting/3085895032?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Medicaid Regulatory Analyst at HCSC

 
 

POSITION IS FOR THE CHICAGO OFFICE, WITH A HYBRID/FLEX WORK SCHEDULE

Project Management (not IT related), Utilization Management, Care Management PREFERRED


BASIC FUNCTION:

This position is responsible for monitoring Medicaid and related regulations and policy changes impacting operations; participating in audits; supporting tracking and submission of Medicaid State Contract(s) related deliverables, including fulfillment of internal and contractual reporting requirements; working with other areas of the organization on the development, testing and implementation of organization, process and system changes to ensure the requirements of the Medicaid program are met; and assisting MCO in coordination of the contract with the State/CMS enterprise-wide.

JOB REQUIREMENTS:


Bachelor Degree in Business OR 2 years experience with health insurance.

1 year of experience with health insurance benefits and/or operations.
Knowledge of Medicaid and Medicare product(s).
Verbal and written communication skills.
Experience presenting trends and findings in meetings with management.
Experience organizing multiple tasks and responsibilities.
Experience analyzing data reports.
Experience developing and running queries in a database.
PC proficiency to include Microsoft Word, Excel, PowerPoint, and Outlook.

#LI-Hybrid

CB
DICE 14
CA


Relocation assistance will not be provided for this position.
Sponsorship will not be provided for this position.

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.


Requirements:

Expertise Government Programs, Regulatory & Compliance Job Type Full-Time Regular Location IL – Chicago

 
 

 
 

 
 

Clipped from: https://www.themuse.com/jobs/hcsc/medicaid-regulatory-analyst-2f945a?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

CMS- Health Insurance Specialist (Data Analysis and Studies)

 
 

Department of Health And Human Services
Policy and Programs Group (PPG)

COVID-19 Vaccination Requirement

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

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI), Policy and Programs Group (PPG).


As a Health Insurance Specialist (Data Analysis and Studies), GS-0107-11/12, you will perform limited data analysis related to national health insurance programs, such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), Marketplace Exchange/private health insurance.

Learn more about this agency

Help

Overview

  • Accepting applications

 
 

  • Open & closing dates

05/12/2022 to 05/26/2022

  • Salary

$74,950 – $116,788 per year

  • Pay scale & grade

GS 11 – 12

Location

Yes—as determined by the agency policy.

  • Travel Required

Not required

  • Relocation expenses reimbursed

No

  • Appointment type

Permanent

  • Work schedule

Full-time

  • Service

Competitive

  • Promotion potential

12

  • Job family (Series)

0107 Health Insurance Administration

  • Supervisory status

No

  • Security clearance

Not Required

  • Drug test

No

  • Position sensitivity and risk

Non-sensitive (NS)/Low Risk

  • Trust determination process

Credentialing

Suitability/Fitness

  • Announcement number

CMS-CMMI-22-11495501-ST

  • Control number

653967100

Videos


Help

Duties

  • Serves as a Health Insurance Specialist and designs, plans and conducts data and/or research studies concerning the trends and Impact to CMS programs.
  • Prepares and performs data studies that identify complex trends and outlines the potential impact to CMS programs.
  • Prepares analysis of organizational priorities related to healthcare and/or healthcare administration.
  • Conducts analysis of policy issues and topics, research background information, the origin of laws of laws, and the intended impact in order to make effective policy recommendations.

Help

Requirements

Conditions of Employment

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

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.


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


In order to qualify for the GS-11, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-09 grade level in the Federal government, obtained in either the private or public sector), to include: 1) Conducting data studies to identify trends in health insurance program or healthcare administration; AND 2) Conducting data studies related to a specific subject; AND 3) Using applications such as SAS/STATA/R/Python and database management systems, such as SQL to prepare summary reports based on analysis that provide metrics for decision makers.

– OR –

Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing 3 full years of progressively higher level graduate education leading to such a degree or Ph.D. or equivalent doctoral degree or LL.M., if related to the position being filled.
– OR –
Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at the grade GS-11. Therefore, only education in excess of a master’s or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree, may be used to combine education and experience.


TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see “Required Documents” section below for what documentation is required at the time of application.


In order to qualify for the GS-12, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-11 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Planning data studies to evaluate the effectiveness of health insurance program initiatives; AND 2) Contributing to data studies of operation procedures to recommend solutions to policy issues; AND 3) Utilizing applications such as SAS/STATA/R/Python and database management systems, such as SQL to prepare data into reports, charts, graphs or other formats to reflect to outcome of analysis.


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


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


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


Time-in-Grade: To be eligible, current or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.


Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11495501

Additional information

Bargaining Unit Position: Yes

Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized

Financial Disclosure: Not Required

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



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


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


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

Read more

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

Review our benefits

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

How You Will Be Evaluated

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

Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with any interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.


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


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


  • Decision Making
  • Problem Solving
  • Research
  • Written Communication

 
 

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

Review our benefits

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

  • As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have – whether you’re a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you’re eligible under their policies.

The following documents are REQUIRED:


1. Resume
showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


3. College Transcripts. Although this position does not require a degree, you may substitute college credit in whole, or in part, for experience at specified grade levels. You must submit a copy of your transcript at the time of application in order to substitute your education for the required experience. If you do not submit a transcript, your education will not be considered in determining your qualifications for the position. You may submit an unofficial transcript or a list of college courses completed indicating course title, credit hours, and grades received. An official transcript is required if you are selected for the position.


College Transcripts and Foreign Education: Applicants who have completed part or all of their education outside of the U.S. must have their foreign education evaluated by an accredited organization to ensure that the foreign education is comparable to education received in accredited educational institutions in the U.S. For a listing of services that can perform this evaluation, visit the National Association of Credential Evaluation Services website. This list, which may not be all inclusive, is for informational purposes only and does not imply any endorsement of any specific agency.


PLEASE NOTE: A complete application package includes the online application, resume, transcripts (if qualifying through education substitution or a combination of education and experience) and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume, transcripts (if applicable) and CMS required documents, will result in you not being considered for employment.


Additional Forms REQUIRED Prior to Appointment:

  • Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
  • Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
  • Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.

If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.

If you are relying on your education to meet qualification requirements:

Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

  • Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 05/26/2022 to receive consideration.


    IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.


    We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:

 
 

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month and year (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.

  • To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  • Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
  • After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
  • You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.

To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to ashton.bundy1@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

Agency contact information

Ashton Bundy

Email

ashton.bundy1@cms.hhs.gov

Address

Center for Medicare and Medicaid Innovation
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

Once your online application is submitted, you will receive a confirmation notification by email. Your application will be evaluated to determine your eligibility and qualifications for the position. After the evaluation is complete, you will receive another email notification regarding the status of your application.


Within 30 business days of the closing date,05/26/2022, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

  • The Federal hiring process is setup to be fair and transparent. Please read the following guidance.

 
 

Help

Required Documents

The following documents are REQUIRED:


1. Resume
showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


3. College Transcripts. Although this position does not require a degree, you may substitute college credit in whole, or in part, for experience at specified grade levels. You must submit a copy of your transcript at the time of application in order to substitute your education for the required experience. If you do not submit a transcript, your education will not be considered in determining your qualifications for the position. You may submit an unofficial transcript or a list of college courses completed indicating course title, credit hours, and grades received. An official transcript is required if you are selected for the position.


College Transcripts and Foreign Education: Applicants who have completed part or all of their education outside of the U.S. must have their foreign education evaluated by an accredited organization to ensure that the foreign education is comparable to education received in accredited educational institutions in the U.S. For a listing of services that can perform this evaluation, visit the National Association of Credential Evaluation Services website. This list, which may not be all inclusive, is for informational purposes only and does not imply any endorsement of any specific agency.


PLEASE NOTE: A complete application package includes the online application, resume, transcripts (if qualifying through education substitution or a combination of education and experience) and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume, transcripts (if applicable) and CMS required documents, will result in you not being considered for employment.


Additional Forms REQUIRED Prior to Appointment:

  • Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
  • Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
  • Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.

If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.

If you are relying on your education to meet qualification requirements:

Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

Help

How to Apply

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 05/26/2022 to receive consideration.


IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.


We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month and year (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.

  • To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  • Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
  • After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
  • You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.

To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to ashton.bundy1@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

Read more

Agency contact information

Ashton Bundy

Email

ashton.bundy1@cms.hhs.gov

Address

Center for Medicare and Medicaid Innovation
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

Once your online application is submitted, you will receive a confirmation notification by email. Your application will be evaluated to determine your eligibility and qualifications for the position. After the evaluation is complete, you will receive another email notification regarding the status of your application.


Within 30 business days of the closing date,05/26/2022, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

Read more

 
 

Clipped from: https://www.usajobs.gov/job/653967100?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

External Auditor 2 | Ohio Department of Medicaid

 
 

This position may be telework eligible on a hybrid basis; the selected applicant must complete the initial training period prior to being eligible to telework. All requests to telework are reviewed on a case-by-case basis and must be approved by ODM’s Chief Human Resources Officer.

About Us



The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. ODM is implementing the next generation of Ohio Medicaid to fulfill its bold, new vision for Ohio’s Medicaid program – focusing on the individual rather than the business of managed care.


The goals of the next generation of Ohio Medicaid are:


  • Emphasize a personalized care experience
  • Improve care for children and adults with complex behavioral health needs
  • Improve wellness and health outcomes
  • Support providers in better patient care
  • Increase program transparency and accountability


What You Will Do At ODM


Office: Legal Counsel


Bureau: Program Integrity


Classification: External Auditor 2 (PN: 20042207)


Job Overview


The Ohio Department of Medicaid is seeking an audit professional to be part of our Bureau of Program Integrity. This position focuses on the prevention and detection of fraud, waste, and abuse. This position is in Franklin County and may require travel. As an External Auditor 2, your responsibilities will include:


  • Monitoring Medicaid providers for compliance through onsite and desk reviews
  • Audits and onsite reviews may include a variety of providers and partner state agencies and may have a higher concentration of effort with specific provider/agency types for certain periods depending on data analysis, risk assessment, known issues, changes in regulations, industry trends and/or overall complexity of the audits or reviews
  • Participating in monitoring efforts coordinated with other ODM or non-ODM teams
  • Working independently or collaboratively with bureau staff (e.g., reviewing provider payment claims and data related to payments or individual care)
  • Assisting with provider education and working collaboratively with other affected ODM bureaus
  • Handling confidential records and information, and using a variety of tools to analyze and understand relevant data


What’s In It For You


At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:


Medical Coverage


  • Quality, affordable, and competitive medical benefits are offered through the Ohio Med PPO plan.
     

Dental, Vision and Basic Life Insurance


  • Dental, vision and basic life insurance premiums are free after one year of continuous service.


Time Away From Work and Work/Life Balance


  • Paid time off, including vacation, personal, and sick leave
  • 11 paid holidays per year
  • Childbirth/Adoption leave


Ohio Public Employees Retirement System


  • OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of their salary towards their retirement. The employer contributes an amount equal to 14% of the employee’s salary. Visit the OPERS website for more information.
    Deferred Compensation


 
 

  • The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.Completion of undergraduate core coursework in accounting, business administration, computer science or related field; 24 mos. exp. in auditing or accounting which must have included 12 mos. auditing exp. in accordance with auditing standards or in accordance with prescribed management policies &/or procedures as specified on agency position description.


     
     

  • Or 4 yrs. exp. in auditing or accounting which must have included 2 yrs. auditing exp. in accordance with auditing standards or in accordance with prescribed management policies &/or procedures as specified on agency position description.
  • Or 12 mos. exp. as External Auditor 1, 66461.
  • Or equivalent of Minimum Class Qualifications for Employment noted above.


     
     

     
     

    Clipped from: https://www.linkedin.com/jobs/view/external-auditor-2-at-ohio-department-of-medicaid-3066168257/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Title IV-E Medicaid Eligibility Specialist (DCFS), Ogden | State of Utah

 
 

Job Description


Move forward in your career by applying for a Title IV-E Medicaid Eligibility Specialist for the Child & Family Services (DCFS) Ogden office! You’ll be working together with a team in administrative support services to achieve safety, well-being, and permanency for abused or neglected children; and success in providing services for families in our communities.


Principle Duties


They Also Achieve Success By Performing The Following Tasks


A Title IV-E Medicaid Eligibility Specialist works independently managing cases in an accurate and timely manner by collecting information required for Title IV-E and Medicaid eligibility for children in foster care, applying Title IV-E and Medicaid policy, procedure, and rules to determine eligibility, reviewing cases for continued coverage, entering data into relevant databases, and maintaining records. They are also responsible for Subsidized Adoption Medicaid, which includes subsidized adoption determinations, maintaining case files, and medical mileage reimbursement. They obtain documentation from caseworkers and other valid sources for verification of eligibility criteria; consult with Division staff regarding eligibility requirements and refer children/families to DWS for Medicaid application when the information indicates the family may be eligible for Medicaid or when children return or remain home.


  • Conducting eligibility reviews and updating case information when necessary.
  • Entering data into relevant database such as EREP, MMIS, and SAFE to ensure the availability of health care coverage and appropriate collection of funding for services.
  • Issuing medical cards.
  • Maintaining accurate and complete documentation in the case record to support eligibility.
  • Processing eligibility and adoption agreements for children who are receiving adoption assistance or processing eligibility for interstate placement for foster care or adoption assistance.
  • Referring clients to other available services to meet needs where appropriate.
  • Using MMIS (Medicaid Management Information System).
  • Using SAFE (i.e., State social services computer application program).
  • Using EREP (State benefit program).


Ideal Candidate


The model candidate for this position is someone who is:


  • A current employee of the State of Utah.
  • Detail oriented.
  • Organizationally sound.
  • Adept at communicating effectively, clearly, and concisely both verbally and in writing, in a manner which shows sensitivity, tact, and professionalism.
  • Strongly committed to providing excellent customer service.
  • Able to weigh relative costs and benefits of a potential action.
  • Accomplished in practicing great people skills.


Preference


Preference May Be Given To Candidates Who


  • Are current State employees
  • Have experience in or knowledge of Title IV-E and Medicaid
  • Have two years or more experience working in government or public programs
  • Have excellent accuracy in using Microsoft Word and Google


Why You Should Join Our Team


Be an integral part of DCFS working together to keep children safe and strengthen families in our communities. Experience a sense of accomplishment for a job well done and enjoy work life balance! We offer great health benefits and retirement plans, generous paid time off, and a balanced work schedule to afford quality time spent with your family. Click here to see what makes working for the State of Utah awesome: Compensation & Benefits.


The Agency


Contribute to our communities and proactively support the Division of Child and Family Services by helping us keep children safe and strengthen families. DCFS CLICK HERE

 
 

Clipped from: https://www.linkedin.com/jobs/view/title-iv-e-medicaid-eligibility-specialist-dcfs-ogden-at-state-of-utah-3071589396/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic