Category: Curator- Job Hunter

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• Position Description*:
  
• About us:*
  

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

One of Mathematica’s core values is a deep commitment to diversity, equity, and inclusion. Our research is more robust because it is informed by a variety of diverse perspectives, and our mission to improve societal well-being is strengthened by a greater understanding of issues and challenges facing the populations we serve. Mathematica’s ongoing commitment to diversity and inclusion is woven into our everyday actions, policies, and practices. We are dedicated to maintaining a work environment in which everyone is treated with respect and dignity. We offer Employee Resources Groups on a variety of topics, local diversity and inclusion activities in each office, and a Diversity council.

• About this opportunity:*
  

We are seeking a highly motivated person to join our team as a Solutions Analyston our Medicaid practice team in the Health Unit. As a Solutions Analyst, you will work closely with clients and internal project teams that include technical and non-technical staff to develop and document business solutions to address our clients’ pressing policy and business challenges, such as how to implement reporting systems to monitor program performance or how to assess and improve the quality of data for federally required reporting or data analysis/research. The solutions are often data analytic in nature and include an information technology component. Solutions include web applications such as reports and dashboards, data collection or reporting tools (may be web-based), and technical assistance toolkits.

Solutions analysts are liaisons between clients, typically federal and state agency staff, and Mathematica staff to help develop solutions that address client’s most pressing challenges while considering the client’s constraints (such as, resources, budgets, regulations, policy, and systems). Solutions analysts facilitate discussions with the client to ensure that the Mathematica project team understands client needs and will work with Mathematica staff to design and develop the appropriate solution. Throughout the process, solutions analysts will assess client requests and technical constraints against project goals and provide the client with options. Solutions analysts manage client meetings, which may include design sessions, requirements gathering meetings, and routine check ins.

Our ideal candidate thrives working in collaborative team environments, is comfortable interacting with staff who have varying degrees of technical knowledge, has strong problem-solving skills, a drive to understand how things work, comfort working in “gray” areas and learning quickly, and isn’t afraid to ask questions. The ideal candidate is also experienced with using or willing to learn about various technical solutions or languages to help clients solve problems. They are also able to quickly assume a role that requires engaging Mathematica staff across a range of job classifications and clients from entry-level to executive leadership positions.

• Position Requirements:*
  

 
 

• Master’s degree with at least one year of relevant experience working on some aspect of the Medicaid program and engaging end users of a technical solution and liaising with business and technical subject matter experts, or Bachelor’s degree with commensurate experience
  
• Excellent communication skills including the ability to make complex information understandable to many audiences with various types and levels of subject matter and technical expertise
  
• Ability to identify gaps or issues in processes and technological solutions (such as business intelligence reporting systems or web-based dashboard) and present opportunities for improvement
  
• Highly skilled at leading discussions that identify problems and provide plausible solutions that meet client capabilities and budgets
  
• Experience engaging a range of client stakeholders with varying skillsets by applying a variety of methods (such as interviews and focus groups) and approaches (such as human-centered design)
  
• Experience with Medicaid data and systems or program operations
  
• Basic grasp of data analysis (for example, working with large data sets, cleaning data, and tabulations or descriptive statistics), data structures (such as relational databases), or system design techniques (such as commercial-off-the-shelf [COTS] products, software as a service, etc)
  
• Ability to elicit needs from clients and translate them into to formal written requirements.
  
• Strong organizational skills and attention to detail
  
• Ability to deal tactfully and diplomatically with others
  
• Ability to handle multiple priorities, sometimes simultaneously, under deadline pressure.
  
• Familiarity with agile principles, knowledge of relational databases, basic programming ability, or human-centered design approaches is a plus
  
• Position may involve up to 25% travel
  

Position Requirements:

• Responsibilities:*
  

 
 

• Serve as a liaison between project teams, technical staff, and client.
  
• Create opportunity assessments, business cases, process analysis documents, and other project planning and execution documents
  
• Work with project teams to develop written business requirements from verbal conversations.
  
• Assist with the development of processes and systems
  
• May assist with project management (for example, schedule and financial management)
  
• May assist with the development of and participate in system testing, creating test plans, and coordinating testing activities
  
• May assist in creating quality assurance and quality control (QA/QC) plans and coordinating QA/QC activities
  

We offer our employees a stimulating, team-oriented work environment, competitive salaries, and a comprehensive benefits package, as well as the advantages of employee ownership. We provide generous paid time off. Visit our web site at ~~~

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

To apply, please submit cover letter, resume, location preferences, writing sample, and salary requirements at time of application.

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

We also welcome applications from candidates who wish to work remotely/virtually full-time.

This position offers an anticipated base salary of $65,000 – $95,000 annually. This position may be eligible for an annual bonus based on company and individual performance.

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

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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Centene CorporationIndianapolis, IN

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• You could be the one who changes everything for our 25 million members.
  
• Centene is transforming the health of our communities, one person at a time.
  
• As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
  
• This opening is for a Project Manager III position.
  
• In this role, you will plan, organize, monitor, and oversee complex projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives.
  
• + Manage the full project life cycle including requirements gathering, creation of project plans and schedules, obtaining and managing resources, managing budget, and facilitating project execution, deployment and closure
  
• + Utilize corporate and industry standard project management tools and techniques to effectively manage projects.
  
• + Assist with establishment and maintenance of corporate project management methodology and other department procedures
  
• + Maintain detailed project documentation including meeting minutes, action items, issues lists and risk management plans
  
• + Provide leadership and effectively communicate project status to all stakeholders, may include written executive summaries
  
• + Negotiate with project stakeholders to identify resources, resolve issues, and mitigate risks
  
• + Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and company’s objectives
  
• + Provide functional and technical knowledge across multiple business and technical areas
  
• + Monitor the creation of all project deliverables to ensure adherence to quality standards including design documents, test plans, training materials, and operations documentation
  
• + Flexible work solutions including remote options, hybrid work schedules and dress flexibility
  
• + Competitive pay
  
• + Paid Time Off including paid holidays
  
• + Health insurance coverage for you and dependents
  
• + 401(k) and stock purchase plans
  
• + Tuition reimbursement and best-in-class training and development
  
• Bachelor’s degree in Business Administration, Healthcare Administration, related field, or equivalent experience.
  
• Master’s degree preferred.
  
• 4+ years of project management and implementation or program management experience.
  
• Proficient with MS Office applications and project management tools.
  
• Experience working with and leading diverse groups and matrix managed environments.
  
• PMP, PgMP, or CAPM preferred.
  
• All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
  
• Medicaid Implementation Project Manager
  

Clipped from: https://www.gettinghired.com/job-details/5987740/director-kentucky-medicaid-health-plan-cfo/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description
This role will function as the CFO for the Kentucky State Medicaid Health Plan, and will lead the respective markets’ ability to achieve its financial and strategic goals by managing and driving business actions and financial goals across the Plan and the Aetna Medicaid segment. The annual P&L responsibility for the Kentucky State Medicaid Health Plan is approximately $1.8 billion. The Plan CFO will:

1. Partner with the Kentucky Plan CEO and their senior management team to maintain financial and operational control of the business.
2. Lead a team responsible for managing the financial close, and planning and forecasting processes.
3. Leverage prior experience to ensure the quality and integrity of P&L/cost center owner level reporting, membership and/or expense forecasts, product reporting and balance sheet reporting.
4. Collaborate with constituent areas including Actuarial, Underwriting, Network and Medical Economics to execute on growth priorities.

Responsibilities:
1. Partner with the Kentucky State Medicaid Plan CEO and respective leadership team to execute business priorities and manage full P&L responsibility.
2. Drive results; demonstrates urgency and holds self and the team accountable for achieving high standards of performance and service
3. Lead the coordination and development of the Kentucky State Medicaid Plan financial budgets and forecasting tools/processes.
4. Identify emerging product/market trend vulnerabilities and opportunities through analysis; develop and implement action plans where necessary
5. Establish development of major action plans necessary for the Kentucky State Medicaid Plan and monitor implementation to seize competitive opportunities and/or respond to performance shortfalls/plan variances.
6. Identify, implement, monitor, and track effective medical cost analysis through coordination with medical directors, network management, actuaries, etc.
7. Partner with other financial disciplines, e.g., actuarial, Medical Economics, to assure rates with the state, product and risk alignment with business unit financial performance targets.
8. Lead financial analysis and recommendations in support of management’s evaluation of strategic and business initiatives.
9. Influence development of direct reports and broader team through effective coaching, mentoring and development planning

The successful candidate will have the ability to:
• Drive strategic business discussions with senior leadership team within the division and state health plans
• Encourage others through positivity, vision, confidence, challenge, and recognition
• Recognize that change is essential, set goals for change and lead purposeful efforts to adapt work that aligns with the state vision
• Influence people across the enterprise and execute strategic priorities
• Manage a team of people leaders and their teams and position each for future development and growth
• Resolve problems and influence decisions on business issues
• Communicate clearly and present appropriate level of information to senior leaders
• Understand when to raise issues to senior leaders and how to bring functional teams together to solve those issues
• Work independently of the Aetna Medicaid CFO and to know when to raise issues and get their involvement
• Ability to create accountability for oneself and others responsible for performance whether directly on the finance team or within the business unit

The successful candidate will have skill In:
• Financial management experience including strategic and business planning, accounting and financial analysis.
• Collaboration with the Medicaid CFO leadership team and ability to work towards shared goals.
• Work with functional areas to drive results
• Setting strategy and driving results
• Analytical reviews to identify issues and develop creative solutions
• Professional and executive presence
• Perform financial impact analysis for contracts/ vendors and support negotiations

Required Qualifications
• Minimum 10 years financial experience including strategic and business planning, financial planning, analysis, P&L, reporting or accounting
• Industry knowledge of Healthcare/managed care, insurance
• Leadership and people manager experience
• Project Management and Process Improvement experience.
• Travel 5-10% of the time. In-state travel requires use of personal vehicle. Have valid/active driver’s license and proof of vehicle insurance. Some travel out of state also anticipated for internal meetings.

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
• Medicaid Product knowledge
• Master’s degree, CPA, or FSA preferred
• Degree in Finance, Accounting, Actuarial Science, or similar disciplines

Education
Bachelor’s degree Required

Business Overview
At CVS Health, 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 strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. 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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Remote Business Analyst with Medicaid Experience

Performs moderately complex analysis of business goals, objectives and needs, and the general business environment to align information technology solutions with business initiatives. Acts as liaison between technical personnel and non-technical personnel.

Essential Job Functions
Needs to have a  Claims and Encounter Health Care background. Knowing EDI and/or SQL is a Huge Plus. This is a Senior position so I would expect this person to know how to mentor others. Good understanding on using EXCEL. Knows what a SDLC process is and knows how to follow it
Plans, designs and recommends business processes to improve and support business activities.
Analyzes and documents client’s business requirements and processes and communicates these requirements by constructing conceptual data and process models, including data dictionaries and volume estimates from organization.
Creates test scenarios and develops test plans to be used in testing the business applications in order to verify that client requirements are incorporated in to the system design. Assists in analyzing testing results throughout the project.
Provides input into developing and modifying systems to meet client needs and develops business specifications to support these modifications.
Facilitates meetings with clients to gather and document requirements and explore potential solutions.
Assists in coordinating business analyst tasks on information technology projects and provide support to other team members.
Assists in analyzing testing results in all phases.
Participates in technical reviews and inspections to verify ‘intent of change’ is carried out through the entire project.
Assists in providing time estimates for project related tasks.
Assists with developing the methods and procedures required to identify whether current business goals and objectives meet organizational needs.

Basic Qualifications
Bachelor’s degree or equivalent combination of education and experience
Bachelor’s degree in business administration, information systems, or related field preferred
Six or more years of business analysis experience
Experience working with the interface of information technology with functional groups within an organization
Experience working with business processes and re-engineering
Experience working with computer programming concepts and basic language

Other Qualifications
Interpersonal skills to interact with customers and team members
Good communication skills
Good analytical and problem solving skills
Presentation skills to present to management and customers
Personal computer and business solutions software skills
Good ability to work in a team environment with multiple team members

Equal Opportunity Employer Veterans/Disabled

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Anthem

Modesto, CA

13 hours ago

3 people have applied

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

THIS IS A WORK FROM HOME OPPORTUNITY —- HYBRID WORK OPTION PREFERRED IN LAS VEGAS, NV

Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .

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

The NV Medicaid Business Analyst Intern will focus on solving organizational problems by analyzing processes, workflows, and systems with the objective of identifying opportunities for either improvement or automation. The analyst will have the opportunity to learn about Medicaid and work with all levels of management to gain an in-depth understanding of our strategy and services

Primary responsibilities include supporting:

• Improve, execute, and effectively communicate significant analyses that identify meaningful trends and opportunities across the business
  
• Participate in regular meetings with management, assessing and addressing issues to identify and implement improvements toward efficient operations
  
• Provide strong and timely financial and business analytic decision support to business partners and various organizational stakeholders
  
• Develop actionable roadmaps for improving workflows and processes, and establish and organize KPIs in line with global directives
  
• Comply with all federal, state, and local legislation
  
• Interpret data, analyze results using analytics, research methodologies, and statistical techniques
  
• Develop and implement data analyses, leverage data collection systems and other strategies that optimize statistical efficiency and quality
  
• Act as a liaison between staff and management, analyzing and interpreting data involving company procedures, policies, and workflows
  
• Prepare, analyze, and summarize various weekly, monthly, and periodic operational results for use by various key stakeholders, creating reports, specifications, instructions, and flowcharts
  
• Conduct full lifecycle of analytics projects, including pulling, manipulating, and exporting data from project requirements documentation to design and execution
  
• Evaluate key performance indicators, provide ongoing reports, and recommend business plan updates
  Functions OR examples of projects for this role:
  
• Identify and drive operational improvements including but not limited to claims processing, prior authorizations, provider contracting, credentialing, and member/provider services.
  

Qualifications

• Pursuing a degree in Industrial and Systems Engineering, Operations Management, Engineering, Business Technology, Business Management, Engineering Management, Healthcare Management, Statistics, Management, Business Administration, Insurance, Data Analytics, or other related degrees
  
• This internship is from June to August and is 40 hours per week
  
• Must be enrolled fulltime at an accredited college or university during internship
  
• Students must be authorized to work in the U.S. without future visa sponsorship requirements
  

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For, is ranked as one of the 2020 Worlds Most Admired Companies among health insurers by Fortune magazine, and a 2020 Americas 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.

REQNUMBER: PS58444-California

Benefits

Working from home

Flexible working hours

Daycare

Signing bonus

Healthcare

Equal parental leave

Vision insurance

Dental insurance

Life insurance

Paid time off

Gym membership or discounts

Pension plan

Student loan repayment

Paid parental leave

Analyst Jobs in Modesto

Jobs at Anthem in Modesto

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Clipped from: https://tarta.ai/j/TsMA4H4BKrWuRFkY7nkH-director-of-state-public-policy-in-birmingham-al-at-humana?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description

Humana is a market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.

Against that backdrop, we are seeking a talented professional to join our team as Director, State Public Policy. This role resides within the Corporate Affairs Department and will serve as an expert in state public payer, Medicaid and Duals public policy while working with subject matter experts and business units within the Humana enterprise including our Retail, Provider, Healthcare Services, and Humana Pharmacy Solutions (HPS) business units.

You will be an instrumental part of Corporate Affairs at Humana by assisting in the development of Humana’s public policy positions for our public payer businesses with an emphasis on Medicaid, Medicare Supplement, state retiree, Duals policy, and future state public health programs. This will require you to engage across the company to analyze public policy, develop positions, and draft deliverables supporting Humana business strategy.

We are open as to where this position can be located, but cities in Kentucky, Florida, Illinois, Ohio, Texas, Wisconsin, or Washington D.C. would be ideal.

Responsibilities

+ Under direction of the Vice President of Strategy and State Affairs, and with input from enterprise subject matter experts, analyze, draft, and develop state public payer policy positions to support the enterprise’s priorities.

+ Performs necessary research and analyses to support enterprise positions and priorities.

+ Provides regulatory guidance, general issue management and strategic stakeholder engagement support to Corporate Affairs and business leaders.

+ Develops and maintains an archive of legislative and regulatory analyses, policy briefs, reports, position statements, and other materials pertinent to Humana’s public payer policy and advocacy work.

+ Works closely with Humana Medicare, Medicaid and other lines of business to develop value propositions, white papers and other advocacy materials which support state business development opportunities.

+ Drafts and communicates concise and clear descriptions/analyses/summaries of key issues to Corporate Affairs and Humana businesses.

+ Monitors state Medicaid trends. Contributes policy expertise to state-level advocacy efforts on public payer issues including Medicaid expansion, an extension of Medicaid managed care to new populations and programs, integration of the Duals population and state initiatives that affect the role of managed care in Medicaid programs.

+ Acts as an interface between Humana and national advocacy, trade associations, and public policy organizations; assists in the management of policy consultants; develops external stakeholder outreach strategies.

+ Maintains current awareness and analyzes/compares trends, positions, and issues promoted by other companies, trade, and advocacy organizations active on Medicaid-related issues.

+ Assists in the preparation and drafting of testimony, regulatory comments, and position statements sent to legislative and regulatory bodies and other interested parties concerning legislation, policies, published reports, regulations, and statutes governing Medicaid, long-term services and supports (LTSS), and other waiver programs.

Key Candidate Qualifications

The successful candidate will have extensive experience (typically 8+ years) in health policy – preferably as a Medicaid, State legislative or executive branch staffer or equivalent experience in Medicaid policy, trade group, law firm, or policy organization. This person will also have strong knowledge of state health administrative/regulatory/licensure rules and guidance as well as state health policy. Key to success will be a proven track record of applied analysis, research, and resource development supporting healthcare policy, and translating information from diverse resources into actionable policy documents for use in an advocacy setting or otherwise. A Bachelor’s degree is required, preferably in health/public policy, economics or health care administration, although a Master’s degree will be a strong plus.

In addition to the above, the following professional qualifications and personal attributes are also sought:

+ Prefer demonstrated, strong relationships with policy makers and thought leaders in the state public policy arena.

+ Ability to work in cross-functional teams (matrix environment) including interfacing with business executives to develop and align policy/advocacy positioning with strategic business goals.

+ Prefer an academic background in policy, public affairs, business, or a clinical profession.

+ Solid understanding of relevant policy and regulatory issues and ability to translate complex issues in clear, concise manner to business leaders and advocacy team (technical and non-technical audiences)

+ A passion for the development of innovative, high quality government healthcare programs

+ Experience working in a matrixed organization, with proven ability to work collaboratively through various departments and functional areas, promoting a culture of proactive teamwork.

+ Strong conceptual and creative thinker with an ability to identify trends and interrelationships

+ Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences internally and externally.

+ Strong creative problem-solving, negotiation, and multi-tasking skills in time-sensitive settings.

+ Highly-developed interpersonal skills with ability to build strong working relationships, internally and externally.

+ Ability to meet clearly stated expectations and take responsibility for achieving results

For this job, associates are required to be fully COVID vaccinated (preferred) or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

+ Provide proof of full vaccination or commit to testing protocols OR  

+ Provide proof of applicable exemption including any required supporting documentation

Medical, religious, state and remote-only work exemptions are available.

Scheduled Weekly Hours

40

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NaphCare has an great opportunity for a Medicaid Administrative Analyst to join our Corporate Headquarters in Birmingham, AL. The Medicaid Administrative Analyst will research and interpret regulatory payment policies and claims processing guidelines for multiple Medicaid states. The ideal candidate will have a strong knowledge and previous experience of CPT, ICD-10, HCPCS, Code Modifiers as assigned by the Centers for Medicare and Medicaid Services (CMS). Compliance


NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare. We recognize that we serve a unique and diverse patient population, and our onsite teams take pride in bringing excellence in care to a population in great need. Be part of a world-class team of professionals who are revolutionizing correctional healthcare.


Responsibilities:


* Perform data analysis tasks, which include extracting fee schedules, provider files, base rates and edits using software programs such as Microsoft Excel.
* Assist in maintaining fee schedules and data in all systems.
* Liaison with third party pricing and editing vendors (i.e. 3M, Payer Compass, Optum).
* Educating internal staff regarding payment systems and procedures.
* Analyze claims pre and post processing to ensure Medicaid rates and edits are applied accurately.
* Assist in reviewing provider appeals to determine if claims paid accurately.


Requirements:


* Bachelor’s degree or equivalent combination of education and applicable job experience.
* Minimum of three years of experience with Medicaid billing, claims processing and reimbursement.
* Experience with multiple Medicaid states and provider types (i.e. hospital, professional, ambulance, DME, clinical lab, etc.) preferred.
* Experience with working in claims payment systems; with multiple pricing and editing software (i.e. 3M, Payer Compass, Optum programs, etc.) preferred.
* Experience with Medicare billing and reimbursement; both Part A and Part B a plus.
* CPC certification a plus.


This is not a remote position.


Equal Opportunity Employer: disability/veteran


Outstanding Benefits Package:


NaphCare offers competitive benefits, including health, prescription, dental, Employment Assistance Program (EAP) services, vision and 401(k). NaphCare offers term life insurance at no cost to the employee and provides PTO, paid holidays and an array of voluntary benefits. Employees enrolled in our health insurance program receive prescriptions free of charge when filled at our in-house pharmacy or mail order program.

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Job Description – State Medicaid Director (11723) (21142925). Position Title:. State Medicaid Director (11723) – ( 21142925 ). Description :. This position is the Medicaid and Health Services Executive Director. The position is responsible for medical, rehabilitative, and mental health service programs by overseeing the following Department Divisions: Behavioral Health and Developmental Disabilities Division, Health Resources Division and Senior and Long Term Care Division. The position directly supervises three division administrators and two Medicaid managers, and indirectly supervises approximately 1400 FTE. The position also carries the designation of the State Medicaid Director. Key Responsibilities Include:. Executive Leadership, Supervision and Management. Provides executive leadership to the agency as member of Senior Management Team that consists of the agency Director, three Executive Directors, fourteen division Administrators, Chief Legal Counsel, Chief Human Resources Officer, Chief Information Officer, Chief Finance Officer and Public Information Officer.. Establishes business plans and objectives and administers, coordinates and evaluates programs and activities.. Implements the agency management plan. Ensures that directives are implemented by agency divisions.. Executes the authority of the agency Director.. Advises the Director concerning agency policies, programs, and activities.. Provides overall policy direction and control and monitors the status of programs to ensure agency goals and objectives are accomplished.. Evaluates existing management systems for improvement. Identifies and promotes needed organizational changes.. Coordinates at the executive level with other state or local agencies, provider groups, and federal agencies to maintain cooperative relationships and solve problems.. Serves as the State Medicaid and CHIP Director. Is the primary state contact for the federal Center for Medicare and Medicaid Services. Approves state plan amendments and waivers.. May act as agency Director in his or her absence.. Directs and Controls Division Operations. Provides direction and review of matters dealing with, general administration, contracting, operating procedures, and non-routine or sensitive program matters.. Establishes, directs and monitors implementation of division and program priorities. Ensures resources, including staffing, are available and effectively utilized to insure achievement of goals.. Negotiates and settles disputes between divisions or between the agency and the public.. Oversees health service policy matters of division and major program budgets. Directs policy reviews to verify compliance with agency and federal objectives.. Oversees legislative activity. Reviews legislation and fiscal notes, lobbies, testifies and ensures legislative requests are completed. Liaises with the legislature.. Work with the Department’s Chief Innovation Officer to better align clinical and non-clinical supports to address social determinants of health, improve beneficiary outcomes. Liaise with tribal and Indian Health Service leadership to ensure transparency and coordination on efforts to improve the health outcomes of native populations.. Human Resource Management. Determines organizational structure for areas responsible.. Delegates authority to subordinate executive and management employees and holds them responsible for performance of their divisions.. Provides oversight, direction, consultation and assignment of duties to management and executive level employees.. Ensures subordinate compliance with state and Department human resource rules, regulations, policies, and collective bargaining agreements.. Oversees collective bargaining and labor management issues.. Physical and Environmental Demands: Typical office environment. Regular travel throughout the state, with or without advance notice, 10%. Stress and long hours are common to the position.. For a full copy of the job description, please contact Shannon Voss at 406-444-6920 or @mt.gov .. Qualifications :. Required for the First Day of Work :. Knowledge of federal and state Medicaid rules, regulations, programs, budgeting and governmental relations.. Knowledge of DPHHS structure, functions, programs, and organizational relationships and the laws, rules, and regulations that govern the operation of health programs in the State of Montana.. Knowledge of public administration including the legislative process and management of programs with statewide impact.. Leadership ability.. Ability to manage multiple and competing high-profile, sensitive or controversial issues.. Ability to develop and implement innovative and unconventional approaches to challenging situations.. Ability to establish ones credibility and use data to directly persuade or convince others to support an idea or direction.. Ability to direct and coordinate health service program operations and increase efficiency.. Ability to build effective networks of governmental relations that support programs administered.. Minimum Required Education and Experience. Bachelor’s degree in business, public, hospital, or health administration; human services; health-care services; or a directly-related field.. Five or more years of senior-level management and supervisory experience of large programs with substantial staff and budgets.. Other combinations of related education and experience may be considered on a case-by-case basis if the applicant has an unrelated bachelor’s degree.. Preferred: Specific experience with Medicaid, CHIP or Medicare.. Experience in a medical field such as nursing, mental health, addiction, etc.. Experience in health facility administration.. Women (and/or) minorities may be under-represented in this position and are encouraged to apply.. To be considered for this position, at the time of submitting the online application you must also submit a resume .. Why Helena, Montana?. Helena is the beautiful capital city of Montana. Situated in the picturesque backdrop of the Rocky Mountains and with a population of just over 32,000, Helena offers small town living and diverse opportunities for anyone to feel at home. Whether you are interested in outdoor recreation, immersing yourself in arts and culture, or retracing history, Helena has something for you.. The State of Montana offers a comprehensive benefits package, including:. 15 paid vacation days per year. 12 paid sick days per year. 10 paid holidays per year. Health Coverage. Retirement Plan. To view State of Montana’s medical, dental, vision coverage, and other offerings, you can visit our Health Care and Benefits website at, https://benefits.mt.gov/. This is an open until filled position. Initial review of applications will be November 9, 2021 .. Successful applicant(s) are required to successfully pass all DPHHS specific background check(s) relevant to each position.. Applicant Pool Statement : If another department vacancy occurs in this job title within six months, the same applicant pool may be used for the selection. Training Assignment : This agency may use a training assignment. Employees in training assignments may be paid below the base pay established by the agency pay rules. Conditions of the training assignment will be stated in writing at the time of hire.. Job : Business/Analyst/Statistics Salary: $ 66.80 – 66.80 Hourly Benefits Package Eligibility : Health Insurance, Paid Leave & Holidays, Retirement Plan Number of Openings : 1 Employee Status : Regular Schedule : Full-Time Shift : Day Job Travel : Yes, 10 % of the Time Primary Location : Helena Agency : Department of Public Health & Human Services Union : 000 – None Bargaining Unit : 000 – None Posting Date : Nov 2, 2021, 8:45:46 PM Closing Date (based on your computer’s timezone) : Ongoing. Required Application Materials : Resume. Contact Name : Shannon Voss | Contact Email : @mt.gov | Contact Phone : 406-444-6920 The State of Montana has a decentralized human resources (HR) system. Each agency is responsible for its own recruitment and selection. Anyone who needs a reasonable accommodation in the application or hiring process should contact the agency’s HR staff identified on the job listing or by dialing the Montana Relay at 711. Montana Job Service Offices also offer services including assistance with submitting an online application.. State government does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, pregnancy, childbirth or medical conditions related to pregnancy or childbirth, age, physical or mental disability, genetic information, marital status, creed, political beliefs or affiliation, veteran status, military service, retaliation, or any other factor not related to merit and qualifications of an employee or applicant.. Be careful – Don’t provide your bank or credit card details when applying for jobs. Don’t transfer any money or complete suspicious online surveys. If you see something suspicious, report this job ad.. The CFO plays a crucial role in defining and establishing the necessary management and accountability systems to support a customer-driven, results-oriented,…. We’re seeking an outstanding, experienced Remote Chief Financial Officer to lead us through key financial decisions, structuring, and organization across…. The Chief Human Resource Officer (CHRO) works collaboratively with organizational managers to provide leadership, mentoring and administrative support to…. Franklin Foundation Hospital–Franklin County, AL. The Chief Nursing Officer reports directly to the Chief Executive Officer. The Chief Nursing Officer works closely with the hospital’s Administrative Team….. The Chief Information Security Officer (CISO) is responsible for establishing and maintaining the information security program to ensure that information…. The Chief Financial Officer (CFO) provides executive leadership and oversight of the hospital financial operations by developing and maintaining effective…. Reporting to the Montana State Fund Board of Directors, the President & CEO serves as Chief spokesperson for MSF and provides overall, leadership and support…. Clinical Management Consultants–Helena, AL. An amazing opportunity is now available for a Chief Medical Officer (CMO) in Western Montana! Sitting within the Rocky Mountains, and between Yellowstone…. Sign in to start saving jobs in your profile.. Do you want to receive recommendations for similar jobs?

 
 

UnitedHealthcare is a company that’s on the rise. We’re expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn’t about another gadget, it’s about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life’s best work.(sm)

It is expected that each United Healthcare Services employee adhere to UHG & RMHP Policies and Procedures, including but not limited to Corporate Mission Statement, Corporate Values & Ethics, and Corporate Code of Conduct.

Positions in this function organize, collect, review and report health and social information through Member phone outreach and home visits while demonstrating multicultural sensitivity and effective communication skills with Medicaid members. This position follows established safety protocols in the community setting, as well as established preventive and disease management programs for health promotion and education. Deliver culturally appropriate information regarding the availability of health and community resources that will reduce barriers to care. The primary functions of this position include transition of care and care coordination planning for Members following a behavioral health treatment service and peer consultation regarding behavioral health services.

If you are located in CO, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

• Serves as an expert in discharge and transition of care planning for Members receiving behavioral health treatment services
  
• Respect confidentiality and maintain confidences as described in the UHG Employee Handbook and acknowledged through signature by all employees. The ability to maintain confidentiality is a critical and essential component of this position
  
• Collaborates and works closely with the Behavioral Health Utilization Review Team and Behavioral Health Network Providers for discharge and transition of care planning
  
• Serves as a consultant to care coordination teams
  
• Respects confidentiality and maintain confidences as described in the Confidentiality Security Agreement that is signed by all employees. The ability to maintain confidentiality is a critical and essential component of this position
  
• Participates in Interdisciplinary care team meetings as indicated
  
• Serves as community liaison and maintain relationships with Behavioral Health Network Providers, key individuals in the community and serves as an advocate by coordinating linkages or referrals to improve health, social, and environmental conditions for members
  
• Coordinates and performs duties of communicating the mission and role of the organization to community associations, senior groups, ethnic clubs and groups, and churches
  
• Serves as the direct personal contact in the community to Members who are unable to be reached through phone calls
  
• Conducts Member assessments
  

 
 

• Assess the changing needs and condition of the Member and communicate this information to all involved Care Coordinators, community partners, physician and other appropriate individuals, according to department policies and procedures
  
• Document assessments, Member/family response to care coordination interventions at the time of the encounter. Meet departmental standards and deadlines for timely completion of all required documentation and meet current agency productivity standards
  
• Educates and assist identified Members about behaviors that can enhance their health, successfully navigating the health system
  
• Facilitates access to preventive and disease management health services
  
• Develops a plan of management associated with health care goals for each member addressing the diverse needs in a culturally appropriate wa
  
• Develops and maintains a report system for outcomes
  
• Communicates Member issues requiring interventions to appropriate departments and providers
  
• Maintains confidentiality and uses only the minimum amount of protected health information (PHI) necessary to accomplish job related responsibilities. Maintains confidentiality of patient information
  
• Participates in staff meetings, case conferences and in-services. Maintains familiarity with all policies and procedures that impact decisions and care
  
• This position requires travel. Requires independent, reliable, flexible, and on-demand, transportation at the incumbent’s expense for travel between various locations and timely arrival and departure from various locations. If the employee chooses to satisfy this requirement by driving a vehicle, the employee must meet the requirements for Colorado licensure and company requirements for liability insurance coverage
  
• Completes all duties in accordance with company safety policies and practices
  
• Other functions may be assigned and management retains the right to add or change the duties at any time
  
  
  

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:

• Degree in social work, social sciences or counseling
  
• 3+ years of experience in the Behavioral Health Field
  
• 2+ years of progressive related experience working with diverse populations, community or faith based organizations
  
• Knowledge of health education, motivational strategies, and an empathetic manner working with the underserved
  
• 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:

• 3+ years of experience in Behavioral Health Care Management
  
• Health care setting experience
  
• Knowledge of healthcare business
  
• Knowledge of local area
  
• Bilingual in English/Spanish
  

Physical and Mental Requirements:

• The physical and mental requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made upon request to enable individuals with disabilities to perform the essential functions. Please contact HR to make such a request
  
• Ability to execute regular, reliable, and predictable performance of the essential functions of this job through a consistent ability to be physically and mentally present at the assigned work location, at the prescribed time, with the prescribed tools and with the availability necessary to successfully complete the essential duties described herein
  
• Ability to handle and manage stress associated with the performance of job duties
  
• Ability to appropriately interact with, and get along with others including supervisors, coworkers, customers and other stakeholders
  
• Ability to work collaboratively with others as set forth in the job description
  
• Ability to accurately and timely follow directions of supervisors
  
• Ability to perform the essential functions of this job at the assigned primary work location for this job, which is in one of the RMHP office locations
  
• Ability to perform the essential functions of the job at the assigned primary work location for this job, which is in the employee’s home
  
• Ability to effectively speak, understand and be understood, and communicate in English
  
• Ability to hear adequately on the phone, in person and in group settings
  
• Ability to travel primarily within the State of Colorado on a daily basis
  
• Ability to be exposed to changing weather conditions
  
• Ability to travel between various locations and to timely arrive and depart from various locations
  
• Ability to provide independent, reliable, flexible, and on-demand, transportation at the employee’s expense. If the employee chooses to satisfy this requirement by driving a vehicle, requires ability to meet the requirements for Colorado licensure and company requirements for liability insurance coverage
  
• Ability to work a flexible schedule including before and after core business hours and occasional evenings and weekends
  
• Ability to work in front of a computer screen and keyboard, sitting and/or standing up to 8-10 hours per day (possibly longer if required)
  
• Ability to work in home settings that include varying physical, social, and cultural environments
  
• Ability to work in environments that may have exposure to communicable disease while performing patient care activities
  
• Ability to see adequately to visually evaluate and assess the member’s or potential member’s physical condition and living environment
  
• Ability to see computer screen and work papers
  
• Ability to access, research and interpret information from a variety of media (e.g., computer screen, projected images, printed material) and individuals
  
• Ability to work in normal office environment conditions and with various office equipment (e.g., computer, keyboard, mouse, calculator, copier, printer, fax, scanner, telephone)
  
• Ability to move to access various offices and a wide variety of meeting settings
  
• Ability to perform a variety of tasks that involve standing, walking, sitting, stooping, kneeling, bending and twisting, occasionally climbing stairs or using an elevator, possibly reaching chest high and overhead for materials
  

Competencies. Our commitment to our Values Based Competencies reflect specific behaviors that represent how we broadly work together and with customers and describe the behaviors we expect of employees. All competencies are defined in greater detail in the HUB.

RMHP Job Descriptions. The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. Other functions may be assigned and management retains the right to add or change the duties at any time. Incumbents within this position may be required to assist or find appropriate assistance to make accommodations for disabled individuals (may include: visitors, patients, employees, or others).

Employee Handbook and At-Will Employment. The provisions in the UHG Employee Handbook are guidelines and, except for the provisions of the Employment Arbitration Policy, do not establish a contract or any particular terms or condition of employment between you and UnitedHealth Group. None of the policies constitute or are intended to constitute a promise of employment. UnitedHealth Group may periodically, at its discretion, change, rescind, or add to any policy, benefit or practice with or without prior notice. The handbook is located at https://hub.unitedhealthgroup.com/policies/human-capital/employee-handbook .

This employment relationship is “at will” and is based upon the mutual consent of UnitedHealth Group and yourself.

While we hope that you will always enjoy working for the Company, if you should ever become dissatisfied, you are free to terminate your employment at any time for any reason. Similarly, UnitedHealth Group may terminate your employment at any time for any reason, with or without notice or prior discipline. This “employment-at-will” relationship may not be modified for any employee, except in a written agreement signed by UnitedHealth Group’s Chief Executive Officer or the Senior Executive of Human Resources.

RMHP Administrative Policies & Procedures. Rocky Mountain Health Plans (RMHP) policies and procedures are available to employees electronically on the RMHP SharePoint site at http://ConnectRMHP/CompInfo/SitePages/Home.aspx or from Human Resources. RMHP has also adopted a compliance plan to serve as a general guide to help employees fulfill RMHP compliance obligations. The compliance plan and a summary of the compliance plan are available on all computer desktops and on the RMHP SharePoint site at http://ConnectRMHP/CompInfo/SitePages/Home.aspx or from Human Resources.

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 at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That’s why you’ll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life’s best work.(sm)

Colorado Residents Only: The hourly range for Colorado residents is $21.68 to $38.56. 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.

Job Keywords: Medicaid Behavioral Health Outreach Coordinator, CO, Colorado, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote

 
 

Clipped from: https://www.glassdoor.com/job-listing/medicaid-behavioral-health-outreach-coordinator-telecommute-in-co-unitedhealth-group-JV_IC1164330_KO0,65_KE66,84.htm?jl=1007612813054&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description:

Role: Sr. Healthcare Analyst / Medicaid SME

Location: Basking Ridge, New Jersey

Duration: Full time

Primary responsibilities:

• Function as a Subject Matter Expert (SME) on Medicaid and Medicare directly interfacing with state Business users.
  
• Participate in requirements gathering sessions with State users and client team members to understand business need and analyze requirements
  
• Able to juggle multiple tasks and work with the lead to prioritize work to ensure customer expectations are met.
  
• Work independently with little to no supervision by seeking guidance on work priority and dedication to client success.
  
• Collaborate with other Data Analysts / Business analysts to understand reporting needs and be a self-starter to accomplish objectives.
  
• Review and provide feedback on reporting requirements, either created internally or externally, for feasibility, gaps in requirements, and overall business value.
  
• Perform data analysis using SQL and validate business requirements
  
• Document test cases based on requirements and perform functional testing.
  
• Gain proficiency in modifying and developing new SAP Business Objects reports.
  
• Be a team player and work under supervision of senior analysts as needed to meet project objectives.
  

Required qualifications

• Bachelor’s degree in computer science, computer information systems, data analytics, or a related field.
  
• 10+ years of experience working as a business or data analyst in any Industry vertical
  
• 7 + years of working as a business user or analyst in a healthcare vertical
  
• 5+ Working as an analyst in the Medicaid line of business within depth knowledge in claims adjudication, eligibility, provider performance etc.
  
• 3+ years’ experience working with SQL and databases with proficiency in data analysis.
  
• Experience working in both Agile and Waterfall SDLC
  

Preferred Qualifications:

• 5+ years of experience as a business or data analyst in a Data warehousing setting
  
• Candidates with working knowledge in SAP Business Objects reporting
  
• Experience working in a healthcare Data warehouse involving claims, recipients, providers, and other subject areas.
  
• Experience reporting on large datasets from a data warehouse, and techniques for working with data in volume effectively to create reports and dashboards
  

 
 

Clipped from: https://www.linkedin.com/jobs/view/sr-healthcare-analyst-medicaid-sme-at-the-xela-group-2878763246/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic