Description

SHIFT: Day Job

SCHEDULE: Full-time

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

Primary duties may include, but are not limited to:

+ Receiving and responding to state or federal regulatory complaints related to claims

+ Managing health plan dispute escalations

+ Quality review of various dispute outcomes

+ Managing complex system issues

+ Managing state updates

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

Qualifications

Requirements:

+ BA/BS degree

+ Minimum of 5 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry

+ Or any combination of education and experience which would provide an equivalent background

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS59557-Florida

 
 

Clipped from: https://www.mendeley.com/careers/job/medicaid-state-operations-analyst-7894555?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic
 

 
 

The Lead, Medicaid Technology Product Enablement devises an effective strategy for executing and delivering on IT business initiatives. The Lead, Medicaid Technology Product Enablement requires a solid understanding of how organization capabilities interrelate across department(s).

The Lead, Medicaid Technology Product Enablement collaborates with the business and functional stakeholders to identify and deliver strategic enablement solutions that support profitable Medicaid business growth. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), and could lead multiple managers or highly specialized professional associates. Understands department, segment, and organizational strategy and operating objectives. Makes decisions regarding own work methods, often in ambiguous situations, and requires minimal direction, receiving guidance where needed. Able to prioritize and deliver multiple tasks with tight timelines. Acts as a change agent with an agile mindset to quickly pivot based on evolving information in a highly ambiguous environment. Builds and maintains partnership with key stakeholders. Possesses excellent written and verbal communication and presentation skills. Demonstrates a high level of executive presence and leadership skills. Able to communicate with high level of business acumen. Able to thrive in a fast-paced, growth-oriented environment Responsibilities

Duties may include, but are not limited to, the following:

• Develop solutions based on our consumer journey to meet our members where they are
  
• Drive work from concept to implementation across multiple teams – both business and development
  

 
 

• Enhance the consumer experience with intelligent solution design and execution
  
• Oversees team to ensure complete requirements meet the state contracts and exceed the member expectation
  
• Organize delivery in small executable blocks of work
  
• Partner with the business teams to drive priority
  
• Empower a team of professional employees to own value chains and stream dependencies between systems, identify synergies, and reduce risk to implementation timelines
  

 
 

• Engage in solution design session with Medicaid architects and individual system architects to identify solutions that will support Medicaid growth
  
• Support Medicaid CIOs by identifying and offering cross market opportunities
  
• Reduce silos between systems and business processes
  
• Propose opportunities for system enhancements and innovation to better meet consumer needs
  
• Own relationship with vendor an internal supported solutions
  

 
 

• Engage in contract negotiations and development of statement(s) of work with external vendors
  
• Document consumer journey map to technical solutions
  
• Builds strategic partnerships and manages relationships between IT and the aligned business group leaders
  
• Obtain and synthesize complex data to tell value stories by product
  
• Serves as trusted leader and partner to deliver high quality products
  

 
 

• Champions culture change, process improvement, and drives adoption of agile ways of working
  

Required Qualifications:

• Bachelor’s Degree
  
• 6 or more years of technical experience
  

 
 

• 2 or more years of management experience
  
• 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
  
• Ability to manage multiple tasks and deadlines with attention to detail
  

 
 

• Ability to communicate effectively and deliver presentations to senior leaders
  
• Proven experience organizing and directing multiple teams and departments
  
• Excellent communicator in written and verbal form
  
• Extremely versatile, dedicated to efficient productivity
  
• Experience planning and leading strategic initiatives
  

 
 

• Proficient with full Microsoft Office suite, Microsoft Visio, Microsoft Teams
  

Preferred Qualifications:

• Master’s Degree
  
• Experience in Medicaid
  

 
 

• Experience in Product Management
  
• Strong understanding of regulatory and compliance metrics
  
• Knowledge of/Certification in SAFe Agile methodology
  
• Consulting experience with a focus on operations management
  
• Proven success in a project/program management role
  

 
 

• Nimble business mind with a focus on developing creative solutions
  
• Strong reporting skills, with a focus on interdepartmental communication
  

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 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

Clipped from: https://jobs.laimoon.com/jobs/externalview/31390881?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

*Description* The Data and Reporting Professional 2 generates ad hoc reports and regular datasets or report information for end-users using system tools and database or data warehouse queries and scripts. The Data and Reporting Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action..

*Responsibilities* The Data and Reporting Professional 2 integrates data from multiple sources to produce requested or required data elements. + Programs and maintains report forms and formats, information dashboards, data generators, canned reports and other end-user information portals or resources. + May create specifications for reports based on business requests.

+ Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. + Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. + Follows established guidelines/procedures.

+ This role is considered work at home.*Required Qualifications* + Bachelor’s degree or equivalent experience + Demonstrated technical experience with database management applications, including but not limited to Access, MySQL, SQL Server Management Studio, Oracle PL/SQL, analyzing data, and applying a range of software solutions to improve processes + Proficiency in working with Microsoft Excel, including converting raw data sets into actionable business insights + Experience in developing, maintaining, and collecting structured and unstructured data sets for analysis and reporting + Ability to take ownership of multiple projects and deliverables simultaneously + Strong verbal and written communication skills with the ability to effectively promote and install technical solutions to complex problems across a variety of business units in the organization. + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + Must be available to work Monday – Friday Business hours and adjust the work schedule due to business needs.

*Work At Home Requirements* Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work. + Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required..

*Preferred Qualifications* + Experience.*building applications* in cloud-based low code development platforms such as.*Quickbase*,.*Microsoft PowerApps, or ServiceNow.

* + Working knowledge of various coding languages such as.*SQL, Python, JavaScript, HTML, CSS* + Previous Managed Care experience + Previous Medicaid Operations experience.*Additional Information
Interview Format* As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability.

Modern Hire Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence.*(please be sure to check your spam or junk folders often to ensure communication isn’t missed)* inviting you to participate in a Modern Hire Voice interview.

In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews..

*Scheduled Weekly Hours* 40.

 

Web Reference : AJF/183721974-405
Posted Date : Wed, 12 Jan 2022

 
 

Please note, to apply for this position you will complete an application form on another website provided by or on behalf of Humana. Any external website and application process is not under the control or responsibility of JobServe – Work@Home Jobs

 
 

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A MMIS Subject Matter Expert (SME) is responsible for evaluating agency needs, as-is and to-be business processes, and technical designs to provide analysis and advice on strategies for information technology solutions and non-technical solutions. The majority of the system development work will be outsourced to vendors and other State organizations.

Duties include:

• Requirements development execution, including the elicitation, analysis, specification and validation.

• Documenting and analyzing agency business processes and recommending improvements.

• Documenting and analyzing data requirements and relationships.

• Participate in the requirements management processes, including change control; version control; tracking and status reporting; and traceability.

• Providing requirement interpretation and guidance to technical and test teams.

 
 

 
 

Qualifications

• Bachelor’s degree
  
• 5+ years’ of experience in Medicaid, Medicare, or related social programs
  
• Proficient in Medicaid policy
  
• Strong written and verbal communication skills
  

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-subject-matter-expert-at-new-health-consulting-2873452090/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

• Job Description – State Medicaid Director (11723) (21142925)
  
• State Medicaid Director (11723) – ( 21142925 )
  
• 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
  
• 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 Shannon.
  
• 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.
  
• 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.
  
• 15 paid vacation days per year
  
• 12 paid sick days per year
  
• 10 paid holidays per year
  
• To view State of Montana’s medical, dental, vision coverage, and other offerings, you can visit our Health Care and Benefits website at,
  
• 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.
  
• 66.80 – 66.80 Hourly Benefits Package Eligibility : Health Insurance, Paid Leave & Holidays, Retirement Plan
  
• : 1 Employee Status : Regular Schedule : Full-Time
  
• : Day Job : Yes, 10 % of the Time
  
• : Helena Agency : Department of Public Health & Human Services Union : 000 – None Bargaining Unit : 000 – None
  
• : Nov 2, 2021, 8:45:46 PM : Ongoing
  
• Required Application Materials : Resume
  
• Contact Name : Shannon Voss | Contact Email : shannon.voss@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.
  

 
 

• Clipped from: https://tarta.ai/j/grwzTX4B_wGWf_EJCC0p-state-medicaid-director-in-helena-al-at-cti-education-group?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic
  

 
 

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.

We are hiring a Director II Healthcare Management. This role will lead our Louisiana Medicaid markets case and utilization management areas, and support population health as it relates to these areas. Responsible for the development, implementation, and oversight of integrated Medical Management of more than one member population type with varying degrees of medical complexity. Oversees case and utilization management execution/decision making for managed member populations. Is accountable to plan executive or executive team member dependent on plan size/complexity and is involved in the development of the strategic vision, goals, and objectives for medical management. Serves as liaison to state regulatory agencies.

Primary duties may include, but are not limited to:

+ Directs and provides leadership for designing, developing, and implementing integrated medical management program to meet the demographic and epidemiological needs of the populations serviced.

+ Partners with other health plan/corporate leaders to develop and deliver innovative care management services, root cause analyses and solutions to achieve quality outcomes.

+ Directs Healthcare Management Program including disease management, case management, and utilization management.

+ Partners with Provider Relations, Quality Management, Health Promotions, and Community Relations to develop and implement effective provider communications, quality assurance, and member outreach programs.

+ Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.

+ Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state/and or federal program requirements.

+ Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Qualifications

Minimum Qualifications

Requires a BA/BS degree in a health care field and a minimum of 10 years clinical work experience including prior management experience; or any combination of education and experience which would provide an equivalent background.

Previous experience with NCQA accreditation and HEDIS reporting required.

Preferred Qualifications

RN preferred.

MS/MA degree in a health care field or MBA with Health Care concentration preferred.

Utilization management and case management experience.

Experience working for a managed care organization.

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.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS62837-Baton%20Rouge-Baton%20Rouge

 
 

Clipped from: https://www.mendeley.com/careers/job/director-ii-healthcare-management-louisiana-medicaid-8324416?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic
 

 
 

As a Program Analyst, you will oversee the assignment of work to various contractors providing the Agency with information technology (IT) support, ensuring that the work is properly performed.

 
 

Duties

 
 

• Administers all phases of major contracts for IT software development and maintenance, operational support, and/or other resources and services.
  
• Recognizes potential areas of concern and develops alternative measures to support group and other Agency contract needs.
  
• Provides technical expertise in assigned areas by gathering, organizing, and interpreting data and information.
  
• Prepares position papers and executive submittals to discuss the far-reaching proposals to revise program requirements or modify existing organizational arrangements.
  
• Provides input to the CMS IT user community and ensures that group activities are completed with the cooperation and coordination of all appropriate parties.
  

 
 

 
 

Qualifications

 
 

In order to qualify for the GS-13:

 
 

You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience, to include:

1) Managing acquisition-related projects through all phases of the contract lifecycle (i.e. new procurement solicitation and selection activities and providing day-to-day contract administration support);

2) Overseeing IT contracts that provide a wide range of IT services with varying degrees of technical complexity; and

3) Developing budget plan(s) for IT related contracts in order to conduct program analysis(e.g. forecasting risks, problems, trends and other variable that impact projected costs).

 
 

 
 

***For those of whom, that are current Federal employees please visit here: https://www.usajobs.gov/job/629706800#required-documents. To the public, please click the apply button to be directed to the USAjobs.gov link.

 
 

Clipped from: https://www.linkedin.com/jobs/view/program-analyst-at-centers-for-medicare-medicaid-services-2865110092/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Found in: Talent US Sponsored – calendar_today 16 hours ago

Description

Job Brief

In house Legal Counsel role primarily responsible for day-to-day legal support of the company’s Medicaid managed care plans.

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

Primarily responsible for day-to-day legal support of the company’s Medicaid managed care plans as detailed herein. Provides professional legal counsel on a variety of complex or specialized legal activities in accordance with the established standards of the legal profession to protect the organization’s reputation and business interests and help ensure it complies with all relevant laws, regulations and contractual requirements. Provide legal advice within area of expertise to area managers to ensure their activities, policies, business practices, and transactions comply with all relevant laws, regulations and contractual requirements. Makes recommendations to senior management on how to respond to legal issues or proposed changes in laws, regulations and contractual requirements. Reviews and approves legal contracts, letters of agreement, policies and procedures, responses to regulatory inquiries, responses to Request for Proposals and other documents related to a variety of operational matters to protect the organization’s legal and business interests.

Education/Experience:

• License to practice law in PA or another state.
  
• Knowledge and experience in: Health Care and laws and regulations pertaining to Medicaid managed care, Medicare, and commercial exchange; Provider contracts and Provider-related litigation; vendor contracts; and/or business transactions.
  
• Experience providing legal support to Medicaid managed care organizations preferred but not required.
  
• 7-10 years of experience after receiving law degree.
  
• Strong analytical skills and written and verbal communication skills a must.
  
• Ability to effectively manage competing priorities.
  
• Collaborative style.
  

BackShareApply Now

 
 

Clipped from: https://us.bebee.com/job/20220106-99a8460c5ffc008c9c27171697a76c48?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Care Manager (RN) (Medicaid). Job in Newark Allied-IT Jobs

About NYC Health + Hospitals

MetroPlus 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, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus 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.

 
 

Clipped from: https://allied-it.gr8jobs.net/jobs/care-manager-rn-medicaid-newark-new-jersey/466598307-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

**Description**

The Lead, Medicaid Technology Product Enablement devises an effective strategy for executing and delivering on IT business initiatives. The Lead, Medicaid Technology Product Enablement requires a solid understanding of how organization capabilities interrelate across department(s).

The Lead, Medicaid Technology Product Enablement collaborates with the business and functional stakeholders to identify and deliver strategic enablement solutions that support profitable Medicaid business growth. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), and could lead multiple managers or highly specialized professional associates. Understands department, segment, and organizational strategy and operating objectives. Makes decisions regarding own work methods, often in ambiguous situations, and requires minimal direction, receiving guidance where needed. Able to prioritize and deliver multiple tasks with tight timelines. Acts as a change agent with an agile mindset to quickly pivot based on evolving information in a highly ambiguous environment. Builds and maintains partnership with key stakeholders. Possesses excellent written and verbal communication and presentation skills. Demonstrates a high level of executive presence and leadership skills. Able to communicate with high level of business acumen. Able to thrive in a fast-paced, growth-oriented environment

**Responsibilities**

**Duties may include, but are not limited to, the following:**

+ Develop solutions based on our consumer journey to meet our members where they are

+ Drive work from concept to implementation across multiple teams – both business and development

+ Enhance the consumer experience with intelligent solution design and execution

+ Oversees team to ensure complete requirements meet the state contracts and exceed the member expectation

+ Organize delivery in small executable blocks of work

+ Partner with the business teams to drive priority

+ Empower a team of professional employees to own value chains and stream dependencies between systems, identify synergies, and reduce risk to implementation timelines

+ Engage in solution design session with Medicaid architects and individual system architects to identify solutions that will support Medicaid growth

+ Support Medicaid CIOs by identifying and offering cross market opportunities

+ Reduce silos between systems and business processes

+ Propose opportunities for system enhancements and innovation to better meet consumer needs

+ Own relationship with vendor an internal supported solutions

+ Engage in contract negotiations and development of statement(s) of work with external vendors

+ Document consumer journey map to technical solutions

+ Builds strategic partnerships and manages relationships between IT and the aligned business group leaders

+ Obtain and synthesize complex data to tell value stories by product

+ Serves as trusted leader and partner to deliver high quality products

+ Champions culture change, process improvement, and drives adoption of agile ways of working

**Required Qualifications** :

+ Bachelor’s Degree

+ 6 or more years of technical experience

+ 2 or more years of management experience

+ 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

+ Ability to manage multiple tasks and deadlines with attention to detail

+ Ability to communicate effectively and deliver presentations to senior leaders

+ Proven experience organizing and directing multiple teams and departments

+ Excellent communicator in written and verbal form

+ Extremely versatile, dedicated to efficient productivity

+ Experience planning and leading strategic initiatives

+ Proficient with full Microsoft Office suite, Microsoft Visio, Microsoft Teams

**Preferred Qualifications** :

+ Master’s Degree

+ Experience in Medicaid

+ Experience in Product Management

+ Strong understanding of regulatory and compliance metrics

+ Knowledge of/Certification in SAFe Agile methodology

+ Consulting experience with a focus on operations management

+ Proven success in a project/program management role

+ Nimble business mind with a focus on developing creative solutions

+ Strong reporting skills, with a focus on interdepartmental communication

**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 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

 
 

Clipped from: https://www.mendeley.com/careers/job/lead-technology-solutions-medicaid-8468410?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic