Category: Curator- Job Hunter

 
 

Summary

The Insurance / Healthcare job family contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare.

Develops and implements general insurance and health policies in accordance with state and federal laws. Responds to provider and member concerns resolve problems / issues.

Provides directions for utilization review. Ability to collaborate with, state officials and with organized healthcare groups and associations on various Medicaid member issues related to benefits and data maintenance.

Responsibilities :

• Effectively manage a team of 10 Member Eligibility Specialists
  
• Preform and manage administrative duties such as employee performance, training, evaluations, corrective actions and time management.
  
• Provide ongoing internal customer support for process questions and problems.
  
• Oversee operational support for an internal update platform to facilitate member file maintenance.
  
• Interact and foster a good working relationship with the client as well as Department of Family and Children Services (DFCS)
  
• Manage Medicaid member-related business support responsibilities, which include production monitoring, file maintenance, ad hoc reporting, and consultation with internal and external users.
  
• Develop analytical skills and increases applications knowledge within the team and lead efforts to develop department core competencies, execute cross training, and implement succession plan.
  
• Review data and make independent decisions.
  
• Applies extensive knowledge of business unit processes to support requirements of business unit.
  
• Ensures customer satisfaction by handling unique and difficult situation / projects under minimal direction in a timely and quality manner.
  
• Able to resolve / recommend action on most issues.
  
• Handle escalated issues from customers with minimal assistance.
  
• Ability to design and implement training programs for internal and external customers.
  
• Serve as liaison between client and account staff with regard to training and education.
  

Education and Skills

Education and Experience Required :

• Minimum bachelor’s degree and 2 years of supervisory experience managing at least 4 people (additional supervisory experience may substitute for the degree on a year-for-year basis).
  
• Typically, 5-8 years of working experience.
  

Knowledge and Skills :

• HIPAA security policies and procedures
  
• Strong level of understanding and application of healthcare related technologies.
  
• In-depth knowledge and experience with project management, research and problem resolution techniques.
  
• Ability to plan and meet deadlines for complex projects / issues with knowledge to others.
  
• Subject matter expert regarding policies and procedures.
  
• Ability to research and resolve customer and leader inquiries by identifying trends and utilizing available resources.
  
• Self-motivated with strong time management and organizational skills.
  
• Provide assistance to team and peers.
  
• Working knowledge of Avaya Contact Center Manager System a plus but not required
  

Work Environment

• Office Environment
  

Clipped from: https://www.talent.com/view?id=a3d16b309541&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Requisition ID

 
 

20048174

 
 

Category

 
 

Sales/Pre-Sales

 
 

Travel Requirements

 
 

25%

What we do  

 
 

We’re the leader in analytics. Through our software and services, we inspire customers around the world to transform data into intelligence. Our curiosity fuels innovation, pushing boundaries, challenging the status quo and changing the way we live. 

 
 

What you’ll do

 
 

We’re looking for a Principal Industry Consultant in Medicaid Operations and Enterprise Systems, with experienced managing in multiple program areas and divisions, a broad understanding of the mechanics, drivers and goals of Medicaid agencies today and in the future. 

 
 

You will act as a subject matter expert, providing business and high-level technical support for pre-sales activities for SAS’ Medicaid EDW/Analytics solutions as part of a team of other subject-matter experts across government and health care programs. 

 
 

This is hands on work, proposal writing, customer presentations, and support during project implementation.  It is also deeply connected work with our customers and stakeholders, including speaking at conferences, testifying before legislatures, boards and commissions, and working directly with customers from the line level to top executives and elected officials before and after purchasing.

 
 

You will be expected to develop an understanding of SAS solutions and how they can solve Medicaid challenges ranging from access and equity to quality of care and cost effectiveness as well as program integrity through the applied use of analytics, data management and business intelligence. 

 
 

You’ll work as part of a team supports a broad range of programs in dealing with their challenges, including customer work within Medicare/Medicaid and other government benefits programs (e.g. SNAP, TANF, WIC), taxation, unemployment, worker’s compensation, procurement, audit and/or oversight of general government programs, and more. 

 
 

We are seeking a person with experience and passion with direct experience working with these types of people, either directly, or through consulting, and one who will complement the opportunities we are pursuing as well as the broader skill sets of the team. 

 
 

Your role would have you doing the following types of activities:

 
 

• Serve as a broad subject matter expert on Medicaid operations, guiding efforts with the sales and pre-sales organizations to develop account approaches, craft and deliver client presentations and key capability demonstrations.
  
• Participate in capture process activities to help in pre-solicitation strategy, intelligence gathering and positioning.
  
• Support written proposal development and subsequent orals presentations, as well as contract negotiations.
  
• Support the development of marketing materials and SAS sales training
  
• Demonstrate SAS’ experience and leadership through authoring publications, speaking at industry events, participating in work groups and being active in social media channels
  
• Engage with various levels of government officials to impact policy and promote proper use of analytics and data in Medicaid modernization and program integrity efforts.
  
• Provide subject matter expertise and guidance to customers and SAS implementation staff or partners during solution implementations.
  

 
 

What we’re looking for: 

• Seven (7) years or more of experience in Medicaid operations across multiple programs or divisions
  
• Experience in writing Requests for Proposals (RFPs) and evaluating RFP responses
  
• Public speaking experience, including national Medicaid/industry conferences, and testimony before legislative bodies
  
• Experience presenting complex ideas and concepts to department/agency heads or senior government executives
  
• Strong verbal, written and interpersonal communication skills
  
• Ability to work and learn independently and as part of a team
  
• Ability to travel domestically and internationally as business needs require (avg. 25+%) 
  
• Location: Remote, home-based within continental U.S.
  

Desirable

• Experience in program integrity or cost containment efforts in Medicaid
  
• Experience responding to Requests for Proposal (RFP’s) and other forms of government procurements to include (a) developing win themes, (b) writing content, (c) conducting structured reviews, and (d) participating in orals presentations and technical demos.
  
• Familiarity and understanding of business intelligence and analytics to further program goals and improve outcomes
  
• Extensive network of contacts throughout Medicaid agencies at a national level, fostered from conferences and shared work group participation.
  
• Experience in working with the Centers for Medicare and Medicaid Services (CMS) on policy, administrative, and certification
  
• Pre-solicitation capture process familiarity
  

 
 

Why SAS

• We love living the #SASlife and believe that happy, healthy people have a passion for life, and bring that energy to work. No matter what your specialty or where you are in the world, your unique contributions will make a difference. 
  
• Our multi-dimensional culture blends our different backgrounds, experiences, and perspectives. Here, it isn’t about fitting into our culture, it’s about adding to it – and we can’t wait to see what you’ll bring.
  

 
 

Additional Information:

 
 

SAS is an equal opportunity employer. All qualified applicants are considered for employment without regard to race, color, religion, gender, sexual orientation, gender identity, age, national origin, disability status, protected veteran status or any other characteristic protected by law. Read more: Equal Employment Opportunity is the Law. Also view the supplement EEO is the Law, and the Pay Transparency notice. 

 
 

Equivalent combination of education, training and experience may be considered in place of the above qualifications. The level of this position will be determined based on the applicant’s education, skills and experience. Resumes may be considered in the order they are received. SAS employees performing certain job functions may require access to technology or software subject to export or import regulations. To comply with these regulations, SAS may obtain nationality or citizenship information from applicants for employment. SAS collects this information solely for trade law compliance purposes and does not use it to discriminate unfairly in the hiring process.

 
 

In order to work at SAS, you must be fully vaccinated against COVID-19. If there is a medical or religious reason preventing you from receiving an available COVID-19 vaccination, and you are selected as a candidate for consideration, we have an accommodations process in place to evaluate those requests.

 
 

All valid SAS job openings are located on the Careers page at www.sas.com. SAS only sends emails from verified “sas.com” email addresses and never asks for sensitive, personal information or money. Should you have any doubts about the authenticity of any type of communication from, for, or on behalf of SAS, please contact us at Recruitingsupport@sas.com before taking any further action.

 
 

Want to stay up to date with life at SAS, products and jobs? Follow us on LinkedIn 

 
 

From <https://careers-sas.icims.com/jobs/28476/principal-industry-consultant%2c-medicaid-operations—remote/job?iis=Social+Networks&iieid=po164850112463421e6d&in_iframe=1&mobile=false&width=1170&height=500&bga=true&needsRedirect=false&jan1offset=-360&jun1offset=-300>

 
 

 
 

 
 

 
 

Clipped from: https://careers-sas.icims.com/jobs/28476/principal-industry-consultant%2c-medicaid-operations—remote/job?iis=Social+Networks&iieid=po164850112463421e6d&mobile=false&width=1170&height=500&bga=true&needsRedirect=false&jan1offset=-360&jun1offset=-300

Get access to My SAS, trials, communities and more.

 
 

Job Description

UnitedHealthcare is a company that’s on the rise. We’re expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn’t about another gadget, it’s about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life’s best work.(sm) This position provides leadership for the Community and State Health Plans Medicaid products in their assigned market to support continued growth and innovation. The position is a member of the health plan senior leadership team and will work collaboratively with the CEO, COO and CFO to ensure overall strategies are aligned with the market level business objectives. This position will oversee the Medicaid community agenda and field-based outreach teams to develop market leading provider and community engagement to forge solid external relationships. This position is responsible for forecasting and has accountability in achieving growth (Acquisition and retention) targets. This is an external and internal facing role. If you are located in NC, you will have the flexibility to telecommute as you take on some tough challenges. This position has to be located in the state of North Carolina. The preferred location is the Greensboro, NC office. Telecommuters that live in the state of North Carolina will also be considered. Primary Responsibilities: Develop and execute and continually update overall strategies for Medicaid product offering to maximize product growth, member retention, innovation and member and provider experience Drive smart Growth in membership and market share in designated market by developing solid relationships across segments and departments (Network, marketing, clinical, quality, finance) Lead, develop and uphold accountability of Medicaid products forecasting models with complete understanding of Auto assignment algorithms, eligibility requirements, self-select, and involuntary vs voluntary term ratios Manage local Medicaid field-based outreach teams and work directly with M&R regional sales leaders to leverage DSNP Outreach strategies and teams across segments Able to flex strategies to address local market nuances and unique requirements to assure that we are keeping healthcare “local” while maintaining a solid presence in the market Partner with local and functional teams to assure appropriate health plan benefit design and value-added services Formulate impactful relationships that drive engagement with community-based organizations and faith-based organizations Develop and implement provider engagement strategies (including Field-based approaches and face to face visits Providers) in partnership with Network partners that specifically focuses on membership growth and retention and making UHC the insurer of choice for UHC Lead and provide oversight for the Field community outreach team that orchestrates member events, potential consumer events, and community-based goodwill and general awareness that make UHC the insurer of choice Manage and uphold accountability for marketing, sponsorship and outreach budgets Represent the Health Plan at State meetings, community events, and media relations; Assist in developing new county expansions for existing Medicaid; Assist in implementing future product opportunities Ensure compliance to health plan State contract for MCO functions entailing Marketing, Communications, Engagement with Community Based Providers and Provider Network and outreach activities Lead and develop top field talent in designated markets, while creating bench strength and opportunities for professional growth within the team 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: Bachelor’s degree 5 years people management experience Experience working in Managed Care Experience building analytical skills including generating ROI, business case forecasting and growth opportunities Proven track record developing and deploying market strategies Preferred Qualifications: Master’s degree (MPA / MBA) Active health license Familiar with possible Medicaid referral sources (i.e. CBOs, providers, etc.) Bi-lingual Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance 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 at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That’s why you’ll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life’s best work.(sm) 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://b-jobz.com/us/web/jobposting/3012104891?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description
This position is for Training Delivery related to Member Services, Provider Relations and CICR. As a Trainer you will be responsible for developing and delivering training sessions to a uniquely defined designated audiences of learners. You will also collaborate with local leadership and national curricula design teams to ensure the successful development and transfer of learning from the classroom back to the job.

Additional responsibilities:
– Oversee the classroom environment for long-term and complex training situations, managing all aspects of student performance and feedback to management
– Perform performance analysis with business leaders to identify performance gaps, appropriate training interventions, and other variables required to improve business performance
– Revise and customize national curriculum to reflect unique geographic, product and/or audience variations
– Lead training sessions for designated audiences
– Initiate & participate in the administrative process of Aetna’s performance management processes in hew hire situation with appropriate business/educational management
– Work with local business leaders to align the performance variables required to transfer learning back to the job
– Assess the effectiveness of training programs during and at designated intervals after delivery
– Develop and conduct follow-up assessments to determine the effectiveness and, when appropriate, ROI of training programs
– Provide feedback from program participants and local business leaders back to national curriculum design and development organization(s)
– Participate in the development effort to enhance the curricula based on that feedback

Required Qualifications
1+ years experience in member services, provider relations
Must be able to travel up to 25%

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
Medicaid, Medicare or health insurance experience
Able to manage multiple tasks
Experienced in Microsoft products
Familiar with use of Webex, Zoom, etc.

Education
Associates degree, required

Bachelor’s degree, preferred

Business Overview
Bring your heart to CVS Health
Every 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.themuse.com/jobs/cvshealth/medicaid-training-delivery?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Share Job

Suggest Revision

CareFirst BlueCross BlueShieldColumbus, OH

Apply Now

• PURPOSE:The Population Health Strategy Consultant works closely with internal and external customers in CareFirst Community Health Plan District of Columbia to perform regulatory, accreditation and contractual oversight on quality.
  
• The Consultant collaborates with internal subject matter experts of relevant departments and stakeholder to provide consulting and advisory services to achieve program or contract goals.
  
• Performance Transformation: Employs consulting skills to manage behavior change and influence work flow improvements that optimize outcomes and value.
  
• Thoughtfully implements processes and technologies in business processes to assure the highest state of quality performance.
  
• Manages and track the risks associated with each requirement.
  
• Conducts a thorough review of stakeholders’ opportunities, data patterns, and outcomes to inform business decision making.
  
• Researches any variances and seeks resolution.
  
• Proactively manage the impact of proposed changes in performance patternsEffective Communication and Stakeholder Management: Builds and manages relationships with internal and external stakeholders.
  
• Identifies opportunities to improve the compliance of requirements and quality performance.
  
• Conduct proper education and training to the stakeholders to continuously foster the culture of quality.
  
• Facilitate relevant quality committees to ensure the effectiveness of quality governance structure.
  
• Active participation in best practice development and knowledge sharing, team activities, and administrative functions.
  
• Education Level: Master’s Degree in Public Health, Health Administration, Business Administration, or related field OR In lieu of a Master’s degree, an additional 6 years of relevant work experience is required in addition to the required work experience.
  
• Experience: 2 years health care experience.
  
• Consulting skills and/or direct experience in a consulting role.
  
• Experience in a clinical setting or knowledge in a clinically related field.
  
• Project management experience.
  
• Experience using Client Relationship Management (CRM) System(s).
  
• Knowledge, Skills and Abilities (KSAs)Demonstrated ability to effectively comprehend complex data analysis.
  
• Executive presentation skills.
  
• Effective written and interpersonal communication skills.
  
• Effective at building relationships with various levels of business professionals and/or clinicians.
  
• 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.
  
• DC Medicaid – QualityEqual 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 visit our website to apply: www.
  
• carefirst.com/careersFederal 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.
  
• 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 or feel small controls and objects.
  
• The associate must frequently talk and hear.
  
• Weights up to 25 pounds are occasionally lifted.
  

 
 

Clipped from: https://jobsearcher.com/j/population-health-strategy-consultant-dc-medicaid-at-carefirst-bluecross-blueshield-in-columbus-oh-eJ7lBQq?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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 evolving, high-performance culture that empowers you to make an impact?


LOCATION: This is a remote work-from-home position in Ohio. Ohio residency is required.


HOURS: General business hours, Monday through Friday. Occasional evening or weekend hours may be required to meet business needs.


Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning.


Primary Duties May Include, But Are Not Limited To

• Ensures member access to services appropriate to their health needs.
  
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
  
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
  
• Coordinates internal and external resources to meet identified needs.
  
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
  
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
  
• Negotiates rates of reimbursement, as applicable.
  
• Assists in problem solving with providers, claims or service issues.
   
  

Qualifications


Required Qualifications

• Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
  
• Current active unrestricted RN license from the state of Ohio.
  
  
  

Preferred Qualifications

• Previous case management or care management experience.
  
• Home health and/or discharge planning experience.
  
• Previous Medicaid or Medicare experience.
  
• AS or BS in nursing.
  
• Certified Case Manager.
  
• Prior experience working remotely.
  
• Virtual training/learning 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 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://www.linkedin.com/jobs/view/rn-nurse-case-manager-i-medicaid-at-anthem-inc-3012859122/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description

Supplemental Information

This position is located within the Louisiana Department of Health / Medical Vendor Administration / Eligibility Field Operations / Rapides Parish Announcement Number: MVA/PJ/154295 Cost Center: 305-2050400 Position Number(s): 50380809 This vacancy is being announced as a Classified position and may be filled as a Probationary or Promotional appointment.

Applicants must have Civil Service test scores for 8100-Professional Level Exam in order to be considered for this vacancy unless exempted by Civil Service rule or policy.

If you do not have a score prior to applying to this posting, it may result in your application not being considered.

Applicants without current test scores can apply to take the test here.

Working Job Description:

The Specialized Operations & Support Medicaid Analyst (MA) is a position responsible for acquiring extensive knowledge of Medicaid policy and procedures and using same to make timely and accurate Medicaid eligibility determinations.

The MA is responsible for providing eligibility assistance to members and applicants in the manner of their choosing which may be electronic, by mail, by email, in person, or most often by phone.

This position requires competency of web-based programs.

Work conditions are primarily sedentary on a computer.

The MA will also be required to reach out to applicants and enrollees by phone.

The ideal candidate is an individual who works independently, is detail-oriented, has excellent customer service skills, can perform routine activities, is attentive to deadlines, and is a team player.

Projects in the Specialized Operations & Support Unit frequently change to meet agency goals, adaptability is key.

Medicaid eligibility is fundamental to the overall Medicaid program, and mastery of eligibility policy and procedure may provide a path for career growth in the health insurance field.

As part of a Career Progression Group, vacancies may be filled from this recruitment as a

Medicaid Analyst

1 or 2

depending on the level of experience of the selected applicant(s).

The maximum salary for the

Medicaid Analyst

2 is

$57,179

.

Please refer to the ‘Job Specifications’ tab located at the top of the LA Careers ‘Current Job Opportunities’ page of the Civil Service website for specific information on salary ranges, minimum qualifications and job concepts for each level.

To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities.

Applicants are responsible for checking the status of their application to determine where they are in the recruitment process.

Further status message information is located under the Information section of the Current Job Opportunities page.

*

Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application.

Applications may be rejected if incomplete.

*

A resume upload will

NOT

populate your information into your application.

Work experience left off your electronic application or only included in an attached resume

is not eligible to receive credit

For further information about this vacancy contact:

Paula Jackson

paula.jackson@la.gov

LDH/HUMAN RESOURCES

BATON ROUGE, LA 70821

225 342-6477

This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.

Qualifications

MINIMUM QUALIFICATIONS:

A baccalaureate degree.

SUBSTITUTIONS:

Six years of full-time work experience in any field may be substituted for the required baccalaureate degree.

Candidates without a baccalaureate degree may combine work experience and college credit to substitute for the baccalaureate degree as follows:

A maximum of 120 semester hours may be combined with experience to substitute for the baccalaureate degree.

30 to 59 semester hours credit will substitute for one year of experience towards the baccalaureate degree.

60 to 89 semester hours credit will substitute for two years of experience towards the baccalaureate degree.

90 to 119 semester hours credit will substitute for three years of experience towards the baccalaureate degree.

120 or more semester hours credit will substitute for four years of experience towards the baccalaureate degree.

College credit earned without obtaining a baccalaureate degree will substitute for a maximum of four years full-time work experience towards the baccalaureate degree.

Candidates with 120 or more semester hours of credit, but without a degree, must also have at least two years of full-time work experience tosubstitute for the baccalaureate degree.

NOTE:

Any college hours or degree must be from a school accredited by one of the following regional accrediting bodies: the Middle States Commission on Higher Education; the New England Association of Schools and Colleges; the Higher Learning Commission; the Northwest Commission on Colleges and Universities; the Southern Association of Colleges and Schools; and the Western Association of Schools and Colleges.

NOTE:

An applicant may be required to possess a valid Louisiana driver’s license at time of appointment.

Job Concepts

FUNCTION OF WORK:

To make initial and continuing determination, under close supervision, as to clients’ eligibility for all Medicaid programs.

LEVEL OF WORK:

Entry.

SUPERVISION RECEIVED:

Medicaid Analysts typically report to a Medicaid Analyst Supervisor.

May receive supervision from higher level personnel.

SUPERVISION EXERCISED:

None.

LOCATION OF WORK:

Department of Health and Hospitals, Medical Vendor Administration.

JOB DISTINCTIONS:

Differs from Medicaid Analyst 2 by the presence of close supervision and the absence of independent action.

Examples of Work

EXAMPLES BELOW ARE A BRIEF SAMPLE OF COMMON DUTIES ASSOCIATED WITH THIS JOB TITLE.

NOT ALL POSSIBLE TASKS ARE INCLUDED.

Under close supervision, the entry level Medicaid Analyst learns to perform the following duties:

Conducts interviews with clients and makes other necessary collateral contacts for verification in determining eligibility for Medicaid Programs.

Examines application packets for timeliness, completeness, and appropriateness prior to authorization of reimbursement.

Makes decisions on complex eligibility factors and determines level of benefits for federal and state funded programs as a result of the rolldown procedure.

Interprets and applies complex federal, state, and agency policies for each program.

Conducts special investigations and compiles reports concerning fraud and location of absent parents.

Counsels and refers potentially eligible recipients or applicants to other agencies.

Contacts individuals, companies, businesses, local, state and federal agencies as needed to obtain or to verify information.

Records findings, recommendations, and services provided; completes case record forms and necessary correspondence in connection with assigned cases.

 
 

Clipped from: https://jobzhq.com/jobs/medicaid-analyst-1-2_a0d27c039602feb3_0_0?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

CSG Government Solutions is a national leader in planning, managing and supporting complex projects that modernize the information technology and business processes of large government programs. For more than 20 years, we have applied our expertise, innovation, and results-oriented mindset to the most complex program modernization projects of over 200 government and other organizations including 46 state and territory governments, the U.S.

Department of Health and Human Services, the U.S. Department of Labor, and large municipal governments. CSG provides multiple service offerings to our valued clients.

PMO by CSG brings all the expertise and experience needed to establish and operate a full-service PMO. IV&V by CSG provides independent insight into all aspects of a project, with a focus on risk identification, analysis, and mitigation. QA BY CSG deploys highly experienced teams and innovative methods, knowledge, and tools to assure that complex projects achieve our client’s objectives.

Strategy BY CSG brings our high-value resources to provide insight into best practices OCM by CSG? operates on the principle that people are the key to realizing and sustaining the benefits of program modernization. CSG is seeking business analysts with 3+ years of Medicaid and MMIS experience to join our consulting staff. You will work on highly productive project teams delivering our services to state government agencies nationwide.

The responsibilities and qualifications are as follows: Responsibilities and Qualifications include: Working as member of a project team functioning as a business analyst for large-scale technology projects utilizing agile methodologies Facilitating the elicitation and documentation of business requirements and joint application design sessions Reviewing functional and technical requirements and design specifications Analyzing business processes and workflows Conducting quality reviews of design documents Conducting quality reviews of test plans and procedures Analyzing requirements traceability throughout the system development life cycle Facilitating the development of test scripts and test data necessary for performing user acceptance testing Creating project documentation including meeting minutes, deliverables, project status reports and presentations Tracking issues, risks, action items and decisions using standard project management techniques and tools Communicating project issues and risks to the project management team Familiar with MMIS Certification Process, a plus Experience with Medicaid Enterprise Checklist Toolkit (MECT) framework, a plus Experience with MMIS planning, procurement, and/or operations, a plus Knowledge of Medicaid Information Technology Architecture (MITA), a plus Travel may be necessary from 25%- 50%..

*All candidates authorized to work in the US without sponsorship are eligible to apply* Working at CSG Clients trust us with their most difficult challenges, so we have to be at the top of our game. And you will be, too. You’ll also find that we’re able to keep it in perspective, combining a strong work ethic with an appreciation for a balanced life.

It’s a team atmosphere, where dedicated professionals with complementary talents encourage one another to do their best work in an environment focused on integrity, growth, and excellence. These are just a few of the many reasons why CSG has been named one of America’s Best Management Consulting Firms three years in a row by Forbes Magazine. Our Focus on Professional Development We’re dedicated to the personal growth of our employees and have programs that enable you to enhance your skills and pursue your career goals within our company.

Our Professional Development group works with you to develop an individual Professional Development Plan (PDP) that aligns your goals with the skills we need to deliver the highest quality services to our clients. Your PDP addresses staffing assignments, training and other factors that keep you on the path to a rewarding career. Our training program, The CSG Way, is focused on continuously developing the skills of our employees and sharing knowledge across our organization.

The program includes courses that develop your analytical, management, and leadership skills; expand your program knowledge; and prepare you for project assignments. Benefits Competitive Benefits including Medical and Dental Insurance, Life Insurance, Short-Term and Long-Term Disability Insurance, 401k with employer match, Paid Vacation and Holidays For more information about CSG Government Solutions visit www.csgdelivers.com. CSG Government Solutions is an Equal Opportunity Employer. M/F/D/V.

 

Web Reference : AJF/321246622-202
Posted Date : Thu, 07 Apr 2022

 
 

Please note, to apply for this position you will complete an application form on another website provided by or on behalf of CSG Government Solutions. Any external website and application process is not under the control or responsibility of IT JobServe

 
 

 
 

Clipped from: https://it.jobserve.com/job-in-Wheat-Ridge-Colorado-USA/BUSINESS-ANALYST-MEDICAID-MMIS-10ee1845b80762b088/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Medicaid Program Support – Solution Manager

Are you an experienced, passionate pioneer in technology? An operations professional who wants to work in a collaborative environment. As an experienced Medicaid Program Support-Solution Manager, you will have the ability to share new ideas and collaborate on projects as a consultant without the extensive demands of travel. Consider an opportunity with our US Delivery Center – we are breaking the mold of a typical Delivery Center.

Our US Delivery Centers have been growing since 2014 with significant, continued growth on the horizon. Interested? Read more about our opportunity below …

Work you’ll do/Responsibilities
 

• Lead cross-functional project teams by task assignment and follows up to ensure on-time completion
  
• Maintain and follow client budget guidelines
  
• Lead multiple project assignments, project tracking, issue resolution, time gathering, and reporting, and communicating project progress
  
• Conduct regular project reviews and communicate the status of projects in both a formal and informal setting
  
• Provide continuous improvement by re-engineering processes to ensure quality and efficiency
  
• Evaluate alternatives, and implement effective solutions; preparing reports, and planning, assigning, and supervising the work of others
  
• Implement Medicaid program redesigns as needed
  

The Team


Deloitte’s Government & Public Services practice-our people, ideas, technology, and outcomes-is designed for impact. Our team of over 15,000+ professionals brings a fresh perspective to help you anticipate disruption, reimagine the possible and fulfill your mission promise.


The US Operations Transformation Offering applies deep sector knowledge and technical business operations consulting experience to take a more strategic view of our clients’ priorities, helping them to prepare for growth, embrace the digital agenda, optimize costs, and maximize operational efficiency. Our market offerings include Operating Model Transformation and Center for Process Bionics.

QualificationsRequired

• Bachelors’ degree in a business-related field and or equivalent professional work experience
  
• 10+ years of progressive experience managing mid to large-scale projects.
  
• 10+ years of experience working in the public sector and/or health care setting
  
• Medicaid Enterprise Systems experience
  
• Subject matter expert on Health & Human Services program operations and policy
  
• Experiencedeveloping and creating project plans that display project milestones in accordance with SDLC and PMP governance guidelines
  
• Experience in leading, managing, and directing project teams on project deliverables within client budget guidelines (Fixed or Variable)
  
• Ability to lead, or facilitate discussions on scrum or agile best practices, workflows, and toolsusage
  
• Advanced knowledge/experience with Microsoft Professional Suite (Word, Excel, & PowerPoint) and Microsoft Project
  
• Travel up to 10% annually
  
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
  

Preferred

 

• PMP, CAPM, PMI-ACP, CSM
  

Clipped from: https://www.glassdoor.com/job-listing/medicaid-program-support-solution-manager-location-open-deloitte-JV_IC1145778_KO0,55_KE56,64.htm?jl=1007773185488&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

At CMS, we believe that at the core of our organization are the employees that carry out the Agency’s vision of advancing health equity, expanding coverage, and improving health outcomes.

 
 

About the role:

 
 

As a IT Specialist (Data Management), you will provide high-level technical expertise to accomplish analysis of options and development of the design for advanced data systems, software, and complex programming specifications.

 
 

What you’ll do:

 
 

-Serve as an IT Data Management Specialist and advisor to leadership at the Division and Group level.

-Consults with customers and applies analytical processes to the planning, design, and implementation of data management methods to meet the business requirements of customer organizations.

-Uses business intelligence tools as appropriate to generate reports, create visualizations, and develop compelling stories that convey information to non-technical audiences.

-Recommends improvements to upstream processes to improve data quality.

-May represent the component or CMS at resource management planning meetings.

 
 

Experience we’re looking for:

 
 

In order to qualify for the GS-13, you must meet the following:

 
 

1) Manage cloud enabled projects such as AWS (Amazon Web Services) based cloud data management and reporting tools;

2) Analyze data sharing methods, identify efficiencies and implement changes;

3) Manage large scale database operations to ensure security, encryption, replication procedures are met AND

4) Monitor overall team performance.

 
 

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 within 30 calendar days of receiving notice to do so, 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 HHS Workplace Flexibilities policy.

 
 

Come see why over 6,000 employees say CMS is their employer of choice! In addition to dynamic and exciting opportunities, CMS offers generous compensation and benefits programs, an outstanding work-life balance, and most important, the opportunity to give back to your community, state and country by making a difference in the lives of Americans everywhere.

 
 

You MUST apply through USAJOBS to be considered.

 
 

Clipped from: https://www.linkedin.com/jobs/view/it-specialist-data-management-at-centers-for-medicare-medicaid-services-3009364444/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic