Company: Gainwell Technologies LLC

Job Summary:

Manages client relationships and acts as a trusted advisor, thought leader and general manager to grow the business through sales Develops a client-centered agenda (plan), improves the financial quality of the account [s] (grow), harnesses innovations to meet contractual commitments (deliver) and provides the leadership that aligns teams and holds members accountable for results (lead).  Provides pan-company leadership working across company and with the customer as one unified company account team.  Use of this job family is restricted:  must own an account, sub-region/region P & L.

 
 

Responsibilities:

• Unique mastery and recognized authority on relevant subject matter knowledge including technologies, theories, or techniques
• Develops strategy and set functional policy and direction.
• Acts as a functional manager within area of expertise but does not manage other employees as a primary job function.
• Leads large, cross-division functional teams or projects that affect the organizations long-term goals and objectives.
• Contributes to the development of innovative principles and ideas
• Successfully operates in the most complex disciplines, in which the company must operate to be successful.  Provides highly innovated solutions
• Routinely exercises independent judgment in developing methods, techniques and criteria for achieving objectives. 
• Delivers Account  Business Plan (ABP), Account Financial Plan (AFP), and Account Operating Plan (AOP)
• Leads, coordinates, and manages the long-term, consultative, client relationship to become the client’s trusted advisor
• Establishes and manages, a program to achieve client service excellence
• Meets or exceeds financial commitments
• Delivers on company’s contractual commitments, technical or process innovations
  Enforces a change management mechanism for requests   outside the agreed scope
• Ensures a strong governance framework and meeting cadence within company and between company and the customers
• Leads all employees who provide services to the client, either directly or indirectly

Education and Experience:

• Bachelor’s Degree or equivalent, MBA or equivalent preferred
• 10-12 years’ experience in account leadership roles such as sales, delivery or business management
• At least five (5) years previous account management experience in managing State Medicaid Management Services
• Previous experience with a Medicaid Management System or with major operations-related components of an Medicaid Management System or other large healthcare systems and an ongoing relationship management with a large client.
• Experience working in a matrixed  environment
• Experience in IT industry required  and vertical industry preferred
• P & L, sales and risk management skills required

Knowledge and Skills:

• General Management Skills
• Consultative sales skills
• Financial Acumen
• Knowledge of IT Industry, including trends and competitors
• In depth knowledge of vertical industry
• Change Management skills
• Strong communication skills

 
 

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Found in: beBee S2 US

Description:

UnitedHealthcare is a company that’s on the rise. We’re expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn’t about another gadget, it’s about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life’s best work.(sm)

In this role you will supporting the Michigan Health Plan executive team as relates to operation data analysis. You will be mining, analyzing claims and HEDIS data. Your take your experience to develop usable reports to help the leadership make informed decisions.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Analyze and interpret data to identify trends, patterns and opportunities for the business and clients
• Communicate analysis and interpretation to appropriate audiences
• Produce, publish, and distribute scheduled and ad-hoc client and operational reports relating to the development and performance of products, processes, and technologies

The question is how effective can you be in interpreting and analyzing large amounts of information from multiple sources and use it to tell a meaningful story? The challenge will be to manage outcomes of various studies that include analyzing, reviewing, forecasting, trending and then presenting information for operational and business planning, all while adapting to change quickly.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• Bachelor’s degree in Business, Finance, Health Administration or related field or equivalent experience
• 3+ years of experience in business/finance including analysis experience with a solid understanding of data storage structures
• 3+ years of experience working with Medicare or Medicaid data fields
• 3+ years of working experience with Medicare or Medicaid Claims data
• 3+ years of experience in analysis of business process and workflow and providing an evaluation, benchmark and/or process improvement recommendations
• 3+ years of experience with PC-based software programs and automated database management systems (Excel, Access, PowerPoint)
• 2+ years of experience using SAS and/or SQL for data queries and data analytics
• 1+ years of experience with project methodology (requirements, design, development, test, and implementation)

Preferred Qualifications

• Michigan Medicaid experience
• Prior experience working with HEDIS data

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That’s why you’ll find some of the most amazingly talented people in health care here. We serve the health care needs of low- income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life’s best work.(sm)

Colorado Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action 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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Medicaid, HEDIS, Data Analysis, Michigan, Medicare, SAS/SQL, Claims data, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote

calendar_today 7 hours ago

 
 

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Centene is transforming technology and creating a digital evolution that will empower us to better serve our over 25 million members. Our scope covers all forms of healthcare, including Medicaid, Medicare, Marketplace, Commercial, and even specialty coverage.

Job Locations: Tampa, FL; Atlanta, GA

As a Senior Actuarial Analyst, your talents and skills will be challenged, recognized and rewarded. We are a pay-for-performance environment that promotes employees based on talent and contribution. In order to maintain our tremendous growth in this space, our over 400 member Actuary team is growing. Located across the country, this team uses:

• Technical skills to build leading edge models, predict outcomes and assess future impacts
• Business skills to develop strategy with senior leadership
• Personal skills to interact with state, federal and private employer customers
• Management skills to organize cross department projects

In this Senior Actuarial Analyst role, you will:

• Assist in financial analysis, pricing and risk assessment to estimate outcomes.
• Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes
• Assist with developing probability tables based on analysis of statistical data and other pertinent information
• Analyze and evaluate required premium rates
• Assess cash reserves and liabilities enable payment of future benefits
• Develop and run data reports
• Assist with determining the equitable basis for distributing money for insurance benefits
• Participate in merger and acquisition analysis

 
 

Education/Experience:

• Bachelor’s degree in related field or equivalent experience.
• Combination of years of experience and number of actuarial exams passed equals or exceeds 5 (Rule of 5). For example, 2 years of actuarial experience and 3 passed actuarial exams.

License/Certification: Combination of years of experience and number of actuarial exams passed equals or exceeds 5 (Rule of 5). For example, 2 years of actuarial experience and 3 passed actuarial exams.

Job Locations: Atlanta, FA; Tampa, FL

Areas of focus within our Actuarial Department includes: Medicare / Medicaid; Marketplace / Commercial; Risk Adjustment; Reserving; Analytics; Value-Based Contracting, Cost Reporting, and Health Policy

About Us:

Centene Corporation, a FORTUNE 25 company, is the leading multi-national healthcare enterprise committed to helping people live healthier lives. We are revolutionizing the world of healthcare through digital transformation. Our world class teams use collective innovation to turn visions into action and challenge what is possible.

We are an industry leader with a local focus and a global vison:

• Listed on FORTUNE magazine’s World’s Most Admired Companies List for 2nd consecutive year.
• Ranked No.2 on the FORTUNE 500 Measure Up Initiative, a new benchmark to identify companies building inclusive and fair workplaces.
• National footprint in all 50 states, serving 1 in 15 individuals in the U.S.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Job Field: Actuarial Services
 

By submitting your interest in this job, you agree to receive text notifications with additional steps to complete your job application. You will receive up to 6 messages from the number “63879”. Message & data rates may apply. Please refer to our privacy policy for more information.

 
 

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As a Nurse, you will be focusing in the areas of clinical quality improvement programs; utilization management and clinical standards impacting health service delivery.

 
 

What you’ll do:

 
 

• Provide recommendations about clinical aspects of nursing practice and programs that pertain to national-level programs affecting a variety of health care settings and clinicians.
• Provide clinical nursing perspective in the assessment of policies, projects, and data related to the measurement of quality, legislative and administrative proposals, and make recommendations to agency managers.
• Prepare issue papers, briefing materials, manuals, presentations, reports and correspondence for an assigned health policy area.

 
 

Experience we’re looking for:

 
 

(1) Assisting with researching policies regarding clinical aspects of program operations.

(2) Interacting with internal and external stakeholders to provide clinical nursing advice or guidance.

 
 

– OR –

 
 

Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing 3 full years of progressively higher level graduate education leading to such a degree or Ph.D. or equivalent doctoral degree or LL.M., if related to the position being filled.

 
 

– OR –

 
 

Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at grades GS-11. Therefore, only education in excess of a master’s or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree, may be used to combine education and experience.

 
 

To see full list of eligibility criteria, see job posting on USAJOBs.

 
 

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Financial Management Analyst

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicaid and CHIP Services, Financial Management Group (FMG), Division of Financial Operations East-Branch A.

As a Financial Management Analyst, GS-0501-12, you will perform a variety of financial management duties and must have
knowledge of financial principles and procedures in carrying out assignments.

25% or less – You may be expected to travel up to 25% for this position.

• Job family (Series)

0501 Financial Administration And Program

• Requirements

Requirements

Conditions of Employment

• You must be a U.S. Citizen or National to apply for this position.
• You will be subject to a background and suitability investigation.
• Time-in-Grade restrictions apply.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.

Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.

In order to qualify for the GS-12, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-11 grade level in the Federal government, obtained in either the private or public sector, to include:

1) Developing and reviewing budgets reports or expenditures to ensure compliance; AND 2) Gathering and/or analyzing information pertaining to financial operations; AND 3) Compiling financial data answering specific requests for information; AND 4) Identifying issues in budget or financial proposals and recommending solutions.

Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.

Time-in-Grade: To be eligible, current or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11230240

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: Yes

Tour of Duty: Flexible

Recruitment/Relocation Incentive: Not Authorized

Financial Disclosure: Not Required

Full-Time Telework Program for CMS Employees: CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page.

Additional Forms REQUIRED Prior to Appointment:

• Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
• Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
• Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.

The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.

If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.

How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with any interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.

Once the announcement has closed, your online application, resume, transcripts and CMS required documents will be used to determine if you meet eligibility and qualification requirements listed on this announcement. If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration. Please follow all instructions carefully. Errors or omissions may affect your rating.

Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):

• Analysis
• Financial Management
• Oral Communication
• Writing

Background checks and security clearance

Security clearance

Not Required

Drug test required

No

Position sensitivity and risk

Non-sensitive (NS)/Low Risk

Trust determination process

Credentialing, Suitability/Fitness

• Required Documents

Required Documents

The following documents are REQUIRED:

1. Resume
showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.

PLEASE NOTE: A complete application package includes the online application, resume, transcripts and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume, transcripts and CMS required documents, will result in you not being considered for employment.

• Benefits

Benefits

A career with the U.S. Government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time, or intermittent. Contact the hiring agency for more information on the specific benefits offered.

 
 

 
 

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Description

How would you like to make a difference in the health of the children of Idaho and have an impact on your community? The Idaho Department of Health and Welfare, Division of Medicaid has an opening for the clinical position of a Program Specialist – DHW in the Clinical & Quality Management Program.

This position is located in beautiful Idaho and will be open statewide. This is a telecommuting position and will be part of the Children’s Medicaid team. This individual will work closely with the families and treatment providers of children with serious emotional disturbance to safely transition these children between inpatient and outpatient levels of care. We are seeking applicants with backgrounds in counseling or social work, critical thinking skills, developed interpersonal skills, excellent written and verbal communication skills, and the ability to work tactfully and professionally as a team player.

We offer a competitive benefits package which includes excellent medical, dental and vision insurance; generous vacation and sick leave accrual beginning as soon as you start; eleven (11) paid holidays a year; participation in one of the Nation’s best state retirement systems; multiple savings plans and optional 401K; life insurance; wellness programs; ongoing training opportunities; optional flex scheduling; telecommuting; and more.

Example of Duties

• Complex case management coordination working directly with members and families who require intensive and complex services
• Directly manage logistical operations for successful Children’s Medicaid residential placements, to include in-state and out-of-state placements
• Work closely with treatment teams at psychiatric residential treatment facilities across the country, from admission to discharge, to ensure appropriate care is sustained through each stay
• Work directly with quality improvement organization (QIO) to ensure appropriate access to and ongoing care for children who are admitting, residing or discharging from psychiatric residential treatment
• Partner with other State agencies and community providers to transition members between inpatient and outpatient levels of care
• Problem-solve access to care issues, especially for children residing in more rural and frontier communities across the state
• Participate in a Quick Reaction Team (QRT) to support youth discharging from a variety of out-of-home placements
• Provide exemplary customer services advocating for the members’ needs
• Possess the ability to distill complex multi-disciplinary issues and situations into readily understandable with recommendations for resolution and improvements
• Lead, participate, and coordinate treatment team meeting calls for denials which includes parent/guardian, clinicians, behavioral health care coordinator, caseworker, probation officer and others as necessary
• Work as part of an engaging team to manage the care of some of Medicaid’s most vulnerable children, ensuring medical necessity and transitions of care
• Collates and reports on care access for members assigned in caseload

Minimum Qualifications

You must possess all the minimum qualifications listed below to pass the exam for this position. Click on the Questions tab associated with this announcement for the details regarding minimum qualification requirements. The Supplemental Questions on the application are the exam questions. If it is a written answer, please make sure you answer each question with enough detail to determine how you meet the requirements. Do not put see resume as your answer to written questions. Answer each written question thoroughly. Failure to do this may result in not passing the exam and disqualify you from being considered for this position.

• Experience developing, recommending, and evaluating operating procedures and recommending changes.
• Experience developing technical written materials such as policies, technical manuals or rules/regulations.
• Experience providing technical program assistance to internal and external stakeholders.

Supplemental Information

Additional Qualifications: Are not required, however, having the minimum qualifications and the education and/or experience below will increase your score.

• Current licensure as a behavioral health professional in the State of Idaho (e.g., LPC, LCSW, LMSW, LCPC, LMFT).
• Bachelor or master’s degree in social work, psychology, marriage and family counseling/therapy, psychosocial rehabilitation counseling, psychiatric nursing, or closely related field of study.
• Experience with children’s mental health and good knowledge of behavioral health treatment approaches and stages of development. Gained by providing two years of social/treatment services in an institutional, clinical, correctional, or community-based setting.
• Experience working with individuals with developmental disabilities. Gained by two years providing social/treatment services in institutional, clinical, or community-based setting.

DEDICATED TO STRENGTHENING THE HEALTH, SAFETY, AND INDEPENDENCE OF IDAHOANS

People Making A Difference!
 

VISIT US ONLINE
Learn About a Career with DHW

https://healthandwelfare.idaho.gov/about-dhw/dhw-careers

For all Idaho state government jobs:

https://dhr.idaho.gov

–
***PLEASE NOTE: application assistance is not available after the business hours listed below, on the weekends, or on holidays and you must apply before 11:59 pm on the closing date. When applying, use CHROME as your browser to avoid complications.

If you have questions, please contact us at:

TROUBLE APPLYING: 1-855-524-5627

(Monday through Friday, 6am – 5pm, Pacific Time)

EMAIL:

dhwjobs@dhw.idaho.gov
(answered Monday through Friday during business hours MST)

Email is the quickest way to get an answer to your questions.

PHONE:

(208) 334-0681
(answered Monday through Friday during business hours MST)

–

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* Position Description*:. As a member of the Mathematica’s State Health and Medicaid Business Development team, you will have the opportunity to:*. Contribute to the strategic framework for Mathematica’s ongoing business development activities in State Medicaid.

Evaluate and make recommendations to leadership to develop new technical solutions, partner with existing businesses to offer mature technical solutions for clients, or acquire businesses to enhance Mathematica’s technical solutions portfolio. Engage potential customers to develop relationships that lead to new business. Build and maintain a team of partners, and manage teaming and subcontractor agreements.

Partner with Mathematica’s internal technical group to provide Medicaid subject matter expertise to inform go-to-market activities for digital product and platform solutions, like the development of prototypes, pricing, licensing, and market research. Identify technical solutions that meet Medicaid business needs. Participate in brainstorming and writing activities for technical proposal language used in response to RFPs and other solicitations.

Work collaboratively across technology and advisory services teams to ensure adequate material is documented and available for BD activities. Stay connected to technical project delivery by serving in a high-level oversight role. Coordinate the communication of highly specialized policy and technology outputs to client leads. Position Requirements*:. Position Requirements*.

Graduate degree and at least 5 years of experience working with cross-functional technology and advisory services teams in a public policy consulting context. The ability to apply technology to provide solutions for decision makers regarding complex policy issues, with at least 5 years of experience leading activities for implementing health information technology solutions. Demonstrated experience leading responses to RFPs including capture planning activities, developing and managing a team of partners, and navigating the connection of sales and delivery teams pre- and post-sales.

Demonstrated experience developing Implementation-Advanced Planning Documents or Advanced Planning Documents for state Medicaid technical solutions. Demonstrated experience with health care projects, knowledge of state Medicaid programs and data, including public health. Working knowledge of digital processes, technologies, and tools such as Agile, Jira, Confluence, and Tableau.

Proficiency with Microsoft Office Suite products. Experience building and leading teams. Enthusiastic, highly team-oriented, able to work in a matrixed environment on a fast-moving, growing team.

Preference will be given to candidates who have worked with one or more State Medicaid agencies to design, develop, implement, configure, or integrate health information systems. To apply, please submit a cover letter, resume, and contact information for three professional references at time of application. Review of applications will start in April 2021, applications completed before May 2021 will receive priority in consideration.

Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on the project. If you work on such a project, you will be required to obtain the requisite security clearance. This position is open in the following cities and states; however, we are all currently working from home and provide the support and flexibility needed to work from home.

We ask the candidates to identify their preferred location for when we return to working in-person. Available Locations: Chicago, IL; Ann Arbor, MI; Washington, DC; Princeton, NJ; Woodlawn, MD; Cambridge, MA; Seattle, WA; Oakland, CA 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. 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..

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Job Description

Director of Legal & Compliance Job DescriptionLeads Privacy and Compliance functions within the Organization.

Functions as an independent and objective legal advisor to business partners that identifies and evaluates data privacy compliance issues.

Provides subject matter expertise and designs corporate privacy trainings; monitors legal and regulatory trends.

Enables business and helps to protect the privacy of all stakeholders, including employees, customers, suppliers, and members of the public.

Key Responsibilities: Develop, implement, and maintain Privacy policies and procedures, working collaboratively with stakeholders across the companyProvide legal expertise on interpretation and application of data protection laws.

Partner with the IT Department to ensure the organization maintains appropriate IT Security, administrative, technical, and physical safeguards to protect personal and health informationMonitor changes in Privacy laws and regulations; assess the impact to the organization and its strategic goals, and revise policies & procedures as appropriateScope and perform periodic privacy risk assessments, mitigation, and remediation, including data control design and monitoring, as well as the mitigation of privacy and security risks.

Strategically advise on the development of new services or enhancements to existing services to ensure “privacy by design” and “privacy by default” principles.

Support HIPAA risk assessment and company’s compliance obligations as a HIPAA Business Associate.

Provide support and guidance as needed when it comes to compliance with privacy laws.

Support contract negotiation and drafting for complex privacy and compliance issues.

Conduct employee training in the areas of Privacy and other compliance, and develop compliance champions throughout the organizationCoordinate with Internal Audit to conduct periodic assessments of the effectiveness and performance of company’s privacy compliance program.

Functional Knowledge, Skills, and Competencies: Experience working in or with the healthcare industry or healthcare-related products that require compliance with HIPAA; strong technical knowledge of all aspects of the HIPAA regulationExperience designing and managing privacy risk assessments.

Outstanding written communication and proofreading skills, particularly with executive-level communications.

Ability to work independently and lead experienced attorneys and multiple diverse projects.

Ability to plan, organize and prioritize a varied, heavy, and continually expanding workload.

Ability to maintain confidentiality of customers, employees and proprietary information.

Experience working with CCPA/CPRA; strong technical knowledge of all aspects of CCPA/CPRA regulationExperience supporting an organization becoming compliant with HIPAA & CCPA/CPRA and maintaining ongoing operational complianceExperience training workforces in Privacy and other compliance areasOther duties as assignedBusiness Expertise: Outstanding written and oral skills.

Superior report writing and presentation skills.

Unquestionable ethics and integrity.

Strong interpersonal skills: team player with ability to deal effectively with individuals at all levels.

Demonstrated ability to produce high-quality work in a timely fashion and provide effective guidance on legal issues to business clients.

Job Type: Full-timeBenefits:401(k)401(k) matchingDental insuranceDisability insuranceEmployee assistance programHealth insuranceHealth savings accountLife insurancePaid time offRetirement planVision insuranceSchedule:Monday to FridaySupplemental Pay:Bonus payExperience:Compliance management: 1 year (Preferred)License/Certification:Legal Certification (Preferred)Work Location:Fully RemoteWork Remotely:Yes

 
 

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Position:  Associate Director, Medicaid Implementation – Remote, US
Description
The Associate Director, Medicaid Implementation (Project Management) manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Associate Director, Medicaid Implementation (Project Management) requires a solid understanding of how organization capabilities interrelate across department(s).

Responsibilities
The Associate Director, Medicaid Implementation (  Project Management  ) develops and maintains a Medicaid Implementation Project Management Office (MPMO). Responsible for the strategic and operational oversight of multiple projects to support business objectives through project planning and implementation. Responsible for project management methodology and standard reporting.
Leads large scale and complex projects and initiatives throughout across the entire enterprise.

Provides leadership and oversight of the business unit’s entire implementation processes; managing company adherence to standard implementation processes for both Business and IT.

Manages project staff involved in the planning, development and implementations.

Manages business and program implementations to meet budget, timeline, and contractual requirements.

Maintains standard business implementation organizational structures, team structures, work breakdown structures, work planning, issue logs, decision logs, change control and executive reports.

Provides input on operating models, including standard corporate functional and information system models, performance metrics, expected outcomes and plan impacts.

Coordinates enterprise wide cross-functional tasks between various internal and external areas to ensure successful project outcomes.

Communicates project status to all internal and external stakeholders.

Mentors project team members and stakeholders using appropriate tools and techniques in order to increase and maintain commitment to portfolio objectives.

Identifies and reduce redundancies among projects when necessary.

Leads change management activities.

Identifies and develop contingency plans to mitigate and address risks.

Sets the pace and manage the cadence of Medicaid Implementation activities.

Acts as the Humana point of contact for implementation activities with the government partners during the implementation.

Supports Market leadership in delivering the contractual obligations required under the State Medicaid RFP/Contract.

Required

Qualifications
Bachelor’s Degree or equivalent experiences.

Five (5) or more years of technical and/or business project management experience.

Two (2) or more years of leadership experience.

Must have a room in your home designated as a home office; away from high traffic areas where confidential information may be secured.

Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NO

T allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.

Associates working in the state of Arizona must comply with the Tobacco Free Hiring   Policy (see details below under Additional Information)   and upon offer will be subjected to nicotine testing as part of a 10-panel drug test.

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

Preferred

Qualifications
Knowledge of Systems Development Life Cycle, Waterfall, and Agile Development Methodologies.

Possess a solid understanding of operations, technology, communications and processes.

Proficiency in Microsoft Office programs.

Experience working in Medicaid and/or Medicare.

Possess a solid understanding of operations, technology, communications and processes.

Six Sigma and / or Project Management Institute certification.

Additional Information
Travel:
up to 25% to various states.

Direct Reports:
up to 12 associates.

Work Days/Hours:
Monday – Friday;
Eastern Time Zone.

The following policy applies ONLY to associates working in the state of Arizona:
Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, Humana adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.

Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Montage/Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
40

 
 

 
 

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Job Description

Come as you are | Become who you want to be | That is our promise.

Acknowledging the National history of systemic inequality and inequity, DMAS continues to take a stand for social justice.

DMAS remains committed to creating a more diverse, inclusive and equitable environment in Virginia by fostering excellence internally and externally in providing services to Medicaid Members and the Commonwealth.

We are driven by a core commitment to diversity, equity and inclusivity.

DMAS promotes a working environment where persons from all backgrounds and experiences are welcome, safe, and respected.

Ven como eres | Conviértete en quien quieres ser | Ésta es NUESTRA promesa.

Reconociendo la historia nacional de desigualdad e inequidad sistémica, DMAS continúa defendiendo la justicia social.

DMAS mantiene su compromiso de crear un entorno más diverso, inclusivo, y equitativo en Virginia fomentando la excelencia interna y externa en la prestación de servicios a los Miembros de Medicaid y al estado de Virginia.

Nos impulsa un compromiso fundamental con la diversidad, la equidad y la inclusión.

DMAS promueve un ambiente de trabajo donde las personas de todos los orígenes y experiencias son bienvenidas, están seguras y son respetadas.

The Department of Medical Assistance Services (DMAS) is currently seeking a Policy Integrity Analyst to provide managed care oversight in the review of program integrity strategies and provide technical assistance as needed.

This role will perform compliance reviews of Medicaid services to determine compliance with contracts/agreements in addition to Federal and State regulations and policy; Determine through medical record reviews that the criterion for reimbursement is met and services were rendered according to federal, state regulations and policy for all Medicaid programs; Identify the existence of abusive billing practices.

They will identify non-compliance, overpayments and potential fraud, abuse and waste and take necessary steps for reporting; Process referrals and complaints received, to include processing referrals to be sent to the Medicaid Fraud Control Unit (MFCU) at the Office of the Attorney General (OAG); Participate in policy/procedure development and provide training and/or technical assistance to providers, Managed Care Plans and DMAS staff.

In addition, they will conduct compliance reviews on fee-for-service and managed care provider types enrolled in the Medicaid Program, as well monitor compliance with auditing contracts and managed care plans using Federal and State regulations, DMAS policy and contract compliance.

Through reviews, they will determine that the criterion for reimbursement is met according to federal, state regulations and policy for all Medicaid programs; identify the existence of any abusive billing practices, overpayments, potential fraud, or abuse and waste, and take the necessary steps for reporting their findings.

Minimum Qualifications

Qualified candidates, at minimum, must have:Knowledge of managed care plans, principles and technical methods of medical auditing, utilization review/utilization management for Medicaid programs and contract compliance.

Knowledge of federal and state Medicaid regulations, policy and procedures.

Knowledge of the health and social service needs of children and/or disabled individuals, and others with special health care needs.

Knowledge of medical standards of treatment and medical terminology; ICD and CPT coding and clinical aspects of medical care.

Knowledge of current health care trends, quality assurance issues and health care statutes and regulations.

Skilled in the use of PC, spreadsheets, database and word processing programs as well as Medical Management Information Systems.

Demonstrated ability to analyze legislative and regulatory statutes and interpret health care contracts.

Demonstrated ability to prepare comprehensive reports and communicate effectively through presentations.

Ability to review and present complex and highly technical policy analyses.

Ability to analyze the audit findings using a spreadsheet software program.

Ability to organize and prioritize work assignments, prepare reports, develop and conduct trainingAbility to maintain the privacy and security of Protected Health Information (PHI) and other confidential information.

Ability to analyze computer-generated reports and medical records to determine the appropriateness of billing and medical necessity for and appropriateness of treatment.

Ability to work independently and to communicate effectively orally and in writing.

Ability to develop and maintain effective working relationships in order to successfully achieve core tasks.

Experience with healthcare policy development, review and revisions.

A valid Virginia driver’s license is required.

Preferred Qualifications

Special Requirements

This position is expected to work both remotely and/or in the office as driven by business needs.

Ability to work remotely is required.

The Department of Medical Assistance Services is an Executive Branch agency.

In accordance with Governor Ralph Northam’s Executive Directive Number 18, all Executive Branch employees and state contractors who enter the workplace or have public-facing work duties must disclose their vaccine status to the designated agency personnel.

Executive Branch employees who are not fully vaccinated or who refuse to disclose their current vaccine status must undergo weekly COVID-19 testing and disclose weekly the results of those tests to the designated agency personnel.

This provision applies to all Executive Branch employees whether working remotely or in the office.

Special Instructions to Applicants

DMAS will only accept online applications/resumes submitted through the RMS by 11:59 p.m. on the referenced closing date.

In accordance with the DHRM Employment Equity Initiative adopted on July 1, 2019, State applications have been streamlined.

Applicants have the option to utilize their resume to provide detailed work history.

Consideration for an interview is based solely on the information within the application and/or resume.

Applicants requiring accommodation to apply for this position should contact the Agency receptionist for assistance.

ADA/EEO/AA

Name DMAS Talent Acquisition

Phone

Fax

Email askhcdtalentacq@dmas.virginia.gov

 
 

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