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Strategic Market Director, Medicaid – Blue Ridge Mountain Territory – Johnson & Johnson Health Care Systems Inc.


Johnson & Johnson Health Care Systems Inc. (Strategic Customer Group) is recruiting for a Strategic Market Director, Regional and Government Accounts – Medicaid, covering PA, DC, KY, VA, MD, and WV. This is a field-based role; residing in one of the covered states is preferred.


Johnson & Johnson Health Care Systems Inc., Strategic Customer Group, provides account management and customer support services to key health care customers, including leading health plans, pharmacy benefit managers, and government health care institutions. The company also provides contract management, logistics and supply chain functions for the major Johnson & Johnson franchises.


At the Janssen Pharmaceutical Companies of Johnson & Johnson, what matters most is helping people live full and healthy lives. We focus on treating, curing and preventing some of the most devastating and complex diseases of our time. And we pursue the most promising science, wherever it might be found.


The Janssen Pharmaceutical Companies of Johnson & Johnson, provide medicines for an array of health concerns in several therapeutic areas. Our goal is to help people live healthy lives. We have produced and marketed many first-in-class prescription medications and are poised to serve the broad needs of the healthcare market – from patients to practitioners, from clinics to hospitals. For more about the Pharmaceutical Companies of Johnson & Johnson, visit: http://www.janssenpharmaceuticalsinc.com

We are Janssen. Our mission drives us. Our patients inspire us. We collaborate with the world for the health of everyone in it.


Responsibilities

• Establish, maintain and enhance product access through optimal formulary positions, drive sales growth by leading local market selling and pull through and optimizing price through sound negotiating strategies for the pharmaceutical products in Neuroscience, Infectious Disease, Pulmonary Arterial Hypertension, and support for products as needed in Immunology, Oncology, and Cardiovascular therapeutic areas.
  
• Negotiate terms and conditions of contracts, providing access for products using clinical and economic value propositions, as well as marketing resources, to obtain favorable access.
  
• Navigate the complex payer marketplace and works to achieve maximum account penetration to increase scope and areas of influence within assigned National or Regional Accounts which may include health plans, state or local governments, physician medical groups or other payer organizations.
  
• Complete customer calls and meets with assigned accounts to further advance Janssen Pharmaceutical product status, accessibility, and use, as required.
  
• Set appointments and presents technical information in group presentations and one-one interactions.
  
• Collaborate regularly with other Strategic Market Directors, National Account Directors, Region Business Directors, Division Managers and other J&J partners to ensure open lines of communication and synergistic efforts within the accounts.
  
• The individual will interact with RWV & E (Real World Value and Evidence) MSL’s (Medical Science Liaisons) to utilize their expertise and support with customer accounts.
  
• Collaborate with Brand, Finance, Compliance, Legal, and Pricing Strategy to provide account information and influence product decision-making in favor of their strategies.
  
• Provide leadership and suggested direction to the account team, identifying opportunities for share growth and seeks to develop Regional synergies that both enhance the Company position and result in National impact.
  
• Interact as appropriate with field sales management to develop local pull through strategies and ensure growth is maximized within the assigned geographies.
  
• Accountable to develop customer specific account strategies to capitalize on new business opportunities across all assigned product lines.
  
• Serve as the voice of the customer and collaborates with internal partners such as Brand, Contracting, and Finance to incorporate their concerns and interests into brand strategy.
  
• Serve as a resource in the role of expert to all internal partners on the business models and trends of payers and as the local market expert on reimbursement and access within their assigned geographies.
  
• Responsibilities must be carried out with strict adherence to Janssen Compliance guidelines.
  
  
   
  

Qualifications


Qualifications

• A minimum of a Bachelor’s Degree is required
  
• A minimum of six (6) years’ healthcare industry experience is required
  
• A minimum of three (3) years of sales, marketing, contracting or related experience is required
  
• A minimum of two (2) years of pharmaceutical, medical/surgical or device sales management experience is preferred
  
• Payer experience is preferred
  
• Experience working in channels such as large payers, national and regional health plans, state and local governments, PBM’s, SPP’s and Physician Medical Groups is preferred
  
• Prior account management experience or experience with health plans is preferred
  
• Prior experience with Director and Senior Level Health Plan Executives within the assigned geographical area is preferred
  
• Knowledge of formulary processes, contractual negotiations and implementation, and healthcare industry trends is required
  
• The ability to understand multiple disease states, therapeutic areas, clinical and pharmacoeconomic data as it relates to the assigned product areas is required
  
• This position requires the ability to regularly use discretion and judgment and to establish an effective work schedule that accommodates frequent disruptions to routines and flexible work hours in accomplishing objectives
  
• This position requires travel (up to 30% domestic) based on candidate location including required meetings and training, and some overnights
  
• This position is a field based position, covering customers in PA, DC, KY, VA, MD, and WV. The ideal candidate will reside one of the assigned states.
  
• Candidates must possess a valid driver’s license issued in the United States and must successfully complete a background investigation, to include a review of your driving record history
  
  
   
  

At Johnson & Johnson, we’re on a mission to change the trajectory of health for humanity. That starts by creating the world’s healthiest workforce. Through cutting-edge programs and policies, we empower the physical, mental, emotional, and financial health of our employees and the ones they love. As such, candidates offered employment must show proof of COVID-19 vaccination or secure an approved accommodation prior to the commencement of employment to support the well-being of our employees, their families and the communities in which we live and work.

For more information on how we support the whole health of our employees throughout their wellness, career and life journey, please visit www.careers.jnj.com.

Johnson & Johnson Family of Companies are equal opportunity employers, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, protected veteran status, disability status, or any other characteristic protected by law.

Primary Location

United States-Pennsylvania–

Other Locations

North America-United States-District of Columbia, North America-United States-Kentucky, North America-United States-Maryland, North America-United States-Virginia, North America-United States-West Virginia

Organization

Johnson & Johnson Health Care Systems Inc. (6077)

Job Function

Sales

Requisition ID

2206014995W

Clipped from: https://www.linkedin.com/jobs/view/strategic-market-director-medicaid-blue-ridge-mountain-territory-johnson-johnson-health-care-systems-inc-at-johnson-johnson-2935683166/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Maximus is seeking a Business Analyst, working remotely, responsible for performing detailed requirements analysis, documenting processes, and validating system performance against requirements.

*As a large employer and Federal contractor, Maximus is subject to various vaccine mandates across our lines of business. Maximus is committed to complying with any applicable vaccine mandates. The specific vaccine requirements for this position will be outlined throughout the selection process. Individuals who believe they may qualify for a medical or religious accommodation will have the opportunity to apply for an accommodation following an offer of employment.

Primary Responsibilities:

· Deliver results after thorough research of functional needs by collaborating and communicating with various stakeholders, both internal and external to the company

· Apply strong analytical reasoning to understand end user’s requirements and transforms them into operational application

· Acquire deep knowledge of working systems and bring efficient and effective changes for better performance

· Participate in the administration of project and program contract activities

· Extract, analyze, and report data to support program activity and assist in management decision making

· Audit, evaluate, track, and report program implementation and project activity for Quality Assurance and contract compliance purposes

· Plan, implement and maintain program and contractual changes

· Work closely with operations and systems staff to define requirements, test criteria, and success factors

Job Requirements:
 

Minimum Requirements:

· Bachelor’s degree with 3+ years of experience

· May have additional training or education in area of specialization

· Develop solutions to a variety of problems of moderate scope & complexity

· General application of concepts & principles

· Contribute to the completion of organizational projects & goals

· Frequent use and general knowledge of industry practices, techniques, and standards

· Apply knowledge and skills to complete a wide range of tasks

· Communicates on complex or sensitive issues or drafts such responses for supervisor or manager

· 3+ years of MMIS experience

· Experience with legacy to cloud-based projects

 
 

 
 

Clipped from: https://localjobs.fox8jobs.com/jobs/business-analyst-medicaid-provider-systems-remote-atlanta-georgia/516369275-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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Public Consulting GroupWashington, DC

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• Overview About Public Consulting Group Public Consulting Group, LLC. (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives.
  
• Founded in 1986 and headquartered in Boston , Massachusetts, PCG has over 2 , 500 professionals in more than 60 offices worldwide.
  
• PCG’s Education practice offers consulting services and technology solutions that help schools, school districts, and state education agencies/ministries of education to promote student success, improve programs and processes, and optimize financial resources.
  
• To learn more, visit Responsibilities Role: PCG is currently seeking a State Medicaid Lead to work in Tennessee and support our Tennessee State-Wide Medicaid service line.
  
• For the right motivated individual, this is an excellent opportunity to grow with us and help special needs students and school districts across the region recover available federal reimbursements.
  
• The Lead will work in a deadline-oriented, fast-paced environment as part of a growing team consisting of consulting and operations staff.
  
• The State Lead will specifically support their assigned Project Manager/Client Lead in all aspects of project execution.
  
• This position revolves around operational functions of our school-based Medicaid implementation and ongoing support services.
  
• Preference is for candidates living in or around Tennessee.
  
• The ideal candidate is personable, proactive in anticipating client needs, enjoys meeting clients in person, and feels a sense of duty to follow-up with client requests and maintain client satisfaction.
  
• Qualifications Required Skills: + Excellent client management and customer service skills.
  
• + Strong analytical and reporting skills, including the ability to analyze and organize data.
  
• + Excellent organizational, oral presentation and written communication skills.
  
• + Ability to manage time to meet critical deadlines for several ongoing projects.
  
• + Ability to work independently and with a team.
  
• + Database skills.
  
• We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences.
  
• At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications.
  
• We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law.
  
• PCG will not tolerate discrimination or harassment based on any of these characteristics.
  
• PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.
  
• Connect With Public Consulting Group!
  
• Public Consulting Group is an equal opportunity employer.
  
• All qualified applicants receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, protected veteran status, or status as a qualified individual with a disability.
  
• VEVRAA Federal Contractor.
  

 
 

Clipped from: https://jobsearcher.com/j/state-medicaid-lead-at-public-consulting-group-in-washington-dc-j8Q7l00?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Responsible for researching, analyzing, documenting and coordinating the resolution of escalated and/or complex claims issues for the Health Plan and requires expert knowledge of all systems, tools and processes.

Primary duties may include, but are not limited to: 

• Receiving and responding to state or federal regulatory complaints related to claims
  
• Managing health plan dispute escalations
  
• Quality review of various dispute outcomes
  
• Managing complex system issues
  
• Managing state updates
  

Qualifications

Requirements: 

• BA/BS degree
  
• Minimum of 5 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry
  
• Or any combination of education and experience which would provide an equivalent background
  

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.


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. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/7886612-medicaid-state-operations-analyst?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Overview:

Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit www.guidehouse.com.

Responsibilities:

We are seeking a Senior Consultant with experience and knowledge of national healthcare reform and its impact on state Medicaid, public health or state and local health and human services programs, including health benefits exchanges, Medicaid expansion, Medicaid managed care, Medicaid program operations, program improvement and state compliance requirements, as well as a strong understanding about various state and local programs and policies across the country. The successful candidate will:

• Assist state agencies, including Medicaid, Behavioral Health, Developmental and Intellectual Disabilities, State Units on Aging and/or Social/Human Services in the development of strategic plans to support the statewide implementation of healthcare reform
  
• Assist clients in assessing business and technical requirements related to the implementation of healthcare reform, including managed care programs and Accountable Care arrangements
  
• Research and stay abreast of all states’ healthcare reform efforts
  
• Perform data and qualitative research activities to address state research needs
  
• Document and communicate findings and support development of recommendations and follow-up steps to respond to findings
  
• Identify and collaborate with broad range of healthcare stakeholders
  
• Participate in analysis of client-identified issues or problems
  
• Manage projects and engagements of various sizes and durations
  
• Supervise and support the development of staff
  
• Effectively manage client interaction and managing client expectations
  
• Provide subject matter expertise, as requested and appropriate
  
• Help develop business with new clients, as requested
  
• Participate in non-client related firm-building activities
  
• Assure high-quality client work product
  

Qualifications:

Required Qualifications:

• A Bachelor’s degree in business administration (finance or accounting), economics or similar discipline – OR – A Master’s degree in health policy and administration, public policy, public health, social service administration OR equivalent
  
• 2-3 years of previous work experience in the health care industry, preferably in a consulting capacity or consulting firm
  
• Knowledge of state health agencies and healthcare reform, e.g., Medicaid, public health, health insurance, and health reform organizations (legislative, executive, governor’s office)
  
• Superior written and oral communication skills
  
• Excellent quantitative analysis skills
  
• A strategic problem solver
  
• Demonstrated ability to self-manage task execution and manage discreet task / project / initiative functions.
  
• Working knowledge of Word, Excel, PowerPoint, and Access as well as the ability to conduct research through use of the internet and other information sources
  
• The ability to work overtime as necessary
  
• Ability to travel to meet client needs (10-30%) as required
  

Additional Requirements:

The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.

• The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
  
• The targeted starting base salary for this position is $74,200-$110,300.
  

Disclaimer:

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Rewards and Benefits

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance
  
• Personal and Family Sick Time & Company Paid Holidays
  
• Position may be eligible for a discretionary variable incentive bonus
  
• Parental Leave and Adoption Assistance
  
• 401(k) Retirement Plan
  
• Basic Life & Supplemental Life
  
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
  
• Short-Term & Long-Term Disability
  
• Tuition Reimbursement, Personal Development & Learning Opportunities
  
• Skills Development & Certifications
  
• Employee Referral Program
  
• Corporate Sponsored Events & Community Outreach
  
• Emergency Back-Up Childcare Program
  

 
 

 
 

Clipped from: https://www.glassdoor.com/job-listing/senior-consultant-government-healthcare-solutions-medicaid-program-design-and-operations-guidehouse-JV_IC1148170_KO0,88_KE89,99.htm?jl=1007683813845&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

About Children’s Home Society

At CHS, our mission is to promote the right of every child to a permanent, safe, and loving family. Guided by our core values of compassion, integrity, excellence, and innovation, we believe that our people are the reason behind our success. Being a member of the CHS family means joining a team committed to championing children’s’ well-being and sharing a belief in the transformative power of family.

Founded more than a century ago, CHS is a recognized leader in transforming families and communities, with an annual budget of nearly $30M and over 300 employees. With offices in 10 cities across North Carolina and remote work opportunities, we are continuing to grow a workforce that is equitable, diverse, and inclusive.

CHS is proud to be celebrated as a 2021 Best-in-Class employer by Gallagher. Gallagher’s Best-in-Class awards recognize employers that excel in supporting their employees’ physical, emotional, career and financial wellbeing for better organizational outcomes.

We believe that healthier families shape healthier communities. That is why we are committed to giving every child and family a voice and relentlessly advocating for their success. We put heart and discipline into helping families grow healthy and strong, and connecting them to tools, skills, and knowledge critical for their well-being. When we empower families to be the best versions of themselves, we can lead the way for meaningful change.

Position Summary: The Medicaid Billing Specialist will be responsible for overseeing the billing process for our clients, submitting claims to Medicaid, examining denials, and troubleshooting problems. Our Medicaid Billing Specialist will also maintain security procedures to protect patient confidentiality. The claims are then examined for Medicaid guideline compliance and completion before submission. All claims are filed in a timely manner to expedite payment. Medicaid Billing Specialist will also review daily billing reports, keep up with submission dates and follow up on unpaid claims. This position will be an office position with some remote flexibility.

SKILLS & COMPETENCIES

• An understanding of various forms, codes (CPT & ICD), insurance terminology and insurance company remittance advice.
  
• Strong analytical abilities and attention to detail with desire and commitment to take full ownership and accountability for his/her area of responsibility
  
• Display sensitivity to the service population’s cultural and socioeconomic characteristics.
  
• Professionalism with high standards of integrity, confidentiality, and accuracy
  
• Self-motivated team player, with strong organizational skills
  
• Demonstrates in-depth knowledge and experience in patient accounting, scanning, data quality monitoring and internet-based insurance websites
  
• Knowledge of Medicaid billing requirements
  
• Requires ability to identify and understand issues and problems
  
• Ability to apply high levels of critical thinking and understanding
  
• Ability to operate a cloud-based phone system, computer, calculator, and other office equipment.
  
• Ability to type, follow directions and complete assignments within given deadlines and to establish priorities
  
• Excellent/effective oral and written communication skills
  
• Excellent phone etiquette and internal/external customer service skills
  
• Experience with Microsoft Word and Excel
  
• Strong knowledge of data processing concepts, use of computers and Microsoft Office
  
• Certificates, Licenses, Registrations, and/or Medicare certification are a plus, but not required.
  
• Prolonged periods of sitting at a desk and working on a computer
  
• Ability to lift 15 lbs.
  
• Perform other duties related to department goals and projects as needed
  

EDUCATION/EXPERIENCE

• Associate degree with 4 year’s business office experience in a healthcare environment required.
  
• Previous experience working with commercial or other third-party insurance claims and reimbursement procedures required.
  
• Clinical practice and/or Medicaid billing experience preferred.
  
• Business courses such as medical terminology, accounting, finance, cash applications, typing, and word processing preferred.
  

 
 

Clipped from: https://www.ziprecruiter.com/c/Childrens-Home-Society-of-North-Carolina/Job/Medicaid-Billing-Specialist/-in-Greensboro,NC?jid=e08b208514b2f809&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Service Coordination Supervisor

NHTD & TBI Medicaid Waiver Programs

AIM Independent Living Center is a nonprofit agency based in Corning, NY which provides supports and services to people with all types of disabilities in the Southern Tier and Finger Lakes regions of upstate New York. 

AIM operates the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Medicaid waiver programs, which provide home- and community-based services to people with disabilities. These programs enable people to live safely and independently in their own homes as an alternative to institutional care.

The Service Coordination Supervisor manages a team of service coordinators who support participants in the NHTD and TBI waiver programs. This position meets with all potential participants in these programs to assist with application, enrollment and developing plans for service, and provides ongoing oversight once services begin. The Service Coordinator Supervisor also maintains their own caseload of consumers.

This position offers a competitive salary; medical, dental and vision insurance; life insurance; a retirement plan with a matching contribution; and generous paid time off.

View the job description and apply online at aimcil.com/careers. For more information about AIM, visit aimcil.com or call (607) 962-8225.  

   Clipped from: https://regionalhelpwanted.com/twin-tiers/jobs-nhtd-tbi-medicaid-waiver-programs-aim-independent-living-center-corning-ny/123154423/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

IA United States

Job Description

The Iowa Medicaid Enterprise (IME) division of the Department of Human Services (DHS) is seeking a knowledgeable and creative Medicaid Program Manager to join the team. Be part of an organization that is continually working to modernize and innovate solutions to improve the quality of life and health outcomes for the state’s Medicaid members.    The (IME) is an endeavor that unites State Staff and “Best of Breed” contractors into a performance-based model for the administration of the Iowa Medicaid program. Medicaid is a state-federal funded program that is administered by the Department of Human Services of the State of Iowa and is the second largest insurance program in the State of Iowa.  The IME establishes the state’s policy to oversee performance and compliance of the Medicaid Managed Care program.   This position requires strong knowledge of Medicaid policies and is responsible for the administration of the Medicaid programs.  Continual analysis of coverage and reimbursement policies are conducted to assess current and pending federal requirements.  Looking at future programmatic changes and options to meet federal and state program goals is a critical component of this job. Identifying, managing and capturing performance data to conduct performance analysis of Managed Care Organizations (MCO) and vendors is another important aspect of the job duties. Additional duites include:   * Write State Plan Amendments (SPA) for the Centers for Medicare and Medicaid Services (CMS)  * Draft Code language for Medicaid covered services incorporating service definitions, provider qualifications and reimbursement methodology in accordance with CMS regulations and state law * Consult with the Attorney General’s office and relevant constituency groups  * Collaborate with Iowa Medicaid Enterprise contract manager(s) to track, monitor and modify the process as needed  * Draft and publish administrative rules per guidelines * Develop and conduct training as needed or required for implementation guide * Monitor federal and state regulations and requirements on a routine basis. * Continually analyze, review and assess national trends, CMS initiatives, best practices and prepare benefit analysis or comparison analysis or proposed benefits and associated cost for Iowa IME/DHS; summarize with recommendations. * Provides program quality assurance and quality improvement reviews for  * Provides process improvement proposal and manages implementation   Employee must have an excellent knowledge of Medicaid services and supports and the medical background needed be able to understand and work with state and federal legislation relative to the areas of program responsibility.    Preference will be given to applicants who have any of the following experience or education:  * Licensed Masters Social Worker (LMSW) * Licensed Independent Social Worker (LISW) * Licensed Mental Health Counselor (LMCH) * Master’s degree in a human services field  * RN/BSN background * Demonstrated ability to strategically apply policy analysis and development inclusive of IT system structure supports  * Demonstrated experience drafting health care policy * Demonstrated experience interpreting health care data and national health care metrics The Iowa Department of Human serves almost a million Iowans through health coverage, mental health and disabilities services, long-term care and treatment, and adult, children, and family services. Our mission is to help Iowans achieve healthy, safe, stable, and self-sufficient lives through the programs and services we provide. We have a great total compensation package for all of our full-time employees, including: * Iowa Public Employees’ Retirement System (IPERS) * Retirement Investors Club (RIC) (Employer Sponsored Retirement Plan) * Health, Dental and Vision Insurance * Vacation Leave  * Sick Leave * Paid Holidays (9 days/year) * Flexible Spending Accounts * Life Insurance * Long-Term Disability Insurance To learn more about benefits available to State of Iowa employees visit the benefits web page.   DHS values those with “lived experience” and encourages adults who were fostered as youth, foster parents, and/or parents who were in the DHS system to apply.  Minorities, women, persons with disabilities and veterans are encouraged to apply (Hearing and Speech Impaired – Relay Iowa 1-800-735-2942 TDD).     Our agency uses E-Verify to confirm the employment eligibility of all newly hired employees. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify.  Applicants must meet at least one of the following minimum requirements to qualify for positions in this job classification: * Graduation from an accredited four-year college or university with a degree in business or public administration, management information systems, industrial management, or statistics, and experience equal to three years of full-time work in management analysis or project management. * Seven years of full-time work experience in management analysis or project management. * A combination of a total of seven years of education and full-time experience (as described in number one), where thirty semester hours of accredited college or university course work equals one year of full-time experience. * Current, continuous experience in the state executive branch that includes two years of full-time work as a Management Analyst 2 or two and a half years as a Management Analyst 1. For additional information, please click on this link to view the job description.

 
 

Clipped from: https://us-jobs-today.com/job-detail/925951568/medicaid-program-manager-medical-services?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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ConduentLexington, KY Full-time

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• About Conduent Through 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.
  
• Executes routine inbound and outbound call center activities concerning the business products/services, using a standard script and established guidelines and under supervision, in order to meet SLAs Ascertains nature of the transaction/call and assesses whether it can be handled in place, needs to be transferred, or further follow-up is required, in order to provide client with appropriate resolution.
  
• Provides customer with appropriate standard information requested.
  
• Derives all necessary information from customer to update database.
  
• Understands when to seek help and/or escalate to a more senior role.
  
• Qualifications Diploma or GED Call Center experience Medicaid Eligibility or Insurance enrollment experience is a plus Computer Proficiency a must Job Track Description: Performs business support or technical work, using data organizing and coordination skills.
  
• Performs tasks based on established procedures.
  
• In some areas, requires vocational training, certifications, licensures, or equivalent experience.
  
• General Profile Ability to perform in an analytical and operational process.
  
• Entry-level position with limited requirements for licenses, training, and certifications.
  
• Applies experience and skills to complete assigned work.
  
• Works within established procedures and practices.
  
• Works with a close degree of supervision.
  
• Functional Knowledge Has basic skillset in a range of processes, procedures, and systems.
  
• Business Expertise Supports in the achievement of company goals by understanding how teams integrate for the best outcome.
  
• Impacts a team through quality of the services and information provided.
  
• Follows standardized procedures and practices and receives close supervision and guidance.
  
• For consistency, methods and tasks are described in detail.
  
• Leadership Has no supervisory responsibilities.
  
• Problem Solving Ability to problem solve, self-guided.
  
• Evaluates issues and solutions to provide the best outcome for the client and end-users.
  
• Has limited opportunity to exercise discretion.
  
• Interpersonal Skills Exchanges information and ideas effectively.
  
• Responsibility Statements Assesses calls to provide service immediately, be transferred, or require follow-up for client resolution.
  
• Identifies customer needs by referring to case notes and examining each as a specific case.
  
• Performs routine call center activities concerning business products and services.
  
• Uses standard scripts and established guidelines and under supervision, to meet SLAs. Provides customers with information that is specialized.
  
• Communicates in a warm and empathetic manner.
  
• Gathers all necessary information to update the database.
  
• Escalates issues to senior levels, based on complaints or concerns.
  
• Explains company policies to customers.
  
• Performs other duties as assigned.
  
• Complies with all policies and standards.
  
• Closing Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.
  
• People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the “Submit” button at the bottom of the form.
  
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Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Be part of an extraordinary team

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

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://anthemcareers.ttcportals.com/jobs/8590016-director-writing-and-proposal-development-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic