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State of Colorado Criminal Investigator II (Medicaid Fraud) Job in Denver, CO

 
 

Department Information

This position is open only to Colorado state residents.

The Criminal Justice Section is seeking experienced criminal investigators to join the Medicaid Fraud Unit. The Medicaid Fraud unit is crucial to reducing the Medicaid Fraud and patience abuse across the state. This position is ideal for someone that not only takes pride in the skills and abilities that they have developed thus far in their career, but seeks to expand that skillset whenever the opportunity is presented, while also assisting others in developing and improving their skills and abilities. They should not be satisfied with doing “just enough” and be comfortable with working investigations both independently and as part of a multidisciplinary team. Someone that loves things that seem impossible and has a desire to join a collaborative and engaging team in a great work environment.


WHO WE ARE
The Office of the Attorney General/Department of Law is the “People’s Lawyer”. The Attorney General, Phil Weiser, was elected by the people of Colorado and is the State’s chief lawyer and law enforcement official. Our vision for the Department of Law is: “Together, we serve Colorado and its people, advancing the rule of law, protecting our democracy and promoting justice for all.” Our core values and commitment to diversity, equity, and inclusion, drive our actions and demonstrate our focus on being principled public servants who are innovative and better together.


Visit our website to learn more: https://coag.gov/.

Description of Job

WHAT YOU WILL DO
The Colorado Medicaid Fraud Control Unit (COMFCU), maintains a strong commitment to ensuring that Coloradans have access to the highest quality of care from dedicated providers while continuing to take an aggressive approach to reducing Medicaid fraud and patient abuse across the state.


The dual missions of the COMFCU are:

  • To protect the state and federal funds dedicated to providing health care and medical services to Colorado Medicaid beneficiaries.
  • To hold individuals accountable for the abuse, neglect, or financial exploitation of clients in board and care facilities as well as those in facilities that accept Medicaid dollars.

These positions are critical team members of the COMFCU that will work both independently and as part of a multidisciplinary team to conduct thorough white-collar investigations of suspected criminal activity by Medicaid providers or their employees. These positions may also be assigned to civil investigations in support of the Colorado False Claims Act. Additionally, the incumbents will provide technical training, advice and assistance to other law enforcement agencies in the investigation of such matters.


This recruitment may also be used to fill other Criminal Investigator positions at the Department of Law.

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

WHAT WE ARE LOOKING FOR


Minimum Qualifications: Please document all relevant experience in detail on your application. Experience will not be inferred or assumed. Any part-time experience listed will be prorated.

  • Bachelor’s degree from an accredited institution in a field of study directly related to the work assignment; AND
  • Two years of professional investigative experience as a sworn detective or criminal investigator at the felony level for a government law enforcement agency;

As part of your application, please attach a writing sample. While an affidavit is strongly preferred, a summary of investigation prepared in a complex case, or a substantial criminal investigative report will also be accepted.


Note: Candidates possessing a foreign degree must submit a translation (evaluation) of their degree from an accredited institution, such as The National Association of Credential Evaluations Services in order to be given credit for the degree.


Substitutions

  • Investigative experience as a detective or criminal investigator at the felony level for a government law enforcement agency may substitute for the degree requirement on a year-for-year basis.

Required Competencies: The following knowledge, skills, and abilities are required for this position and will be considered during the selection process, including examination and/ or interview:

  • Demonstrated organizational skills, including the ability to multi-task, prioritize tasks, and meet deadlines;
  • Demonstrated work experience managing or leading large-scale or complex investigations;
  • Strong oral and written communication skills, including the ability to communicate concisely and effectively;
  • Customer service and interpersonal skills, including the ability to work on a team;
  • Strong critical thinking and analytical skills.

Preferred Qualifications: In addition to the minimum qualifications, if you possess any of the following specifically include the details on your application, as this information will be used to assess your qualifications and may be used to determine a top group of applicants.

  • Experience investigating and researching matters involving violations of State and Federal regulations;
  • Work experience with Medicaid or Medicare regulations and statutes;
  • Experience investigating document intensive white collar fraud cases from intake to completion;
  • Work experience with database programs, such as Excel or Access, used to analyze data and track evidence;
  • Proficiency in Spanish;
  • Training as a forensic interviewer;
  • Experience in planning tactical operations;
  • Experience working with a multidisciplinary investigation and prosecution team;
  • Experience conducting public outreach;
  • Certified Fraud Examiner;
  • Experience/training as a FTO or as a LE instructor;
  • Experience investigating crimes of domestic violence including, but not limited to strangulation;
  • Experience as an investigator working cases with victims/witnesses with developmental or intellectual disabilities.

Conditions of Employment:

  • Applicants must pass a thorough background investigation prior to appointment.
  • Candidates must be Colorado P.O.S.T. certified at the time of application. In accordance with C.R.S. §24-31-303 (5)(a) and (b), applicants must be Colorado P.O.S.T. certified, including the requirement of completing a physical and psychological evaluation (if it has been more than three years since a physical and psychological evaluation has been conducted). Following a conditional job offer, but prior to appointment, a candidate not meeting the requirement of C.R.S. §24-31-303(5)(b) will be subject to a physical and psychological evaluation to determine fitness to serve as a peace officer. Must be proficient with a handgun. Must be available, sometimes on short notice, to travel within and outside the State of Colorado. Must be available to work nights and/or weekends when necessary to conduct fast-paced investigations, execute search warrants, or prepare for trial. Applicants must pass a thorough criminal and personal background check, including a review of the personnel file from prior employment.
  • Position may be required to work outside of regular business hours, including possible early mornings, evenings, weekend, and overnight assignments. Position must have a valid CO driver’s license.
  • Effective September 20, 2021, employees will be required to attest to and verify that they are fully vaccinated for COVID-19, or, submit to twice-weekly serial testing. Upon hire, new employees will have three (3) business days to provide attestation to their status with proof of vaccination, or begin twice-weekly serial testing for COVID-19.


    Testing will be considered paid work time. Additional information regarding testing will be provided to those it applies to.


    Note: Fully Vaccinated means two (2) weeks after a second dose in a two-dose series of the COVID-19 vaccine, such as the Pfizer or Moderna vaccine, or two (2) weeks after the single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine, as defined by the State of Colorado’s Public Health Order and guidance issued by the Colorado Department of Public Health & Environment.

HOW TO APPLY
Required Application Materials:

  • A completed State of Colorado Application: Applicants are responsible for ensuring that the application provided is fully completed and clearly describes their education, training and experience as it relates to this position. Applications left blank or marked “See Resume” will not be considered.
  • Writing Sample: As part of your application, please attach a writing sample. While an affidavit is strongly preferred, but a summary of investigation prepared in a complex case, or a substantial criminal investigative report will also be accepted. If you do not attach this writing sample, your application will be removed from consideration.

Veteran’s Preference: In order to be considered for veteran’s preference you must attach a copy of your DD214 forms as well as any documentation required to prove disability or marital status.


Your application will be reviewed by a qualified Human Resources Specialist to determine if you meet the minimum qualifications for this position. If your application does not demonstrate that you meet the minimum requirements, you will be notified that you will not proceed in the selection process for this position. If your application is rejected and you have questions, you may contact Daisy Zepeda at 720-508-6510 or daisy.zepeda@coag.gov.

Assessment Information:

Colorado Revised Statutes require that all state employees be hired and promoted through comparative analysis of merit and fitness. Upon meeting the minimum qualifications, the next phase of the process is typically a structured application/resume review by a panel of subject matter experts against the job duties and/or preferred qualifications in this job announcement to determine technical competence, depth and breadth of experience and potential job fit.

  • Technical Competence – Technical experience as it relates to the duties outlined in this job announcement.
  • Depth and Breadth of Experience – Experience that covers multiple areas outlined in this job announcement and demonstrates the level of responsibility assigned.
  • Job Fit – Experience will be evaluated to determine how well experience aligns with and meets the business needs of this position. Current experience is preferred.

It is imperative that the “Work Experience” section of your application is complete and specifically addresses your qualifications, experience, work product, and accomplishments as they relate to the Description of the Job, Minimum Qualifications, and Preferred Qualifications as listed above. Failure to include adequate information or follow instructions by the closing date may result in your application not being accepted and/or may affect your inclusion in the final pool of eligible applicants as the materials may be used to identify a top group for additional assessment or establish an eligible list for referral to the hiring manager for final consideration.


Appeal Rights: If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.


An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email, US Mail, faxed or hand delivered within ten (10) calendar days from your receipt of notice or acknowledgement of the department’s action.


For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board go to spb.colorado.gov or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director’s Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.

Supplemental Information

 
 

WHY WORK FOR US


We Embrace Flexibility
We aim to produce outstanding work product for all of our customers


We Are Committed to Diversity
At the Department of Law, we know that we are better together when our differences are valued and everyone is inspired and empowered to contribute. As such, we strive to provide a safe environment where individuals feel valued and respected for who they are; demonstrate a behavior and mindset where differences are welcomed and individuals are equally treated and empowered to do their best work; and promote growth and innovation through a diverse workforce that contributes to creative problem solving and delivers excellent work.


We Have Strong Core Values
Our core values drive our actions. At the Department of Law, we are: 1) principled, maintaining the highest ethical standards, rigorous legal analysis, and careful evaluation of facts; 2) public servants, who are always ensuring our work is not about us, but instead is about the people of Colorado; 3) innovative, by seeking to identify the best approach, make deliberate decisions, and look to improve; and 4) “better together,” by working to support each other and collaborate.


We are Committed to Developing our Employees
We are deeply invested in our talent and regularly provide meaningful opportunities for personal and professional growth through training and coaching. Further, our professional development and performance goal setting process is collaborative and ongoing, and aimed at helping our employees grow and succeed.


We Offer Excellent Benefits
In addition to the comprehensive State of Colorado benefits package including competitive medical and dental health plans, employer-paid life insurance, paid holidays, retirement plans with Colorado PERA, and vacation and sick leave earned each month, there are many other unique benefits that we offer, including:

  • Medical and dental health plans
  • Employer-paid life insurance
  • Paid vacation and sick leave earned each month
  • 10 paid holidays per year
  • Public Service Loan Forgiveness – A borrower may qualify for forgiveness by making 120 on-time payments while employed full-time in public service, if they have certain kinds of federal loans in a qualifying repayment plan
  • Free access to an on-site fitness center
  • Strong, flexible retirement benefits (Download PDF reader) including 401K and 457 plans
  • Distinctive career advancement opportunities throughout the State personnel system
  • Excellent work-life programs, such as flexible work schedules, professional development opportunities, and an employee discount program

To learn more about our benefits visit: https://www.colorado.gov/dhr/benefits.


The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.


The Department of Law is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Julie Christopher, at Julie.Christopher@coag.gov or call 720-508-6511 .


If you have any questions regarding this position, please contact HR Specialist Daisy Zepeda at daisy.zepeda@coag.gov

 
 

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Virtual Medicaid Implementation Coordinator Job in Pensacola, FL at Medicaid Eligibility – Internal

 
 

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Medicaid Eligibility – Internal – CSOPensacola, FL

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  • SHIFT: Work From Home
  • This is a remote position with extensive travel.
  • Do you want to be a part of a family and not just another employee?
  • Are you looking for a work environment where diversity and inclusion thrive?
  • Submit your application today and find out what it truly means to be a part of a team.
  • At Parallon, you have options.
  • You can choose from a variety of benefits to create a customizable plan.
  • You have the ability to enroll in several medical coverage plans including vision and dental.
  • You can even select additional a la carte benefits to meet all your needs.
  • Enroll in our Employee Stock Purchase Plan (ESPP), 401k, flex spending accounts for medical and childcare needs, and participate in our tuition reimbursement and student loan repayment programs.
  • Parallon is dedicated to the growth and development of our colleagues.
  • We will provide you the tools and resources you need to succeed in our organization.
  • We are currently looking for an ambitious Implementations Coordinator to help us reach our goals.
  • Unlock your potential here!
  • Primary responsibilities are in the areas of Implementation and Support.
  • The Operations Coordinator is responsible for administering the mandated training curriculum; and for sustaining a supportive role for project implementation as well as existing office operations.
  • The Operations Coordinator is required to fulfill short term and extended, local and long distance travel assignments.
  • Must maintain and perform the basic duties of the Medicaid Eligibility Advocate position.
  • The Implementations Coordinator is responsible for affecting ongoing quality, productivity, and efficiency by applying a proactive approach to all daily operational duties.
  • The Operations Coordinator must be able to travel 90% to 95% of their time.
  • Previous eligibility experience preferred but not required.
  • Each employee is required to fulfill obligations regarding all daily operational duties; and to adhere to all operational policies and procedures.
  • Employees shall work professionally with patients, hospital employees, agency caseworkers and their respective colleagues.
  • Will be responsible for training and mentoring new Parallon onsite employees for Medicaid Eligibility.
  • Employees shall screen and evaluate referred self-pay patients for existing insurance coverage, federal and state assistance programs, or hospital charity applications.
  • Employees are to secure authorization to represent the patient and complete the application for federal or state programs.
  • Employees must be able to complete and file applications.
  • Employees are to obtain legally relevant medical evidence, physician statements and all other documentation required for eligibility determination.
  • Employees are to maintain proper follow-up through the use of daily cycles and by calling government caseworkers to assure all mandated information has been received by the agency to verify application status and progress.
  • Employees must document progress notes to the patient’s file and the hospital computer system so that hospital personnel can easily identify the progress and status of each referral.
  • Employees must demonstrate proper and effective case management skills.
  • Adhere to work schedules as mandated by supervisor.
  • Maintain work flow in a consistent and timely manner.
  • Performs other duties as assigned
  • Bachelor’s Degree preferred.
  • 3 years’ of Medicaid Eligibility experience preferred
  • Ability to mentor and train new employees
  • Excellent communication skills are required
  • Parallon is an industry leader in revenue cycle services.
  • We partner with over 650 hospitals and 2,400 physician practices nation-wide.
  • Our parent company, HCA Healthcare has been consistently named a World’s Most Ethical Company by Ethisphere and is ranked in the Fortune 100.
  • We are a family 270,000 strong!
  • Our Talent Acquisition team is reviewing applications immediately.
  • Highly qualified candidates will be promptly contacted by our hiring managers for interviews.
  • Submit your resume today to join our community of caring!
  • We are an equal opportunity employer and value diversity at our company.
  • We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
  • Our Company’s recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously.
  • During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.)
  • from you via email.
  • The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking.
  • For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.
  • HCA Healthcare is a collaborative healthcare network, driven by physicians, nurses and colleagues helping each other champion the practice of medicine to give people a healthier tomorrow.
  • With a comprehensive network of more than 270,000 people across approximately 1,800 care facilities, our scale enables us to deliver great outcomes for our patients, provide superior nursing care and be a preferred place for physicians to practice medicine.
  • We never stop in our pursuit of insights and care advances based on the knowledge and data we gain from approximately 30 million patient encounters a year.
  • Every day, we raise the bar to improve the way healthcare is delivered, not just in our facilities, but everywhere.
  • We’re committed to improving more lives in more ways, and above all else, we are committed to the care and improvement of human life.

 
 

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Health Equity Director Medicaid Job Brooklyn New York

 
 

Description

SHIFT:

Day Job

SCHEDULE:

Full-time

 Be part of an extraordinary team!  


We are looking for leaders ls 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?


 Health Equity Director – New York Medicaid (PS69159)


Location:


Must reside in the state of New York and be willing to work from NYC office as needed in the future. Prefer applicants in the New York City area.


 How you will make an impact:  


The Health Equity Director is responsible for assisting New York Health Plan community and stakeholder engagement experience, while applying application of science-based quality improvement methods to reduce health disparities. Primary duties may include, but are not limited to:


+ Assist with the strategic design, implementation, and evaluation of health equity efforts in the context of the population health initiatives;


+ Inform decision-making around best payer practices related to disparity reductions, including the provision of health equity and social determinant of health resources and research to leadership and programmatic areas;


+ Inform decision-making regarding best payer practices related to disparity reductions, including providing Health Plan teams with relevant and applicable resources and research and ensuring that the perspectives of members with disparate outcomes are incorporated into the tailoring of intervention strategies;


+ Collaborate with the Health Plan analytics team to ensure the Health Plan collects and meaningfully uses race, ethnicity, and language data to identify disparities at a population level;


+ Coordinate and Collaborate with members, providers, local and state government, community-based organizations, and other entities to impact health disparities at a population level and ensure that efforts addressed at improving health equity, reducing disparities, and improving cultural competence are designed collaboratively with other entities to have a collective impact for the population.


Qualifications


Minimum Requirements:


+ Requires a BA/BS degree and 5+ years of experience, preferably in public health, social/human services, social work, public policy, health care, education, community development, or justice; ination of education and experience, which would provide an equivalent background.


 Preferred


Qualifications:


+ Knowledge of New York City public health initiatives, socio-economic communities and resources.


+ Strong background in health analytics.


+ Proven background in project/program management.


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,

 
 

Clipped from: https://www.learn4good.com/jobs/brooklyn/new-york/healthcare/1034221508/e/

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Policy Director, Medicare/Medicaid job in Atlanta

 
 

 
 

Found in: Appcast US Premium – 22 hours ago

Atlanta, United States UnitedHealth Group Full time

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life’s best work.(sm)

As a member of the (Complex Care Division of the) National Policy and Influence Team, the Policy Director will lead duals-related policy work including identifying emerging trends and developing proactive positions and responsive materials. The individual will work across internal teams to maintain awareness of challenges and opportunities as well as identify opportunities to be innovative in service to dually eligible individuals. The successful candidate will have a strong mastery of developing and presenting advocacy materials that support market positioning to influence senior leadership as well as other internal and external stakeholders.

If you are located in the EST or CST time zone, you will have the flexibility to telecommute* as you take on some tough challenges. 

Job Scope and Guidelines

  • Serve as SME for all duals policy ensuring deep understanding of Medicaid and Medicare policies– tracking trends and developing advocacy positioning and external thought leadership related content
  • Develop and execute on a robust policy agenda consistent with business priorities
  • Drive external thought leadership strategy to accomplish advocacy agenda and influence national policy conversation in support of duals growth and sustainability
  • Develop internal and external educational programming to increase awareness/knowledge of DSNPs internally and demonstrate thought leadership externally
  • Possess a strong awareness of DSNP policy trends to allow for strategic decision making necessary to navigate engagement with organizational leaders internally and externally
  • Build and maintain relationships with internal Product and health plan teams and establishing processes for shared understanding and agreement on business risk, opportunities and approaches through joint planning documents and scenario planning tools
  • Consistently present to state agency staff in C&S and M&R duals markets
  • Research and provide market opportunity analysis related to C&S and M&R duals markets
  • Develop and review national policy advocacy and thought leadership documents
  • Engage in ad hoc research related to duals-related emerging policy trends
  • Supports policy analysis and development of advocacy positioning in other policy areas, as needed

Functional Competencies

  • Background in Health Care/Medicaid/Public Health
  • Knowledge of duals-related policies and trends
  • Experience engaging in policy research and analysis, preference in area of duals, DSNPs and the intersection with Medicaid
  • Strong writer/editor, particularly policy, legislative, or regulatory writing
  • Excels in use of word, excel, and PowerPoint
  • Systems thinker with strong analytical thinking skills

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:

  • Undergraduate degree or equivalent work experience
  • 5+ years of experience working in managed care organizations, State/Federal Governmental Agencies, Consulting, State Legislative and/or Congressional offices
  • 2+ years of background in DSNP/Medicare/Medicaid experience
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Preferred Qualifications:

  • Master’s Degree in Public Policy, Public Administration, Health Administration or related field
  • Intermediate level of proficiency in analyzing policy information; experience communicating the findings to a variety of audiences
  • Excellent interpersonal writing, oral, and presentation skills
  • Experience in effectively and efficiently managing multiple priorities and projects in a fast-paced environment

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

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

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

Colorado, Connecticut or Nevada Residents Only: The Salary range for Colorado Connecticut and Nevada residents is $97,300 to 176,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives

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.

 
 

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Analyst, Actuarial – Medicaid | CVS Health

 
 

Job Description


Join the Medicaid actuarial team supporting the new Ohio RISE health plan and provide support for business-critical functions in a role with vast opportunities to build the skills necessary to become a well-rounded actuary.


  • Unlike some actuarial roles that focus on one particular core function, the Medicaid team supports a wide array of actuarial responsibilities.
  • Take full ownership of assigned projects.
  • Leverage more advanced technical skills to achieve business solutions and demonstrate solid understanding of business and product processes.
  • Clearly articulate analysis to health plan leadership and encourage fact-based decision making.


#AetnaActuary


Required Qualifications


 

  • Existing proficiency with Microsoft Excel and Word.
  • Demonstrated analytical and computing skills.
  • Demonstrated initiative and perseverance.
  • Excellent oral and written communications skills.


     

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


 

  • We are looking for individuals interested in pursuing their ASA/FSA credentials and have demonstrated progress on actuarial exams.
  • 1 to 3 years related work experience in the Actuarial field; experience with Medicaid is not a requirement.
  • Existing proficiency with SQL.


Education


  • A Bachelor’s degree with a strong math background is required.


     

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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Medicaid Transport Coordinator

 
 

 
 

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The Medicaid Transport Coordinator oversees all aspects of the Medicaid transport program. The coordinator will work closely with the Senior & Disabled program to ensure that senior and disabled clients with transportation barriers can get to medical appointments. The coordinator will also serve as a member of the agency’s leadership team. This will be a full time position at 37.5 hours per week.

JOB DUTIES and RESPONSIBILITIES INCLUDE:
1. Develop and implement the Medicaid Transport Program including development of program and safety policies and procedures as needed.
2. Schedule and coordinate appointments between drivers and clients.
3. Data entry and submitting monthly billing.
4. Recruit, train, supervise, and assign volunteers and interns for service program.
5. Receive client referrals, conduct service eligibility intake, perform onsite needs assessment, and develop service plan for client.
6. Review and assess services provided at contract completion.
7. Maintain client and volunteer contract files, and agency statistical reporting database.
8. Assist with presentations to community groups/organizations to help develop partnerships and collaboration of complementary program initiatives.
9. Coordinate and assist supervisor with contract compliance and reporting.
10. Develop clientrelated informational materials as needed.
11. Participate in agency staff meetings and trainings, as required.
12. Other related duties as assigned by management.

QUALIFICATIONS INCLUDE:
Education & Experience

Associate Degree in Human Services or related field.
Previous experience recruiting and supervising volunteers.
(Or a combination of education and experience providing the knowledge, skills, and abilities to successfully perform the work)

License(s) & Certification(s)

Must have valid driver license and auto liability insurance if personal vehicle is used for work related travel.
Skills and Abilities
Spanish/English bilingual or additional languages helpful.
Desire to work with elderly and disabled individuals.
Strong leadership and supervisory skills.
Effective organization skills and solid initiative.
Proficient in Microsoft Office Suite applications, including Excel, Word, PowerPoint, Publisher and Outlook programs. EmpowOR database knowledge preferred.
Must have strong and effective communication skills (oral and written).
Working knowledge of standard office procedures and technologies (phone, computer, printer, photocopier, scanner, fax machine) is needed.
Demonstrated ability to work harmoniously with people from varied cultural, socioeconomic, educational and experiential backgrounds.

WORKING CONDITIONS / PHYSICAL REQUIREMENTS: Work is generally performed in an office environment, unless otherwise indicated in job duties. Participation in service projects may frequent standing and/or walking. Extended sitting may be required. Sufficient mobility required for use of standard office equipment. Hearing and communication ability must be sufficient to perform essential job functions. Travel within and outside Agency’s service area may be required for community outreach, meetings, training and other jobrelated activities.

COMPENSATION AND BENEFITS:

Wage between $20.87 $23.04 per hour (DOE)

Benefits include:

Medical & Dental Insurance including Rx and Vision
Life Insurance and AD&D coverage
SIMPLE IRA Retirement Plan (3% Employer Match)
Employee Assistance Program
Voluntary supplemental Cafeteria 125 Plan
Paid Sick and Vacation Leave
12 Paid Holidays per year
Health club discounts

(Community Action reserves right to modify, amend, or terminate any benefit at any time for any reason.)

TO APPLY:
Qualified candidates are encouraged to apply by providing ALL items requested. Please submit the following:

(1) Community Action Application (2) Resume (3) Letter of Interest.


You can find all job announcements and apply online on our website at www.communityactionskagit.org


Community Action of Skagit County reserves the right to extend application deadlines and to modify the selection schedule without notice, to form eligibility lists for, or make appointments to, other positions with similar employment requirements.

Community Action of Skagit County is an Equal Opportunity Employer. Should you require accommodation in the application process, please contact our HR Department.

 
 

Clipped from: https://bellingham.craigslist.org/npo/d/mount-vernon-medicaid-transport/7455738035.html?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Senior Third Party Risk Management Analyst (Medicaid) Job in Owings Mills, MD at CareFirst BlueCross BlueShield

 
 

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CareFirst BlueCross BlueShieldOwings Mills, MD Full-time

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  • PURPOSE:The Integrated Risk Management (IRM) department is responsible for the education, empowerment, and governance of business owners in identifying and managing operational risks in a consistent and integrated manner.
  • IRM, facilitated by the Integrated Compliance teams and business owners across the enterprise, establishes frameworks for effectuating consistency within operational risk management.
  • The IRM team is a catalyst for change, providing leadership and subject matter expertise for establishing and maturing risk mitigation and controls critical to the success of the overall organization.
  • Specifically, the IRM team is responsible for identifying and mitigating risks; managing controls and safeguards to minimize the impact of potential and existing risks affecting the organization; ensuring compliance with laws, regulations, and organization frameworks; and monitoring and effectuating remediation of issues identified.
  • This requires strong collaboration and partnership with business owners and stakeholders across the enterprise.
  • Provide Oversight and Governance of Third PartiesSupport maintenance of the centralized repository for third parties including accountable business owners, inherent risk, and tier for each respective third party relationship inclusive of delegated vendors for Medicaid plans.
  • Provide support to the Medicaid Integrated Compliance team to ensure compliance with the Third Party Risk Management (TPRM) framework and standards to ensure that controls in place surrounding data protection, privacy, and access (among other areas) are compliant with CareFirst standards and risk appetite.
  • Support completion of Pre-Delegation Audits per CMS requirements on third party Delegated vendors to assess controls in place both at CareFirst and at the third party, in collaboration with subject matter resources across all relevant risk domains to determine residual risk of third party relationships.
  • Establish Standards and Frameworks for Standardization and Consistent UnderstandingEstablish and implement policies and procedures that address: formal baseline risk assessments, ongoing risk assessments, and re-evaluation of baseline risk assessments; the performance of assessments for operational areas specific to DC and Maryland Medicaid plans.
  • Collaborate with the Integrated Compliance team and key subject matter resources across all relevant risk domains to define and establish frameworks (e.g., Compliance, Risk Assessment, Risk Governance) and definitions for key data elements.
  • Maintain frameworks to meet industry standards (e.g., NIST, HITRUST).
  • Contribute to the development of enterprise-wide training and awareness materials that educate associates and leadership on Medicaid best practices, pervasive Medicaid risk management issues, Medicaid risk management tools and processes, and lessons learned.
  • Oversight, Monitoring, and Execution of AssessmentsConducting audits and risk assessments in accordance with Centers for Medicare and Medicaid Services (CMS) requirements for a DC and Maryland Medicaid health plansConduct formal baseline risk assessments and ongoing risk assessments for operational areas specific to Medicaid activities to include periodic re-evaluations of the accuracy of the baseline Medicare risk assessments (minimum annually) in alignment with 42 C.F.R.
  • Establish and ensure monitoring of Delegated vendors for continuous monitoring purposes for complying with all applicate Medicaid regulations, as well as internal policies.
  • Govern and support associates in the completion of third party and control assessments, including self-assessments, to ensure the adequacy of controls in place to safeguard the organization, including tracking, monitoring, and managing issues identified.
  • Maintain documentation for re-performance ability, including leveraging the Governance Risk and Compliance (GRC) tool and repository (e.g., Compliance 360).
  • Contribute to the repository of best practices and tools/accelerators related to third party assessments, operational risk assessments, and control self-assessments.
  • Governance, Risk & Compliance (GRC) ProgramProvide support to the Medicaid Integrated Compliance team and the Medicare and Medicaid Compliance Officer to ensure compliance with the established Common Compliance Framework (CCF).
  • Leadership and DevelopmentResponsible for mentoring more junior associatesMaintains accountability for the accuracy of information maintained within the centralized repository.
  • Maintains responsibility for timely escalation of concerns identified during risk and control assessments to the IRM Director and the Medicare and Medicaid Compliance Officer.
  • The intent of this list of primary duties is to provide a representative summary of the major duties and responsibilities of this job.
  • Incumbents perform other related duties assigned.
  • Specific duties and responsibilities may vary based upon departmental needs QUALIFICATION
  • Education Level: Bachelor’s Degree In lieu of a Bachelor’s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
  • Experience: 5+ years of work experience in risk management, third party risk management, Medicare/Medicaid audit, Medicare/Medicaid compliance, Medicare/Medicaid security governance or Medicare/Medicaid legal services role.
  • Technical knowledge of and experience executing CMS compliance and audit requirements, CMS audit protocols, CMS monitoring projects, and/or CMS risk assessments.
  • Understanding of legal requirements and health insurance operationsPossess or in the process of obtaining a relevant risk or business certification (e.g., CPA, CIA, CISA, CISM)Hands on with the implementation, support, or assessment of third party risks or operational risks.
  • Knowledge, Skills and Abilities (KSAs):Capabilities and experience in performing independent assessments, including compliance & legal reviews, contract reviews, testing controls, and developing & reviewing assessment reports.
  • Problem solver who works independently and within a team using interpersonal skills, including excellent oral and written communication skills.
  • Understands and possesses general project management skills relevant to performing assessment functions and responsibilities.
  • Ability to work effectively in a fast-paced environment with frequently changing priorities, deadlines and workloads that can be varied for extended periods of time.
  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
  • Considerable judgment, tact, initiative, accuracy, trustworthiness and integrity.
  • MD Medicaid- Program ManagementEqual 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/senior-third-party-risk-management-analyst-medicaid-at-carefirst-bluecross-blueshield-in-owings-mills-md-XEb6L64?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Director Writing for Medicaid Proposal Development | Anthem, Inc.

 
 

Description


SHIFT: Day Job


SCHEDULE: Full-time


Be part of an extraordinary team


We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?


Build the Possibilities. Make an extraordinary impact.

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



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


How You Will Make An Impact


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


Qualifications


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


Highly Preferred Skills And Experience


  • Former proposal writing experience, preferably on Medicaid Health plan proposals
  • People management experience


We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.


Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

 
 

Clipped from: https://www.linkedin.com/jobs/view/director-writing-for-medicaid-proposal-development-at-anthem-inc-2959887951/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Project Coordinator – Medicaid Job in Phoenix, AZ at Aetna

 
 

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AetnaPhoenix, AZ

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  • Job DescriptionThe Project Coordinator position supports the Medicaid Formulary team.
  • Primary duties include formulary submission and installation.
  • In addition this role is responsible for verifying the quality and accuracy of the formulary through the validation and audit process.
  • This role is responsible for other duties as assigned.
  • Fundamental Responsibilities:Formulary Support including formulary development and maintenance support.
  • Maintenance of Business (MOB) file creation and QC for multiple Medicaid Health Plans.
  • Formulary database maintenance support.
  • Monthly formulary update documents creation.
  • Audit & mock audit review and testing.
  • Review benefits testing scenarios for Medicaid/MMPOther duties may include: Project management support and contribution to policy & procedure development as well as process and desktop documents.
  • 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.
  • Business OverviewAt 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.

Clipped from: https://jobsearcher.com/j/project-coordinator-medicaid-at-aetna-in-phoenix-az-xbAjgGa?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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NAVITUS HEALTH SOLUTIONS LLC Product Manager

 
 

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

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