Category: Curator- Job Hunter

 
 

 
 

Found in: S US – 4 hours ago

Los Angeles, CA, United States KPMG Full time

Historically, the travel requirement for this position has ranged from 80-100%. The safety and well-being of our people continues to be the top priority, and our decisions around travel are informed by government COVID-19 response directives, recommendations from leading health authorities, and guidance from a number of infectious disease experts. For now, all KPMG business travel, international and domestic, is currently restricted to client-essential sales/delivery activity only. At some point in the future and with the safety of people as the critical factor, the travel requirement will likely increase, possibly to previous levels, but KPMG is committed to balancing client requirements with new delivery capabilities.

The KPMG Advisory practice is currently our fastest growing practice. We are seeing tremendous client demand, and looking forward we don’t anticipate that slowing down. In this ever-changing market environment, our professionals must be adaptable and thrive in a collaborative, team-driven culture. At KPMG, our people are our number one priority. With a wealth of learning and career development opportunities, a world-class training facility and leading market tools, we make sure our people continue to grow both professionally and personally. If you’re looking for a firm with a strong team connection where you can be your whole self, have an impact, advance your skills, deepen your experiences, and have the flexibility and access to constantly find new areas of inspiration and expand your capabilities, then consider a career in Advisory.

KPMG is currently seeking a Director State and Local CA Medicaid in Customer & Operations for our Consulting practice.

Responsibilities:

• Manage and deliver large, complex public services and state/local government engagements that identify, design and implement creative business and technology services for Medicaid government clients
  
• Develop and execute methodologies and solutions specific to the public sector and state/local government industry coupled with proven experience with Medicaid and MMIS modernization, with preference for prior work with large Medicaid programs in the western United States
  
• Handle engagement risk, project economics, planning and budgeting, account receivables and definition of deliverable content to help to ensure buy-in of proposed solutions from top management levels
  
• Develop and maintain relationships with many senior managements at state/local government agencies, positioning self and the firm for opportunities to generate new business
  
• Evaluate projects from a technical stance, helping to ensure that the development methods used are correct and practical; evaluate risks related to requirements management, business process definition, testing processes, internal controls, project communications, training and organizational change management
  
• Manage the day-to-day interactions with client managers
  

Qualifications:

• Minimum ten years of recent experience in the Health and Human Services Medicaid solution delivery market, working for a commercial off-the-shelf (COTS) solution provider or consulting organization with a minimum of eight years of experience managing large, complex technology projects on the scale of a State Medicaid Maintenance Management Information System (MMIS) solution along with proven experience with Medicaid and MMIS modernization
  
• Bachelor’s degree of technical sciences or information systems from an accredited university or college
  
• Prior experience and has served in a team supervisory role on at least one MMIS implementation and one MMIS M&O engagement such as Program Manager, Module Project Manager, Solution Architect, Technical Solution Lead, or Quality/Testing Manager
  
• Demonstrated experience leading teams of more than twenty staff, including staff from diverse organizations to successfully implement and operate technology-based solutions; experience and relationships with states in the western United States preferred
  
• Hands-on experience with the Center for Medicare and Medicaid Services (CMS) Medicaid Information Technology Architecture (MITA), Medicaid Certification Lifecycle, associated toolkit and CMS checklists
  
• Capable of presenting Medicaid topics to large, varied audiences in either written or verbal presentation format and experience in working on customer proposals or deal capture teams in the State Medicaid market
  
• Travel may be up to 80-100%
  
• Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future
  

KPMG LLP (the U.S. member firm of KPMG International) offers a comprehensive compensation and benefits package. KPMG is an affirmative action-equal opportunity employer. KPMG complies with all applicable federal, state and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other category protected by applicable federal, state or local laws. The attached link contains further information regarding the firm’s compliance with federal, state and local recruitment and hiring laws. No phone calls or agencies please.

At KPMG, any partner or employee must be fully vaccinated or test negative for COVID-19 in order to go to any KPMG office, client site or KPMG event. In some circumstances, individuals who are not fully vaccinated may also be required to have a reasonable accommodation to not be fully vaccinated for COVID-19.

 
 

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**Provider Network Provider Network Relations/Provider Management AE I -Medicaid MCO experience [ Cincinnati, OH ]**

Location: Cincinnati, OH

Primary Job Function: Provider Network

ID**: 21783

**Job Brief**

Medicaid Manage Care related credentialing, claims, provider training/education, healthcare and provider services experience.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .

**This role is eligible for a $2,000 sign-on bonus**

**Responsibilities:**

+ The Provider Network Provider Network Relations/Provider Management Account Executive I is responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers.

+ Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations.

+ AE I maintains in depth understanding of Plan’s contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues.

+ Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the Plan’s territory in keeping w/ State and Federal contact mandates for all products.

+ Identifies, contacts and actively solicits qualified providers to participate in Plan at new and existing service areas and products, assuring financial integrity of the Plan is maintained and contract management requirements are adhered to, including language, terms and reimbursement requirements.

+ Maintains complete understanding of Plan reports and metrics and uses them to evaluate the performance of assigned providers/practices/facilities, determining, communicating and implementing plans for providers to improve performance and measuring ongoing performance.

+ Uses data to develop and implement methods to improve relationship.

+ Assists in corrective actions required up to and including termination, following Plan policies and procedures.

+ Supports the Quality Management department with the credentialing and re-credentialing processes, investigation of member complains and any potential quality issues.

+ Maintains a functional working knowledge of Facets, including the provider database and routinely relays information about additions, deletions or corrections to the Provider Maintenance Department.

+ Maintains and delivers accurate, timely activity and metric reports as required.

+ Identifies and maintains strong partnerships with appropriate internal resources and stakeholders.

**Education/ Experience:**

+ Bachelor’s Degree.

+ 1 to 3 years experience in a Provider Services position working with providers.

+ 3 to 5 years experience in the managed care/health insurance industry.

+ Medicaid experience preferred.

+ Demonstrated strength in working independently, establishing influential relationships internally and externally, meeting and training facilitation skills, priority setting and problem solving skills.

+ **Must reside in or nearby Cincinnati,Ohio.**

**_Key words: Must have credentialing, claims, provider training/education, healthcare and provider services experience._**

EOE Minorities/Females/Protected Veterans/Disabled
 

Clipped from: https://www.mendeley.com/careers/job/provider-network-account-executive-i-cincinnati-oh-6908699?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Found in: S US – 3 hours ago

Redwood City, United States Wider Circle Full time

At Wider Circle, our team is on a mission to connect neighbors for better health, and we’re looking for equally passionate colleagues across the country to help us make a positive impact on the communities we serve. We are growing at warp speed to reach those who need us most, paving the way to become 1 million members strong. We are proud to support a culture of caring, diverse and visionary change-makers who enjoy working in a fast-paced environment and experiencing new things, every day. We partner with health plans and physician groups in neighborhoods across the country to provide fun and educational in-person and virtual programs for members who share similar interests and life experiences. Think of us as a social group with a bigger purpose: Helping Medicare and Medicaid members get the care they deserve while surrounded by a trusted circle of friends, close to home. Today, Wider Circle is proud to bring its unique neighborhood care programs to more than 320 communities in 5 different languages. Join us as we build connections for better health in communities across the country.

Wider Circle is looking for a Vice President of Operations to lead our Medicaid division with the following skills:

Top Five Skills

Connects with the Mission
Wider Circle’s mission should be a significant factor in this person’s desire to consider the position. The right person will be a values-driven individual who immediately aligns with Wider Circle’s values, connects and compliments teammates, and demonstrates the appropriate passion within their personal life.
Outspoken and Resolute
To create value for our Medicaid sponsors, we need to engage hard-to-reach members and find new ways to engage them that balance outcomes and economics. To find new solutions, we work in groups and create a contest of ideas. The ideal candidate will defend their reasoning through debate and challenge and have the grit to stay the course.
Health Plan End Market Experience
The right candidate understands our customers – Health Plans and Payer organizations such as Medicare Advantage & Medicaid Plans. This individual will have 3-5 years of experience in a health services startup, health provider, or other organization serving health plans.
Flexibility
Responding to members’ and customers’ needs with the consistency and passion that typify Wider Circle requires flexibility. Work processes, work teams, and speed adjust to meet those needs, and this individual would like this type of work dynamic.
High Clock Speed
For us, clock speed is the pace at which a person likes to go about their work. It’s a matter of preference more than anything. At Wider Circle, the pace of work tends to be fast, and this individual would prefer that pace of work.
Responsibilities
 

• Manage the service delivery for our Medicaid sponsors
  
• Lead the implementation of new Medicaid programs
  
• Lead the implementation of services with new Medicaid MCO’s
  
• Develop staffing plans, operational metrics, and budgeting to meet the Company’s objectives for its Medicaid services
  
• Participate in the development of new content and process solutions
  
• Manage the execution and reporting of Medicaid service design experiments
  
• Develop operational processes specific to each Medicaid program
  
• Manage the data retrieval and analysis of data from the system of record to provide actionable recommendations to the COO
  
• Create and maintain operating procedures and processes
  
• Lead the development of a Quality Assurance program for the Medicaid services
  
• Manage the creation of training materials and collaboration with the training team
  

Requirements
 

• 10+ years of experience working with low-income individuals
  
• 10+ years of service delivery experience
  
• Demonstrated project & vendor management experience
  
• Experience working at investor-backed startups
  
• Experience working at growth-stage startups is a plus
  
• Demonstrated experience with service or campaign development is a plus
  
• Bachelor’s degree is required, Master’s degree preferred
  
• Exceptional working knowledge of GSuite, Salesforce, and reporting databases such as Tableau.
  

Benefits
As a venture-backed company, Wider Circle offers competitive compensation including:
 

• Comprehensive health coverage including medical, dental, and vision
  
• 401(k) Plan
  
• Paid Time Off
  
• Employee Assistance Program
  
• Health Care FSA
  
• Dependent Care FSA
  
• Health Savings Account
  
• Voluntary Disability Benefits
  
• Basic Life and AD&D Insurance
  
• Adoption Assistance Program
  
• Training and Development
  

And most importantly, an opportunity to make the world a better place

Wider Circle is proud to be an equal opportunity employer that does not tolerate discrimination or harassment of any kind. Our commitment to Diversity & Inclusion supports our ability to build diverse teams and develop inclusive work environments. We believe in empowering people and valuing their differences. We are committed to equal employment opportunity without consideration of race, color, religion, ethnicity, citizenship, political activity or affiliation, marital status, age, national origin, ancestry, disability, veteran status, sexual orientation, gender identity, gender expression, sex or gender, or any other basis protected by law.

  Clipped from: https://us.trabajo.org/job-1373-20220119-9493fbd8714009f72c36e7b0990bd3cf?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

About this job

Description

The Strategy Advancement Advisor provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for business segments or the company at large. The Strategy Advancement Advisor works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Strategy Advancement Advisor leads initiatives to analyze complex business problems and issues using data from internal and external sources. Brings expertise or identifies subject matter experts in support of multi-functional efforts to identify, interpret, and produce recommendations and plans based on company and external data analysis. Ensures that policies and procedures align with corporate vision.

Read more about this job

Apply now

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The best part of this company is the commitment to associates, which naturally leads to commitment to members.

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Medical Director, Mid-South

 
 

Equal Opportunity Employer
It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact yourcareer@humana.com for assistance.

Humana Health and Safety Policy
Humana and its subsidiaries will require full vaccination for associates and select contractors who conduct work outside of their home on behalf of Humana. This applies to those who work within our facilities; interact directly with members and patients; attend in-person meetings or trainings; and/or represent Humana at events or volunteer activities. Medical and religious exemptions will be available, and this policy will not supersede state or local laws. Learn more

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Humana will never ask, nor require a candidate to provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact yourcareer@humana.com to validate the request.

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Clipped from: https://careers.humana.com/job/14696632/strategy-advisor-medicaid-dual-eligible-growth-strategy-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Are you an experienced, passionate pioneer in technology? An operations professional who wants to work in a collaborative environment. As a Senior Medicaid Business Specialist, you will have the ability to share new ideas and collaborate on projects as a consultant without the extensive demands of travel. Consider an opportunity with our US Delivery Center – we are breaking the mold of a typical Delivery Center.

Our US Delivery Centers have been growing since 2014 with significant, continued growth on the horizon. Interested? Read more about our opportunity below …

Work you’ll do/Responsibilities

+ Perform discovery of Medicaid business requirements

+ Translate business requirements into user stories and technical requirements

+ Communicate the project status throughout the project lifecycle to all team members.

+ Identify and resolve issues that may negatively impact project deliverables

+ Act as a SME on questions surrounding the Medicaid industry

The Team

Deloitte’s Government & Public Services practice-our people, ideas, technology and outcomes-is designed for impact. Our team of over 15,000+ professionals bring fresh perspective to help you anticipate disruption, reimagine the possible, and fulfill your mission promise.

Our Health Technology team implements repeatable solutions to solve our government clients’ most critical health technology related issues. We advise on, design, implement and deploy solutions focused on government health agencies “heart of the business” issues including claims management, electronic health records, health information exchanges, health analytics and health case management.

Our clients seek a fresh perspective on how to leverage reusable, interoperable and flexible solutions that will enable them to reduce costs, improve health outcomes and respond to public health crises. Professionals will use their deep health, government and technology consulting experience to strategically help solve our client’s technology challenges.

Required Qualifications

+ Bachelors’ degree in business-related field and or equivalent professional work experience

+ 6+ years of experience in the Medicaid industry

+ 6+ years of experience writing business requirements and user stories on technology projects

+ Experience working with claims authorizations

+ Strong written and verbal communication skills, especially related to client-facing environments

+ Travel up to 10% annually

+ Limited immigration sponsorship may be available.

Preferred Qualifications

+ PMP Certification

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.

 
 

Clipped from: https://www.mendeley.com/careers/job/senior-medicaid-functional-analyst-8503834?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic
 

 
 

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., it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .

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

The 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 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS58444-California
 

Clipped from: https://www.mendeley.com/careers/job/medicaid-business-analyst-intern-summer-2022-8273710?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

At CMS, we believe that at the core of our organization are the employees that carry out the Agency’s vision of advancing health equity, expanding coverage, and improving health outcomes.

 
 

About the role:

 
 

As the Deputy Director for the Center for Medicare & Medicaid Innovation (CMMI), you will share responsibility with the Deputy Administrator / CMMI Director for providing executive leadership to the planning, organization, coordination and management of the program and administrative activities for innovative models aimed at improving quality of care and reducing costs for Medicare and Medicaid and the beneficiaries served by these programs.

 
 

What you’ll do:

 
 

• Oversight of a 10-year, $10 billion budget for activities initiated under Section 3021 of Affordable Care Act (ACA), ensuring appropriate use, reporting, and internal controls.
  
• Leads and develops a diverse group of 400+ staff and managers that includes researchers, clinicians, health insurance specialists, IT specialists, data scientists.
  
• Manages, plans and develops methods to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care, and improving the coordination, and efficiency of health care services.
  
• Works with stakeholders, including patients and beneficiaries, and model participants in the development, issuance, launch and administration of innovation programs, models and initiatives.
  
• Provides advice and guidance to the Deputy Administrator/CMMI Director related to CMMI strategic planning as well as to the establishment of performance goals and measures for CMMI and its leadership team and staff.
  
• Undertakes highly complex and sensitive assignments involving Section 3021 of ACA strategies, initiatives and other operational and program issues.
  
• Advises the Deputy Administrator/CMMI Director on major operational and program issues involving personnel, financial, model development and implementation and other priorities of the Center.
  
• Maintains strong working relationships with other parts of the CMS organization, and coordinates closely with the Department, other Federal agencies and other non-Federal organizations necessary to CMMI?s operations.
  
• Represents the Deputy Administrator/CMMI Director before key officials of CMS, the Office of the Secretary, the White House, Congress, other Federal and State agencies, and other stakeholders on matters relevant to and impacting CMMI?s priorities.
  
• Promotes principles of quality management (e.g., a culture of teamwork and collaboration; customer focus; employee involvement and career development; diversity, equity and inclusion; and continuous improvement in carrying out responsibilities).
  

 
 

Experience we’re looking for:

 
 

Executive Core Qualifications (ECQs)

 
 

• Leading Change: The ability to bring about strategic change, both within and outside the organization, to meet organizational goals. Inherent to this ECQ is the ability to establish an organizational vision and to implement it in a continuously changing environment.
  
• Leading People: The ability to lead people toward meeting the organization’s vision, mission, and goals. Inherent to this ECQ is the ability to provide an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts.
  
• Results Driven: The ability to meet organizational goals and customer expectations. Inherent to this ECQ is the ability to make decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks.
  
• Business Acumen: The ability to manage human, financial, and information resources strategically.
  
• Building Coalitions: The ability to build coalitions internally and with other Federal agencies, State and local governments, nonprofit and private sector organizations, foreign governments, or international organizations to achieve common goals.
  

 
 

Professional/Technical Qualifications (PTQs)

 
 

This position also requires that you possess PTQs that represent knowledge, skills, and abilities essential for success in this role. The following PTQs must be evident in your resume”

 
 

• Demonstrated expertise in payment and delivery system reform and a deep understanding of Medicare and Medicaid, the challenges facing these programs and the beneficiaries they serve. Leadership skills to build coalitions and partnerships with health care stakeholders to advance health system transformation.
  
• Ability to lead the development, implementation, evaluation and validation of complex new care models and payment approaches to improve quality, advance health equity, and address health expenditures and affordability for Medicare and Medicaid beneficiaries. Detailed knowledge and in-depth understanding of tools and levers to improve quality of care, payment incentives, and affordability through innovation models and initiatives.
  
• Experience working directly with CMS staff and agency leaders on matters impacting Medicare and/or Medicaid. Understanding of the organizational structure, responsibilities and operational aspects of CMS, HHS, the Executive Office of the President (including the Office of Management and Budget), congressional committees with jurisdiction over Medicare and Medicaid, and other relevant Federal and State agencies that impact CMMI’s priorities.
  

 
 

You MUST apply through USAJOBS to be considered.

 
 

To see the full list of qualifications and eligibility criteria, click apply to review the job announcement on USAJOBS.

 
 

Apply by 2/18/22!

 
 

Clipped from: https://www.linkedin.com/jobs/view/deputy-director-at-centers-for-medicare-medicaid-services-2879469606/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description


The Director, Medicaid Value-Based Payment Solutions will be responsible for leading the development, evolution, and performance of Humana Healthy Horizon’s (Medicaid) value-based payment (VBP) model portfolio. This senior level leader will oversee a team of direct reports to design, implement, administer, and evaluate Medicaid VBP models to drive improved provider experience and achievement of path-to-value goals. The Director, Medicaid Value-Based Payment Solutions requires an in-depth understanding of how organization capabilities interrelate across the function or segment.


Key Responsibilities


Responsibilities

• Identify opportunities and design strategies to improve quality outcomes and reduce overall cost of care using business analytics, quality metrics, and claims data.
  
• Develop and implement new innovative VBP models for range of provider types, including behavioral health, maternity, specialists, and PCPs, creating glide paths to move providers from volume to value
  
• Guide VBP model design, including performance metrics and benchmarks, reporting packages, and financial terms.
  
• Oversee administration of Medicaid specialty VBP models, including provider reporting packages, settlements/reconciliations, and provider educational materials and tools
  
• Consult on negotiations of PCP risk arrangement terms
  
• Oversee implementation of VBP models in new markets, including developing key business rules and establishing standard processes.
  
• Collaborate with matrixed corporate and market teams, including provider services, finance, analytics, and contracting, to operationalize VBP models and ensure alignment of VBP models with enterprise strategies.
  
• Partner with finance team to conduct impact analysis and modeling for new and existing VBP models
  
• Manage VBP portfolio to KPIs agreed upon with senior leaders. Present regularly to senior leaders on progress and performance.
  
• Drive positive experiences and performance among participating providers
  
• Establish and maintain standard operating procedures and policies to guide team work
  
• Effectively manage team of direct reports
  
  
  

Required Qualifications

• Bachelor’s Degree
  
• 7+ years of experience in managed care operations, provider reimbursement and analytics, and value-based care
  
• 4+ years progressive leadership experience hiring, training, and managing associates
  
• Expertise in VBP model design, financial modeling, operations, and contracting strategies
  
• Ability to understand and analyze financial, utilization, and performance data
  
• Passion for people development and demonstrated leadership success (both internally and externally)
  
• Ability to identify, structure and solve complex business problems
  
• Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team.
  
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  
  
  

Preferred Qualifications

• Master’s degree
  
• Expertise in Medicaid and Medicaid managed care
  
• Experience performing claims data analysis to inform VBP model design
  
• Experience designing and administering specialty VBP models (e.g., behavioral health, maternity)
  
  
  

Additional Information

• For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are 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, including booster 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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Found in: S US – 10 hours ago

**Description**

The Medicaid Lead, Technology Solutions builds strategic partnerships and manages relationships between IT and the aligned business group(s). The Lead facilitates guidance to business partners on information technology (IT) solutions, stays current on and leverages industry trends, and challenges business and IT to drive for best outcomes by leveraging the best technology solutions. This is achieved by having a clear understanding of business, its strategic direction, and targeted outcomes along with technology trends both internal and external to the organization. The role serves as the Single Point of Contact representing assigned business area(s) to the IT organization and representing Humana IT with internal business partners along with State and Federal regulators. The Lead ensures RFP responses are accurate and reflect the true and competitive capabilities Humana brings to the table, ensures internal SLAs are in place to support contracts and technology is configured to operate within contractual obligations. The Lead drives solutions at an organizational level to provide maximum value and align to the overarching IT strategy. They measure value to demonstrate and promote the value of IT to their respective areas and the organization as a whole.


**Responsibilities**

**Responsibilities**

+ Builds and maintains relationships with regulators and business leaders to understand the business strategy and needs and to advocate technology solutions to deliver results.


+ Acts as a trusted conduit – the voice of the customer to IT and the voice of IT to the customer, ensuring the objectives of both are met.


+ Stays current on relevant technologies leading efforts to match business needs with best technology solutions.


+ Ensures Technology investment roadmaps stay relevant and accurately reflect the investment plan and timing for assigned business areas.


+ Owns end to end accountability for the ongoing quality control development and delivery of IT products and services for each assigned business area. Accountable for program execution and delivery in line with initiative objectives, benefits, and success criteria. Develops, shares, and leverages best practices across IT


+ Works with the business to define, prioritize, and manage projects that align with the business and IT strategy, for annual strategic plan


+ Leads teams to gathers business requirements and clarify scope during initial discovery by conducting meetings/interviews, and facilitating large group/cross-functional sessions with partners


+ Effectively influences key stakeholders, team members, and peers outside of direct control of this role, to deliver optimal solutions in line with the best interests and expectations of the business partner.


+ Conducts executive level briefings presentations and solution recommendations

**Required Qualifications**

+ Solid understanding of operations, technology, communications and processes


+ Possess 10+ years of progressive experience leading continuous improvement efforts, evaluating existing systems and implementing process improvements.


+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences

**Preferred Qualifications**

+ Bachelor’s degree

**Additional Information**

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 ahealthcarecompany committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

+ Provide proof of full vaccinationor 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.

LI#Remote

This opportunity does provide remote (work at home).

**Scheduled Weekly Hours**

40

**Scheduled Weekly Hours**

40

 
 

Clipped from: https://us.trabajo.org/job-1373-20220119-ed9e056b486d0859cc54a1073a7b35c9?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Summary


The Senior Analytics Consultant will lead the firm’s design and conducting of complex analyses using the Transformed Medicaid Statistical Information System (T-MSIS) data set to answer priority questions, meet the data analytic needs of our clients and generally advance our mission to improve the health and wellbeing of individuals and communities by making publicly funded health care, and the social services that support it, more accessible, equitable, and effective. With latitude for independent judgment, responsibilities are focused on interpreting and analyzing T-MSIS data and other large health care claims data sets and financial data from health care payers and providers. Additionally, the Senior Analyst will support the firm’s design and conducting of complex analysis using Medicare claims data sets and Medicare beneficiary demographic datasets. The Senior Analytics Consultant will operate in both a team environment and independently, with minimal supervision in a variety of projects to organize and analyze data for patterns, trends, and strategic insights in support of the firm’s consulting engagements. Lastly, the Senior Analytics Consultant will assist with all phases of quantitative research including programming, data management and the interpretation and presentation of results.


Work Performed
 

• Performs data extraction, uploading data, manipulation, cleaning, quality checking and analysis.
  
• Designs and conducts data analyses
  
• Utilizes the Transformed Medicaid Statistical Information System (T-MSIS) in the Virtual Research Data Center (VRDC)
  
• Works with other large health care and financial data sets, such as Medicare claims and Medicare beneficiary demographic data sets
  

 
 

• Interprets findings and prepare materials to clearly communicate analytical summations to management.
  
• Analyzes and creates reports to summarize data findings for clients
  
• Processes Medicaid eligibility, encounter and claims data to identify enrollment, utilization, and spending trends in Medicaid across or within states.
  
• Using eligibility, encounter and claims data, models the fiscal impact of changes to provider payment rates, billing rules, and modifications to service arrays.
  
• Assists in the development of audience-appropriate reports and presentations to summarize findings from analytical research associated with the tasks.
  
• All other job duties as assigned.
  
   
  

Education/Training

Bachelor’s degree in computer science, economics, finance, accounting, public policy, or related field is preferred. Equivalent work experience equivalent will be considered. Master’s degree is ideal.


Experience


A minimum of five years of experience working with health care data. The preferred candidate will have experience with the Transformed Medicaid Statistical Information System (T-MSIS) data set or with the MSIS data previously. Experience with SAS. Intermediate Microsoft Office applications skills including MS Excel, Word, PowerPoint and Access.


Knowledge, Skills And Abilities

• Experience in the manipulation and evaluation of large data sets of health care claims, managed care encounters and financial information.
  
• Experience utilizing eligibility and claims data to provide insight to challenging publicly funded health care problems.
  
• Knowledge of financial analysis techniques
  
• Knowledge of health care policy and data.
  
• Creative problem solving.
  
• Strong analytical and statistical skills.
  
• Excellent attention to detail.
  
• Strong communication skills
  
• Superior interpersonal skills.
  
• Highly organized and able to work under tight deadlines.
  
• Preferred: Experience using Tableau or PowerBI.
  
   
  

Work Aids and Equipment Used

Computer, printer, copier, scanner, fax, telephone, web conferencing, Internet, video conferencing.


Working Conditions

Work is sedentary in nature and performed in an office environment. Involves frequent contact with staff and clients. Work may be stressful at times. May require travel at times (:5%).


Physical/Mental Demands

Work requires hand dexterity for office machine operation; stooping, climbing, and bending to files and supplies; mobility to complete errands; stand/sit for up to eight hours each day; ability to communicate clearly when using the telephone; requires sitting, standing, walking, reaching, bending, lifting, and twisting at times; moderate levels of stress. Ability to lift up to 20 pounds at times.


Vaccine Requirement


In accordance with the Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors, Health Management Associates (HMA), has adopted the Federal Contractor COVID-19 Vaccination Policy to comply with the requirements for entities that are assigned to federal contracts/subcontracts, and to safeguard the health of our colleagues and their families; our clients and visitors; and the community at large from COVID-19.


This policy applies to current and future HMA colleagues. Proof of vaccine will be required after an offer of employment is extended and accepted. Employment will be contingent upon the employer receiving proof of being fully vaccinated. Fully vaccinated means receiving two doses of Moderna or Pfizer COVID-19 vaccine, or one dose Johnson& Johnson COVID-19 vaccine.


HMA IS AN EQUAL OPPORTUNITY EMPLOYER

 
 

Clipped from: https://www.linkedin.com/jobs/view/senior-analytics-consultant-transformed-medicaid-statistical-information-system-t-msis-at-health-management-associates-inc-2879451692/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic