Category: Curator- Job Hunter

Anthem, Inc. (Birmingham AL, USA) Follow 2 days ago

The health and safety of our associates, members and communities is a top priority for Anthem. This priority has become increasingly important as we continue to face the challenges of the COVID-19 pandemic. Anthem believes vaccination is the best way to reduce the spread of COVID-19 and protect our members, associates and communities. To minimize the risk of transmission of the COVID-19 virus and maintain a safe and healthy workplace to safely serve our members, vaccination may be required for specific roles. (At Anthem, fully vaccinated means it has been at least two weeks since you have received the second dose of a two-dose vaccine such as Moderna or Pfizer, or the single dose of a single dose vaccine, such as Johnson & Johnson). Anthem has a mandatory vaccination policy applicable to all associates in patient/member-facing positions (i.e. associates who work in or visit clinics, member homes, or care facilities (“direct patient/member-facing interactions”)) and positions required to work in any Anthem location. Accommodation for medical and sincerely held religious reason for not being vaccinated, consistent with applicable law, will be considered for reasonable accommodation on this basis. Anthem continues to monitor the pandemic following all CDC guidelines, federal, state and local laws. Policies continue to be adjusted as new information emerges. Medicaid New Market Transitions Director Location: Birmingham, AL JobFamily: Business Development/Planning 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. Medicaid New Market Transitions Director Location: The ideal candidate would be located in an Eastern or Central time zone with a 50% travel expectation, yet this position will consider other Anthem locations. Anthem’s Government Business Group’s Medicaid New Market Transition team is looking for a Medicaid New Market Transitions Director to join its team. This high-performing individual contributor will be responsible for creating and executing strategies and tactical plans to win new business (new markets, alliance partnership, acquisitions, etc.). Leads, oversees, develops and ensures successful procurement of new business, resulting in increased Medicaid growth and P&L opportunities and expansion of Anthem’s market footprint. Focus for this role will be on initial ground game development, state and legislative relationship development in coordination with Government Relations, regulatory and compliance. Primary duties may include, but are not limited to: Creates and executes the initial market strategy enabling Anthem to win the business by understanding the key needs of the customer (State, Provider, Alliance, etc.) in partnership with multiple matrix partners including Finance, Government Relations, Diversified Business Group, Network, Operations and Clinical organizations. Identifies and develops new relationships and advocacy in the market(s) with state, provider, and not for/non- profit organizations. Develops and supports new innovative programs and market specific pilots targeting growth including internal and external vendor partnerships. Provides business expertise in each new business venture to proactively understand what Anthem’s portfolio currently can offer, what will need to be developed, and the ROI to ensure there is a mutually beneficial outcome for both parties when building new programs. Prior to engaging in procurement activities, builds brand recognition with community partners in partnership with the Medicaid Marketing organization to better support RFP activities and win new business. Qualifications Requires a BA/BS degree in a related field and a minimum of 8 years of leadership experience; or any combination of education and experience, which would provide an equivalent background. Preferred Qualifications: Experience in a health plan leadership role and leadership role in M&A and/or RFP activities. Experience and knowledge of MCO most notably in the Medicaid industry is strongly preferred. Demonstrated results in three or more of the following areas required: Product Development, Market Strategy, Market Research or Risk Management. Experience in building strong client relationships with key stakeholders including clients, government agencies, and vendor partners. Excellent written, oral and interpersonal communication skills with the proven ability to negotiate expectations between multiple parties. Experience interacting confidently with senior management, as s subject matter expert and comfortable with influencing decision-making. Applicable to Colorado Applicants Only Annual Salary Range: $124,404 – $155,505 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. 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. Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem. EEO is the Law EqualOpportunityEmployer/Disablity/Veteran Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees. Anthem, Inc. is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at abilityicareerhelp.com for further assistance. WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Please be advised that Anthem will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission here by selecting the ‘Rip-offs and Imposter Scams’ option. Anthem requires a completed online application for consideration of employment for any position.

Clipped from: https://www.recruit.net/job/transition-director-jobs/8F70953B7D6F5174?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

The Medicaid Data & Analytics Product Owner Liaison (POL) is responsible for product planning and delivery though the product lifecycle. They partner with the State Product Owner (PO) and technology architects to create and sell a compelling vision for the product that will achieve stakeholder objectives. The POL then works with the State PO, project manager, and technology architects to prioritize the product backlog into epics and features that maximize business value. The POL further refines backlog items as needed, participates in Agile Scrum ceremonies, and clarifies business requirements for the Scrum team. The POL operates with limited supervision and must demonstrate excellent time management, work planning, and communication.
 
Minimum of 4 years Business analysis experience for data and analytics systems development including business process design, requirements gathering, documentation, and testing
 
Minimum of 4 years Microsoft Office experience including Excel and Word
 
Minimum of 2 years Working with healthcare claim or encounter data
 
Minimum of 1 year Work experience as a Product Owner, Product Manager, or related role
 
Minimum of 1 year Agile Scrum 1 years SQL experience to facilitate analysis and testing Preferred Skills TX Medicaid business and systems knowledge Experience creating queries and reports using SAP Business Intelligence BusinessObjects Previous work experience as a Project Manager Experience developing data warehouse and business intelligence solutions
 
What We Believe
 
We have an unwavering commitment to diversity with the aim that every one of our people has a full sense of belonging within our organization. As a business imperative, every person at Accenture has the responsibility to create and sustain an inclusive environment.
 
Inclusion and diversity are fundamental to our culture and core values. Our rich diversity makes us more innovative and more creative, which helps us better serve our clients and our communities. Read more here
 
Equal Employment Opportunity Statement
 
Accenture is an Equal Opportunity Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion or sexual orientation.
 
All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.
 
Accenture is committed to providing veteran employment opportunities to our service men and women.
 
For details, view a copy of the Accenture Equal Opportunity and Affirmative Action Policy Statement.
 
Requesting An Accommodation
 
Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.
 
If you would like to be considered for employment opportunities with Accenture and have accommodation needs for a disability or religious observance, please call us toll free at 1 (877) 889-9009, send us an email or speak with your recruiter.
 
Other Employment Statements
 
Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.
 
Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.
 
Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.
 
The Company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.
 

Membership Enrollment

Senior Process Associate

In the role of process associate, you will execute transactions as per prescribed guidelines and timelines, reviews and validates the inputs from the other team members, support your manager in training activities, daily operations reviews and help in escalation resolution with the objective to meet service level agreement targets for the specific process within the guidelines, policies and norms of Infosys.

Responsibilities may include but are not limited to:

• Performs processes to resolve the following eligibility exceptions within the required State/Regulatory timeframes:
• Enrollment file errors, ID card generation errors, PCP assignments and, 834 enrollment files to vendor/third-party administrators.
• Process COB eligibility through company application to ensure accurate information is represented in company’s enrollment system
• Assists with the support of the newborn enrollment functions, including call center, claims, and encounter requests for verification and updates, PCP assignment activity, enrollment record error reports, enrollment/dis-enrollment activity and Mass Member Moves.
• As needed is available to support special projects
• Prioritizes daily, weekly, and monthly job tasks to support regulatory requirements and service level agreements.
• Displays imitative to complete assigned tasks timely and accurately and balances workload to assist peers and Supervisor.
• Provides knowledgeable response to internal and external inquiries regarding eligibility, ID cards, selection of primary, care provider, and state enrollment transactions.
• Reconciles eligibility with State Agencies using varied methods. Tracks and documents all transactions with State Agencies.

Location for this position is Phoenix, AZ.

Qualifications

Basic

• High School Diploma or GED Equivalent

• At least 1 year of related work experience

Preferred

• Attention to detail and a high level of accuracy
• Ability to identify which form received and accurately follow appropriate workflow based on form number or type.
• English Language proficiency – Proficiency of 4 for reading and 3 for spoken/written
• Strong data entry skills
• Typing expectations (40-50 WPM with 97.50% accuracy)

• Ability to work independently and use provided resources to seek solutions to problems.

• Well-developed analytical skills to evaluate and determine the appropriate course of action.

• At least 3 – 5 years of relevant work experience in US healthcare member enrollment (Medicaid, Medicare, or Commercial)
• Should possess the basic knowledge to work on MS offices tools. Demonstrated proficiency in computer navigation and functionality.

Note: Applicants for employment in the U.S. must possess work authorization which does not require sponsorship by the employer for a visa (H1B or otherwise).

COVID-19 Considerations:

Vaccination required. Masks are required to enter the office. Extra screening, sanitation and disinfecting procedures are in place.

Work Remotely: This role is based out of Austin, TX and is temporarily remote until company’s decision to return to office.

The job entails sitting as well as working at a computer for extended periods of time. Should be able to communicate by telephone, email, or face to face.

About Us

Infosys BPM, the business process management subsidiary of Infosys (NYSE: INFY), provides end-to-end transformative services for its clients across the globe. The company’s integrated IT and BPM solutions approach enables it to unlock business value across industries and service lines, and address business challenges for its clients. Utilizing innovative business excellence frameworks, ongoing productivity improvements, process reengineering, automation, and cutting-edge technology platforms, Infosys BPM enables its clients to achieve their cost reduction objectives, improve process efficiencies, enhance effectiveness, and deliver superior customer experience.

Infosys BPM has 32 delivery centers in 16 countries spread across 6 continents, with more than 38000 employees from over 80 nationalities, as of Nov 2019.

The company has been consistently ranked among the leading BPM companies globally and has received over 60 awards and recognitions in the last 5 years, from key industry bodies and associations like the Outsourcing Center, SSON, and GSA, among others. Infosys BPM also has very robust people practices, as substantiated by the various HR-specific awards it has won over the years. The company has consistently been ranked among the top employers of choice, on the basis of its industry leading HR best practices. The company’s senior leaders contribute widely to industry forums as BPM strategists.

EOE/Minority/Female/Veteran/Disabled/Sexual Orientation/Gender Identity/National Origin

Clipped from: https://www.linkedin.com/jobs/view/medicaid-enrollment-specialist-at-infosys-bpm-2844172819/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. In 2020, ODM introduced a new vision for Ohio’s Medicaid program — one that strengthens Ohio’s future and ensures everyone has the chance to live life to its full potential.
 
Today, more than 90 percent of Ohio Medicaid members are supported by managed care organizations. During the year ahead, ODM will begin implementing a new vision for care; focusing on the individual, a strong partnership among MCOs and the department, and supporting specialization in addressing critical needs.
 
A program that puts the individual first
 
They Are
 
Adopting Governor DeWine’s philosophy of service to Ohioans, ODM embarked on an aggressive effort to redesign its managed care program. The goal is to provide more personal, holistic care and supports for millions of Ohioans served by Medicaid. Listening to feedback from more than 1,100 individuals and organizations we identified five procurement goals that would put the individual front and center of Medicaid’s program and policy decisions.
 

• Emphasize a personalized care experience
• Improve care for children and adults with complex behavioral health needs
• Improve wellness and health outcomes
• Support providers in better patient care
• Increase program transparency and accountability
   

UNLESS REQUIRED BY LEGISLATION OR UNION CONTRACT, STARTING SALARY WILL BE SET AT STEP 1 OF THE PAY RANGE
 
Office: Data Governance & Analysis
 
Classification: Health Services Policy Specialist (PN 20099220, 20099223, & 20045458)
 
Job Overview
 
The Ohio Department of Medicaid (ODM) is seeking to fill three positions in its Data Governance & Analysis team. These positions will support the ongoing procurement efforts of the agency as it transforms healthcare delivery in the state into a person-centered enterprise. The three positions available are:
 
Healthcare Informatics Specialist (PN 20045458) –
 

• Provide analytic support for strategic planning, policy development, and program evaluation for ODM healthcare services
• Assist in communication of data and metrics to a variety of stakeholders as part of ODM’s Dashboarding Analytics team
• Attend meetings to assist in the development of tools, metrics, dashboards, and models to aid policy decision-making
• Develop and implement scalable analytics reporting using analytics software such as SAS, R, Hadoop, and Tableau
• Establish standards for data consistency and analytic support
• Prepare reports related to state and federal requirements, especially those related to State Children’s Health Insurance Program (SCHIP)
   

Pharmacy Informatics Specialist (PN 20099220) –
 

• Heavily involved in the implementation of monitoring metrics to be applied to Ohio’s first-in-the-nation approach to Medicaid pharmacy benefits which is the Single Pharmacy Benefit Manager program (SPBM)
• Critical to developing best practices that drive improved health outcomes across the state
• Attend meetings to assist in the development of tools, metrics, dashboards, and models to aid policy decision-making
• Respond to requests for data from internal and external stakeholders
• Conduct literature reviews to identify and implement best practices in program oversight
• Prepare reports related to state and federal requirements
• Familiarity with healthcare or pharmacy data or policy is preferred, but not required
   

Managed Care Informatics Specialist (PN 20099223) –
 

• Heavily involved in the monitoring and reporting related to the newly contracted Medicaid managed care plans
• Work on an interdisciplinary team on topics related to population health measurement, health equity, quality improvement, and performance metric design
• Assist in the assessment of several unique elements of the ODM managed care contract, including community investment requirements and transparency initiatives
• Attend meetings to assist in the development of tools, metrics, dashboards, and models to aid policy decision-making
• Respond to requests for data from internal and external stakeholders
• Conduct literature reviews to identify and implement best practices in program oversight
• Prepare reports related to state and federal requirements
• Experience in quality improvement methods and performance metric design is preferred but not required
   

The ideal candidates will be familiar with relational databases and demonstrate experience with data analysis. They will be self-directed and enthusiastic about conducting research to enhance program evaluation and oversight. Those from a variety of backgrounds including but not limited to public health, public administration, business administration, information technology, data analytics, sociology, and political science are encouraged to apply.
 
Completion of graduate core coursework in health services administration, mathematics, statistics, actuarial science, public administration, allied health sciences, nursing, economics or comparable field; 2 yrs. exp. in health services research &/or health policy analysis; 12 mos. trg. or 12 mos. exp. in research methodology, measurement & testing, analysis of variance & survey sampling; 12 mos. trg. or 12 mos. exp. in use of computer programs/applications with emphasis on relational data bases, use of computer hardware, software used for spreadsheets, statistical analysis & graphics presentation & word processing; 1 course or 3 mos. exp. in multiple regression or multivariate analysis.
 

• Or completion of undergraduate core coursework & 12 mos. exp. in one of following: health services administration, mathematics, statistics, actuarial science, public administration, allied health sciences, nursing, economics, public health, or comparable field; 2 yrs. exp. in health services research &/or health policy analysis; 12 mos. trg. or 12 mos. exp. in research methodology, measurement & testing, analysis of variance & survey sampling; 12 mos. trg. or 12 mos. exp. in use of computer programs/applications with emphasis on relational data bases, use of computer hardware, software used for spreadsheets, statistical analysis, graphics presentation & word processing; 1 course or 3 mos. exp. in multiple regression or multivariate analysis.
• Or 2 yrs. exp. as Health Services Analyst, 65211.
• Or equivalent of Minimum Class Qualifications For Employment noted above.
   

Primary Location
 
United States of America-OHIO-Franklin County-Columbus
 
Work Locations
 
Lazarus 5
 
Organization
 
Ohio Department of Medicaid
 
Classified Indicator
 
Classified
 
Bargaining Unit / Exempt
 
Bargaining Unit
 
Schedule
 
Full-time
 
Work Hours
 
8:00AM – 5:00PM
 
Compensation
 
$33.07/hour
 
Unposting Date
 
Jan 9, 2022, 11:59:00 PM
 
Job Function
 
Statistics/Mathematics
 
Job Level
 
Individual Contributor
 
Agency Contact Information
 
HumanResources@medicaid.ohio.gov

Clipped from: https://www.linkedin.com/jobs/view/healthcare-informatics-specialist-three-positions-health-services-policy-specialist-at-ohio-department-of-medicaid-2844180262/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Location: Company:

Baltimore County, MD

CareFirst BlueCross BlueShield

Resp & Qualifications
PURPOSE:
The purpose of the Manager, Network Analytics is to execute on business objectives with data and to ensure alignment with the vision of the Network Innovation and Strategy team (the business). This individual will be responsible for organizing the technology, processes, associates, and financial resources necessary to address the current and future analytics needs of the business and market across all lines of business (Commercial & Government Programs). Provides thought leadership and acts as a subject matter expert in the designing and recommending of appropriate analytical approaches and methodologies. Provides management responsibility into data-driven insights that inform the business’s strategic direction.
ESSENTIAL FUNCTIONS:
– Manage a team with a focus on the development of analytics capabilities across the company, including self-service capabilities through technology implementation, best practices and training. Ensure team members serve as a trusted advisor to clients on analytics and data. Understands market-specific requirements, including regulatory reporting requirements. Shares findings and recommendations with market network leads based on analytics.
– Interpret statistical analyses and help clients derive meaning from them. Uses analyses to develop and inform network strategy in partnership with business stakeholders. Work with Network Leads to ensure centralized adequacy reporting and accreditation submissions.
– Develop and deliver presentations and reports of analytic findings. Creates data-driven (such as utilization, capacity planning, and general network data) recommendations and presents this to leadership. Organizes data across all lines of business to support sales, business development opportunities, and accreditation submissions. Leverages industry knowledge to interpret data and present recommendations on network strategy. Own reporting tools/vendor management needed to support analytics work and monitors budgeting for tools
– Develop hypotheses and research questions to address clients’ needs. Conduct a wide range of quantitative, qualitative, and mixed-methods analyses to answer clients’ research questions. Work with Director on leveraging data to monitor and track departmental goals.
– Develop analytic frameworks and select appropriate analytic methods to answer clients’ research questions. Develop standardized processes related to data requests to support the business.
– Partner with stakeholders to understand data requirements and with internal and/or external resources to develop tools and services such as segmentation, modeling, dashboard development, decision aids, and business case analysis to support the organization. Oversees vendor contracts and implementation of tools needed to support network analytics work.
– Uses multiple data sets to create reports and data presentations, and eventually creating data dashboards, for leadership and managerial use. Monitors adequacy and utilization of CareFirst’s provider networks across all lines of business.
SUPERVISORY RESPONSIBILITY:
This position manages people – 1-5
QUALIFICATIONS:
Education Level: Bachelor’s Degree in Computer Science, Information Systems or related field. In lieu of a Bachelor’s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 5 years Progressive experience relating to data analytics/data analysis
1 year Supervisory experience or demonstrated progressive experience.
Licenses/Certifications
– Data Management\Certified Analytics Professional (CAP)
– Data Management\MapR Certified Data Analyst
Preferred Qualifications:
– Master’s Degree
– Conceptual data and cloud architecture – understands major native data components in Azure and/or AWS and there relationships and use cases.
– Mastery of relational database theory include SQL and at least one major RDBMS
– Well versed in Big Data scenarios and applications
– Experience with multiple analytics delivery tools, methods, and platforms including PowerBI and/or Tableau
– Understanding of Advanced Analytics use cases and the applications of AI/ML for predictive analytics
Knowledge, Skills and Abilities (KSAs)
– Strong quantitative and qualitative skills.
– Knowledge and understanding of analytical tools, such as SAS, Excel, SQL.
– Excellent communication skills both written and verbal
– Ability to train others.
– Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Department
Department: DC Medicaid – Provider Service
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Closing Date
Please apply before: 1/13/21
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
REQNUMBER: 15866

Clipped from: https://www.adzuna.com/details/2744955985?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description for Medicaid/Medicare appeal and grievance Analyst:

Our client is looking for analysts who will assist with the implementation of client’s remediation plan for the grievances and appeals

 
 

Responsibilities for Medicaid/Medicare appeal and grievance Analyst:

• Act as a member advocate addressing member or provider concerns
  
• Evaluate, review and evaluate appeals and grievances in compliance with state, federal and other regulatory requirements
  

 
 

Qualifications for Medicaid/Medicare appeal and grievance Analyst:

• Medicare/Medicaid Grievances and Appeals experience is a must
  
• Supporting and assisting with leading other team members
  
• Will assist with the implementation of client’s remediation plan for the backlog of grievances and appeals
  

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-medicare-appeal-and-grievance-analyst-at-system-soft-technologies-2838511034/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Supplemental Information

This position is located within the Louisiana Department of Health / Medical Vendor Administration / Eligibility Section /Tangipahoa


Announcement Number: MVA/PJ/3504
Cost Center: 305-2050410
Position Number(s): 60776 & 50593161


This vacancy is being announced as a Classified position and may be filled as a Job appointment or Probationary appointment.


(Job appointments are temporary appointments that may last up to 48 months)

Applicants must have Civil Service test scores for 8100-Professional Level Exam in order to be considered for this vacancy unless exempted by Civil Service rule or policy. If you do not have a score prior to applying to this posting, it may result in your application not being considered.


Applicants without current test scores can apply to take the test here.

Working Job Description:

The Medicaid Analyst (MA) is a position responsible for acquiring extensive knowledge of Medicaid policy and procedures and using same to make timely and accurate Medicaid eligibility determinations. The MA is responsible for providing eligibility assistance to members and applicants in the manner of their choosing which may be electronic, by mail, by email, in person, or most often by phone. This position requires competency of web-based programs. Work conditions are a combination of sedentary work on a computer and assistance to members by phone in a call-center format. The ideal candidate is an individual who works independently, is detail-oriented, has excellent customer service skills, can perform routine activities, is attentive to deadlines, and is a team player. Medicaid eligibility is fundamental to the overall Medicaid program, and mastery of eligibility policy and procedure may provide a path for career growth in the health insurance field.

As part of a Career Progression Group, vacancies may be filled from this recruitment as a Medicaid Analyst 1, 2 or 3 depending on the level of experience of the selected applicant(s). The maximum salary for the Medicaid Analyst 3 is $70,117. Please refer to the ‘Job Specifications’ tab located at the top of the LA Careers ‘Current Job Opportunities’ page of the Civil Service website for specific information on salary ranges, minimum qualifications and job concepts for each level.


To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.


*Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.*


A resume upload will NOT populate your information into your application. Work experience left off your electronic application or only included in an attached resume is not eligible to receive credit


For further information about this vacancy contact:
Paula Jackson

paula.jackson@la.gov
LDH/HUMAN RESOURCES
BATON ROUGE, LA 70821
225 342-6477

 
 

Qualifications

MINIMUM QUALIFICATIONS:

A baccalaureate degree.

SUBSTITUTIONS:
Six years of full-time work experience in any field may be substituted for the required baccalaureate degree.


Candidates without a baccalaureate degree may combine work experience and college credit to substitute for the baccalaureate degree as follows:


A maximum of 120 semester hours may be combined with experience to substitute for the baccalaureate degree.


30 to 59 semester hours credit will substitute for one year of experience towards the baccalaureate degree.
60 to 89 semester hours credit will substitute for two years of experience towards the baccalaureate degree.
90 to 119 semester hours credit will substitute for three years of experience towards the baccalaureate degree.
120 or more semester hours credit will substitute for four years of experience towards the baccalaureate degree.


College credit earned without obtaining a baccalaureate degree will substitute for a maximum of four years full-time work experience towards the baccalaureate degree. Candidates with 120 or more semester hours of credit, but without a degree, must also have at least two years of full-time work experience tosubstitute for the baccalaureate degree.

NOTE:
Any college hours or degree must be from a school accredited by one of the following regional accrediting bodies: the Middle States Commission on Higher Education; the New England Association of Schools and Colleges; the Higher Learning Commission; the Northwest Commission on Colleges and Universities; the Southern Association of Colleges and Schools; and the Western Association of Schools and Colleges.

NOTE:

An applicant may be required to possess a valid Louisiana driver’s license at time of appointment.

Job Concepts

FUNCTION OF WORK:

To make initial and continuing determination, under close supervision, as to clients’ eligibility for all Medicaid programs.

LEVEL OF WORK:

Entry.

SUPERVISION RECEIVED:

Medicaid Analysts typically report to a Medicaid Analyst Supervisor. May receive supervision from higher level personnel.

SUPERVISION EXERCISED:

None.

LOCATION OF WORK:

Department of Health and Hospitals, Medical Vendor Administration.

JOB DISTINCTIONS:

Differs from Medicaid Analyst 2 by the presence of close supervision and the absence of independent action.

Examples of Work

EXAMPLES BELOW ARE A BRIEF SAMPLE OF COMMON DUTIES ASSOCIATED WITH THIS JOB TITLE. NOT ALL POSSIBLE TASKS ARE INCLUDED.

Under close supervision, the entry level Medicaid Analyst learns to perform the following duties:

Conducts interviews with clients and makes other necessary collateral contacts for verification in determining eligibility for Medicaid Programs.

Examines application packets for timeliness, completeness, and appropriateness prior to authorization of reimbursement.

Makes decisions on complex eligibility factors and determines level of benefits for federal and state funded programs as a result of the rolldown procedure.

Interprets and applies complex federal, state, and agency policies for each program.

Conducts special investigations and compiles reports concerning fraud and location of absent parents.

Counsels and refers potentially eligible recipients or applicants to other agencies.

Contacts individuals, companies, businesses, local, state and federal agencies as needed to obtain or to verify information.

Records findings, recommendations, and services provided; completes case record forms and necessary correspondence in connection with assigned cases.

 
 

Clipped from: https://www.indeed.com/viewjob?jk=974de65f71978a75&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description


The Population Health Strategy Director is responsible for improving the quality of care and outcomes while managing costs for a defined group of people. This role requires an in-depth understanding of how organization capabilities interrelate across the function or segment. Candidate must reside within the state of Louisiana.


Responsibilities


Humana’s Bold Goal is to improve the health of the communities we serve as evidenced by more healthy days. The Population Health Strategy Director identifies health needs such as chronic diseases or disabilities, or the health needs of the under-served and advises executives to develop functional strategies (often segment specific) that positively impact Social Determinants of Health (Food insecurity, Transportation and Housing challenges, Isolation, etc.) This leader will work collaboratively to deliver high-impact partnerships and programmatic strategy.


Responsibilities Include The Following


This is an exciting opportunity to develop, lead and implement comprehensive population health strategy and interventions in partnership with leadership and business units.

• Oversee the MCO’s strategic design, implementation, and evaluation of population health initiatives based on a deep understanding of scientific population health principles
  
• Sponsor and champion MCO and system-wide initiatives, including cultivating the support necessary to achieve the desired operational objectives for each initiative
  
• Liaison with Louisiana Department of Health (LDH) on population health activities
  
• Develop and implement operational plans that address the market opportunities/challenges and align with the established population health goals.
  
• Build and maintaining sustainable strategic relationships with community partners, state agencies, and providers.
  
• Lead a team of specialized professional associates focused on positively impacting Social Determinants of Health for Medicaid members in the community
  
• Create evidence-based, scale-able and financially sustainable population health solutions.
  
• Consult with Market’s and all Humana Lines of Business to expand “Bold Goal” population health strategies through plan operations
  
• Success in this role will be based on the ability to work on multiple projects, influence without authority, pivot as priorities change and navigate ambiguity in a fast-paced environment.
  
  
  

Required Qualifications

• Bachelor’s Degree in nursing, social work, health services research, health policy, information technology, or other relevant field
  
• Minimum five (5) years of progressively responsible professional experience in population health, service coordination, ambulatory care, community public health, case or care management, or coordinating care across multiple settings and with multiple providers.
  
• Minimum three (3) years of leadership experience.
  
• Experience working in Medicaid and preferably in a managed care setting.
  
• Ability to analyze data and make data-driven recommendations for quality improvement
  
• Excellent interpersonal skills; ability to develop effective relationships with a broad array of people internally and externally, including community partners.
  
• Experience with program planning, implementation, and evaluation
  
• Ability to take personal initiative and work independently, as well as part of a team
  
• Ability to meet deadlines in a complex and fast-paced environment
  
• Proficiency in Microsoft applications including Word, Advanced Excel, and PowerPoint
  
• Must be passionate about contributing to an organization focused on continuously improving consumer experience
  
• Candidate must reside within the state of Louisiana.
  
  
  

Preferred Qualifications

• Master’s Degree
  
  
  

Additional Information

• Travel: up to 25% to Baton Rouge, LA and vicinity
  
• We will require full COVID vaccination for this job as 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 documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.
   
  

Scheduled Weekly Hours


40

 
 

Clipped from: https://www.linkedin.com/jobs/view/director-population-health-strategy-louisiana-medicaid-at-humana-2827874289/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

SECTION: Medicaid Fraud Control Section/Criminal Law Division

 
 

CLASS: Medicaid Fraud Analyst I/II

 
 

LOCATION: North Huntingdon

 
 

POSITION TYPE: Full-time, Non-civil service, Union

 
 

WORK HOURS: 8:30 – 5:00

SALARY RANGE: MA I: Pay Range 5 – Starting salary $40,900

MA II: Pay Range 7 – Starting salary $52,851

 
 

BASIC FUNCTION:

 
 

An employee in this position performs work which involves the retrieval, analysis, and compilation of data and the verification and dissemination of information pertinent to investigations into the Medicaid Fraud and Abuse amendments, the Neglect of Care-Dependent Persons Act, and other applicable State and Federal regulations. The employee is responsible for assisting with/conducting the retrieval, compilation, and summarization of information needed by Special Agents in the course of an investigation. Supervision is received from an investigative or administrative superior who reviews the work while in progress and upon completion.

 
 

EXAMPLES OF DUTIES:

• Assists with determining, or determines under the direction and guidance of an experienced analyst and/or supervisor, data requirements, sources, and parameters and gathers the needed information within the given time constraints using a variety of methods, inclusive of various computer programs
  
• Meets with appropriate personnel within the OAG or other governmental agencies to ascertain needs with respect to assignments
  
• Makes requests for pertinent documents needed for the analysis of referrals/intake complaints or pending information
  
• Contacts individuals to schedule meetings, and participates in the meetings, in order to gather needed data
  
• Assists with the preparation of, or prepares under the direction and guidance of an experienced analyst and/or supervisor, summarizations of data gathered by editing, compiling, and tabulating
  
• Provides assistance to agents relative to data checks, background checks, and claims histories
  
• Assists with the execution of search warrants for the purpose of cataloging data and documentary evidence
  
• Assists with the conduct of, or conducts under the direction and guidance of an experienced analyst and/or supervisor, various surveys of limited scope when an assignment requires such and prepares reports of findings
  
• Prepares spreadsheets, charts, and graphs
  
• Assists with the review of, or reviews under the direction and guidance of an experienced analyst and/or supervisor, computer printouts, vouchers, or other documents to ascertain the needed data
  
• Provides litigation support through the preparation and presentation of material/evidence for official proceedings/court
  
• Testifies in court proceedings and grand jury proceedings regarding analytical findings. Inputs data into computer system by utilizing a computer keyboard
  
• Performs other duties as assigned
  

 
 

MINIMUM EXPERIENCE AND TRAINING:

 
 

Qualifications for Medicaid Fraud Analyst I are as follows:

• A Bachelor’s Degree from an accredited institution OR
  
• Graduation from high school and four years of relevant experience that would afford the individual the needed knowledge and skills to perform the job OR
  
• Any equivalent combination of education, training, and experience that would enable the individual to perform the duties of the job
  

 
 

Qualifications for Medicaid Fraud Analyst II are as follows:

• A Bachelor’s Degree from an accredited institution and two years of relevant experience that would afford the individual the needed knowledge and skills to perform the job OR
  
• A Master’s Degree in criminal justice or a related field OR
  
• Graduation from high school and six years of relevant experience that would afford the individual the needed knowledge and skills to perform the job OR
  
• Any equivalent combination of education, training and experience that would enable the individual to perform the duties of the job
  

 
 

PREFERRED KNOWLEDGE, SKILLS, AND ABILITIES:

 
 

• Knowledge of Microsoft Excel (advanced)
  
• Experience using Pivot Tables
  
• Possess excellent oral and written communication skills and be able to communicate with employees throughout all levels of the organization
  
• Ability to work both independently and in a team environment
  

 
 

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-fraud-analyst-i-ii-at-pennsylvania-office-of-attorney-general-2828001833/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Found in: beBee S2 US

Description:

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
An Update to Humana’s Health and Safety Policy At the start of the pandemic, Humana made a promise that we would put the health and safety of our associates, our members and our community as our top priority – and we’ve consistently delivered on that promise.

As a leader in healthcare innovationand with the rise of COVID-19 infection rates,we have a responsibility to be part of the solution.

Therefore,we have updated our Health and Safety policy as follows.

Humana will requirefull vaccinationfor associates and select contractors who conduct work outside of their home on behalf of Humana. This appliestothosewhowork withinour facilities; interact directly withmembers and patients; attend in-person meetings ortrainings; 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. Humana values thehealth and well-being of our associates.

We have access to highly effective vaccines that are scientifically proven to reduce the risk of infection, and the risk of hospitalization or death among those who are infected.

And the best way for us to deliver on our promise to keep everyone safe is to take this step.

Scheduled Weekly Hours 40<>

calendar_today 20 hours ago

Clipped from: https://us.bebee.com/job/20211207-01a38b9ee5ff32e5bef7ee83acccce08?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic