Category: Curator- Job Hunter

Benefits

LIBERTY Dental Plan is seeking to add Business Analyst to our team. Position will be remote with the ability to report into the Tampa, FL office as needed.

 
 

Ideal candidate will have experience working with Florida Medicaid.

This position is responsible for monitoring and oversight of the end-to-end encounter management workflow. This position analyzes complex encounter inbound/outbound process issues, using data from internal and external sources to provide insight to decision-makers. The ability to clearly articulate issues and solutions to team members, management, and external entities is crucial to the success of this position.

• Responsible for documenting, monitoring and analyzing the end-to-end encounter life cycle, both inbound and outbound.
  
• Identify and interpret encounter data, submission requirements and performance metrics per regulatory and health plan guidelines.
  
• Research and document all encounter errors in systems/databases; perform statistical and trend analysis.
  
• Perform root cause analysis of claims/encounters processing and submission issues; communicate with management and provide recommendations.
  
• Collaborate with other departments (e.g. EDI) on designing and implementing system/business process adjustments as needed to meet encounter data processing and submission goals.
  
• Communicate with and provide clear documentation to other departments on issues causing encounter pends/denials and potential solutions.
  
• Collaborate with health plans, clearinghouses and product vendors on encounter-related issues.
  
• Develop encounter-related reports (e.g. exception reports, root cause analysis outcome reports, etc.) and provide to other departments for error resolution, follow-up and performance monitoring.
  
• Participate in resolving encounter data and process issues.
  
• Maintain desktop procedures, workflows and policies & procedures for encounters.
  
• Recommend balanced approaches to system design and process-oriented solutions to optimize performance.
  
• Review and research inquiries from regulatory bodies and/or health plans related to submission data, including score cards from health plans.
  
• Other duties as assigned.
  

Education and/or Experience:

• Bachelor’s degree in a healthcare field or equivalent experience required
  
• 4+ years of experience as a Business Analyst or similar role, preferably focused in managed healthcare analysis
  
• 4+ years of experience in the healthcare payer / health insurance industry.
  
• 4+ years of experience with ANSI X12 EDI standards for healthcare.
  
• 3+ years of Florida Medicaid experience.
  
• Experience with multiple areas of health plan operations (e.g. Member Services, Provider Relations, Claims, etc.).
  
• Experience with user acceptance testing, training, writing business requirements, and mapping business processes.
  
• Experience submitting Florida Medicaid encounters is preferred.
  

Specific Skills/Knowledge:

• Must be comfortable with SQL, Excel, Access, Visio, PowerPoint, and Word.
  
• Excellent verbal and written communication and interpersonal skills.
  
• Strong time management and organizational skills.
  
• Ability to work under pressure, escalate issues when needed, and manage multiple tasks and deadlines while maintaining accuracy.
  
• Self-motivated with ability to work independently or as a team.
  

Environment and/or Physical Factors:

Work is generally performed within an office environment, with standard office equipment available. Sedentary work involves extensive sitting, typing, close range vision most of the time.

Sponsorship and Relocation Specifications:

LIBERTY Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.

 
 

https://www.glassdoor.com/job-listing/encounter-analyst-florida-medicaid-liberty-dental-plan-JV_IC1154429_KO0,34_KE35,54.htm?jl=4163952419&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Luisiana Remote

medicaid procurement retirement statewide regulations insurance supervision health training deferred administering absence

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Job Concepts

 
 

Function of Work:

To administer small and less complex statewide Medicaid program(s).

 
 

Level of Work:

Program Manager.

 
 

Supervision Received:

Broad from a higher-level manager/administrator.

 
 

Supervision Exercised:

May provide functional supervision in accordance with the Civil Service Allocation Criteria Memo.

 
 

Location of Work:

Department of Health and Hospitals.

 
 

Job Distinctions:

Differs from Medicaid Program Monitor by responsibility for administering small and less complex statewide program(s).

 
 

Differs from Medicaid Program Manager 1-B by the absence of supervisory responsibility.

Differs from Medicaid Program Manager 2 by the absence of responsibility for administering medium size and moderately complex statewide program(s).

Examples of Work

Supervises the auditing of eligibility enrollment of all Medicaid programs statewide.

 
 

Reviews work of eligibility review staff for quality assurance.

 
 

Plans, coordinates, and controls small or less complex statewide program(s).

 
 

Plans, develops, implements and monitors comprehensive Medicaid program policies.

 
 

Conducts and directs studies/special projects pertaining to the programs assigned.

Analyzes the impact of federal, state, and local legislation; advises agency officials; prepares position statements; presents testimony at hearings; writes legislation.

Reviews and analyzes complex data and system reports to ensure compliance with program regulations.

 
 

Administers the day-to-day operational functions of the Medicaid fee for service programs. Assures that program policy and procedures are properly applies in accordance with federal and state laws and regulations.

Develops and writes agency rules and regulations governing the administration of all supervised Medicaid programs and submit them for publishing in the official state publication in accordance with the requirements of the Administrative Procedures Act.

Implements Medicaid regulations directing provider participation standards and recipient benefits. Analyzes multi-mullion dollar Medicaid claim data and project the fiscal impact for budget forecasting.

 
 

Identifies, verifies and analyzes the various revenue sources for the program(s). Determines and/or confirms match requirements. Monitors availability of revenue sources and promptly identifies existing or potential financing problems.

Benefits Louisiana State Government represents a wide variety of career options and offers an outstanding opportunity to “make a difference” through public service. With an array of career opportunities in every major metropolitan center and in many rural areas, state employment provides an outstanding option to begin or continue your career. As a state employee, you will earn competitive pay, choose from a variety of benefits and have access to a great professional development program. Flexible Working Arrangements – The flexibility of our system allows agencies to implement flexible working arrangements through the use of alternative work schedules, telecommuting and other flexibilities. These arrangements vary between hiring agencies. Professional Development – The Comprehensive Public Training Program (CPTP) is the state-funded training program for state employees. Through CPTP, agencies are offered management development and supervisory training, and general application classes on topics as diverse as writing skills and computer software usage. Insurance Coverage – Employees can choose one of several health insurance programs ranging from an HMO to the State’s own Group Benefits Insurance program. The State of Louisiana pays a portion of the cost for group health and life insurance. Dental and vision coverage are also available. More information can be found at . Deferred Compensation – As a supplemental retirement savings plan for employees, the State offers a Deferred Compensation Plan for tax deferred savings.

 
 

Holidays and Leave – State employees receive the following paid holidays each year:

New Year’s Day, Martin Luther King, Jr. Day, Mardi Gras, Good Friday, Memorial Day, Independence Day, Labor Day, Veteran’s Day, Thanksgiving Day and Christmas Day. Additional holidays may be proclaimed by the Governor. State employees earn sick and annual leave which can be accumulated and saved for future use.

Your accrual rate increases as your years of service increase. Retirement – State of Louisiana employees are eligible to participate in various retirement systems (based on the type of appointment and agency for which an employee works).

These retirement systems provide retirement allowances and other benefits for state officers and employees and their beneficiaries.

 
 

State retirement systems may include (but are not limited to):

Louisiana State Employees Retirement System (), Teacher’s Retirement System of Louisiana (), Louisiana School Employees’ Retirement System (), among others.

LASERS has provided this to give you more detailed information about their system.

 
 

https://tarta.ai/j/jk5AcHwBPV406l6XxvsA-medicaid-program-manager-1-a-modularity-procurement-new-at-luisiana?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Source: Appcast US

THIS POSITION IS OPEN TO CURRENT OR FORMER OKDHS EMPLOYEES ONLY.

 
 

This position is located in Oklahoma City, Oklahoma.

Medicaid Long-Term Care Eligibility Analyst 9752

Annual salary: $81,317.11 + Full state benefits

DHS offers free child care for all employees. This benefit will be in effect until May 2022. For more information contact

 
 

Travel: Occasional

 
 

Must posses a valid driver’s license and maintain required car insurance.

 
 

Under administrative direction, position reviews and analyzes legal documents and financial information to determine the eligibility of applicants for Medicaid Long-Term Care whose applications are considered to be complex.

Minimum Qualifications

Active membership in the Oklahoma Bar Association and five (5) years of experience in estate planning;

 
 

OR

 
 

Certified Public Accountant and five (5) years of experience in estate planning;

 
 

OR

 
 

Master’s degree in accounting and six (6) years of experience in estate planning;

 
 

OR

 
 

Bachelor’s degree in accounting and seven (7) years of experience in estate planning.

Preference Statement

In addition to having experience in estate planning, preference may be given to applicants with experience with mineral ownership and small businesses, including farming and ranching.

Job Responsibilities

• Serves as legal resource for Adult and Family Services long term care employees and management staff: WEEKLY RESPONSIBILITIES:
  
• Research legal issues regarding possible policy or instruction to staff changes.
  
• Represent the agency on behalf of the local office regarding long-term care hearings where
  

client is represented by legal counsel.

• Advise Adult and Family Services staff on mineral valuation issues and property issues on a
  

timely basis. Including research and determination as to values of such assets and whether they

 
 

need to be included in determining eligibility.

 
 

Serve as a resource to the Legal Division:

• Draft fair hearing summaries on behalf of DHS in contested cases as requested by DHS Legal
  

Division.

• Will work on a diverse team and directly with people from diverse racial, ethnic, and socioeconomic backgrounds.
  

______________

 
 

OKDHS is a Fair Chance Employer.

 
 

This is an unclassified state position

 
 

Announcement Number – 21-GH149

 
 

83011972

 
 

https://us.melga.com/job/2021-10-11_e0cfe92c7b100409a4541279dc477f05?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Resp & Qualifications

PURPOSE:
Under minimal supervision, the Care Manager researches and analyzes a member’s medical and  behavioral  health needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes.

ESSENTIAL FUNCTIONS:

• Identifies  members  with acute/complex medical and/or behavioral health conditions.  Engages onsite and/or telephonically with member, family and providers to  develop a comprehensive plan of care to address the member’s needs at various stages along the care continuum. Identifies relevant CareFirst and community resources and facilitates program, network, and community referrals.

 
 

• Collaborates with member and the interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address member’s medical, behavioral and/or social determinant of health needs. Engage members and  providers  to review and clarify treatment plans ensuring alignment with medical benefits and policies to facilitate care between settings. Monitors, evaluates, and updates plan of care over time focused on member’s stabilization and ability to self manage. Ensures member data is documented according to CareFirst application protocol and regulatory standards.

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level: Registered Nurse
Experience: 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience.
Preferred Qualifications: Bachelors degree in nursing
CCM/ACM or other RN Board Certified certification in case management. Federal Employee Program (FEP) Book of Business (ONLY): Must have CCM/ACM or other RN Board Certified certification in case management. Incumbents not certified at the time of hire must have two years of case management experience and meet requirements to take CCM or ACM exam and successfully achieve the certification within the first year of employment.
Licenses/Certifications:
RN  – Registered Nurse – State Licensure And/or Compact State Licensure RN- Registered Nurse in MD, VA or Washington, DC 
Accredited Case Manager (ACM) Federal Employee Program (FEP) Book of Business (ONLY): Must have CCM/ACM or other RN Board Certified certification in case management. Incumbents not certified at the time of hire must have two years of case management experience and meet requirements to take CCM or ACM exam and successfully achieve the certification within the first year of employment OR
CCM – Certified Case Manager Federal Employee Program (FEP) Book of Business (ONLY): Must have CCM/ACM or other RN Board Certified certification in case management. Incumbents not certified at the time of hire must have two years of case management experience and meet requirements to take CCM or ACM exam and successfully achieve the certification within the first year of employment. Upon Hire Pref
 

Knowledge, Skills and Abilities (KSAs)
Knowledge of clinical standards of care and disease processes.
Ability to produce accurate and comprehensive work products with minimal direction
Ability to triage immediate member health and safety risks.
Basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits)
Excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for members.
Knowledgeable of available community resources and programs.
Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and PowerPoint
Ability to provide excellent internal and external customer service
 

Department

Department: DC Medicaid- Clinical Enterprises

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: 11/3/21

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

 
 

Clipped from: https://carefirstcareers.ttcportals.com/jobs/7717664-care-manager-dc-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Apply for this job now Location Bend, Oregon Job Type Permanent Posted 3 Oct 2021

Looking for a way to make an impact and help people?Join PacificSource and help our members access quality, affordable care!PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.Position Overview: Under limited supervision, assist Medicaid Administration staff in ensuring organizational adherence to contractual requirements with the Oregon Health Authority, external entities, providers, payers, and other states, as applicable. Employ an effective and efficient organizational skill set to coordinate department needs. Coordinate PacificSource activities to ensure contract deliverables are reviewed, compliant, and submitted timely. Works closely with CCO leadership and other stakeholders, contract management support, schedules, timelines, and review processes. Provide support on critical work groups to track and document contract changes. This role interacts with internal and external stakeholders and partners.Essential Responsibilities: Develop and maintain effective solutions and processes to manage schedules, timelines, activities, and milestones for Medicaid contract deliverables and reports for multiple CCOs. This includes all Medicaid contract types; CCO contracts with the Oregon Health Authority, Cover All Kids, and Choice Model Services, across multiple service areas where PacificSource has contracts of this type.Coordinate and collaborate with leadership and key stakeholders to ensure timely, accurate, and complete submissions of 170+ State deliverables per CCO, on an annual basis, consistent with PacificSource standards. This volume is subject to change with each contract cycle.Manage the deliverable process with internal and external stakeholders to improve the quality and integration of deliverable content.Ensure all state and federal guidance related to deliverables and reports is current and distributed to internal stakeholders that are accountable for the deliverable.Using independent judgement, provide a final review (before submission to Medicaid Administration leadership for final submission) of all contract deliverables and reports (including the redaction process) to ensure compliance with requirements, guidance, and use of state templates. This review includes, but is not limited to, ensuring a consistent voice for each service area, content review, grammar and punctuation accuracy and consistency, and branding of final documents.Document, store, and manage final submission materials.Coordinate with and support internal and external stakeholders to provide a resource for contract questions, interpretations, expectations, and requirements.Attend State meetings and work groups, as applicable.Maintain a current working knowledge of applicable Medicaid rules and regulations.Provide support for aligning Medicaid contract activities in each CCO region.Maintain collaborative partnerships with key PacificSource departments and leaders.Assume a supporting role in working with providers, the State, and other partners.Supporting Responsibilities: Perform day-to-day tasks for the Medicaid Administration department as needed.Meet department and company performance and attendance expectations.Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.Perform other duties as assigned.Work Experience: Minimum three years of experience in the health care, managed care, or public health administration industry and/or equivalent experience required. Relevant knowledge in the following areas preferred: the Oregon Health Plan, health care operations, and demonstrated organizational skills.Education, Certificates, Licenses: Bachelor degree in Business Administration, Health Administration or other related field or a combination of equitable work and education experience required. Certificates in Business Administration or Technical Writing preferred.Knowledge: Excellent organizational skills demonstrating efficient documentation methods. Demonstrated successful communication and interpersonal skills. Ability to be nimble in a fast-paced environment with competing deadlines. Demonstrated skills with the following software: Microsoft Office Suite (e.g. Outlook, Word, Excel, PowerPoint, and Visio), Adobe or Foxit PDF software, and SharePoint. Competencies AdaptabilityBuilding Customer LoyaltyBuilding Strategic Work RelationshipsBuilding TrustContinuous ImprovementContributing to Team SuccessPlanning and OrganizingWork StandardsEnvironment: Work inside in a general office setting with ergonomically configured equipment. Travel is possible approximately 10% of the time.Our ValuesWe live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:We are committed to doing the right thing.We are one team working toward a common goal.We are each responsible for customer service.We practice open communication at all levels of the company to foster individual, team and company growth.We actively participate in efforts to improve our many communities-internally and externally.We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.We encourage creativity, innovation, and the pursuit of excellence.Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Apply for this job now

Details

• Job Reference: 388794457-2
• Date Posted: 3 October 2021
• Recruiter: PacificSource
• Location: Bend, Oregon
• Salary: On Application
• Sector: Administration
• Job Type: Permanent

 
 

Clipped from: https://50states-jobs.com/jobs/medicaid-contract-specialist-bend-oregon/388794457-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Details

Medicaid Program Specialist 1 (PCN 06-4017)

This listing closes on 10/19/2021 at 5:00 PM Alaska.

Salary

$26.82 Hourly

Location Anchorage, AK

Anchorage, AK

Job Type

Full Time

Department

Health & Social Services

Job Number

30973

Closing date and time

10/19/2021 at 5:00 PM Alaska

Division

Health Care Services

Position Open To

Alaska Residents Only

Bargaining Unit

General Government

Range

16

• Description
• Benefits

Job Description

This position is open to Alaska Residents only. Please check our residency definition to determine if you qualify.

 
 

 
 

 
 

 
 

 
 

Are you looking to start a rewarding career with the State of Alaska?

Do you have attention to detail, a high degree of accuracy and a great work ethic? 

Then we are looking for you! 

 
 

What you will be doing: 

This position serves within the Systems and Analysis unit in direct support of the Medicaid Management Information System (MMIS).  The incumbents are responsible for quality assurance, contract management tasks, DDI (design, development and implementation) tasks, and monitoring changes in health industry standards, federal and state requirements as they relate to Medicaid and the MMIS.

This position serves as the lead specialist of the Provider Functional Area, monitors interfaces, claims processing outcomes, identifying system problems and propose solutions, and conducting system acceptance test reviews

Our organization, mission, and culture:  

The mission of the Division is to provide all eligible Alaskans access to quality Medicaid services. 

 
 

The vision of the Division is to improve quality of health care for all Alaskans, attract excellent providers and provide outstanding customer service. 

 
 

The contributions of the selected candidate ensure that the goals and visions of the Division are being met by ensuring the integrity of the system is maintained and conformed to the federal and state rules and regulations.

The benefits of joining our team:  

We are a dynamic, innovative, and fast-paced team.  All input is valued, and we are always looking to provide growth and learning opportunities for our team members.

The working environment you can expect:  

This position is conveniently located at 4601 Business Park Blvd., in mid-town Anchorage. We are close to restaurants, shopping, bike paths, and Cuddy Family Midtown Park.  Free parking is provided. The current schedule is two days in office, and three days teleworking.

 
 

Who we are looking for:  
To be successful in this position a candidate will need the following knowledge, skills and abilities:  

• Experience in conducting detailed, comprehensive and technically-oriented reviews of system testing documents, audit trails, system outputs, related reports and documents.
• Experience and skills that demonstrate an ability to independently analyze and apply comprehensive business rules, regulations, policies, and health payer industry standards as they apply to claims system processing.
• Ability to successfully work with multiple priorities (multi-tasking) while maintaining a very high degree of accuracy on detail-oriented tasks.
• Ability to work independently and interdependently to analyze design concepts and system modifications for thoroughness, accuracy, and compliance with federal and state standards. 
• Ability to take initiative and to find new methods to improve work tasks with limited supervision.
  
   

To view the general description and example of duties for an Medicaid Program Specialist 1, please go to the following link: https://www.governmentjobs.com/careers/Alaska/classspecs 
 

Minimum Qualifications

Any combination of education and/or experience that provides the applicant with competencies in 

• Analytical Thinking/Problem Solving: Uses a logical, systematic, and sequential approach to address problems or opportunities or manage a situation by drawing on one’s knowledge and experience base and calling on other references and resources, as necessary. 

 
 

• Oral Communication: Expresses information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information (for example, technical, sensitive, controversial); makes clear and convincing oral presentations; listens to others, attends to nonverbal cues, and responds appropriately. 

 
 

• Written Communication: Writes in a clear, concise, organized, and convincing manner for the intended audience. 

Previous Experience equivalent to those typically gained by:

Experience such as supporting the administration of a Medicaid or Medicare program, health insurance service, health insurance management information system, health insurance finance or accounting program, Supplemental Security Income benefits or vocational rehabilitation program; auditing or monitoring medical or public assistance programs for fraud or quality assurance; processing medical claims using medical coding and medical billing knowledge and/or training or education which includes such course work as business administration, computer sciences, economics, healthcare, legal studies, medical billing or coding, public health, public assistance, psychology.

 
 

Special Note:

“Competencies” means a combination of interrelated knowledge, skills, abilities, and behaviors that enable a person to act effectively in a job or situation.

 
 

“Training” and “education” in this guidance are synonyms for the process of acquiring knowledge and skills through instruction. It includes instruction through formal and informal methods (such as classroom, on-line, self-study, and on-the-job), from accredited and unaccredited sources, and long-duration (such as a post-secondary degree) and short-duration (such as a seminar) programs. 

 
 

“Typically gained by” means the prevalent, usual method of gaining the competencies expected for entry into the job.  

Additional Required Information

At time of interview applicant(s) are requested to submit:

1. A copy of academic transcripts (unofficial are acceptable but must include the institution name/URL on documents provided) if required to meet competencies.

Please read the below information carefully. This applies to your application submission.

COVER LETTER 

A cover letter is required.  The cover letter must describe your knowledge, skills, abilities, as they pertain to the job description listed above. Please attach the cover letter as a separate document to your application before applying online. If unable to attach to your application, email or fax the cover letter to the contact number provided in the job posting prior to the closing date of this recruitment.  Your cover letter will be used to determine which applicants will advance to the interview phase of the recruitment and selection process.
Omission of any required documentation will result in an incomplete application and you will not receive further consideration.

EDUCATION 
To verify education being used to meet the required minimum qualifications, you must fill in the Education section of the application. If you have not obtained a degree, please indicate the number of units completed. Copies of transcripts are required to verify educational credentials being used to meet the minimum qualifications for a position and are required with each application.  (Unofficial are okay, please ensure that the institution/URL name is listed on the transcripts). They can be attached at the time of application, provided at the time of interview or if not provided, transcripts will be required prior to appointment.

SPECIAL INSTRUCTIONS FOR FOREIGN EDUCATION 
Education completed in foreign colleges or universities may be used to meet the above requirements, if applicable. If utilizing this education you must show that the education credentials have been submitted to a private organization that specializes in interpretation of foreign educational credentials and that such education has been deemed to be at least equivalent to that gained in conventional U.S. education programs; or an accredited U.S. state university reports the other institution as one whose transcript is given full value, or full value is given in subject areas applicable to the curricula at the state university. It is your responsibility to provide such evidence when applying.  Omission of required documentation listed will result in an incomplete application and you will not receive further consideration.

WORK EXPERIENCE
When using work experience not already documented in your application, please provide the employer name, your job title, dates of employment, and whether full-or part-time. Applications will be reviewed to determine if the responses are supported and minimum qualifications are clearly met. Work experience needed to meet the minimum qualifications must be documented in the application.  If the application does not support minimum qualifications, the applicant may not advance to the interview and selection phase of the recruitment.  A resume will not be used to determine that minimum qualifications have been met for the position in which you are applying.

If you are currently or previously been appointed to a flexibly staffed position please ensure your work experience within a flexibly staffed position indicates the actual dates employed at each level.  Ensure your time and any subsequent flex promotion(s) are documented as a separate position.  This is required as there are minimum qualifications that require experience at a particular level in which the lower level may not be considered. If this information is not accurately reflected in your application this may cause the processing of your application for consideration to be delayed.

NOTE: Attaching a resume or curriculum vitae is not an alternative to filling out the application in its entirety. Noting “see resume or CV” or any similar response on any portion of your application may lead to a determination your application is incomplete and removal from consideration for this job posting.

The State of Alaska does not provide VISA Employer sponsorships.

RECRUITMENT SCOPE 
This position is open to Alaska Residents only. Please check our residency definition to determine if you qualify.

MULTIPLE VACANCIES
This recruitment may be used for more than one (1) vacancy. The applicant pool acquired during this recruitment may be used for future vacancies for up to ninety (90) days after this recruitment closes. Interested applicants are encouraged to apply to each recruitment notice to ensure consideration for all vacancies.

APPLICATION NOTICE
You can ONLY apply for this position through the Workplace Alaska website or via hardcopy application. If you accessed this recruitment bulletin through a job search portal such as ALEXsys or any other database, you MUST use a Workplace Alaska online or hardcopy application to successfully apply. Instructions on how to apply with Workplace Alaska may be found on the Workplace Alaska “How to Apply” webpage, found here: http://doa.alaska.gov/dop/workplace/help/

NOTICE
Questions regarding the application process can be directed to the Workplace Alaska hotline at 800-587-0430 (toll free) or (907) 465- 4095. If you choose to be contacted by email,
please ensure your email address is correct on your application and that the spam filter will permit email from the ‘govermentjobs.com’ domains.  For information on allowing emails from the ‘governmentjobs.com’ domains, visit the Lost Password Help page located at https://www.governmentjobs.com/OnlineApplication/User/ResetPassword.

EEO STATEMENT
The State of Alaska complies with Title I of the Americans with Disabilities Act (ADA). Individuals with disabilities, who require accommodation, auxiliary aides or services, or alternative communication formats, please call 1-800-587-4095 in Juneau or TTY: Alaska Relay 711 or 1-800-770-8973 or correspond with the Division of Personnel & Labor Relations at: P. O. Box 110201, Juneau, AK 99811-0201. The State of Alaska is an equal opportunity employer.

Contact Information

WORKPLACE ALASKA APPLICATION QUESTIONS & ASSISTANCE
 Questions regarding application submission or system operation errors should be directed to the Workplace Alaska hotline at 1-800-587-0430 (toll free) or (907) 465-4095 if you are located in the Juneau area. Requests for information may also be emailed to recruitment.services@alaska.gov. 

For applicant password assistance please visit: https://www.governmentjobs.com/OnlineApplication/User/ResetPassword

For specific information in reference to the position please contact the hiring manager at:

Name: Tiana Mikes, Medicaid Program Specialist 4
Phone: 907-375-7744
Fax: 907-561-1684
Email: tiana.mikes@alaska.gov

Careers with the State of Alaska offer MANY benefits

The following information describes typical benefits available to employees of the State of Alaska. Actual benefits received may differ by bargaining unit or branch of government, position type, or be prorated for other than full time work.

For a quick breakdown of the insurance, health, and retirement benefits available for State Employees you can view an orientation video from Division of Retirement and Benefits. (Please note this video is specifically designed for new State Employees.)

Insurance Benefits

• Health insurance, which includes employer contributions toward medical/vision/dental

 
 

• The following employee groups are under AlaskaCare Benefits administered by the State:   See http://doa.alaska.gov/drb/programs/index.html for additional information.

   
   

• AVTEC
• Confidential
• Correctional Officers
• Marine Engineers
• Mt. Edgecumbe Teachers
• Supervisory
• Unlicensed Vessel Personnel/Inland Boatman’s Union
• Exempt employees (not covered by collective bargaining)
• The following employee groups are covered by Union health trusts.  Contact the appropriate Union for additional information.

   
   

• General Government
• Labor, Trades and Crafts
• Public Safety Employees Association
• Masters, Mates & Pilots
• Employer paid Basic Life insurance with additional coverage available (amount depends on Bargaining Unit)

Optional Insurance Benefits

• Group-based insurance premiums for

 
 

• Term life (employee, spouse or qualified same sex partner, and dependents)
• Long-term and short-term disability
• Accidental Death and Dismemberment
• Long-term care (self and eligible family members)
• Supplemental Survivor Benefits
• Employee-funded flexible spending accounts for tax savings on eligible health care or dependent care expenses

Retirement Benefits

• Membership in the Public Employees Retirement System (PERS)/Teachers’ Retirement System (TRS)
• Matching employer contribution into a defined contribution program (new employees)
• Employer contribution into a defined benefit or defined contribution program (current employees)
• Contributions to the Alaska Supplemental Annuity Plan in lieu of contributions to Social Security
• Option to enroll in the Alaska Deferred Compensation Program
• Note:  The Defined Contribution Plan, Supplemental Annuity Plan and Deferred Compensation Program offer a variety of investment options

See http://doa.alaska.gov/drb/retirement/index.html for additional information
 

Paid Leave & Other Benefits

• Personal leave with an accrual rate increase based on time served
• Eleven paid holidays a year
• Gym discounts at participating fitness providers in multiple locations throughout the state.

See http://doa.alaska.gov/drb/ghlb/employee/health/gymListing.html for additional information

Agency State of Alaska Phone (800) 587-0430 (Statewide toll-free number) Website http://workplace.alaska.gov/

Address PO Box 110201


Juneau, Alaska, 99811

 
 

Clipped from: https://www.governmentjobs.com/jobs/3217889-0/medicaid-program-specialist-1-pcn-06-4017?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
  
  

OhioRISE – Ohio Resilience through Integrated Systems and Excellence


As part of Ohio Medicaid’s next generation of its managed care program, Ohio is implementing OhioRISE, a specialized managed care program for youth with complex behavioral health and multi-system needs.


The OhioRISE managed care organization (MCO) will partner with the state, providers, and community organizations to expand access to in-home and community-based services. The MCO will contract with regional care management entities to ensure OhioRISE members and families have the resources they need to navigate their interactions with multiple systems such as juvenile justice and corrections, child protection, developmental disabilities, mental health and addiction, education, and others.


New And/or Enhanced Services Available Through OhioRISE Include

• Intensive Care Coordination
• Intensive Home-Based Treatment – enhanced
• Psychiatric Residential Treatment Facility
• Mobile Response and Stabilization Service
• Behavioral Health Respite – enhanced
  
  

Job Overview


Office: Strategic Initiatives


Classification: Deputy Director 5 (PN 20098838)


As ODM’s OhioRISE Deputy Director, Your Responsibilities Will Include


ODM is seeking a senior healthcare leader to oversee the administrative, programmatic, operational, and clinical development and implementation of the OhioRISE program.

• Providing administrative direction and oversight for the OhioRISE program, including direction and oversight of ODM’s relationship with the OhioRISE managed care plan
• Directing and managing operations of the OhioRISE program within ODM and in partnership with the OhioRISE plan
• Assuring the OhioRISE program’s full integration and coordination with the other components of ODM’s Next Generation of Managed Care
• Holding the OhioRISE program and the OhioRISE managed care plan accountable to the vision and goals set by the OhioRISE cross-agency governance structure
• Overseeing policy and programmatic development and implementation, as well as clinical operations and oversight for OhioRISE
• Engaging multiple state and local systems and other external stakeholders in developing regulatory structures and operational strategies to ensure successful implementation of the OhioRISE program
• Identifying and developing innovative strategies to improve outcomes for children, youth, and young adults served under the OhioRISE program
• Participating in leadership of ODM’s quality improvement framework, quality improvement planning, and quality improvement oversight activities
  
  

The ideal candidate should have strong operational leadership experience and a proven ability to champion the agency’s mission and vision across a variety of audiences and situations.

• Graduate degree from an accredited university or college in business, management or public administration, public health, health administration, social or behavioral science or related field
• Minimum of 5 years of experience in planning and administering a large health services program or health services project management
• Change agent with strong credibility and influencing skills and the proven ability to build relationships and influence stakeholders
• Ability to interface effectively with all levels of the organization as well as leaders working in other sister agencies of state government and other organizations outside of ODM
• Outstanding team leadership and multi-functional/cross-functional team management skills; able to drive a positive employee relations culture
• Strong interpersonal and organizational skills, with a highly collaborative working style and a commitment to diversity and inclusion
• Strategic development and successful execution of large, highly visible, and complex projects involving multiple stakeholders within aggressive time constraints
• Solutions-oriented approach to implement priority initiatives and meet project demands
• Ability to communicate effectively with people at all levels and backgrounds
• Strong presentation skills, written communication skills and experience with a variety of computer software applications and data processing systems
  
  

Primary Location


United States of America-OHIO-Franklin County-Columbus


Work Locations


Lazarus 5


Organization


Ohio Department of Medicaid


Classified Indicator


Unclassified


Bargaining Unit / Exempt


Exempt


Schedule


Full-time


Work Hours


8:00AM – 5:00PM


Compensation


Negotiable


Unposting Date


Ongoing


Job Function


Health Administration


Job Level


Individual Contributor


Agency Contact Information


HumanResources@medicaid.ohio.gov

 
 

 
 

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Job Description

Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care.

In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients.

With Steward in the community, all residents can be sure that there is a world-class doctor close to where they live.

The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.

Position Purpose: The Director of Medicaid Accountable Care Organization provides leadership and day-to-day operational oversight of Steward’s Medicaid ACO program.

This role is also responsible for the planning and implementation of health plan development-related activities.

Grows and directs the Medicaid ACO program, including:

Prepares financial opportunity and risk analysis to recommend program objectives to senior leadership

Directs budget development, contract management, and financial reporting related to the Medicaid ACO program

Collaborates with all necessary departments (Care Management, Performance, Analytics, Finance, IT, Strategy, and Policy) to resolve complex issues related to the initiatives and program

Creates, interprets, and disseminates information across multiple internal and external stakeholders

Ensures compliance with all Medicaid ACO Agreement requirements and applicable laws, rules, and regulations

Leads key governance meetings related to Medicaid.

Evolves the Medicaid ACO program to incorporate substantial health plan operations.

This includes:

Direct health plan development activities, such as defining business requirements and partnering with health plan team to implement health plan functions

Provide direction to the Project Implementation Team within the Project Management Office on health plan development priorities, and oversee project status reports and resource management

Manage relationships with state regulators, including the Executive Office of Health and Human Services and the Division of Insurance.

Review and approve all regulatory-facing deliverables prior to executive sign-off and submission

Identifies opportunities to continually innovate with Medicaid ACO population to achieve performance outcomes, including:

Identifies key tactical and operational initiatives and ensures such initiatives are professionally project managed to meet performance objectives

Designs models and performs ad hoc analysis for the purpose of understanding the historical and future performance of initiatives

Monitors, interprets, and reports on changes in performance, market trends, health care delivery systems, and legislative initiatives that impact program efforts (e.g., CMS ACO regulations, Massachusetts Health Reform)

Coordinates advocacy and lobbying efforts to drive Medicaid ACO program changes

Identifies opportunities in other Steward markets for potential participation in additional Medicaid ACO programs

Other duties as assigned

Education / Experience / Other Requirements

Education:

Bachelor’s degree required

Master’s degree in health care related field strongly preferred

Years of Experience:

Minimum of 5 years of experience in related roles, including large program implementations

Specialized Knowledge:

Possesses strong background in health plan business, program, and operational functions

Creative, flexible, self-motivated, professional able to navigate complex, matrixed environments

Demonstrates critical thinking skills

Proven excellent written and verbal communication skills.

Ability to present information to small and, at times, large audiences

Possesses excellent time management skills with proven ability to effectively manage multiple tasks and priorities at one time

Demonstrates knowledge of managed care concepts for various health plan and capitated programs

Collaborates with multiple providers to provide quality and cost-effective care for risk members.

Accepts flexibility in work schedule willingly.

(e.g., periodic early morning or evening meetings)

Requisite poise, judgment, and trustworthiness to represent Steward to internal and external groups

Maintains information in a confidential manner according to policy

Strong proven leadership and experience with the MassHealth program (i.e., FFS, PCC, MMCO, etc.); network development and ACO experience is highly valued

Strong interpersonal skills and ability to interact positively with a wide range of constituents

Strong organizational and project management skills including development of project parameters, goals, and timelines and outcome measurement

Analytic skills to collect information from diverse sources and summarize the information and data in order to solve problems

Ability to function effectively within an ever-changing environment and to meet deadlines and reprioritize as necessary

Ability to work both independently and within a team environment and a multi-dimensional environment

Possesses sound judgment ability to plan and initiate new activities consistent with achieving service excellence

Some travel may be necessary

Steward Health Care is an Equal Employment Opportunity (EEO) employer.

Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.

Location: Steward Health Care Network · 1301.72330 Steward Health Care Network

Schedule: Full Time, Day Shift, Mon-Fri

 
 

Clipped from: https://jobzhq.com/jobs/director-medicaid-aco_42a244b9312b0b0e_0_0?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Overview:
 

Medicaid Fraud SME – Subject Matter Expert

Company Overview:

CoventBridge Group is the leading worldwide full-service investigation solutions company providing: Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. With offices in the UK and U.S. the company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.

About the Opportunity:

 
 

The Medicaid Fraud SME will be responsible for activities related to fraud investigation development

 

 
 

In assuming this position, you will be a critical contributor to meeting CoventBridge Group’s objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.

This position will report directly to the Program Integrity Supervisor and will work in our Grove City, OH office or if not local, remotely from a home office.
 

Responsibilities/ Requirements:

Responsibilities:
 

• Identify proactive data analysis study ideas, working closely with the Data Analysis, Medical Review and Program Integrity teams to ensure actionable leads with ROI that meets CMS requirement
   
• Develop and coordinate investigative approaches and plans for fraud leads in order to expedite the investigative progress
   
• Help establish and maintain relationships with State Medicaid Agencies and CMS
• Produce and submit required reports according to pre-established time guidelines
• Support team in meeting quality and production standards
• Monitor security of evidence gathered during the development of fraud investigations
• Ensure departmental compliance with Quality Management System and ISO requirements
   
• Perform other duties as assigned by the Manager that contribute to task order goals and objectives

 
 

Requirements:

• Minimum of two (2) years of experience in Medicare or Medicaid fraud investigations including investigation development, data analysis, and problem identification or one (1) year of experience with an advanced degree
  
   

• Excellent oral, written and verbal skills.
• Ability to work independently and with minimal supervision.
   
• Knowledge of statistics, data analysis techniques, and PC skills are preferred.
• Must have and maintain a valid driver’s license issued by the state of residence

Educational Qualifications:

• Bachelor’s Degree or equivalent related experience
• Preference will also be given to those individuals that have attained the Certified Fraud Examiners (CFE) designation or Accredited Health Care Fraud Investigator (AHFI)

 
 

Benefits:
 

Benefits:

• Medical, Dental, Vision plans
• Life, LTD and STD paid by the employer
• 401(k) with company match up to 4%
• Paid Time Off and company paid holidays
• Tuition assistance after 1 year of service

*CoventBridge is proud to be an EEO-AA employer M/F/D/V.*

UPIC

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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 care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. 

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

 
 

This is a 100% remote/virtual opportunity

 
 

The Medicaid Business Development Intern will be responsible for identifying and developing new business growth initiatives by maximizing strategies and growth opportunities in targeted markets identified through the annual planning process.

Primary responsibilities include 

• Monitors and analyzes product lines to help determine optimal strategy
• Provides research, analysis and recommendations on the external environment as part of the development of strategic plans for the business unit.
• Analyzes major competitor strategies.
• Identifies and monitors changing patterns of competition and recommends responses
• Acquires and maintains data/information on market, industry, economic, consumer and competitive conditions and trends pertaining to health insurance/managed care and related services.

 
 

 
 

Qualifications

• Pursuing a degree in Public Policy, Health Care Administration, Business, Health Policy or other related degrees
• This internship is from June to August and is 40 hours per week – 100% Remote Work Location
• Must be enrolled fulltime at an accredited college or university during internship
• Students must be authorized to work in the U.S. without future visa sponsorship requirements
• MS PowerPoint and Excel skills

 
 

We provide benefits to intern and Co-Op students that include 401(k) + Match and access to Anthem’s associate resource groups. Additionally, students receive work related experience, opportunities to grow their professional network, learn new & practical skills, explore a wide range of career paths, mentoring, and the potential to secure a fulltime job following graduation.

 
 

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.

Clipped from: https://anthemcareers.ttcportals.com/jobs/7608792-medicaid-business-development-intern-summer-2022?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic