Category: Curator- Job Hunter

 
 

DataStaff is seeking a Medicaid IT Project Communications Specialist for a long-term contract opportunity with one of our direct clients located in the Raleigh, NC area.

This role is 100% remote and candidates across the US are welcomed to apply.

Job Responsibilities:

• Leading/supporting efforts associated with project and program level communications analysis and development, stakeholder analysis, governance management and facilitation, and achieving strategic program communications goals.
• Conduct interview assessments with stakeholders, engage project delivery teams and stakeholders to implement and execute communications plans, gather information communications tasks and activities, organize, and facilitate formal meetings, design, and create written and visual content for distribution to internal and external parties including, but not limited to, internet/intranet, email, print and other communications channels.
• Interface with business stakeholders may occur daily.

Knowledge and Experience:

• Exceptional facilitation and presentation skills and technically savvy with Tableau and Microsoft Office Suite tools.
• Experience facilitating IT governance and can develop governance materials, facilitate governance meetings according to ‘Roberts Rules of Order’, and maintain excellent rapport with program leaders that participate in the governance forums.
• Expert knowledge of ITIL, PMBOK and Agile processes is a must to manage different aspects of project governance communications.
• Experience in Organizational Change Management is also preferred.

Required Skills:

• 7 Years – Total experience in IT Project Communications management
• 7 Years – Foundational knowledge and understanding of information technology systems and terminology.
• 7 Years – Experience with interpreting complex and detailed technical information and preparing clear, concise communications for non-technical audiences.
• 7 Years – Exceptional communication skills with attention to detail and accuracy.
• 7 Years – Ability to organize and facilitate meetings in a way that keeps participants focused on objectives and desired outcomes.
• 7 Years – Proficient knowledge of PMBOK Stakeholder and Communications Management areas and best practices.
• 7 Years – Strong interpersonal skills and ability to collaborate with diverse cross-functional teams.
• 3 Years – Experience with Agile development methodology, preferably SAFe and/or Scrum
• 7 Years – Experience developing healthy relationships with stakeholders to support communications strategies and performance.
• 7 Years – Experience supporting internal and external communications and engagement programs.
• 7 Years – Experience evaluating results of communication efforts.
• 3 Years – Experience with web, graphic and visual design, particularly dashboard design, preferably in Tableau.
• 7 Years – Strong proficiency of Microsoft Office Suite and communications management tools, including creative software.
• 3 Years – Expert knowledge of ITIL processes

Highly Desired Skills:

• 7 Years – Experience in formal content development including long-form and short-form writing on topics related to government.
• 3 Years – Experience setting up and/or deploying IT governance frameworks
• 3 Years – Experience facilitating IT governance meetings
• 3 Years – Experience developing IT governance meeting materials
• 3 Years – Knowledge of Managed Care, the Medicaid Program, and/or Medicaid Enterprise IT Systems
• 3 Years – Organizational Change Management experience

Desired Skills:

• 3 Years – Experience with HIPAA, PHI, and PII
• 3 Years – Knowledge of AP Stylebook and proofreading and editing.
• 3 Years – Knowledge of data visualization best-practices.
• 3 Years – Public Relations experience a plus.

This opportunity is available on a corp-to-corp basis or as a W2 position with a competitive benefits package. DataStaff, Inc. offers medical, dental, and vision coverage options as well as paid vacation, sick, and holiday leave. As many of our opportunities are long-term, we also have a 401k program available for employees after 6 months.

 
 

Clipped from: https://www.dice.com/jobs/detail/95c254ec6e10367900f8e614034cc129?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. Ameri

Health Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, Ameri

Health Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most.

We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at .

NO EXCEPTIONS PLEASE. MUST RESIDE IN/NEAR DELAWARE

Responsibilities:

 

The AE II is responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers. Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations. AE II maintains in depth understanding of Plan’s contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues.

Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the Plan’s territory in keeping w/ State and Federal contact mandates for all products. Identifies, contacts and actively solicits qualified providers to participate in Plan at new and existing service areas and products, assuring financial integrity of the Plan is maintained and contract management requirements are adhered to, including language, terms and reimbursement requirements.

Maintains complete understanding of Plan reports and metrics and uses them to evaluate the performance of assigned providers/practices/facilities, determining, communicating and implementing plans for providers to improve performance and measuring ongoing performance. Uses data to develop and implement methods to improve relationship. Assists in corrective actions required up to and including termination, following Plan policies and procedures. Supports the Quality Management department with the credentialing and re-credentialing processes, investigation of member complains and any potential quality issues.

Maintains a functional working knowledge of Facets, including the provider database and routinely relays information about additions, deletions or corrections to the Provider Maintenance Department. Maintains and delivers accurate, timely activity and metric reports as required. Identifies and maintains strong partnerships with appropriate internal resources and stakeholders.

Education /

Experience:

 

• Bachelor’s Degree or equivalent experience.
• Minimum of 5 years of managed health care experience with demonstrated skill and proficiency with software applications capable of provider-specific reports, such as network adequacy, payment rules, provider services and directory.
• Required Claims processing and Provider Data Maintenance knowledge.
• Understanding of and experience related to healthcare claims payment configuration process/systems and its relevance/impact on network operations required. This would include experience with Facets or similar applications and their supporting database schema and structure.
• Formal training or equivalent experience in the effective use of reporting and querying software such as MS Excel, MS Access, Crystal Reports and/or SQL required.
• Advanced experience with sophisticated databases. Full competence in report preparation, layout and design.
• Ability to plan, organize and handle multiple tasks.
• In depth expertise in data analysis and data mining. Superior analytical skills.

Clipped from: https://www.learn4good.com/jobs/online_remote/healthcare/587114639/e/

 
 

Medicaid Enrollment Manager

Operations Manager

In the Operations Manager role you will Anticipate, understand, and exceed stakeholder needs and expectations by providing remarkable service in a timely manner, demonstrate open, honest, and transparent communication in all interactions, speaks, listen, convey, and share ideas in a clear, logical, and successful manner. Initiative, demonstrate and exhibit leadership qualities that include, developing skills and encouraging growth, staff involvement in planning, and process improvement, foster quality focus in others, process improvement, and provide frequent performance feedback and encourage positive participation among team members.

Responsibilities may include but are not limited to:

 
 

• Drive operational performance of vendors for each core process to meet contractual requirements and align with the Enterprise strategic objectives.
• Oversee day-to-day stakeholder engagement efforts including hold daily and/or weekly huddles, assess risk and remediate enrollment file management risks, drive priorities and escalation resolutions.
• Lead organizational cross-functional reviews of end-to-end enrollment processes, establish and validate workflows, identify and resolve operational gaps as – needed basis.
• Develop, review and meet organization criteria related to enrollment operations, turnaround times, quality, regulatory and accuracy requirements. Monitor operational performance metrics ensuring plan reporting requirements are met timely and within plan compliance and enrollment deadlines.
• Partner with enrollment peers to generate and validate performance KPI scorecards, reporting deliverables and audit universes. Participate in the presentation of information to customers and internal business areas.
• Lead cross-functional performance improvement initiatives focused on quality, efficiency and customer experience and aligned with strategic objectives such as Medicaid/Medicare STARS.
• Demonstrates a solid understanding of operational processes and controls and monitors the execution of operational changes required by regulations and guidelines associated with Medicaid Enrollment.
• Provide guidance on delegated function oversight, including dashboard development.
• Assist in enhancing metrics related to delegation oversight to ensure compliance with regulatory and plan requirements.
• Serve as the subject matter expert and point of contact for state Medicaid and Medi-Cal agencies.
• Conduct routine regulatory review and document preparation (i.e., state licensure, regulatory notification letters, ownership disclosure charts).
• Ensure all records and files are securely maintained and confidential information is handled with utmost discretion in compliance with legal department policies.
• Create and document process flows, functional and technical requirements in user stories, process maps for user experience design, testing and implementation.
• Accountability for the delivery of key client professional services projects, ensuring projects are effectively delivered on-time projects and to customer expectations. Lead large projects/ programs as needed and delivery ensuring all stakeholders understand respective roles and portfolio process best practices
• Ensure that enrollment process improvement work is conducted in compliance with standard processes, policies and procedures and meets mutually agreed upon success criteria and project timeline metrics.

 
 

Location for this position is Phoenix, AZ.

Qualifications

Basic

•  Bachelor’s Degree
• At least 7 years’ experience

 
 

Preferred

·    Excellent interpersonal and communication skills to deal effectively with all necessary levels within and outside the organization

 
 

·    Demonstrates analytical and innovative excellence for current state and future state challenges at both the strategic and tactical level.

·    Strong organizational skills and superior attention to detail. Strong decision maker.

·    Ability to review documents for accuracy, completeness, and compliance; compile data and information for reports; compose letters and memoranda.

·    Ability to gather and research data (i.e., statutes, regulations, articles).

 
 

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

 
 

COVID-19 Considerations:

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

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

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

About Us

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

 
 

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

 
 

Clipped from: https://www.linkedin.com/jobs/view/operations-manager-medicaid-enrollment-at-infosys-bpm-2714535901/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Humana Inc. Charlotte, NC

medicaid utilization utilization management management coordinator remote health administration utilization review prior authorization managed care dsl

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• Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization
• Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited).
• Proficient and/or experience with medical terminology and/or ICD-10 codes
• In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities.
• The UM Administration Coordinator 2 contributes to administration of utilization management for Humana’s KY Medicaid plan.
• Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.
• This position may be subject to temporary work at home requirements for an indefinite period of time.
• If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.

 
 

Clipped from: https://tarta.ai/j/DqUx5nsBwQhUzTBVT8rX-medicaid-utilization-management-coordinator-remote-work-at-home-in-charlotte-nc-at-humana-inc?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

The Office of Planning and Budget (OPB) exists to serve the Governor and the state in five primary ways:

 
 

Work with the Governor each year to develop a budget recommendation for the upcoming and amended fiscal years that is based on agency requests and that will be presented to the General Assembly

Provide research and analysis to the Governor’s Office and other state agencies related to budgetary items as well as to produce an efficient and effective state government

Review the agencies’ annual operating budgets to ensure that spending plans comply with the approved appropriations act, sound fiscal stewardship, and the Governor’s goals

Develop the state’s strategic plan, outlining the Governor’s vision for the state and how agencies can best support that vision

Supply official demographic and statistical data about the state of Georgia

 
 

 
 

OPB Fiscal Policy Analyst assists in the development and monitoring of agency budgets and policies for executive and legislative review. 

OPB analyst analyze laws proposed by the General Assembly and respond to inquiries from general public, legislators, and state agencies. 

Analyst monitor expenditures as compared to budget and appropriations, and perform detailed and complex revenue and expenditure projections.

 
 

 
 

This posting is for the:

 
 

HEALTH AND HUMAN SERVICES DIVISION (HHS)

 
 

Performs budget and policy analysis related to health care purchasing, state health planning, welfare, veterans’ services, workers’ compensation, and other human and social services.

 
 

Job Duties and Responsibilities:

 
 

Analyze agency budget requests and prepare recommendations for review

Analyze and review agency budget spend plans

Analyze and review agency allotment requests

Analyze complex data sets

Monitor and analyze state and federal legislative and policy proposals and advise division director

Assist in the preparation of fiscal notes on pending legislation

Conduct research on key budget and policy priorities for assigned area

Develop broad expertise into assigned agencies

Work with assigned agencies to gain understanding of agency programs and initiatives

Prepare presentations, white papers and policy briefs on budget recommendations and options, program reviews, and policy related topics for assigned area

Assist in the preparation of various documents published by the office

Prepare responses to public inquiries for management review

Monitor expenditures as compared to budget and appropriations

Perform detailed and complex revenue and expenditure projections

Conduct and review multi-year financial trends

Monitor performance of agency programs

Other duties as assigned

 
 

Job Requirements:

 
 

Ability to multi-task and think critically

Ability to work in a professional group environment

Must be detail oriented

Ability to present to a group

Must be flexible

Ability to effectively communicate orally and in writing

Ability to communicate information in a clear, concise, and logical manner with coworkers, supervisors, and customers, adapting style and content to the audience’s needs

Ability to occasionally move about in an office environment and to and from offsite locations

Ability to manage time and work under environment strict deadlines during peak periods

Limited travel required for agency site visits

Frequent moving of laptop, books, paperwork, etc. under 15lbs

Constant operation of a computer and frequent operation of other office productivity machinery such as a phone, scanner, copier, and printer

Constant use of word-processing, database and e-mail functions to carry out job requirements in a timely manner

Ability to learn and use new software programs

Occasional re-positioning of self to access computer, printer, phone, and other office productivity machinery

Ability to work in EXCEL, Microsoft Suite and other computer applications

Attend workshops, trainings, and meetings when scheduled

 
 

Preferred Qualifications:

-Knowledge of regulations regarding public or Medicaid benefit programs

-Experience in research, gathering, interpreting, and summarizing Medicaid data

-At least two (2) years of Medicaid experience in operations and/or financial analysis, with major duties of which included at least two or more of the following: budgeting, accounting, auditing, financial reporting, or another quantitative field.

 
 

 
 

 
 

Please attach a transcript and resume 

 
 

Additional Information: Due to the volume of applications received by this office, we are unable to provide information on application status by phone.　

Bachelor’s degree in business or related degree from an accredited college or university AND One year work experience in a position equivalent.

Additional Information

• Agency Logo:

 
 

• Requisition ID: FIN030S
• Number of Openings: 1
• Advertised Salary: 63,545.00
• Shift: Day Job

 
 

 
 

Clipped from: https://careers.georgia.gov/jobs/fiscal-policy-analyst-3-8227

 
 

Terms of Employment

• W2 Contract, 4 Months 
• Onsite in Tallahassee, FL 
• Work Schedule:
• M-F 7:00 AM to 6:00 PM MT on all State business days(excluding Wyoming State holidays).

 
 

Overview

• This Call Center Representative is a front-line service position aiding Wyoming Benefits Management System and Services (WY BMS) members and providers regarding programs, policies, and procedures.
• Responsibilities include:
• Answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers.
• Administration of intake documentation into the appropriate systems.
• Overall expectations are to provide outstanding service to internal and external customers and strive to resolve member and provider needs on the first call.
• Performance expectations are to meet or exceed operations production and quality standards. 

 
 

Training Details

• Training Schedule
• 8 AM to 5 PM EST subject to changes if necessary.
• Post Training Schedules
• May vary upon call volumes and other factors.

 
 

Responsibilities

• Responsible for meeting call handling requirements and daily telephone standards as set forth by management; accurately respond to inbound phone calls and processing provider and member inquiries and requests into the appropriate system and database.
• Under general supervision, resolve customers’ service or billing complaints by demonstrating sound judgement; contact customers to respond to complex inquiries or to notify them of claim investigation results and any planned adjustments.
• Under general supervision, resolve customer administrative concerns as the first line of contact this may include
• Claim resolutions and other expressions of dissatisfaction; refer unresolved customer grievances, appeals, and claim resolution to designated departments for further investigation.
• Actively listen and probe callers in a professional and timely manner to determine purpose of the calls, keep records of customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken.
• Under general supervision, research and articulately communicate information regarding member eligibility, benefits, services, claim status, and authorization inquiries to callers while maintaining confidentiality.
• Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
• Assume full responsibility for self-development and career progression; proactively seek and participate in ongoing training sessions (formal and informal).
• Educate providers on how to submit claims and when/where to submit a treatment plan.
• Under general supervision, perform necessary follow-up tasks to ensure member or provider needs are completely met.
• Support team members and participate in team activities to help build a high-performance team.
• Thoroughly document customers’ comments/information and forward required information to the appropriate staff.
• Escalate calls to Call Center Lead when necessary

 
 

Required Skills & Experience

• High school graduate or have equivalent experience.
• Must have Healthcare experience
• Good verbal and written communication skills, attention to detail, customer service skills and interpersonal skills.
• Work independently and manage your time and can accurately document and record customer/client information.
• Customer service-related experience.
• Previous experience with computer applications, such as Microsoft Word and PowerPoint.
• Must be a proficient typist (avg. 35+ WPM) with strong written and verbal communication skills.
• Must be able to maneuver through various computer platforms while verifying information on all calls.
• Must be able to talk and type simultaneously.
• Must be flexible in scheduling and comfortable with change as customer service is an ever-changing environment.
• Must be able to manage difficult calls with angry customers without getting rattled.
• Must be proficient in windows computer systems and able to navigate multiple monitors and systems simulatenously

 
 

Preferred Skills & Experience

• Bilingual Spanish speaking.
• Medicaid experience.

 
 

 
 

Clipped from: https://www.linkedin.com/jobs/view/call-center-csr-healthcare-medicaid-at-ntech-workforce-2709520426/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

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

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

Location: Seeking candidates that reside in the states of either Washington, California, Nevada, Texas, Minnesota, Indiana, Kentucky, or Georgia.

The Pharmacist Program Manager is responsible for serving as the primary pharmacy contact for Amerigroup Washington.

Primary duties include but are not limited to:

• Represent Amerigroup Washington Medicaid pharmacy program for the region, externally;

 
 

• Face of plan to Government Relations, WA HCA
• Attend state meetings, respond to email inquiries

 
 

• Represent Amerigroup Washington Medicaid pharmacy program within the health plan and with PBM vendor
• Maintain, enhance and modify components of the pharmacy program as needed to align with State mandate, health plan goals and pharmacy program national Medicaid best practice
• Prepare and present routine pharmacy program updates within various forums, including but not limited to: quarterly business reviews, regulatory meetings, quality meetings to support accreditation, biweekly trend meetings
• On occasion solve claims issues and complaints with the support of Pharmacy Operations team or Medicaid Account Management team
• Perform routine benefit surveillance to assure benefits are working correcting, optimal penetration of preferred products, low claim reject volumes
• Assure successful implementation of program changes including: state mandates and programs to improve the member and provider experience, contain costs and improve quality of service
• Present and report on Enterprise quality programs that impact the market:

 
 

• Advocate for plan needs
• Identify, develop, and/or advocate for quality programs that will drive more favorable withhold measures (local, enterprise)
• Report on the productivity and outcomes of clinical quality programs
• Assure appropriate access for health plan staff to RX tools
• Assure all necessary client/vendor accountability reporting is complete, accurate an on time.
• Develop and implement communications to pharmacies, prescribers and members as necessary to improve member and provider experience and reduce cost.

Qualifications

• Requires a Registered Pharmacist;
• 2 years of managed care pharmacy experience including knowledge of current health care and managed care pharmacy practices; or any combination of education and experience, which would provide an equivalent background.
• Current state license to practice pharmacy as a RPH is required.
• Minimum 2 years of managed care pharmacy experience that is NOT RETAIL PHARMACY related preferred
• Proficiency in MS Excel, Power Point, Outlook.
• Program Management experience in managed care or other related field
• Must demonstrate proficiency as a key participant in program development, where the program seeks to satisfy regulatory requirements, improve clinical outcomes, quality, cost or other measure.
• Must demonstrate proficiency in clinical/technical communication to business leaders, an ability to communicate messages pertaining to programs and systems using data and other details in a way business leaders can understand
• Day travel and occasional overnight travel may be required
• Experience with government programs (Medicare/Medicaid) strongly preferred

 
 

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.

 

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/7356560-pharmacist-program-mgr-managed-care?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

HHS Technology Group Nashville, TN

HHS Tech Group, we are a software development company specializing in healthcare insurance heavily targeted to State Government health initiatives. Our Software is called Discover your Provider (DYP). The software is built on Java stack and it is modular and easily customizable to enable us to enhance and customize the financial and billing components of our product to fulfill a myriad of complex technical software initiatives for a myriad of solutions. This solution will be implemented for an enterprise wide complex initiative for the State of TN.

The Service Manager shall be familiar with Agency’s business operations and objectives. The Service Manager will participate with Agency in regular meetings and report on all project SLA’s and KPI’s as deemed necessary by the State.

The Service Management Manager is responsible for reporting KPIs and SLAs. This position will enforce contract SLAs associated with the contractors.

• A minimum of five (5) years of managing and reporting on Service Level Agreements.

 
 

• A minimum of five (5) years of reporting on KPI metrics
• A minimum of three (3) years of managing performance outcomes for system upgrades.
• A minimum of three (3) years of experience managing projects of similar size and complexity.

 
 

• A minimum of three (3) years of experience managing and reporting on Incident tickets.

 
 

• Working knowledge of the Contractor’s PI Solution.

The Service Manager must:

1. Provide measurement and monitoring reports to verify compliance with the Service Level Agreements;
2. Review the Solution and Contractor’s performance throughout the Contract and discuss possible improvements;
3. Discuss Upgrades and Enhancements to the Solution or any new technologies that may be available for Agency;
4. Discuss any other Agency-raised issues or concerns; and
5. Provide at Agency’s request such other reports as Agency may request.

Please visit https://hhstechgroup.com/products/#discover-your-provider for more information about HHS Technology Group’s product suite.

HHS Tech Group employees enjoy a very comprehensive and competitive benefit package:

Affordable and comprehensive medical, dental, vision, life insurance, and disability insurance.
Generous 401k matching program fully vested from beginning.
Generously sponsored Medical Insurance through Cigna (PPO or HSA – with company match)

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Clipped from: https://www.ziprecruiter.com/c/HHS-Technology-Group/Job/Service-Manager-Fraud-Waste-and-Abuse-(FWA)-State-Gov-Medicaid/-in-Nashville,TN?jid=976f926f2b912329&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Description
The Senior Product Manager, Digital, will contribute to digital transformation and innovation of data products to present, transform, and distribute Medicare and Medicaid product data to better serve our associates, members, and enterprise partners.
Responsibilities
Humana is a Fortune 100 healthcare company with a long history of successful innovation and reinvention. For more than 50 years Humana has been a proven leader and innovator in the health and wellness industry. A passionate emphasis on people, choice, well-being, and innovation guide our business practices and culture. We’re not just a health insurance company, we are increasingly a healthcare company innovating to best serve seniors and low-income individuals through our Medicare and Medicaid businesses.
The Senior Product Manager, Digital, will contribute to digital transformation and innovation of data products to present, transform, and distribute Medicare and Medicaid product data to better serve our associates, members, and enterprise partners. Our user-facing applications and supporting data products and services will allow Humana to better serve our members through our call centers, care managers, providers, and directly. Products are built using state-of-the-art cloud technologies and data-driven architecture.
As the Senior Product Manager you will work closely with delivery teams to drive product development, users and stakeholders to analyze business systems and processes, business partners to roll out products and ensure adoption, and data analytics partners to communicate results. Our internal development partners include design, engineering, data engineering, dev ops, and QA superstars who follow agile best practices. Our internal stakeholders include insurance product, strategy, customer service, care management, home care, digital health & analytics, and IT.
The Senior Product Manager will report to the Director, Digital and Data Products within the Enterprise Experience Transformation organization. This is a high impact position with high growth potential.
Required Qualifications
– Three or more years of agile product management, business analyst, content management, product owner, or scrum master experience
– Strong analytic and problem-solving skills
– Strong stakeholder management and meeting facilitation skills
– Excellent written and verbal communication skills
– Ability to break down tasks and prioritize based on business needs
– All-hands-on-deck contributor
– WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.
Preferred Qualifications
– Experience navigating complex organizations
– Experience analyzing complex problems and opportunities
– Healthcare business experience
ADDITIONAL INFORMATION
This position can be located in Humana Boston or Louisville offices or remotely elsewhere in US. Post-COVID, occasional travel to Humana offices will be required.
As part of our hiring process, we will be using an exciting interviewing technology provided by 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 or computer 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

 
 

Clipped from: https://tarta.ai/j/U7lew3sBKVDGKatzwajb-senior-product-manager-digital-in-birmingham-al-al-at-humana?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

This is investigative work involving the interpretation of policy to determine Medicaid eligibility for families and children and aged, blind, and disabled individuals. The incumbent makes the initial and continuing determinations of eligibility for Medicaid recipients who live in private and institutional settings. Limited supervision is received from administrative supervisors who oversee a regional office or Central Enrollment Office.

Examples of work performed in this classification include, but are not limited to, the following:

 
 

Assumes responsibility for a Medicaid eligibility determination caseload for a designated territory within a region. 

 
 

Investigates and verifies accuracy of information provided by recipients under the Medicaid programs to determine compliance with State and Federal laws, rules, and regulations.

 
 

Determines an applicant’s eligibility for institutional care based on State and Federal guidelines and verifies the accuracy of information listed on the applicants’ applications.

 
 

Maintains effective public relations with medical facilities and federal, state, county, and city agencies within assigned territory.

 
 

Verifies accuracy of information listed on applicants’ applications including income, bank accounts, and any other assets.

 
 

Makes determination of an applicant’s eligibility based upon established criteria.

 
 

Visits contact centers and medical facilities; assists other regional offices on an as-needed basis.

 
 

Performs related or similar duties as required or assigned.

These minimum qualifications have been agreed upon by Subject Matter Experts (SMEs) in this job class and are based upon a job analysis and the essential functions. However, if a candidate believes he/she is qualified for the job although he/she does not have the minimum qualifications set forth below, he/she may request special consideration through substitution of related education and experience, demonstrating the ability to perform the essential functions of the position. Any request to substitute related education or experience for minimum qualifications must be addressed to the Mississippi State Personnel Board in writing, identifying the related education and experience which demonstrates the candidate’s ability to perform all essential functions of the position.

EXPERIENCE/EDUCATIONAL REQUIREMENTS:

Education:
A Bachelor’s Degree from an accredited four-year college or university.

OR

Education:
An Associate’s Degree or completion of sixty (60) semester hours from an accredited college or university;

AND

Experience:
Two (2) years of experience related to the described duties.

Substitution Statement:
Above an Associate’s Degree or completion of sixty semester hours from an accredited college or university, related education and related experience may be substituted on an equal basis.Additional essential functions may be identified and included by the hiring agency. The essential functions include, but are not limited to, the following:

1. Maintains caseload for Medicaid eligibility.

2. Maintains good public relations and customer service.

3. Collects eligibility data information.

4. Visits Medicaid contact centers and/or long-term care facilities.

 
 

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