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Government and Public Service Sales Executive – Medicaid Enterprise Solutions, Austin, Texas

 
 

Apply for this job now Location Austin, Texas Job Type Permanent Posted 6 Apr 2022

Government and Public Service Sales Executive – Medicaid Enterprise Solutions Deloitte has a dominant presence in the Medicaid Enterprise Systems (MES) space. We are the market leader in MES modular solutions for state government including systems integration and analytics and data warehousing platforms. Deloitte also provides other state healthcare solutions and services, and desires to expand its offerings and market share. We wish to hire a sales executive with a mature understanding of State Medicaid programs, and who has existing client relationships with State Health and Medicaid agencies. The ideal candidate must have knowledge and experience selling Medicaid modular systems and/or other relevant state enterprise healthcare systems. Job Responsibilities: The sales executive will drive new business for Deloitte’s Medicaid Enterprise Solutions. The SE will strategically collaborate with Account and Practice leadership to position and sell our MES offerings. Specific responsibilities include: + Develop leads, cultivate a targeted list of prospects and lead sales efforts within a targeted set of states working closely with Account and Practice leaders + Develop relationships and collaborate with Deloitte leadership to formulate and execute on a go-to-market strategy + Understand the competitive landscape and client needs in order to effectively position MES and Deloitte’s consulting services + Identify and influence key decision-makers at all levels within the client organization + Assist account teams and practice leaders with qualifying, pursuing and closing opportunities + Play a leadership role/drive pursuits and contribute to the development of proposals and coach the team through orals preparation. + Represent Deloitte by spending time in the field, and at conferences/policy forums + Develop strategic and tactical plans to meet or exceed sales objectives + Maintain accurate and timely customer, pipeline, and forecast data working with Sales Operations team The ideal candidate will have a significant level of Medicaid, MMIS or similar business development and executive relationship experience with a proven track record in selling consulting services. The candidate will understand how to develop go-to-market plan that targets the Medicaid/MMIS consumer. The candidate will understand the professional service delivery process and ideally will have experience delivering engagements at some point within their career. Candidates should have a minimum of 5-10 years of relevant experience. Required Experience and Qualifications + 5-10 years of experience as a named account executive and/or business development manager serving State and Local clients + Strong consulting, Health and Human Services and Medicaid background. In-depth understanding of the state government Medicaid enterprise industry and key business issues + Demonstrable ability to leverage pre-existing network of clients or contacts in the marketplace + Proven ability to develop and secure relationships at all levels within a client organization + Ability to integrate, influence, and collaborate with cross-functional teams in client pursuits + Bring executive presence, poise and a commitment to superior quality in all aspects of work + Travel up to 70% (While 70% of travel is a requirement of the role, due to COVID-19, non-essential travel has been suspended until further notice + 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: + Bachelor’s degree EA_ExpHire EA_CMG_ExpHire SalesOpsGreenDot All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.

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Details

  • Job Reference: 555203627-2
  • Date Posted: 6 April 2022
  • Recruiter: Deloitte
  • Location: Austin, Texas
  • Salary: On Application
  • Sector: I.T. & Communications
  • Job Type: Permanent

 
 

 
 

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Quality Improvement Program Lead (National Medicaid Quality)

 
 

Job Description

**Description** Humana Healthy Horizons is seeking a Quality Improvement Program Lead who will be responsible for the end to end ownership of Humana Healthy Horizon’s National Quality Improvement (QI) efforts, capability advancement activities, and the development and maintenance of QI frameworks and toolkits to support Quality associates throughout the line of business. The Quality Improvement Program Lead reports directly to the National Medicaid Quality Director. **Responsibilities** The Quality Improvement Program Lead exercises independent judgment and decision making on complex issues within their scope, works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action. **Responsibilities include:** + Provides direction and oversight of Humana’s QI programs management model and improvement strategy for the Medicaid line of business at the national level. + Develops policy and procedure, and defines/improves processes regarding quality measurement data collection and improvement methodology for all initiatives impacting Medicaid beneficiaries. + Develops and maintains QI methodology play books and tool kits to support market QI efforts. + Serves as the lead of the Quality related functions related to NCQA’s Health Equity Accreditation. + Oversees related work plan development and evaluation of programs across all Medicaid markets. + Nurtures relationships with national and market partners to expand and strengthen quality improvement efforts. + Ensures organizational awareness of key developments and leads in identification and development of national quality interventions. + Drives interdepartmental collaboration to achieve business goals. **Required Qualifications** + Bachelor’s degree. + 3+ years of experience managing Healthcare Quality programs **OR** 8+ years of quality improvement experience. + 5+ years of experience monitoring and improving quality measures (example HEDIS or CAHPS) in a quality improvement / quality management or office based practice setting. + Demonstrated ability to perform moderate to complex data analysis. + Strong relationship building skills. + Excellent written and oral communication skills. + Comprehensive knowledge of Microsoft Office Word, PowerPoint, Excel. + Ability to work independently under general instructions, must be self-directed and motivated. + Must have a room in your home designated as a home office; away from high traffic areas where confidential information may be secured. + Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required. + For this job, associates are required to be fully COVID vaccinated **OR** undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve. + If progressed to offer, you will be required to: Provide proof of full vaccination **OR** Commit to weekly testing, following all CDC protocols, **OR** Provide documentation for a medical or religious exemption consideration. This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work. **Preferred Qualifications** . + Certified Professional in Healthcare Quality (CPHQ) + Experience with quality improvement methodology, preferably with the IHI Model for Improvement. Lean/Six Sigma, or other standardized methodology. + Experience with SharePoint design. + Advanced degree in business, healthcare, or related field. + Project management experience. + Strong business acumen. **Additional Information** + **Travel:** up to 10% + **Work Hours:** Eastern Standard Time(EST) **Interview Format** As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. **Scheduled Weekly Hours** 40

 
 

Clipped from: https://b-jobz.com/us/web/jobposting/938236591?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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RN Care Manager – TANF (DC Medicaid) Job in Columbus, OH at CareFirst BlueCross BlueShield

 
 

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CareFirst BlueCross BlueShieldColumbus, OH

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  • PURPOSE:Under minimal supervision, the Care Manager researches and analyzes a member’s medical and behavioral health needs and healthcare cost drivers.
  • The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes.
  • Identifies members with acute/complex medical and/or behavioral health conditions.
  • Engages onsite and/or telephonically with member, family and providers to develop a comprehensive plan of care to address the member’s needs at various stages along the care continuum.
  • Identifies relevant CareFirst and community resources and facilitates program, network, and community referrals.
  • Collaborates with member and the interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address member’s medical, behavioral and/or social determinant of health needs.
  • Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies to facilitate care between settings.
  • Monitors, evaluates, and updates plan of care over time focused on member’s stabilization and ability to self manage.
  • Ensures member data is documented according to CareFirst application protocol and regulatory standards.
  • Education Level: High School Diploma or GED Experience: 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience.
  • See additional information below if Care Manager position is behavioral health focused.
  • RN – Registered Nurse – State Licensure And/or Compact State Licensure RN- Registered Nurse in MD, VA or Washington, DC Accredited Case Manager (ACM)
  • Bachelors degree in nursing.
  • CCM/ACM or other RN Board Certified certification in case management.
  • Knowledge, Skills and Abilities (KSAs)Knowledge of clinical standards of care and disease processes.
  • Ability to produce accurate and comprehensive work products with minimal direction.
  • Ability to triage immediate member health and safety risks.
  • Basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits).
  • Excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for members.
  • Knowledgeable of available community resources and programs.
  • Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and PowerPoint.
  • Ability to provide excellent internal and external customer service.
  • Department Department:(DC Medicaid – Clinical Enterprise)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 visit our website to apply: www.
  • 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.

 
 

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Provider Network Manager – Medicaid / Medicare

 
 

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? Provider Network Manager – Medicaid / Medicare (PS70008) Location: Remote. Must reside in Louisiana. Prefer commutable distance to New Orleans or Baton Rouge.

How you will make an impact: The Provider Network Manager develops the provider network through contract negotiations (language and rates), relationship development, and servicing. Primary focus of this role is: * Provider contracting and negotiating contract terms. * Typically works with less-complex to complex providers. * Providers may include, but are not limited to, smaller institutional providers, professional providers with more complex contracts, medical groups, physician groups, small hospitals that are not part of a health system, ancillary providers, providers in areas with increased competition or where greater provider education around managed care concepts is required. * Contracts may involve non-standard arrangements that require a moderate level of negotiation skills.


Value based concepts understanding. Fee schedules can be customized. * Works with increased independence and requires increased use of judgment and discretion. * May work on cross-functional projects requiring collaboration with other key areas. * Serves as a communication link between professional providers and the company.


* Conducts more complex negotiations and drafts documents. * Assists in preparing financial projections and conducting analysis as required. Qualifications Minimum Requirements: * BA/BS degree and a minimum of 3 years’ experience in contracting, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background. * Requires some travel within the state of Louisiana. Preferred Qualifications: * Managed Care/health insurance industry experience.


* Knowledge of Medicaid and Medicare provider contracting preferred. * Experience negotiating provider contracts. 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 [email protected] for assistance.

Clipped from: https://www.rapidinterviews.com/job/provider-network-manager-medicaid-medicare-with-anthem-inc-in-metairie-apc-9121?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Data Analyst II (Medicaid) — Remote Available

 
 

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you?ll have access to competitive benefits including a fresh perspective on workplace flexibility.

About Us:

We are revolutionizing the world of healthcare through digital transformation and building a world-class software engineering practice. Our high caliber team delivers leading edge technology and drives innovation to solve complex business challenges. Using collective innovation we are turning visions into action and challenging what is possible to support the healthcare of 1 in 15 individuals.

About You:

You are a highly collaborative, strategic risk-taker driven to make a difference and change the face of healthcare. You thrive in a supportive, result-oriented community and are committed to the relentless pursuit of continuous growth. You are highly agile, excel in fast-paced environments and willing to push outside your comfort zone. You are ready to find your purpose at work

The Role:

We are transforming technology and creating a digital evolution that will empower Centene to better serve our members. Data Analyst will manipulate large data sets to provide insights and trends for our health plans.

As Data Analyst II:

? Build queries to locate relevant data

? Analyze health management programs including: data collection, validation and outcome measurement.


o May include:


? Financial, pharmacy, claims, provider, and member data


? IRS, CMS, HHSC, HEDIS reporting


? Internal data cleansing and data reconciliation analysis


? Trend analysis in various functional areas of health care management.


? Create and generate reports through MS-Excel, MS-Access, and SQL using Business Objects interface and direct links to core databases (ODS/EDW)


? Produce reports for and interface with senior management and internal and external stakeholders.


? Gather and interpret business requirements and monitor data trends to proactively identify issues


? Execute data changes and update core systems as needed


? Handle multiple projects and timelines effectively and communicate risks and issues to manager regularly


? Assist with training lower level Data Analysts.

Our Comprehensive Benefits Package:

? Flexible work solutions including remote options, hybrid work schedules and dress flexibility

? Competitive pay


? Paid Time Off including paid holidays


? Health insurance coverage for you and dependents


? 401(k) and stock purchase plans


? Tuition reimbursement and best-in-class training and development

Additionally you will bring:

? Bachelor’s degree’s related field or equivalent experience.

? 2+ years of statistical analysis or data analysis experience.


? SQL Queries


? Requirements gathering


? Data mining/validation


Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

 
 

Clipped from: https://www.careerboard.com/us/en/search-jobs-in-Illinois,-USA/DATA-ANALYST-II-MEDICAID-REMOTE-AVAILABLE-0D910FD1A2965F3AB0/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Medicaid IT Subject Matter Expert

 
 

Full Time

Work from home available Travel not required

Job Description

TurningPoint is supporting the State of Maryland’s on-going technical and business support and maintenance services for the Medicaid Management Information System II (MMIS II) as a Prime Contractor. The MMIS presently consists of 6 core subsystems:

A. Recipient

B. Provider

C. Claims processing

D. Reference file

E. Surveillance and Utilization Review

F. MARS (Management Administrative Reporting System)

TurningPoint is seeking a Medicaid IT Subject Matter Expert to Provide expertise for transition, planning, support, and development of mainframe legacy to modern system architecture. Provide expertise, development, and support of MMIS II subsystem applications for Claims, Provider, Reference, MARS, Eligibility, and other duties as assigned.

Generalized Experience:

  • At least twelve (12) years of relevant industry experience in the discipline is required.
  • At least ten (10) years of Medicaid Enterprise IT experience.
  • At least ten (10) years of IBM Mainframe OS390 experience.
  • At least ten (10) years Common Business-Oriented Language (COBOL) experience.
  • At least ten (10) Database 2 (DB2) experience.

Specialized Experience:

  • At least ten (10) years of combined new and related older technical experience in the IT field directly related to the required area of expertise.

Preferred Experience:

  • Virtual Sequential Access Method (VSAM)

 
 

  • Job Control Language (JCL)
  • Customer Information Control System (CICS)
  • Information Builders FOCUS

Education:

  • Bachelor’s Degree from an accredited college or university in Computer Science, Information Systems, Engineering, Business or other related scientific or technical discipline.

 
 

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Dice Id : 10121081

Position Id : t618rek11c61nzomwupn8jbj9c

Originally Posted : 18 hours ago

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RN Nurse Case Manager I – Medicaid | Anthem

 
 

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.

 
 

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Posted on

Senior Consultant- Cerner

Senior Consultant

Kansas City, Missouri, United States

Job Description

Cerner is hiring for a Senior Consultant to help implement and manage Medicaid-related reporting projects. You will be responsible for a variety of duties including consulting with clients on reporting requirements, data acquisition, data integration, and analysis across financial, clinical, and operational venues. You will identify opportunities to deliver client value through analytics and facilitate road mapping for analytics-based initiatives. This role allows you to contribute analytics expertise to cross-functional project teams that develop high-impact client solutions. Ideate, design, and oversee development of actionable reports and dashboards that reflect industry trends, competitive landscape, and client-specific factors. You will lead and consult on the design and build of data management solutions that provide data acquisition, data quality, data transformation, and integration of data from disparate sources. You will work with internal and external stakeholders to build custom and off-the-shelf reporting solutions and develop new and innovative analytic pathways to support improved management of state Medicaid agencies. Prepare and present complex information to clients, including written reports and findings, project plans, and presentations.


Working Environment

Yes

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Cerner Jobs and Careers

Time: 3:01

Additional Information

Working Environment Relocation Assistance Available for this Job:

Yes

No

Qualifications

Basic Qualifications

  • At least 8 years of total combined related work experience and completed higher education, including:

 
 

  • At least 2 years of experience in healthcare information technology (HCIT) consulting, HCIT support and/or other client-facing or information technology (IT) solution work experience
  • At least 6 years of additional work experience directly related to the duties of the job and/or completed higher education

Preferred Qualifications

  • Bachelors or Advanced Degree in Public Health, Statistics, Computer Science, Data Science
  • Experience with advanced analytics for a state Medicaid agency
  • Hands-on experience working with T-MSIS data OR Medicaid enrollment/eligibility, pharmacy, provider, and third-party liability data
  • Experience with SQL, Tableau, and Business Objects is helpful but not required
  • Direct experience working with healthcare claims or Medicaid eligibility/enrollment data

Expectations

  • Willing to travel up to 20% as needed
  • Willing to work additional or irregular hours as needed and allowed by local regulations
  • Work in accordance with corporate and organizational security policies and procedures, understand personal role in safeguarding corporate and client assets, and take appropriate action to prevent and report any compromises of security within scope of position
  • Perform other responsibilities as assigned

Applicants for U.S. based positions with Cerner Corporation must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Visa sponsorship is not available for this position.

As a condition of employment, all US-based employees must be fully vaccinated against COVID-19 unless a medical or religious exemption is approved.


Some Cerner positions may be obligated to comply with additional client-facing requirements and occupational health requests, including but not limited to, an immunization set, an annual flu shot, an annual TB screen, an updated background check, and/or an updated drug screen.



Cerner is a place where people are encouraged to innovate with confidence and focus on what is important – people’s health and the care they receive. We are transforming health care by developing tools and technologies that make it more efficient for care providers and patients to navigate the complexity of our health. From single offices to entire countries, Cerner solutions are licensed at more than 25,000 facilities in over 35 countries.

Cerner’s policy is to provide equal opportunity to all people without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, citizenship status, sex, sexual orientation, gender identity or any other legally protected category. Cerner is proud to be a drug-free workplace.


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Right to Work (Spanish)

If you are an individual with a disability who is unable to use our online tools to search and apply for jobs, and need assistance or an accommodation in the recruiting process, please contact us by calling 866-434-1543 or by emailing CernerCareers@cerner.com

  

Clipped from: https://careers.cerner.com/job/88940BR

Posted on

MEDICAID PROGRAM MANAGER 1–A

 
 

Job Description

To administer small and less complex statewide Medicaid program(s). Level of Work:Program Manager. Supervision Received:Broad from a higher-level manager/administrator. Supervision Exercised:May provide functional supervision in accordance with the C…Program Manager, Manager, Program, Administrative

 
 

Clipped from: https://b-jobz.com/us/web/jobposting/926780048?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Louisiana Medicaid Health Plan COO job in New Orleans

 
 

 
 

Found in: Recruit.net US Premium – 23 hours ago

Job Description
Only candidates that live in or are willing to move to Louisiana will be considered.The Manager of Operations is responsible for leading and managing all hands-on operational aspects and activities of various functional areas within the Plan which may include: Claims, Provider Services, Information Technology, Grievance and Appeals, Member Services, Medical Management and the Medicare and Long Term Care lines of business. Assists the Plan leader in the successful growth and performance of the Plan. The Manager of Operations also interfaces, collaborates and works cooperatively with corporate office functional leaders and centralized business departments.
Required Qualifications
Provides day-to-day leadership and management to a service organization that mirrors the mission and core values of the company. Interfaces with corporate office staff as required.* Responsible for driving the Plan toachieve and surpass performance metrics, profitability, and business goals and objectives.* Responsible for employee compliance with, and measurement and effectiveness of all Business Standards of Practiceincluding Project Management and other processes internal and external. Provides timely, accurate, and complete reports on the operating condition of the Plan. Develops policies and procedures for assigned areas. Ensuring that other impacted areas, as appropriate, review new and changedpolicies.* Assists the Plan leader in collaborative efforts related to the development, communication and implementation of effective growth strategies and processes. May be required to spearhead theimplementation of new programs, services, and preparation of bid and grant proposals.* Collaborates with the Plan management team and others to develop and implement action plans for the operational infrastructure ofsystems, processes, and personnel designed to accommodate the rapid growth objectives of the organization.* Assists in defining marketing andadvertising strategies within State guidelines. Participates in the development and implementation of marketing policies for the Plan, and ensures their compliance with program regulations.* Provides assistance inpreparation and review of budgets and variance reports for assigned areas.* Works cooperatively with Network Development team in the development of the provider network. Acts as “client-care officer” through direct contact with all stakeholders. Serves as a liaison with regulatory and other state administration agencies and communicates activity to CEO and reports back to Plan. * Communicates, Motivates and leads a high performance management team. Attract, recruit, train, develop, coach, and retain staff. Fosters a success-oriented, accountable environment within the Plan.* Ensures that performance evaluations and compensation decisions for employees are not influenced by the financial outcomes of claimsdecisions.* Assures compliance to and consistent application of law, rules and regulations, company policies and procedures for all assigned areas. * Prompt response with a sense of urgency/priority to customer requests.Documented follow through/closure. Assists as assigned or required in performing other duties, assignments and/or responsibilities. Must have a managed care experience.
COVID Requirements
CVS Health requires its 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, or religious belief that prevents them from being vaccinated.
If you are 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 within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.
Preferred Qualifications
10+ years work experience that reflects a proven track record of proficiency in the competencies noted.Ability to work collaboratively across many teams, prioritize demands from those team, synthesize information received, and generate meaningfulconclusions.Ability to conceive innovative ideas or solutions to meet clients requirements.Excellent communication and relationship management skills. Express thoughts in an organized and articulate manner. Listen very effectively and build a climate of trust and respect with prospective and existing clients andthe consulting communityAbility to work closely with client service, operations, and investment personnelProven leadership and negotiation skills.Demonstrated leadership with relevant initiatives: Business process, enterprise business project management/consulting, financial strategicplanning and analysis, mergers and acquisitions, strategic planning, risk management.Recent and related managed health care experience.
Education
Bachelor’s degree required; Master’s degree preferred.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

 
 

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