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ConduentHamilton Township, NJ Full-time

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• Job DescriptionAbout ConduentThrough our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them.
  
• You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.
  
• Job DescriptionApplication Processor for Medicaid EligibilityNO WEEKEND WORK
  
• 18.50/hr Onsite in Hamilton, NJInterested in supporting New Jersey Medicaid?
  
• Conduent has immediate openings in processing medicaid applications and verifying for accuracy.
  
• If you’re interested in a medical support career, this may be the opportunity you’re looking for!
  
• What’s in it for you?
  
• Full time position with benefitsPay for performance programEmployee discountsNo weekendsVariable start and end time (8:00 AM-4:30 PM or 8:30 AM-5:00 PM)Paid training 8:00 AM – 5:00 PM Requirements:Must be at least 18 years of age with at least a high school diploma or GED. Must be able to work overtime as needed.
  
• Must submit to a criminal background check and drug test.
  
• Responsibility Statements Identifies customer needs by referring to case notes and examining each as a specific case.
  
• Eligibility review determine whether or not applicants for various programs meet the necessary qualifications.
  
• Gathers all necessary information to update the database.
  
• Escalates issues to senior levels, based concerns.
  
• Performs other duties as assigned.
  
• Complies with all policies and standards.
  
• This is a great opportunity to learn and be a part of the growing medical support community.
  
• Conduent offers benefits and advancement opportunities.
  
• Come join us and help support our Medicaid providers!
  

Clipped from: https://jobsearcher.com/j/application-processer-medicaid-at-conduent-in-hamilton-township-nj-7gdA4vP?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Senior Sales Executive Payment Integrity – Payment Accuracy – State Medicaid

The Solution Sales Executive (State Medicaid focus) is responsible for acting as the sales lead in closing new opportunities in the State Medicaid Agency by demonstrating the unique value proposition of CHC Payment Accuracy Solutions.

What will be my duties and responsibilities in this job?
Identifying opportunities to sell CHC’s Payment Accuracy solutions into net new and existing customers

• Directing and conducting sales presentations with Solution Consultant’s and/or Client Executives
  
• Collaborating with Account Managers and SSE’s to coordinate efforts in identifying leads
  
• Maintaining thorough understanding of the State Medicaid Agency market nationally with emphasis on delivery of CHC Payment Accuracy solutions.
  
• Orchestrate and lead detailed pre-sales planning and strategy, post sales handoff to implementation and ongoing knowledge transfer to Client Executives
  
• Negotiate and close contracts and coordinate with CHC legal and product as needed.
  
• Professional and effective communication skills required including comfort with conversations that create clarity and improve collaboration at all levels within complex and diverse organizations
  
• Effective analytical, problem-solving, and decision-making skills
  

What are the requirements needed for this position?

• Education/Training – BA/BS, MBA preferred.
  
• Minimum of 5 -10 years Sales experience selling Payment software/Payment services directly to State Medicaid Agencies and/or through Fiscal Intermediaries
  
• Experience upselling, nurturing business relationships, retaining and expanding our client’s footprint.
  
• Demonstrated track record & proven quota performance selling to the State Medicaid market
  
• Keeping all opportunities current within Salesforce and providing updates to CHC Management
  
• Experience with Excel, CRM tools, and Net Promoter Score preferred
  

What other skills/experience would be helpful to have?

• Extensive knowledge of Payment Accuracy/Payment Integrity/Cost Containment/Fraud Waste Abuse, Special Investigation Unit/SIU solutions in the healthcare and payer marketplace
  
• Experience selling healthcare software solutions and services directly to State Medicaid Agency
  
• Proficient at executing when experiencing multiple competing priorities
  
• Strong interpersonal and communication skills
  
• The ability to build relationships across the organization, especially at the Payer C-Level and collaborate as necessary to accomplish goals
  
• Maintain State Medicaid industry, product specific knowledge and competitor differentiation
  
• Strong organizational and time management skills
  
• Successful track record of working as a part of dynamic, fast-paced and growing teams that are results oriented and collaborative.
  
• Effective analytical, problem-solving and decision-making skills.
  

What are the working conditions and physical requirements of this job?

• General office demands
  

How much should I expect to travel?

• Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.
  
• Willingness and ability to travel 70% of the time depending on COVID travel restrictions / Current State: We are visiting some clients and not travel 70%.
  
• Territory: National
  
• You can be based out of within 1 hour of major airport
  

#li-remote

Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

COVID Vaccination Requirements

We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and we may require periodic testing for certain roles. In addition, some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to 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.

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with “Applicant requesting reasonable accommodation” as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

 
 

Clipped from: https://www.glassdoor.com/job-listing/senior-sales-executive-payment-integrity-payment-accuracy-state-medicaid-change-healthcare-JV_KO0,72_KE73,90.htm?jl=1007719441469&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Location: Company:

 
 

Description
Humana Healthy Horizons is seeking a Senior Quality Program Delivery Professional who will manage and support quality improvement program strategies and implementations. The Senior Quality Program Delivery Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Responsibilities
– Plans, organize, monitor, and oversee complex projects with cross-functional teams to deliver defined requirements and meet company strategic objectives related to quality improvement, operations, and analytics.
– Utilize data to identify, develop, and implement evidence-based quality and process improvement strategies.
– Coordinate with cross-departmental teams to implement quality functions and processes.
– Maintains detailed project documentation including meeting minutes, action items, issues lists, project plans, and risk management plans.
– Negotiates with project stakeholders to identify resources, resolve issues, and mitigate risks.
– Provides functional and technical knowledge of quality operations and improvement principles in order to support Humana Healthy Horizon’s quality strategy and implementation approach.
– Work creatively and analytically in a problem-solving environment demonstrating teamwork, innovation and excellence.
– Provides status reporting regarding project milestones, deliverables, dependencies, risks and issues, communicating across leadership.
– Understands interdependencies between technology, operations and business needs.
Required Qualifications
– Bachelor’s degree.
– Minimum three (3) years of experience in healthcare quality.
– Understanding of healthcare quality improvement strategies such as IHI’s Model for Improvement.
– Understanding of healthcare quality measures (example HEDIS).
– Previous experience working with Medicaid or Medicaid populations.
– Prior experience working in a fast paced insurance or health care setting.
– Comprehensive knowledge of Microsoft Office Outlook, Excel, Visio, Word and PowerPoint.
– Excellent communication skills, both oral and written, ability to present to large groups.
– 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
– Master’s degree in health services, public health, or health care administration or a related field.
– Certified Professional in Health Care Quality (CPHQ).
– Registered Nurse (RN) licensed without restrictions.
– Familiarity with quality operational functions (policies and procedures, medical record review, quality program description/committee/evaluation, NCQA accreditation, etc.).
– Experience developing provider and member facing materials.
– Knowledge of Humana’s internal policies, procedures and systems.
– PMP certification.
– Strong analytical skills.
Additional Information
– Travel: up to 10%
– Work Hours: Eastern Standard Time (EST) but flexible.
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40

 
 

Clipped from: https://www.adzuna.com/details/2906862061?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

West Alabama Regional Commission

 
 

 Northport, AL Full Time

Job Posting for Medicaid Case Manager at West Alabama Regional Commission

We are looking to hire a full-time Case Manager to work with an in-home assistance program for elderly and disabled individuals. We are part of the West Alabama Regional Commission and offer a variety of competitive benefits including state retirement, and health and life insurance.

Eligible applicants must hold a four-year degree in Social Work, or a closely related field, or be an RN. References are required.

No phone calls please.

West Alabama Regional Commission Area Agency on Aging is an Equal Opportunity Employer.

Job Type: Full-time

Pay: From $36,279.00 per year

Benefits:

• Dental insurance
  
• Employee assistance program
  
• Health insurance
  
• Life insurance
  
• Paid time off
  

Schedule:

• Day shift
  
• Monday to Friday
  

Education:

• Bachelor’s (Required)
  

Shift availability:

• Day Shift (Required)
  

Work Location: One location

 
 

Clipped from: https://www.salary.com/job/west-alabama-regional-commission/medicaid-case-manager/j202111300436474614932?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Your Talent. Our Vision. AT ANTHEM, INC., it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will DRIVE THE FUTURE OF HEALTH CARE.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health benefits companies and a Fortune Top 50 Company.

The MEDICAID BUSINESS DEVELOPMENT INTERN will be responsible for identifying and developing new business growth initiatives by maximizing strategies and growth opportunities in targeted markets identified through the annual planning process.

**Primary responsibilities include**

– Monitors and analyzes product lines to help determine optimal strategy
– Provides research, analysis and recommendations on the external environment as part of the development of strategic plans for the business unit.
– Analyzes major competitor strategies.
– Identifies and monitors changing patterns of competition and recommends responses
– Acquires and maintains data/information on market, industry, economic, consumer and competitive conditions and trends pertaining to health insurance/managed care and related services.

WE PROVIDE BENEFITS TO INTERN AND CO-OP STUDENTS THAT INCLUDE 401(K) + MATCH AND ACCESS TO ANTHEM’S ASSOCIATE RESOURCE GROUPS. ADDITIONALLY, STUDENTS RECEIVE WORK RELATED EXPERIENCE, OPPORTUNITIES TO GROW THEIR PROFESSIONAL NETWORK, LEARN NEW & PRACTICAL SKILLS, EXPLORE A WIDE RANGE OF CAREER PATHS, MENTORING, AND THE POTENTIAL TO SECURE A FULLTIME JOB FOLLOWING GRADUATION.

ANTHEM, INC. IS RANKED AS ONE OF AMERICA’S MOST ADMIRED COMPANIES AMONG HEALTH INSURERS BY FORTUNE MAGAZINE AND HAS BEEN NAMED A 2019 BEST EMPLOYERS FOR DIVERSITY BY FORBES. TO LEARN MORE ABOUT OUR COMPANY AND APPLY, PLEASE VISIT US AT CAREERS.ANTHEMINC.COM. AN_ _N EQUAL OPPORTUNITY EMPLOYER/DISABILITY/VETERAN.

– Pursuing a degree in Public Policy, Health Care Administration, Business, Health Policy or other related degrees
– This internship is from June to August and is 40 hours per week – 100% REMOTE WORK LOCATION
– Must be enrolled fulltime at an accredited college or university during internship
– Students must be authorized to work in the U.S. without future visa sponsorship requirements
– Strong analytical skills
– Strong research skills
– Project management skills
– MS PowerPoint and Excel skills
– Strong communication and presentation skills

 
 

Clipped from: https://www.fox8jobs.com/jobs/medicaid-business-development-intern-summer-2022-bessemer-alabama/521575861-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Position Description:


 

Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding using data science and analytics. Our work yields actionable information to guide decisions in wide-ranging policy areas, from health, education, early childhood, and family support to nutrition, employment, disability, and international development. Mathematica offers our employees competitive salaries, and a comprehensive benefits package, as well as the advantages of being 100 percent employee owned. As an employee stock owner, you will experience financial benefits of ESOP holdings that have increased in tandem with the company’s growth and financial strength. You will also be part of an independent, employee-owned firm that is able to define and further our mission, enhance our quality and accountability, and steadily grow our financial strength. Learn more about our benefits here.

Mathematica is searching for professionals with experience generating insights from data on Medicaid policy and programs at either the state or federal level. In particular, we are looking for individuals who can apply data analytics to support current and emerging work across any number of areas related to monitoring and improving Medicaid programs such as: Value-based purchasing and alternative payment models, enrollment trends, measures of delivery and quality of services for beneficiaries, and to discern outcomes of innovative programs and policies.

The successful candidate will join our group of over 400 health policy professionals, including staff with degrees in data analytics, public health, public policy, economics, behavioral or social sciences, economics, and other relevant disciplines. We offer our employees a stimulating team-oriented work environment, competitive salaries, and a comprehensive benefits package, as well as the advantages of employee ownership.

Duties of the position:

• Participate actively and thoughtfully in multidisciplinary teams, drawing on your past experience with Medicaid programs
  
• Help conduct research and technical assistance projects on topics related to state and federal Medicaid policy
  
• Apply rigorous analytic thinking to the collection and interpretation of quantitative data including analysis of Medicaid administrative data
  
• Bring creative ideas to the development of proposals for new projects
  
• Author project reports, memos, technical assistance tools, issue briefs, and webinar presentations
  
• Contribute to the growth, expertise, and institutional knowledge of staff working in the Medicaid area
  

Position Requirements:


 

Qualifications:

• 3-8 years of experience working in health policy or health research, with a substantial portion of that time related to some aspect of the Medicaid program at the state or federal level
  
• Masters or doctoral degree or equivalent experience in data analytics, public health, public policy, economics, behavioral or social sciences, economics, or other relevant disciplines
  
• Demonstrated ability at modeling program outcomes would be ideal
  
• Strong foundation in quantitative methods and a broad understanding of health policy issues
  
• Excellent written and oral communication skills, including an ability to explain observations and findings to diverse stakeholder audiences including program administrators and policymakers
  
• Demonstrated ability to provide task leadership and coordinate the work of multidisciplinary teams
  
• Strong organizational skills and high level of attention to detail; flexibility to lead and manage multiple priorities, sometimes simultaneously, under deadlines
  

To apply, please submit a cover letter, resume, writing sample, and salary expectations at the time of your application.

Available Locations: Washington, DC; Princeton, NJ; Cambridge, MA; Woodlawn, MD; Ann Arbor, MI; Chicago, IL; Oakland, CA; Seattle, WA

This position offers an anticipated annual base salary of $90,000 – $140,000. This position may be eligible for a discretionary bonus based on company and individual performance.

Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on a project. If you are assigned to such a project, you will be required to obtain the requisite security clearance.

In accordance with Executive Order 14042 and its implementing guidelines, all Mathematica employees must provide documentation that they have been fully vaccinated or obtain an accommodation through Human Resources by providing documentation from a licensed health care provider that they are unable to be vaccinated against COVID-19 because of a disability (which would include medical conditions) or provide an attestation that they are entitled to an accommodation because of a sincerely held religious belief, practice, or observance.

 
 

Clipped from: https://www.glassdoor.com/job-listing/medicaid-researcher-mathematica-policy-research-JV_IC1154545_KO0,19_KE20,47.htm?jl=1006833916815&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Introduction


At CNSI, we strive to be the market leader and most trusted partner for innovative and transformative technology-enabled solutions that improve health outcomes and reduce costs. We’re passionate about helping our clients improve the health and well-being of individuals and families. We succeed when our clients succeed.


Overview


The Healthcare Federal Reporting Specialist is responsible for analyzing business problems, identifying gaps, and developing solutions involving complex information systems under no supervision relates to CMS reporting requirements for Medicaid, Claims, Benefits Administration, Member Eligibility, Provider Enrollment, Prior Authorization, Third Party Liability (TPL) and Contracts Managed Care. This role involves managing requirement scope, determining appropriate methods on potential assignments, and serving as a bridge between information technology teams and the client through all project phases; providing day-to-day direction on State program activities.


Working remotely within the United States is acceptable for this position.

• In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification at the time of hire or transfer.
  
  
   
  

CNSI will not sponsor new employment visa petitions.


Responsibilities

• Provides Medicaid and CHIP expertise and guidance as it relates to Expenditures Reports, Federal Compliance Reports, Management, Analysis and Reporting Subsystem (MARS), Surveillance and Utilization Review Subsystem (SURS) reports.
  
• Analyzes user requirements and client business needs, leveraging expert opinion and expertise.
  
• Share use cases to data analysts for profiling, review results, and infer compliance to Medicaid / CMS processes and guidelines.
  
• Acts as the requirements subject matter expert and supports requirements change management.
  
• Works with customers on presenting technical solutions for complex business functionalities.
  
• Understand the overall system architecture and cross-functional integration.
  
• Demonstrates in-depth knowledge of business analysis to ensure high quality.
  
• Communicates issues and risks to the manager or direct supervisor and assists in developing solutions.
  
  
   
  

Requirements

• 8+ years of healthcare data analysis experience and writing business requirements.
  
• 4+ years of experience in working with State Medicaid and CHIP agencies
  
• 3+ years of experience working with PERM, T-MSIS, CMS Federal Reporting, or similar projects
  
• 2+ years of experience in HEDIS, CHIPRA, or similar quality metrics.
  
• In-depth knowledge of CMS reporting requirements for Medicaid.
  
• In-depth understanding of FFS, Managed Care claim adjudication processes from enrollment to funding/finance.
  
• Knowledge of the Affordable care act and eligibility.
  
• Able to perform complex data analysis using SQL, Excel against data warehouses utilizing large datasets.
  
• Bachelors’ Degree
  
   
  

Preferred Skills:

• Strong knowledge and proficiency in SQL.
  
• Knowledge of the Quality-of-Care program is highly preferred.
  
• Knowledge of data integration and software enhancements/planning.
  
• Masters’ Degree
  
  
   
  

About Us:


At CNSI, we strive to be the market leader and most trusted partner for innovative and transformative technology-enabled solutions that improve health outcomes and reduce costs. We’re passionate about helping our clients improve the health and well-being of individuals and families. We succeed when our clients succeed.


Innovation and commitment to our mission are core to our DNA. And through our shared values, we foster an environment of inclusion, empowerment, accountability, and fun! You will be offered a competitive compensation and benefits package.


CNSI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status, or any other status protected by applicable federal, state, or local law. We are proud of our diversity and encourage all qualified applicants to apply.


Kindly inquire during the interview process if this position is subject to President Biden’s Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors, requiring you to be vaccinated by December 8, 2021.

 
 

Clipped from: https://www.linkedin.com/jobs/view/senior-healthcare-federal-reporting-sme-medicaid-remote-position-at-cnsi-2947025830/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Found in: S US – 21 hours ago

**Description**

Humana is excited to announce the opening of a brand new contact center in Dublin, Ohio Humana was awarded a contract to support the Medicaid members in Ohio with its Healthy Horizons of Ohio statewide Medicaid program, and we need some amazing individuals to join Humana in supporting our new and future members. We have numerous new Inbound Contact Representative openings that will have the pleasure of taking inbound calls from our Ohio Medicaid Members and provide excellent service and support. These are great opportunities to join a Fortune 100 company that continuous to expand and grow within the Healthcare industry


**Responsibilities**

****This position is an in-office position, 485 Metro Place S Dublin, OH 43017. Training will be completed virtually from home.****

The Inbound Contact Representative 2 represents Humana by creating Perfect Experiences for incoming telephone or digital inquiries from Ohio Medicaid Members. The Inbound Contact Representative 2 strives to provide a resolution for member issues or pathway to resolution on each call while providing a perfect call experience. These positions are full-time (40 hours/week) Monday – Friday working an eight and a half (8 1/2) hour shift anytime between the hours of 6:45am and 8:00 pm, EST, based on business requirements. It may be necessary, given the need, to work occasional overtime and weekends.

The Inbound Contact Representative 2 will also make outbound welcome calls to members during periods of low occupancy.

**What we need your help with:**

The Inbound Contact Representative 2 addresses member needs which may include complex benefit questions, resolving issues, educating members, and delivering best-in-class member experiences.


* Handle 20-40 inbound calls daily from members in a fast-paced inbound call center environment, and at times, back-to-back phone calls.


* Documents accurate details of inquiries, comments or complaints, transactions or interactions and records all actions taken in accordance to the request or questions being asked.


* Escalates unresolved and pending member grievances and appeals. Decisions are typically focused on detailed processes and area/department policies and methods for completing assignments.


* Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction.


* Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.


* Participates in daily team chats, accesses a knowledge-based database (Mentor) on every call, and reads emails daily to stay on top of alerts, trainings, and all Medicaid updates/changes.

**COME GROW WITH HUMANA BENEFITS DAY ONE – STELLAR 401K MATCH – PAID TIME OFF – TUITION ASSISTANCE PROGRAMS – STELLAR WELLNESS/REWARDS PROGRAM**

**What you need for success (Required Qualifications):**

* Minimum 2 years of customer service experience


* Must be available to work any shift between the hours of 6:45 am – 8:00 pm EST (M-F), some weekends and overtime required based on company needs


* Training is work at home or virtual. Training will start day one of employment and runs the first 7 weeks with a schedule of 8:00 am – 4:30 pm EST. Attendance is vital for success so no time off is allowed during training and within your first 120 days.


* Demonstrated experience with providing strong customer service and attention to details while listening on calls


* Prior experience managing multiple or competing priorities, including use of multiple computer applications simultaneously


* Prior experience effectively communicating with customers verbally and listening to their needs

**Work at Home Requirements**

* Must have 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 25/10 (25mbs download x 10mbs upload) is required.

**What you need to STAND OUT among the crowd (Preferred Qualifications):**

* Associate’s or Bachelor’s Degree


* Prior inbound call center or related customer service experience


* Prior Healthcare experience


* Fluency in Spanish

**Additional Information**

* Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government

**_For this job, associates are required to be fully COVID vaccinated, including booster 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 ahealthcarecompany 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, including boosteror commit to testing protocols OR_**


+ **_Provide proof of applicable exemption including any required supporting documentation_**

**_Medical, religious, state and remote-only work exemptions are available._**

**Scheduled Weekly Hours**

40

 
 

Clipped from: https://us.trabajo.org/job-1373-20220308-d04fad896bff3eaddba641ed00620d57?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Information

JOB REQUIREMENTS: Pharmacy Benefits Reinvented- As the industry’s alternative pharmacy benefit manager (PBM), we’re committed to making prescriptions more affordable for you and your members. Here at Navitus, our team members work in an environment that celebrates creativity, fosters diversity and encourages growth. We welcome new ideas and share a passion for excellence. Is this you? Find out more below! How do I make an impact on my team? Develops and maintains deep subject matter expertise related to CMS and State Medicaid requirements for provider materials, formulary / PDL, coverage determinations, grievances and appeals, customer care and pharmacy helpdesk, third party liability, 340B, and reporting. Facilitates and oversees the implementation and maintenance of Medicaid functional processes for all Managed Medicaid clients. Develops the necessary project plans and lead projects that enhance the Medicaid operational infrastructure. Participates in state sponsored meetings as requested and disseminates information throughout Navitus. Monitors CMS and State regulations, guidance, and system changes. Ensures the Medicaid functions meet all regulatory requirements. Provides direct functional support for required reporting and provider/member materials. Responsible for operational oversight of the Navitus Managed Medicaid product line. Provides product support for client implementations and subject matter expert support to Navitus Client and Clinical Services Executives representing the client. Supports oversight for issue resolution. Assists with engaging the Program Manger with all non-compliance related issues and/or when obstacles arise. Supports compliance efforts including State, CMS audits and client delegation audits. Supports the development of maintenance of product documentation, including training materials. Accountable for ensuring that policies and procedures (internal controls) are in place to provide reasonable assurance the company assets are protected. Develop and continually evaluate Government Program Operations functions, while monitoring work product measure/targets including turn-around times and accuracy. What our team expects from you? A minimum of a Bachelor’s Degree or equivalent work experience is required. Additional background in business or healthcare administration is desired. Two to five years of relevant experience in administering health insurance programs strongly desired. Experience and expertise in product management, project management and business analysis with a “track record” of tangible success, including team collaboration/relationship-building/management in health care or related environment is essential. Working knowledge of Medicaid regulations, standards, and processes a plus. Ability to be the champion for the Medicaid… For full info follow application link. Navitus Health Solutions is an Equal Opportunity Employer: Disabled/Veterans/Male/Female/Minority/Other ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/E55FA616E1AF4CE0

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Clipped from: https://diversity.usnlx.com/appleton-wi/product-manager-medicaid/8B156EF871774913958429FD92903502/job/?vs=28&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job summary: Title: Medicaid PM Location: Des Moines, IA, United States Length and terms: Long term – W2 or c2c Position created on 03/03/2022 06:29 am Job description:*** Very long term project; Initial PO till for 1 year – expect to go for 3+ years *** Hybrid – some onsite and rest remote *** The role will assist by helping with hiring developers for the enterprise and eventually will run the CCWIS (FACS Replacement) Project. DHS is in the initiation phase of a large, multi-year system implementation project. The scope of the project includes the implementation of a modern architecture platform and procurement of several new Child Welfare modules to meet the ACFS requirements for managing Child Welfare for DHS Foster Care and Adoption. The migration from the current environment to the future-state platform will involve the modernization or replacement of the current legacy system.The position will work manage leaders on the CCWIS project ensuring the Testing, Governance, and sound IT practices are followed to ensure the product meets timelines set forth by leadership and provide a robust product to the business that serves their needs.

POSITION RESPONSIBILITIES AND ESSENTIAL FUNCTIONS+ Ability to work within a project governance structure (methodology, required templates and reporting)+ Ability to interact with, educate, learn from, and drive business and IT teams.+ Ability to work effectively under very broad direction with general supervision+ Ability to motivate team and meet deadlines in a fast-paced and challenging environment.+ Ability to gather and organize multiple simultaneous complex business process scenarios+ Excellent analytical skills + Excellent organizational, presentation, interpersonal and team building skills+ Excellent time management and project planning/strategizing skills+ Strong verbal and written communication skills+ Demonstrated experience with managing client expectations, implementing change management initiatives + Demonstrate experience managing multiple complex funding streams+ Resolve issues and remove barriers for the project team but when necessary escalate to upper management and/or appropriate leadership as appropriate.+ Provide insight and knowledge into improving processes related Application Development, Testing+ Other duties or tasks as assigned by upper management.Required Skills+ 5 years State / Federal Medicaid Program Experience+ Extensive experience working with multiple state business disciplines (i.

e. Fiscal, Policy, Information Technology, Leadership)+ Experience working within a project governance structure (methodology, required templates and reporting)+ Extensive experience with planning, managing IT Development and Testing Teams.+ Strong process development skills, w/ the ability to learn and understand concepts in order to interpret, document and formalize procedures+ Strong process and gap analysis skills+ Excellent management skills, w/ the ability to multitask and manage multiple tasks with changing priorities in a cross-functional environment+ Demonstrate ability to prioritize and manage multiple activities simultaneously while meeting established deadlines+ State / Federal Government Appropriations Experience+ Demonstrated experience with managing client expectations and implementing change management initiativesDesired Skills+ certifications Contact the recruiter working on this position:The recruiter working on this position is Raghu His/her contact number is +(1) () His/her contact email is …

@msysinc.com Our recruiters will be more than happy to help you to get this contract.

 
 

Clipped from: https://www.rapidinterviews.com/job/medicaid-pm-with-msys-in-des-moines-j2c-2229?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic