Category: Curator- Job Hunter

 
 

 
 

Found in: Jobrapido US Premium

Description:

 
 

Goodwill Industries of Greater New York and Northern New Jersey, Inc.

Job Description

Position Title: Senior Fiscal Officer of Medicaid

Position Type: FLSA- Non-Executive

Supervising Staff: YES

 
 

General Purpose: This position serves to ensure that the accounting and finance needs of Mission Services are met. The Director will coordinate closely with the CFO, SVP of Finance, EVP of Mission Services and SVPs of Mission Services to ensure an effective process for planning, budgeting, and tracking the performance of the Mission Services.

Essential Functions: The core responsibilities of the position consist of financial planning and analysis, contract and/or Medicaid administration, and grants management and accounting. The senior fiscal officer fosters a data driven approach and a strong internal customer service sensibility when partnering with executive and senior program managers to assess and plan program direction.

Scope of Responsibility & Positions Supervised: Where applicable describes level of authority, decision making discretion, consequences of actions, supervisory and fiscal responsibility. Provide metrics where possible. Level of supervision received.

Financial Planning & Analysis

• Partner with Mission Services management to develop budgets for programs and social enterprises.
  
• Prepare financial reporting and forecasts to inform program and business management decisions.
  
• Identify opportunities to improve effectiveness and sustainability.
  
• Present financial performance to Mission Services leadership following each monthly close.
  
• Work with data analysis to synthesize financial and non-financial data to create performance dashboards that provide leading indicators of operational and financial performance.
  
• Make recommendations for controlling costs and spending funds more effectively.
  
• Foster team engagement that promotes: 1) deeper understanding of program financial dynamics, 2) opportunities and risks to be addressed and 3) use of data to inform decision making.
  

Medicaid and 3rd Party Biller Management / Contract administration

• Establish / build strong relationships with fiscal counterparts at Provider Companies and funders.
  
• Monitor OMH & OPWDD websites for updated rates & important notifications impacting programs.
  
• Review contracts to ensure with fiscal, programmatic and administrative compliance.
  
• Prepare and facilitate funder approval of program/project budgets.
  
• Monitor spending and recommend adjustments to keep expenditures aligned with budget.
  
• Prepare revenue claims and oversight reports, maintaining required supporting documentation.
  
• Perform monthly reconciliation of the aging report to the general ledger.
  
• Report on and pursue outstanding payments (receivables) from funding sources.
  
• Facilitate continuous improvement of the billing, receivables management and reporting processes.
  
• Manage funder audits.
  
• Participate in funder and association meetings to stay informed and advocate for sensible policies.
  

Accounting

• Ensure accounting records are maintained in accordance with GAAP.
  
• Participate in collaborative effort to improve processes and maintain policies and procedures that optimize productivity and an effective control environment.
  
• Perform accounting for assigned portfolio, managing junior fiscal officers as appropriate.
  
• Complete closing tasks with requisite quality and timeliness to facilitate adherence to internal reporting deadlines.
  
• Provide support in the completion of balance sheet account reconciliation, as necessary.
  
• Prepare audit work-papers for each program/project as required.
  

Leadership & Management

• Create opportunities to develop key talent and establish an environment that fosters collaboration, development, and job satisfaction.
  
• Foster a high standard for internal customer service and continuous improvement.
  
• Promote the attainment of Goodwill’s Strategic Plan, Double Impact.
  
• Lead and/or participate on teams that are pursuing special projects.
  

Qualifications: Describe the minimum educational and experience requirements/preferences.

• BS/BA required. Degrees in accounting, business or public policy strongly preferred.
  
• Five years of accounting experience.
  
• Strong problem-solving and creative skills, sound judgment and the ability to make decisions based on accurate and timely analyses.
  
• Flexible multi-tasker who is willing to “roll up his/her sleeves.”
  
• A proactive sprit; self-motivated, action oriented and results-driven.
  
• Strong interpersonal and communication skills.
  
• A team-player focused on teamwork and collaboration.
  
• Well organized with strong project and process management skills
  
• Honest, direct, kind, and sincere.
  

Skills Required: Describe the minimum skills required or preferred

• Advanced Excel Word and Power Point skills required.
  
• Familiar with BI and other planning & forecasting applications. Microsoft Dynamics D365, Counterpoint and deFacto Planning software experience a plus.
  

Special Working Conditions: Describe unusual working conditions or environmental factors.

• See Attached Physical Demand Analysis
  

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Found in: Talent US

Description:

Position Description :
 

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

Mathematica is searching for professionals with experience generating insights from data on Medicaid policy and programs at either the state or federal level. In particular, we are looking for individuals who can apply data analytics to support current and emerging work across any number of areas related to monitoring and improving Medicaid programs such as: Value-based purchasing and alternative payment models, enrollment trends, measures of delivery and quality of services for beneficiaries, and to discern outcomes of innovative programs and policies.

The successful candidate will join our group of over 400 health policy professionals, including staff with degrees in data analytics, public health, public policy, economics, behavioral or social sciences, economics, and other relevant disciplines. We offer our employees a stimulating team-oriented work environment, competitive salaries, and a comprehensive benefits package, as well as the advantages of employee ownership.

Duties of the position:

• Participate actively and thoughtfully in multidisciplinary teams, drawing on your past experience with Medicaid programs
  
• Help conduct research and technical assistance projects on topics related to state and federal Medicaid policy
  
• Apply rigorous analytic thinking to the collection and interpretation of quantitative data including analysis of Medicaid administrative data
  
• Bring creative ideas to the development of proposals for new projects
  
• Author project reports, memos, technical assistance tools, issue briefs, and webinar presentations
  
• Contribute to the growth, expertise, and institutional knowledge of staff working in the Medicaid area
  

Position Requirements :
 

Qualifications:

• 3-8 years of experience working in health policy or health research, with a substantial portion of that time related to some aspect of the Medicaid program at the state or federal level
  
• Masters or doctoral degree or equivalent experience in data analytics, public health, public policy, economics, behavioral or social sciences, economics, or other relevant disciplines
  
• Demonstrated ability at modeling program outcomes would be ideal
  
• Strong foundation in quantitative methods and a broad understanding of health policy issues
  
• Excellent written and oral communication skills, including an ability to explain observations and findings to diverse stakeholder audiences including program administrators and policymakers
  
• Demonstrated ability to provide task leadership and coordinate the work of multidisciplinary teams
  
• Strong organizational skills and high level of attention to detail; flexibility to lead and manage multiple priorities, sometimes simultaneously, under deadlines
  

To apply, please submit a cover letter, resume, writing sample, and salary expectations at the time of your application.

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

This position offers an anticipated annual base salary of $90,000 – $140,000. This position may be eligible for a discretionary bonus based on company and individual performance.

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

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

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

calendar_today 17 hours ago

 
 

Clipped from: https://us.bebee.com/job/20211207-5f1286153ca03e4faa7f2a378a92fdc1?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Found in: beBee S2 US

Description:

The Special Projects & Government Program Strategy team, within Strategic Market Planning & Analytics (SMP&A) in the Health Plan, provides subject matter expertise and reporting support to the Medicare and Medicaid business lines across all regions.

The team cultivates well-rounded staff due to its diversity of projects, which derive from the strategic priorities of senior leadership.

Medicaid projects roles can vary depending on the initiative at hand and include developing strategies for engaging special populations (e.g. Dual Eligibles), creating program overview materials for senior leadership, and driving analyses to support Medicaid growth and performance.

Most projects involve a combination of data collection and analysis as well as developing summary materials to communicate findings and recommendations to a broad range of stakeholders.

Active participation in a range of market strategy projects essential to KP’s membership and margin goals.

Market Strategy & Analysis Consultants provide analytical/strategic-thinking and leadership skills that enable project teams to: 1) isolate business issues; 2) design and execute analytics for studying business issues (market research, scenario planning, forecasting, market share, profitability, etc); 3) bring technical/content expertise (competitive intelligence, utilization, financial analysis, deep data analysis & programming); 4) vet findings and make formal recommendations to senior levels of KP leadership; 5) create documents (strategic segment plans, utilization reports) that inform critical strategic issues.

Software tools used most often in this role include Microsoft Word, PowerPoint, Excel, Access, and Tableau.

This position is currently remote.

The person in this role may reside in Georgia, California, Colorado, Hawaii, Oregon, Washington State, Virginia, Maryland, or Washington, D.C.

The work hours noted below are aligned with the Pacific Time Zone.

Essential Functions:
 

• Works with business/segment owners to identify key business issues.
  
• Manages major analytical and/or strategy projects.
  
• Develops analytic framework required to analyze business issues.
  
• Sets project and staff priorities.
  
• Owns the outcome- represents findings to stakeholders.
  
• Serves as subject matter/technical expert to Analysts.
  

Basic Qualifications:
Experience- Minimum four (4) years of related experience OR a master’s degree and minimum one (1) year of experience.
Education- Bachelor’s degree in related field, OR four (4) years of experience in a directly related field.

• High School Diploma or General Education Development (GED) required.
  

License, Certification, Registration- N/A
Additional Requirements:
 

• Thorough knowledge of policies, practices and systems.
  
• Complete understanding and application of principles, concepts, practices, and standards.
  
• Full knowledge of industry practices.
  
• Broad application of principles, theories, and concepts in applicable discipline, plus working knowledge of other related fields.
  
• Skilled in MS Excel, Access and other databases. Must know how to manipulate databases such as MS Excel and/or Access, as well as manipulating reports and generating reports.
  
• Must be able to work in a Labor/Management Partnership environment.
  

Preferred Qualifications:
 

• Minimum five (5) years of related experience.
  
• Master’s degree in business, public health, or related preferred.
  

COMPANY:
KAISER
TITLE:
Medicaid Strategy Consultant

LOCATION:
Oakland, California

REQNUMBER:
1013123

External hires must pass a background check/drug screen.

Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

calendar_today 1 day ago

Clipped from: https://us.bebee.com/job/20211207-f4cc45dd57ad0d60aaa5170b350613f8

 
 

Found in: Lensa US

Description:

Location: Owings Mills, MD, United States

PURPOSE:
Director, Pharmacy Services is responsible for implementing the organization’s pharmacy vision and strategic plan for government programs including Maryland Medicaid, Dual Prime Special Needs Plan (DSNP), and Medicare Advantage products. This role has oversight of pharmacy staff and develops and maintains collaborative relationships with clinical, administrative, and other key stakeholders including external vendors to ensure effective operations and value realization of pharmacy programs. This role also serves as a key point of contact with the Maryland Department of Health (MDH) and U.S. Centers for Medicare and Medicaid Services (CMS).

ESSENTIAL FUNCTIONS:

Provides oversight and support for the management of multi-faceted Pharmacy Services Government Programs to reduce pharmacy spend, total cost of care, and improve health outcomes. Supports programs from evaluation through implementation and value realization. Monitors and tracks program activity and performance and communicates outcomes to key stakeholders within the organization.

Respond to the Maryland Department of Health (MDH), U.S. Centers for Medicare and Medicaid Services (CMS), and other federal and state agencies as directed by leadership. Assist in ensuring pharmacy related processes are carried out in accordance with MDH, CMS, and other federal and state requirements and guidance, including executive orders, regulatory requirements, and administrative rules. Prepare for annual submissions to and respond to other requests from MDH and CMS. Oversee the creation and maintenance of the website contents, member/provider/internal communications in accordance with NCQA, Medicare, and MDH requirements.

Manages and directs staff, demonstrating effective performance management of team members and supports activities to maintain a high functioning team. Reviews staffing goals and expectations to ensure that each is consistent and adequate to meet department goals. Provides coaching and motivation to team members ensuring staff has appropriate tools and training. Plans and manages the departmental budget.

Serves as a point of contact for CareFirst’s PBM vendor and other strategic pharmacy vendor partnerships. Ensures vendors execute contract terms. Identifies and implements vendor programs based on CareFirst’s needs such as quality initiatives, compliance, population health, and/or member/provider experience.

Analyzes Medicare and Medicaid pharmacy and medical drug utilization data to identify trends and at-risk populations; recommend and develop appropriate interventions; monitors and takes actions on results. Identifies business process improvements that are aligned with and supportive of business goals and objectives. Contributes to the development of dashboards that monitor critical data elements and tracks results for Executive Leaders. Identifies actional insights based on data and helps to ensure successful implementation of clinical savings.

Develops, provides, and oversees formal written and verbal presentations and other communications related to clinical government pharmacy programs. Able to effectively present pharmacy information to key internal and external stakeholders at an Executive Level.

SUPERVISORY RESPONSIBILITY: This position manages people.
 

QUALIFICATIONS:

Education Level: Medical Degree in Pharmacy

Licenses/Certifications: PHARM D – Licensed Pharmacist Required

Experience:

• 8 years Experience working in the healthcare industry with a focus on a pharmacy benefit administration
  
• 3 years management experience
  

Preferred Qualifications:

• Active Pharmacist license in Maryland, or the ability to obtain Maryland licensure within 6 months of employment
  
• Minimum two years involvement in formulary development, drug use evaluation, and quality improvement activities
  
• Experience with developing and implementing clinical programs
  
• Experience with Medicare Part D and Medicaid guidelines and requirements
  
• Completion of a pharmacy practice or specialty residency (PGY1 or PGY2)
  

Knowledge, Skills and Abilities (KSAs)

• Entrepreneurial, highly motivated, and collaborative
  
• Ability to establish credibility and influence persons of all levels and member executive management and lead them to the proper decisions
  
• Demonstrated track record of building strong relationships, working collaboratively and driving consensus
  
• Ability to identify diverse needs of member constituencies and develop effective solutions
  
• Microsoft Office applications (Word, Excel, Access, PowerPoint)
  
• 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: Pharmacy Services

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.

Actual salary will be based on relevant job experience and work history.

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

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Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the business name of CareFirst Advantage, Inc. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is the business name of Trusted Health Plan (District of Columbia), Inc. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. In Virginia, CareFirst MedPlus is the business name of First Care, Inc. of Maryland (Used in VA by: First Care, Inc.). CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst Advantage, Inc., Trusted Health Plan (District of Columbia), Inc., CareFirst BlueChoice, Inc., First Care, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only.

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 generic information.

Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. To comply with this law, CareFirst must collect information regarding an employee’s identity and employment eligibility and document that information on a document referred to as Form I-9, Employment Eligibility Verification, no later than three business days from when the employee begins work for pay. If you are hired, you will be required to provide certain information on the form necessary to establish your identity and eligibility to work in the United States and certain required supporting documents.

If you experience any technical difficulties during this process, please send an email detailing the specific problem you are having to and we will respond as soon as possible.

The contractor 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. However, 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 contractor’s legal duty to furnish information. 41 CFR 60-1.35(c) If you believe that you have experienced discrimination, contact OFCCP at 800-397-6251 (TTY 877-889-5627 ) or .

calendar_today 1 day ago

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Job Description Summary


POSITION SUMMARY: The Business Analyst primarily functions to review, analyze, and evaluate user requirements and system functionality. Tasks will include performing detailed requirements analysis, documenting processes, and validating system performance against requirements. The Business Analyst should have a natural analytical way of thinking and be able to explain difficult concepts to non-technical users. Medicaid program and system experience are highly desired.


Job Responsibilities

• Evaluating business processes, anticipating requirements, uncovering areas for improvement, and developing and implementing solutions.
  
• Work closely with clients, technicians, and managerial staff.
  
• Perform user acceptance testing.
  
• Contribute expertise in provider services-related business functions, including advanced knowledge in the review and approval of provider eligibility
  
• Lead/support requirements and design sessions
  
• Analyze, document and clarify system business requirements
  
• Create Functional Design Documents for system enhancements
  
• Manage scope and implementation schedules for product releases
  
• Support federal system certification
  
• Execute system tests before User Acceptance Testing
  
• Maintain system documentation
  
• Interact daily with state clients and internal customers regarding system status and day-to-day processing
  
• Support user staff with analysis and resolution of issue reports
  
• Analyze complex data and measure outcomes
  
• Coordinate with technical staff to sufficiently understand technical requirements, specifications, and processes
  
• Interact with company and client managers and perform cost/schedule monitoring
  
• Other duties as assigned by management
  
  
  

Education And Experience Requirements

• A minimum of a bachelor’s degree or four years related work experience
  
• Two years of direct experience as a business analyst in design, development, testing, and implementation of software
  
• Knowledge of Medicaid and provider enrollment business processes
  
• Knowledge of system design and development process
  
• Strong understanding of system testing metrics, best practices, and methodologies
  
• Experience working with State government clients in the Medicaid systems domain preferred
  
• Strong interpersonal skills
  
• Excellent organizational, interpersonal, verbal, and written communication skills
  
• Ability to perform comfortably in a fast-paced, deadline-oriented work environment
  
• Ability to successfully execute many complex tasks simultaneously
  
• Ability to work as a team member, as well as independently
  
  
  

Job Summary


Essential Duties and Responsibilities:

• Deliver consulting project activities for medium- to long-term engagements requiring varied interpersonal and technical skills.
  
• Maintain technical responsibilities, which include problem identification, implementation, testing, client training, and solution deployment.
  
• Analyze complex data and identify patterns, recommend actions, and measure outcomes.
  
• Coordinate with technical staff to understand business requirements, specifications, and processes.
  
• Conduct market research and understand and apply implications of Health and Human market trends.
  
• Create system functional specifications from business requirements.
  
• Interact with company and client managers and perform cost/schedule monitoring.
  
• Identify additional product and service opportunities in customer organization.
  
  
  

Minimum Requirements

• Bachelor’s degree with 3- 5 years of experience consulting within designated function.
  
  
  

MAXIMUS Introduction

Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.


EEO Statement

EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Clipped from: https://www.linkedin.com/jobs/view/business-analyst-medicaid-systems-remote-at-maximus-2831391970/?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.linkedin.com/jobs/view/lead-technology-solutions-medicaid-at-humana-2827870830/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description


Humana’s Enterprise Shared Services (ESS) organization is looking for a Senior Acquisition & Integration Professional to join the Business Management team working from home anywhere in the U.S. The Business Management team leads and operationalizes large-scale, cross functional initiatives to successful and timely outcomes. As part of this team, you will perform project-oriented duties related to the integration of acquired entities into the company as well as support new State Medicaid implementation.


As the Senior Acquisition Integration Professional you will work side by side with leaders and associates within teams across the Consumer and provider Services and Solutions Organization (CPSS), the Medicaid & Duals Organization and the Corporate Mergers & Acquisitions Organization. You will implement activities and projects associated with the assimilation of practices and systems where the primary competence is in project management and integration related disciplines. You must be high energy but easygoing, love collaboration, drive change and possess an outstanding and trusted leadership presence.


Responsibilities


The Senior Acquisition Integration Professional must be resilient and comfortable operating within in ambiguous environment. You will provide project management expertise while executing implementations that focus on delivering successful and timely outcomes including the following:

• Managing & executing implementations (both Medicaid & Medicare) through all project phases including execution, go live and retrospective
  
• Support and empower teams to identify milestones, handle dependencies and risks, track deliverables and remove blockers
  
• Facilitates cross-functional meetings with internal and external stakeholders to vet thru challenges, develop mitigation plans and update project artifacts
  
• Provides regular status updates to leadership by communicating updates, dependencies, escalations, etc.
  
• Collaborates with CPSS business partners and Medicaid Program Operations to improve and build repeatable models for future Implementations.
  
• Assist in moving top priority initiatives to green while ensuring transparency to the sponsors and across CPSS work streams
  
• Interprets Contracts, RFP’s, CMS memos, etc. to consult and guide business implementations
  
  
  

Required Qualifications

• 5+ years’ project management experience leading large-scale projects, meetings and collaboration across internal and external stakeholders
  
• Knowledge of project management tools, change management, dependency management, risk management and when to use them, when not to use them
  
• 5+ years’ experience in health care operations industry
  
• Core business hours align to Eastern Standard Time (EST)
  
• Superior interpersonal and facilitation skills. Ability to quickly build rapport, trust and strong collaboration
  
• Ability to contribute consistently and positively in a fast-paced, ever changing environment. Remain flexible and calm in the face of uncertainty and ambiguity
  
• Able to exercise independent judgement
  
• Excellent organizational, written and oral communications and presentation skills
  
• Self-starter and critical thinker
  
• Proficient in Microsoft Office applications including Project, Power Point, Visio, Teams, SharePoint and Excel
  
• Must have the ability to travel up to 15% based on business need
  
  
  

Work-At-Home Requirements

• WAH requirements: 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 25×10 (25mpbs download x 10mpbs upload) is required.
  
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
  
  
  

Preferred Qualifications

• PMP certification
  
• Advanced Degree
  
• Prior Medicaid experience
  
• Prior Due Diligence/Acquisition experience
  
• Possess solid understanding of how organizational capabilities interrelate across operational work streams
  
• Proven ability to influence at all levels of the organizational model
  
• Experience developing and managing implementations thru run-out and systems sun-setting phases
   
  

Covid-19 Vaccine Policy


For this job, associates are required to be fully COVID vaccinated 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 weekly testing, following all CDC protocols, OR
  
• Provide documentation for a medical or religious exemption consideration.
  
  
  

This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work


Scheduled Weekly Hours


40

 
 

Clipped from: https://www.linkedin.com/jobs/view/senior-acquisition-integration-professional-medicare-medicaid-remote-at-humana-2827868423/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

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

 
 

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

 
 

The RVP CA Medicaid Health Plan Performance & Engagement is responsible for the state of California Medicaid quality management program, marketing and community relations, county management and local engagement, and P&L accountability for LA Care Plan Partner Services Agreement, along with operational performance and contract oversight.

Primary duties may include, but are not limited to:

Establishes performance improvement plans required by the CA state agency.

Drives and maximizes default enrollment opportunities.

Delivers and proactively develops plans on Medicaid incentive opportunity in LA County.

Ensures CA state agency contract requirements with County Public and Behavioral Health Departments are met.

Leads growth and retention priorities with focus on executing ground game strategies.

Represents the Medicaid Health Plan with local officials, provider organizations, regulators, and local community partners.

Leads business initiatives in a matrix environment with growth partners and enterprise teams to ensure performance standards are met.

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

Qualifications

BA/BS degree and a minimum of 10 years related experience, which could include Medicaid managed care, quality management, marketing programs in a highly regulated environment and health care operations; or any combination of education and experience, which would provide an equivalent background.

Travel may be required.

 
 

Preferred

Master’s degree 

Experience working with California State Agency on Medicaid 

Experience driving Medicaid Quality strategy (CA Local Market Experience preferred)

Knowledge of Provider Market related to Medicaid 

Experience with Marketing & Community Relations


We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.


Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

Clipped from: https://anthemcareers.ttcportals.com/jobs/8129453-rvp-ca-medicaid-health-plan-performance-and-engagement?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

**Business Title:** Director State and Local CA Medicaid

**Requisition Number:** 63082 – 60

**Function:** Advisory

**Area of Interest:**

**State:** NM

**City:** Albuquerque

**Description:**

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

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

KPMG is currently seeking a Director State and Local CA Medicaid in Customer & Operations for our Consulting (https://advisory.kpmg.us/) practice.

Responsibilities:

+ Manage and deliver large, complex public services and state/local government engagements that identify, design and implement creative business and technology services for Medicaid government clients

+ Develop and execute methodologies and solutions specific to the public sector and state/local government industry coupled with proven experience with Medicaid and MMIS modernization, with preference for prior work with large Medicaid programs in the western United States

+ Handle engagement risk, project economics, planning and budgeting, account receivables and definition of deliverable content to help to ensure buy-in of proposed solutions from top management levels

+ Develop and maintain relationships with many senior managements at state/local government agencies, positioning self and the firm for opportunities to generate new business

+ Evaluate projects from a technical stance, helping to ensure that the development methods used are correct and practical; evaluate risks related to requirements management, business process definition, testing processes, internal controls, project communications, training and organizational change management

+ Manage the day-to-day interactions with client managers

Qualifications:

+ Minimum ten years of recent experience in the Health and Human Services Medicaid solution delivery market, working for a commercial off-the-shelf (COTS) solution provider or consulting organization with a minimum of eight years of experience managing large, complex technology projects on the scale of a State Medicaid Maintenance Management Information System (MMIS) solution along with proven experience with Medicaid and MMIS modernization

+ Bachelor’s degree of technical sciences or information systems from an accredited university or college

+ Prior experience and has served in a team supervisory role on at least one MMIS implementation and one MMIS M&O engagement such as Program Manager, Module Project Manager, Solution Architect, Technical Solution Lead, or Quality/Testing Manager

+ Demonstrated experience leading teams of more than twenty staff, including staff from diverse organizations to successfully implement and operate technology-based solutions; experience and relationships with states in the western United States preferred

+ Hands-on experience with the Center for Medicare and Medicaid Services (CMS) Medicaid Information Technology Architecture (MITA), Medicaid Certification Lifecycle, associated toolkit and CMS checklists

+ Capable of presenting Medicaid topics to large, varied audiences in either written or verbal presentation format and experience in working on customer proposals or deal capture teams in the State Medicaid market

+ Travel may be up to 80-100%

+ Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future

KPMG LLP (the U.S. member firm of KPMG International) offers a comprehensive compensation and benefits package. KPMG is an affirmative action-equal opportunity employer. KPMG complies with all applicable federal, state and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other category protected by applicable federal, state or local laws. The attached link ( https://assets.kpmg.com/content/dam/kpmg/us/pdf/2018/09/eeo.pdf) contains further information regarding the firm’s compliance with federal, state and local recruitment and hiring laws. No phone calls or agencies please.

**GL:** 3

**GF:** 15304

 
 

Clipped from: https://www.mendeley.com/careers/job/director-state-and-local-ca-medicaid-5105554?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic
 

 
 

BerryDunn is looking to fill up the position of Project Manager/Subject Matter Expert (SME), Medicaid in Charleston, West Virginia, United States. 

BerryDunn is seeking a Project Manager/Subject Matter Expert in Medicaid who will be responsible for the management, reporting, and achievement of project objectives, schedule, quality, resources, and budget for the design, development, and implementation of multiple Medicaid and/or Children’s Insurance Program (CHIP) business initiatives and activities that state health and human services clients may undertake. You will work with the client, team, vendor(s), and federal stakeholders to achieve project objectives. You will report to senior leaders in our Medicaid Practice Group. This position may sit either remotely or in one of our seven office locations.

Travel Expectation: approximately 50% travel to client sites is anticipated in the future to support projects.

You will:

• Support the delivery of services to clients on time, within scope, and within budget, including assigning and managing staff and creating work product
  
• Deliver frequent, clear, and consistent communication to the client, team members, vendor, and direct reports
  
• Develop, review, distribute, and present project status reports
  
• Lead the documentation of project action items, issues, risks, and decisions
  
• Oversee deliverable review facilitation, tracking, and maintenance
  
• Lead staff/team meetings and trainings
  
• Perform and delegate administrative tasks efficiently and effectively, asking questions when instructions are unclear
  
• Estimate and maintain resource projections for responsible tasks; and assist in the development, review, distribution, and presentation of project status reports
  

You have:

• At least 5 to 7 years of public sector experience
  
• At least three years of experience working with state Medicaid agencies
  
• Experience with transformation of business rules into system configurations; business and technical aspects of healthcare information systems; and knowledge of the business areas of the Medicaid Information Technology Architecture (MITA) framework preferred
  
• Experience with assisting and/or leading procurement, testing and/or data governance efforts for a health and human services technology solution implementation
  
• Developing, editing, and presenting summaries, reports, and presentations of complex information and data for project and client teams
  
• Estimating and maintaining resource projections for responsible tasks
  
• Managing a project team
  
• Strong communication skills and attention to detail
  
• Bachelor’s Degree (BA/BS)
  
• Knowledgeable in quality assurance/control procedures and demonstrated proactive problem management skills
  
• Demonstrated ability to excel in a team setting
  
• Strong experience with Microsoft desktop applications
  

In the interest of employee and client safety, BerryDunn asks that all employees working in person at the office, meeting with clients, or attending an in-person event on behalf of BerryDunn be fully vaccinated against COVID-19. This policy provides clarity for our employees and enhances our ability to support clients. Many of our clients are healthcare facilities or government agencies. In many cases, our policy is simply an extension of their requirements. In addition to wearing masks in public areas and socially distancing, being fully vaccinated provides our employees working in person with an opportunity to thrive professionally and personally.

Our Benefits:

We value our employees and offer a variety of attractive benefits, in addition to being part of a high-powered, effective team! Here are just a few of our attractive benefits:

• Health, Dental, Rx and Vision Insurance
  
• Health Savings Account (HSA); Employer contribution
  
• Responsible Paid-Time-Off policy, including Paid Family Leave
  
• 401(K) profit sharing plan with employer match after one year
  
• Life and AD&D Insurance
  
• Long-term Disability Insurance
  
• Long-term Care Insurance
  
• Tuition Reimbursement, Continuing Professional Education, and CPA Exam
  
• Wellness Programs
  
• Mentor Programs
  

About BerryDunn:

BerryDunn is a CPA and Management Consulting firm with over 500 employees throughout the country that provide a full range of services including Management and IT Consulting, Health Analytics/Actuarial Consulting, Audit, Accounting, and Tax. We are headquartered in Portland, Maine, with offices in Arizona, Connecticut, New Hampshire, and West Virginia. BerryDunn has maintained steady growth over its 40+ year history, and the firm is regularly named to national “Top 100” lists, including recent recognition for being a “fastest-growing” firm. We partner with clients across the United States and Canada, and we attribute our growth to attracting, developing, and retaining outstanding employees who help our clients create, grow, and protect value.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

Job ID: 2021-2126

External Company URL: https://www.berrydunn.com/

Street: 300 Capital Street

 
 

Clipped from: https://usajobsgov.org/project-manager-subject-matter-expert-sme-medicaid/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic