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Evolent HealthJefferson City, MO

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• Its Time For A Change
  
• Your Future Evolves Here
  
• Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered.
  
• Our pursuit of this mission is the driving force that brings us to work each day.
  
• We believe in embracing new ideas, challenging ourselves and failing forward.
  
• We respect and celebrate individual talents and team wins.
  
• We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.
  
• Are we growing?
  
• Absolutely about 40% in year-over-year revenue growth in 2018.
  
• Are we recognized?
  
• We have been named one of Beckers 150 Great Places to Work in Healthcare in 2016, 2017, 2018 and 2019, and one of the 50 Great Places to Work in 2017 by Washingtonian.
  
• We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day.
  
• If youre looking for a place where your work can be personally and professionally rewarding, dont just join a company with a mission.
  
• Join a mission with a company behind it.
  
• Essential Functions+ Maintain accurate member records.
  
• Enter eligibility and/or enrollment data into Aldera system on a daily basis including new enrollees, change in circumstance terminations, PCPs, broker and other information.
  
• + Review 834 X12 files during the Aldera system load process.
  
• Research and work any discrepancies or errors.
  
• + Adjust premiums and rates for financial billing.
  
• + Resolve client and internal ticket requests.
  
• + Correspond and communicate with the groups, brokers, and clients through tickets, workflows and emails.
  
• + Meet minimum daily production requirements and produce high-quality work consistently.
  
• + Generate and/or work reports (daily, weekly, monthly.)
  
• + Adhere to existing and new policies and procedures specific to each client.
  
• + All other duties as assigned.
  
• Education and Experience+ High school diploma, 4 year college degree or equivalent experience required.
  
• + Medicaid policy and EDI knowledge preferred.
  
• + Experience coordinating with healthcare clients and/or payers to execute enrollment related activities.
  
• + Interpersonal skills to work well within a team that includes all levels within the organization from clerical and support staff to senior management as well as clients and brokers outside of the organization.
  
• + Ability to work independently, prioritize and work under deadlines.
  
• Attention to detail.
  
• + Understands and can work in a production environment in which performance is tied to operational metrics.
  
• + Integrity and discretion to maintain confidentiality of members HIPAA data.
  
• + Proficient in Microsoft Office (Outlook, Excel, Word.)
  
• As such, we require that all employees have the following technical capability at their home: High speed internet over 10 MBPS and, specifically for all call center employees, the ability to plug in directly to the home internet router.
  
• These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
  
• Evolent Health is committed to the safety and wellbeing of all its employees, partners and patients and complies with all applicable local, state, and federal law regarding COVID health and vaccination requirements.
  
• Evolent expects all employees to also comply.
  
• We currently require all employees who may voluntarily return to our Evolent offices to be vaccinated and invite all employees regardless of vaccination status to remain working from home.
  
• Certain jobs require face-to-face interaction with our providers and patients in client facilities or homes.
  
• Employees working in such roles will be required to meet our vaccine requirements without exception or exemption.
  
• Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.
  
• Compensation Range: The typical range of employees within the compensation grade of this position is.
  
• Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.
  

 
 

 
 

Clipped from: https://jobsearcher.com/j/evolent-health-medicaid-enrollment-specialist-at-evolent-health-in-jefferson-city-mo-qdo3OZD?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to 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 care companies and a Fortune Top 50 Company

Our Government Business Division’s Proposal Development Team is looking for a Proposal Director to join its team.  This high-performing individual contributor is responsible for leading the development of Medicaid Proposals.  He/she serves as the tactical lead in the proposal process–responsible for ensuring we have a compliant, compelling, and complete proposal, working with large numbers of matrixed resources to drive wins in the Medicaid space. 

{Position can work remotely from any US Anthem location} 

Primary duties may include, but are not limited to: Involved in all aspects of proposal development. Assembles internal and external subject matter experts. Ensures quality, completeness and oversight of technical writing. Develops bid strategy with operations and business development teams. Validates and tests the business solution proposed. Reconciles the customer requirements against proposed staffing levels and solutions and identifies any gaps. Directs all proposal and Q&A responses. Leads the activities of lower level staff and contracted staff performing related functions. Develops processes and infrastructure to support submission of bids. Develops win strategies and final proposal submission after reviews.

Qualifications

Minimum requirements:

BA/BS degree in a related field and a minimum of 7 years of related experience; or any combination of education and experience, which would provide an equivalent background.

Highly preferred experience:

-Experience with Medicaid business development pursuits.

-Experience with large Healthcare backed custom Government proposals. 

-Proven win rate with large complex bid responses.

-MBA preferred.

-APMP Foundation certification or equivalent professional certifications preferred.

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/8072723-proposal-director-medicaid-business?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC continues to comply with governmental guidance related to local, state, and federal COVID-19 vaccination for employment. All employees and affiliated staff of UPMC entities are considered essential health care workers and will be accountable to follow the Centers for Medicare & Medicaid Services (CMS) federal vaccine mandate. To be compliant with the federal mandate, employees must complete the approved vaccination dosage regimen currently defined by the federal government. Compliance with the federal mandate is encouraged before hire. Medical and religious exemption requests may be submitted for consideration.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

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• Job ID: 141540148
  
• Status: Full-Time
  
• Regular/Temporary: Regular
  
• Hours:
  
  
• Shift: Day Job
  
• Facility: Corporate Revenue Cycle
  
• Department: Rev Cyc Ins Collections
  
• Location:
  2 Hot Metal Street, Pittsburgh PA 15203
  
  
• Union Position: No
  
• Salary Range: $16.36 to $25.72 / hour
  

Description

UPMC Corporate Revenue Cycle is hiring an Account Representative, Senior to join our team!  This position will primarily work on Medicare as well as Medicaid.  The position will work a Monday through Friday daylight hours and has the flexibility to work shifts between 6:30 AM to 4:30 PM.  The Account Representative will work at our Quantum I location and have work from home opportunities after training, productivity and quality standards have been met.  This position could have the opportunity to work outside of UPMC Williamsport as well.

The Account Representative, Senior is responsible for all fiscal functions necessary to ensure the prompt and correct payment to the hospital of all monies owed by both insurers and patients. Account Representatives, Senior are responsible to: ensure claims are submitted accurately and timely; communicate with insurance companies, patients and physicians regarding payment issues; establish reasonable payment arrangements; recommend adjustments according to UPMC policies; review the posting and balancing of payment/denial and adjustment transactions necessary for closing accounts; identify and assign appropriate status codes; and review high dollar accounts on a regular basis. The Account Representative, Senior is expected to identify recurring problems and procedural deficiencies that need to be reported to management and to serve as a key mentor to staff for training and procedural direction.

Do you have prior experience in Medicare?  If so, this could be the next step in your career!  Apply today!


Responsibilities:

 
 

• Perform duties and job responsibilities in a fashion which coincides with the service management philosophy of UPMC Health System, including the demonstration of The Basics of Service Excellence towards patients, visitors, staff, peers, physicians and other departments within the organization.
  
• Ability to work multiple payers
  
• Verify accuracy of payment posting and reimbursement. Work with appropriate payer and/or department to resolve any payment discrepancies.
  
• Identify root cause issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials. Assist in claim appeal process and/or perform follow-up in accordance with Revenue Cycle policies and procedures.
  
• Managed assigned book of business by ensuring the timeliness and accuracy of billing, collections, contractual postings, payments and adjustments of accounts based upon their functional area standards.
  
• Evaluate and recommend referrals to agency, law firm, Financial Assistance and Bad Debt.
  
• Understand third party billing and collection guidelines
  
• Demonstrate knowledge of the current functionality of the patient accounting systems.
  
• Identify issues and submit corrective action recommendations.
  
• Ability to work independently with minimal supervision
  
• Meet quality assurance benchmark standards and maintain productivity levels as defined by management.
  

 
 

Qualifications

• Must have one year of claims/billing/collections experience; OR four years in a business office setting; OR a Bachelors Degree; OR an equivalent combination of education and experience.
  
• Excellent interpersonal, organizational, communication and effective problem solving skills are necessary.
  
• Must be able to communicate with patients, payers, outside agencies, and general public through telephone, electronic and written correspondence.
  
• Prior working experience on personal computers, electronic calculators and office equipment is needed.
  
• Must be multi-disciplined in billing, collections, denials, credit balances and/or the various payers.
  
• Prior collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred.
  
• Familiarity with third party payer guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial.
  
• This position requires organization and time management skills.
  
• The incumbent must develop and manage relationships with colleagues in a professional, independent manner.
  
• The position requires the ability to maintain confidentiality with regard to all assignments.
  

Licensure, Certifications, and Clearances:


UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

Clipped from: https://careers.upmc.com/jobs/7284837-account-representative-senior?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Overview


The Reimbursement Coordinator assists and provides support for all governmental reimbursement activities. This position is responsible for completing and/or supporting various ongoing projects within the corporate reimbursement department, including but not limited to:

• Timely and accurate preparation of various Novant Health facility cost reports for governmental programs, including Medicare, Medicaid, Tricare;
  
• Analyzing impact of audit adjustments and confirming adjustments are consistent with regulations
  
• Coordinating reimbursement related projects with third party vendors and consultants
  
• Maintaining and sharing knowledge on current Medicare and Medicaid regulations, rules, instructions, and reimbursement changes; quantifying the impact of such changes to Novant Health
  
• Other finance and reimbursement related projects as they arise
   
  

At Novant Health, one of our core values is diversity and inclusion. By engaging the strengths and talents of each team member, we ensure a strong organization capable of providing remarkable healthcare to our patients, families and communities. Therefore, we invite applicants from all group dynamics to apply to our exciting career opportunities.


Qualifications

• Education: Bachelor’s degree required. Degree in accounting or finance preferred.
  
• Experience: 2 Years of healthcare reimbursement experience; including cost reporting, Medicare/Medicaid DSH reporting; Medicare bad debts required.
  
• Licensure/certification/registration: CPA preferred.
  
• Additional skills required: Excel experience required, Microsoft Access experience preferred. Experience with Medicare cost reporting software. Must have good interpersonal and organizational skills and the ability to concurrently manage multiple tasks. Requires excellent communication skills necessary to interact with staff at all levels. Must exhibit patience and a positive attitude and be able to work independently. Must have good analytical skills and be able to evaluate current processes for improvements and efficiencies. Ability to drive/travel since limited travel may occasionally be required.
  
• Additional skills preferred: Healthcare reimbursement experience in a health system highly desirable.
   
  

Responsibilities


It is the responsibility of every Novant Health team member to deliver the most remarkable patient experience in every dimension, every time.

• Our team members are part of an environment that fosters team work, team member engagement and community involvement.
  
• The successful team member has a commitment to leveraging diversity and inclusion in support of quality care.
  
• All Novant Health team members are responsible for fostering a safe patient environment driven by the principles of “First Do No Harm”.
  

 
 

Clipped from: https://www.linkedin.com/jobs/view/reimbursement-coordinator-medicaid-medicare-at-novant-health-2904911703/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

• Conexess Group • Charlotte, NC 28201
  

Job #2004400477

•  
• Description Our History
  

From our start in 2009, Conexess has established itself in 3 markets, employing nearly 200+ individuals nation-wide. Operating in over 15 states, our client base ranges from Fortune 500/1000 companies to mid-small range companies. For the majority of the mid-small range companies, we are exclusively used due to our outstanding staffing track record.

Who We Are

Conexess is a full-service staffing firm offering contract, contract-to hire, and direct placements. We have a wide range of recruiting capabilities extending from help desk technicians to CIOs. We are also capable of offering project-based work.

Conexess Group is aiding a large healthcare client in their search for a Medicare/ Medicaid Product Owner in a remote capacity. This is a long-term opportunity with a competitive compensation package.

• We are unable to work C2C on this role******
   
  

Responsibilities
 

• Accountable for decomposing features into manageable pieces of work called User Stories
  
• Elaborate and refine the detailed requirements (User Stories)
  
• Prepare for and participate in sprint planning
  
• Promote acceptance test-driven development by engaging the team in defining story acceptance criteria
  
• Understand business and technical work being delivered by the team
  
• Participate in team demo and sprint retrospective
  
• Attend weekly PO sync meetings
  
• Partner with the team to plan sprint demo
  
• Define and execute improvement stories
  

Qualifications:
 

• Expert level Medicare/Medicaid business knowledge across Customer Service
  
• Background in health plan core admin
  
• Knowledge of Six Sigma
  
• Ability to manage conflict for ARTs / cross teams
  
• Expert-level knowledge of project and change management and associated methodologies, techniques, processes, and approaches (e.g. Project and Portfolio Management Methodology – PPM)
  
• Knowledge of Agile principles
  
• Budget, cost and profitability management skills
   
  

 
 

Clipped from: https://www.nexxt.com/jobs/medicare-medicaid-product-owner-remote-charlotte-nc-2004400477-job.html?utm_campaign=google_for_jobs&utm_source=google&utm_medium=organic&aff=2ED44C72-8FD2-4B5D-BC54-2F623E88BE26&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to 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 care companies and a Fortune Top 50 Company.

 
 

Location: Candidate must reside in North Carolina.

Responsible for the planning and direction of less complex, specific marketing strategies for a single functional marketing area.

 
 

Primary duties may include, but are not limited to:

 
 

• Directs operations of a single functional marketing area which may include direct marketing, product development, agency management, marketing research, marketing events, or marketing communications.
  
• Directly customer facing with experience working collaboratively with our state and BCBSNC customer.
  
• Directs and develops
  short and long term marketing strategies and tactics to grow profitable membership.
  
• Recommends changes and adjustments to marketing strategies to increase program effectiveness.
  
• May prepare presentations regarding marketing and outreach programs for senior management groups.
  
• Makes recommendations to appropriate functions to achieve product modifications or improvements derived from market research, technical service work or Marketing feedback.
  
• Develops and recommends department operating budgets.
  
• Secures approval of objectives, policies and programs for corporate marketing activities, and evaluates and reports results.
  
• In partnership with brand management, responsible for identifying appropriate media opportunities.
  
• Hires, trains, coaches, counsels and evaluates performance of direct reports.
  

 
 

Qualifications

Minimum Requirements:

Requires a BA/BS degree and a minimum of 8 years of related experience including prior leadership experience; 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.


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/8445780-dir-medicaid-plan-marketing-north-carolina?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 

With over 100 offices and nearly 5,000 associates in major metropolitan areas and suburban cities throughout the U.S. CBIZ (NYSE: CBZ) delivers top-level financial and employee business services to organizations of all sizes, as well as individual clients, by providing national-caliber expertise combined with highly personalized service delivered at the local level.


CBIZ has been honored to be the recipient of several national recognitions:


* 2020 Best Workplaces in Consulting & Professional Services by Great Place to Work
* 2020 Workplace Excellence Seal of Approval by the Alliance for Workplace Excellence
* Top 101 2020 Best and Brightest Companies to Work For in the Nation
* 2020 Healthiest 100 Workplace in America
* 2021 Top Workplaces USA


CBIZ Benefits & Insurance Services is a division of CBIZ, Inc., providing benefits consulting, HRIS technology, payroll, human capital management, property and casualty, talent and compensation solutions, and retirement & investment solutions to organizations of all sizes. CBIZ is ranked as a Top 20 Largest Broker of U.S. Business (Business Insurance Magazine) and a Top 100 Retirement Plan Adviser (PLANADVISER).


Essential Functions and Primary Duties:


* Assisting patients in applying for financial assistance through Medicaid on behalf of our client facility.
* Interviewing patients or authorized representatives via phone or in person to gather information to determine eligibility for medical benefits.
* Obtaining, verifying, and calculating income and resources to determine client financial eligibility.
* Documenting case records using automated systems to form a record for each client.
* Following up with applicants to obtain accurate and complete information within strict timeframes.
* Completing/following up on all forms related to Medicaid eligibility.
* Performing any additional tasks related to the position assigned by the Manager.


Preferred Qualifications:


* Bachelor’s degree.
* Knowledge of Medicaid and Charity Care.
* Experience working in a hospital environment.
* Ability to speak and read Spanish.


Minimum Qualifications:


* High school diploma/GED.
* Must be ambitious and self-directed in a fast-paced environment and can perform in a high volume, multitasking setting.
* Must be trustworthy, professional, detail and goal oriented.
* Must have exceptional customer service and excellent verbal/written communication skills.
* Must be able to learn and work with Medicaid eligibility regulations.

 
 

Clipped from: https://us.trabajo.org/job-640-20220202-8aa6b17fb6b2775fd8269558ee0a71d5?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Position:  Care Manager (RN) (Medicaid)
 

About NYC Health + Hospitals

Metro

Plus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, Metro

Plus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, Metro

Plus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, Metro

Plus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview:

 

The primary goal of the Care Manager is to optimize members’ health care and delivery of care experience with expected cost savings due to improved quality of care. This is accomplished through engagement and understanding of the member’s needs, environment, providers, support system and optimization of services available to them. Care Manager is expected to assess and evaluate member’s needs, be a creative, efficient and resourceful problem solver.

In collaboration with the members’ care team, a plan of care with individualized goals and interventions is developed, implemented and outcomes evaluated.

Job Description

 

• Address member’s problems and needs: clinical, psychosocial, financial, environmental
  
• Provide services to members of varying age, risk level, clinical scenario, culture, financial means, social support, and motivation
  
• Engage members in a collaborative relationship, empowering them to self-manage their physical, psychosocial and environmental health to improve and maintain lifelong well being
  
• Prepare member-oriented plan of care with member, caregivers, and health care providers, integrating concepts of cultural sensitivity and privacy practices
  
• Participate in interdisciplinary rounds
  
• Ensure plans of care have individualized goals and interventions
  
• Communicate plan of care to Primary Care Physician
  
• Address gaps in care with the member and provider
  
• Address members social determinants of health issues
  
• Link members to available resources
  
• Provide care management support during Transitions of Care
  
• Ensure member/caregiver understanding as it relates to language barriers, stress reaction or cognitive limitations/barriers
  
• Train member on relevant chronic diseases, preventive care, medication management (medication reconciliation and adherence), home safety, etc.
  
• Provide Complex care management including but not limited to; ensuring access to care, reducing unnecessary hospitalizations, and appropriately referring to community supports
  
• Advocate for members by assisting them to address challenges and make informed choices regarding clinical status and treatment options
  
• Employ critical thinking and judgment when dealing with unplanned issues
  
• Maintain knowledge of Chronic Conditions and use job aids as a guidance
  
• Maintain accurate, comprehensive and current clinical and non-clinical documentation in DCMS, the Care Management System
  
• Comply with all orientation requirements, annual and other mandatory trainings, organizational and departmental policies and procedures, and actively participate in evaluation process
  
• Maintain professional competencies as a Care Manager
  
• Other duties as assigned by Manager
  

Minimum Qualifications

• Background:
  Registered Nurse, Bachelor’s Degree in Nursing required
  
• An equivalent combination of training, educational background, and experience in related fields such as hospital, home care, ambulatory setting and educational disciplines. Prior experience in Care Management in a health care and/or Managed Care setting preferred
  
• Proficiency with computers navigating in multiple systems and web- based applications
  
• Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
  
• Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
  
• Time management and organizational skills
  
• Strong problem-solving skills
  
• Ability to prioritize and manage changing priorities under pressure
  
• Must know how to use Microsoft Office applications including Word, Excel, and PowerPoint and Outlook.
  
• Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required
  
• If needed, ability to travel within the Metro
  
  Plus service area to participate in facility visits, community events, home visits or other community meetings, including conferences.
  
• Registered Nurse nse
  

 
 

Clipped from: https://www.learn4good.com/jobs/hartford/connecticut/healthcare/944714590/e/

 
 

EPSDT/ MCH Nurse Coordinator

AHCCCS

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs, and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona.

EPSDT/ MCH Nurse Coordinator

Posting Details:

Salary: $64,575
 

Grade: 22
 

Closing Date: Open Until Filled

Job Summary:

The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a EPSDT/Maternal Child Health Care Coordinator. After extensive training, this position has the potential of being worked from home with some in office meetings. Under the leadership of the Managed Care Program Administrator, this position provides oversight of the Early and Periodic Screening Diagnosis and Treatment (EPSDT), Preventive Health, Family Planning, Special Needs Populations and Maternal Health programs within the statewide managed care and fee for-service AHCCCS programs. This position will provide leadership and support to ensure the development of a fully integrated Clinical Quality Management Unit within the Division of Health Care Management. Major duties and responsibilities include but are not limited to:

Job Duties:

* Monitoring of EPSDT, well woman preventive health, maternity, and family planning programs to ensure that state and federal requirements are met.

* Participates in operation reviews, administrative reviews, technical assistance, and focused studies/reviews to ensure compliance with contractual and policy requirements for all lines of business.

* Represents the CQM Unit in developing and providing input to contracts, amendments and policy revisions.

* Provides technical assistance to Contractors and FFS providers, as appropriate regarding contractual and/or policy requirements, accurately and consistently to improve compliance with AHCCCS requirements to improve EPSDT and maternal child health services to AHCCCS Members.

* Collaborates with state and local health and social service agencies, including ADHS, DES/DDD, DCS, Head Start, etc. as well as community and private health care providers.

* Coordinates and completes tracking, evaluations, and responses to Contractor deliverables.

Knowledge, Skills & Abilities (KSAs):

* State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, LTC and Tribal lines of business.

* Knowledge of medical/nursing practice, medical case management protocols, quality management and utilization review protocols as related to the all populations including maternal and child health services, well woman preventive health, family planning services, EPSDT, acute, LTC, chronic long-term elderly and physically disabled, developmentally disabled, behavioral/mental health, children in the foster care system and Tribal lines of business.

* Current quality improvement and health care theories and practices.

* Background in and knowledge of quality management principles and accreditation bodies’ review processes.

* Organizational skills that result in prioritization of multiple tasks including project management to meet goals and deadlines.

* Effective communication with all levels of professionals, corporate and agency officers and members.

* Develop, implement, and review case management and utilization review systems and the ability to offer technical assistance to Acute, LTC, Sister Agency and/or tribal Contractors.

Selective Preference(s):

* Certified Professional in Healthcare Quality

* Current Arizona nurses license

* Baccalaureate degree in nursing (preferred)

* At least one year experience working in a managed care environment

Pre-Employment Requirements:

In accordance with CFR §432.50 FFP, skilled professional medical personnel must have professional education and training in the field of medical care or appropriate medical practice. “Professional education and training” means the completion of a 2-year or longer program leading to an academic degree or certification in a medically related profession. For this position, a licensed Registered Nurse, Physician’s Assistant, Nurse’s Practitioner is required. Experience in the administration, direction, or implementation of the Medicaid program is not considered the equivalent of professional training in a field of medical care.

Benefits:

At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

 
 

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Job details

for the Riparian Division of Two Labs Pharma (pharma servicing)Candidates need to be:- experienced with Medicaid for specialty pharmaceuticals- experienced handling multiple client accounts- super organized- an awesome communicatorJob Type: Full-timePay: $65,000.00 – $75,000.00 per yearBenefits:

• 401(k)
  
• Health insurance
  

Schedule:

• 8 hour shift
  

Supplemental Pay:

• Bonus pay
  

Work Location: Remote

Apply on company website

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