Category: Curator- Job Hunter

 
 

Location: Remote

Categories: Customer Support & Administration

Req ID: 2021-46528

Job Description

About Conduent

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them.

You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Job Description

Responsibility Statements

• Oversees day-to-day operations (functions and activities) for the medical claim adjustments and corrections team, including people management and operational subjects.
• Provides expertise and general claims support to teams in reviewing, researching, investigating, processing, and adjusting claims.
• Assists in business unit performance driving SLAs and adherence to business unit metrics.
• Drives innovation and efficiencies of business opportunities, applying processes improvements, and new systems.
• Helps manage employee teams through coaching and development
• Addresses people matters and identifies development opportunities.
• Day-to-day operations client contact to resolve systems issues.
• Provides feedback to clients on quality and workload issues.
• Generates reports on performance measurement and KPIs to facilitate business decisions.
• Lead project management and implementation activities
• Performs other duties as assigned.
• Complies with all policies, procedures, and standards.

Required Qualifications:

• Bachelor’s Degree (or higher)
• 5+ years of supervisory/managerial experience in claims adjudication (medical claim processing, adjustments, and corrections) and/or Provider Dispute Resolution (PDR) process
• 2+ years of managing relationships with clients and/or vendors
• Intermediate skills with Microsoft Word (create and edit documents and add visual aids), Microsoft Excel (create, edit, sort, filter, create pivot tables), and Microsoft PowerPoint (create and edit presentation)

Preferred Qualifications:

• Understanding of claims processing systems
• 10+ years of healthcare claims leadership experience
• Senior Level Supervisory/Managerial experience in medical claims

Job Track Description:

• Requires broad technical expertise and industry knowledge.
• Accountable for program management functions.
• Assists others in achieving goals.
• Manages performance appraisals and pay reviews.
• Manages training for 3 or more employees.
• Manages hiring and termination actions.
• Requires broad technical expertise and company/industry knowledge.
• Is accountable for program management functions.

General Profile

• Accountable for team performance and results.
• Manages professional employees and/or supervisors.
• Adapts plans and priorities based on resource and operational challenges.
• Acts based on policies, procedures.
• Provides technical guidance to employees, colleagues, and customers.

Functional Knowledge

• Understands and applies concepts in the field of expertise.
• Has growing knowledge of other disciplines.

Business Expertise

• Translates strategy and priorities into work product.

Impact

• Positively impacts the level of service.
• Impacts the team’s ability to meet quality, volume, and timeline targets.
• Guides based on policies, resource requirements, budgets, and business plans.

Leadership

• Builds team engagement to meet service and operational challenges.
• Provides recommendations for OT, operational expenses, and rollup data.

Problem Solving

• Resolves technical, operational, and organizational problems.
• May take part in solving problems across a matrix.

Interpersonal Skills

• Guides and influences internal and external customers, or agencies.

 
 

 
 

Clipped from: https://jobs.conduent.com/job/13813067/manager-medical-claim-adjustments-medicaid-remote-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

CVS Health Overland Park, Kansas

director financial analysis medicaid cfo health people finance travel leadership management

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Job DescriptionThis role must reside near Overland Park, KS office location. You must reside in KS or be willing to relocate near commutable distance to office location.We are hiring a finance leadership role! Aetna, a CVSH Health Fortune 4 company is hiring a Finance lead to support Kansas Medicaid. You will be full-time office based with some work from home opportunity. Must reside in Kansas and be within commutable distance to office location. The Chief Financial Officer (CFO) will implement a defined management process for driving best practices within functions of responsibility. You will direct a group of 4 financial professionals. You oversee the implementation and monitoring of financial functions that support the business units’ financial plans. You may participate in projects that impact all functional disciplines (non-financial) of the company. You will report to the Executive Director, Regional CFO.Fundamental Components:•Oversee the Kansas Medicaid Plan’s budget and forecasting processes. Have access to an actuary and ensure that the Kansas Plan meets state requirements for financial performance and reporting.•Evaluate and analyze the financial impact of key business strategies (, market exits, acquisitions, etc.).• Analyze and critically evaluate growth opportunities.•Direct the evaluation of business area projects, challenging financial resources, resolving expense savings.•Support the coordination and development of business unit financial plans and forecasts.•Oversee the implementation of processes for achieving business goals.•Manage a team of 4 associates and position for future growthRequired Qualifications•Minimum 10+ years financial experience including strategic and business planning, financial planning, analysis, P&L, reporting or accounting•Industry knowledge of Healthcare/managed care, insurance•Leadership and people manager experience•Project Management and Process Improvement experience.•Travel 5-10% of the time. In-state travel requires use of personal vehicle. Have valid/active driver’s license and proof of vehicle insurance. Some travel out of state also anticipated for internal meetings.Preferred Qualifications•Medicaid Product knowledge•Advanced degree in Business and/or FSA/CPA•Degree in Finance, Accounting, Actuarial Science, or similar disciplinesEducation• Bachelor’s Degree requiredBusiness OverviewAt CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

 
 

Clipped from: https://tarta.ai/j/baJvvHsBKVDGKatz78e2-director-financial-planning-and-analysis-ks-medicaid-cfo-in-overland-park-kansas-at-cvs-health?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Navitus

Madison, WI

2 days ago

• Job Type(s)

Full Time

• Industry

Non-Executive Management | Information Technology | Advertising/Marketing/Public Relations

• Job Description

Education: A minimum of a Bachelor’s Degree in Business, Health Care Administration, or closely related field is required. A Master’s degree or seven to ten years of experience in administering health insurance programs product management is strongly desirable.

Experience: Experience and expertise in new product development, product management, marketing and sales and/or strategic planning with a ‘track record’ of tangible success, including leadership and team collaboration/relationship-building/management in a health care or related environment is essential. Direct extensive knowledge and experience with government programs, particularly Medicaid legislation and program content is required. Familiarity with understanding and communicating complex and contradictory state and federal law, regulations or guidance is also required.

Key Skills/Competencies:

• Ability to think strategically (big picture) yet manage projects at a very detailed level
• Project Management, requirements gathering and ability to prioritize continually/multi-task
• Leadership and ability to communicate a compelling vision for the program/products
• Comfortable with a matrix environment
• Ability to build and manage relationships
• Critical thinking/Problem-solving
• Judgment and Decision-making
• Initiative and creativity
• Negotiation Skills and Conflict Resolution/Management
• Communication Skills (written, verbal/presentation and active listening)
• Teamwork/Collaboration
• Customer-Centric Skills, and ability to understand internal and external customers
• Understanding and coping with constant change

Job Summary: Position can be filled in Appleton, Wisconsin, Madison, Wisconsin, Austin, Texas, Phoenix, Arizona, or Remote.

The Medicaid Program Manager (MPM) will be responsible for coordinating and supporting the development, sales and execution of managed Medicaid program and products. The MPM provides expert support for all aspects of program strategy and operations. The MPM assesses program capacity and capabilities for managing new clients, directs and manages the implementation of new CMS and State Medicaid program requirements and oversees SME support. The MPM is responsible for staying abreast of and understanding industry, marketplace, and legal developments, their impact on the business and translating current and emerging market needs into product expansion/enhancement or new product concepts/business cases. The MPM will work with all key functional areas to ensure quality product development and on-going support of the Sales and Client Services departments to support ‘sell-in’ of the products. The MPM is the ‘voice of the customer’ and leads the process of maintaining and improving products, and developing new ones. In addition, the MPM has full P&L (profit and loss) responsibility for the program/products, including forecasting, sales RFPs and finalist presentations, pricing, training, and gathering, interpreting and relaying customer requirement and feedback.

This role requires strong technical writing skills, deep knowledge of Medicaid regulations and a deep knowledge of both the technical and marketing sides of the program.

Job Responsibilities:

• Provides direction on product development for managed Medicaid products and defines the structure for supporting multiple managed Medicaid clients.
• Assesses program capacity and capabilities for managing new clients and oversees SME support of initial and annual client implementations, key business functions, processes and the departments supporting managed Medicaid.
• Coordinates functions and communications throughout the organization as a ‘hub’ to ensure the successful delivery of the Medicaid program for managed care clients.
• Monitors CMS and State Medicaid program regulations, guidance, and systems to determine needs and gaps that impact growth, financial or operational performance.
• Stays abreast of and understands industry, marketplace, and legal developments and their impact on the business. Translates current and emerging market needs into product expansion/enhancement or new product concepts/business cases.
• Assists Navitus in attaining and maintaining a deep understanding of Medicaid.
• Directs and manages the implementation of new CMS and State Medicaid program requirements and transfers operational ownership to the appropriate Navitus department once implementation is complete.
• Develops program performance goals including membership, data and processing quality, profitability, and compliance and oversees program monitoring and reporting.
• Full P&L (profit and loss) responsibility for the program/products, including forecasting sales; training; gathering, interpreting and relaying customer feedback; and working closely with Finance to establish product pricing strategies including base pricing, maintenance and support, and value-added services.
• Ensures Medicaid program and products meet all regulatory requirements.
• Supports Sales force with expertise, training and sales tools, as well as assistance in establishing managed Medicaid partnerships, RFPs responses and finalist presentations.
• Provides direction and oversight for the development, modification and improvement of business processes and policies.
• Develops and continually improves strategies, objectives and policies for the Medicaid program. and identifies and resolves any issues that may hinder program success.
• Develops strong relationships with key internal and external stakeholders and decision makers.

Apply

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Clipped from: https://www.helpwanted.com/amp/ae75c356f3b94-Product-Manager-Medicaid-job-listings?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Description

Humana’s Service Fund organization is looking for a Senior Business Intelligence Engineer to join the team working from home anywhere in the US! In this role, you will be a part of a team that delivers industry-leading capabilities supporting payments for all providers in value-based contracts with industry leading proprietary expertise creating best-in-class transparent business services and solutions. In support of Humana’s strategic growth into Medicaid solutions, we are seeking an experienced individual to lead a dedicated effort as part of a team focused on designing and coordinating the integration of Medicaid into Service Fund.

The successful candidate will engage with diverse organizations within Humana to understand integration points, design and champion best solutions while maintaining clarity on objectives and serving as a subject matter expert on Service Fund processes, capabilities and state specific Medicaid requirements. Leveraging data and analytical skills, you will ensure our resources remain aligned and contracts and membership flawlessly integrate into Service Fund.

Responsibilities

In this role, you will help solve complex business problems and issues with both data and process analysis. You will develop and champion best practice recommendations using collaborative leadership skills. The ideal candidate will bring a background in Medicaid and/or Medicare provider contracting and membership. The candidate will have demonstrable skills in process design, data analysis and project leadership. A team player, who takes pride in the overall success of the organization, supports collaborative goals and demonstrates high emotional intelligence in all aspects of life will be successful.

Core Responsibilities

• Serve as a key resource for the Medicaid Business Organization on behalf of Service Fund
• Responsible for collaborating with Service Fund, Medicaid stakeholders, Provider Contract Load, Enrollment and Finance stakeholders/leaders to understand need and best solutions for integration with Service Fund
• Work cross-functionally with multiple teams within Service Fund to assist in providing clear solutions for complex problems related to Medicaid
• This person will be an individual contributor who helps drive business decisions, and deliver outcomes aligned to department goals and objectives

Required Qualifications

• Bachelor’s degree
• Strong knowledge of writing ad-hoc SQL queries (Exposure to or experience in SQL development a plus – PL/SQL, T-SQL)
• Comprehensive knowledge of Microsoft Office Applications including Word, Excel, Access and PowerPoint
• Strong knowledge of database and business intelligence concepts
• Experience in process design and mapping using Visio or equivalent tools
• Demonstrable expertise with Excel for data analytics and graphical presentations
• Experience in data management, data extraction and data reporting
• Experience in leading others through change and innovation

Work at Home/Remote Requirements

• Must ensure designated work area is free from distractions during work hours and virtual meetings
• Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10×1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

• Advanced degree
• Strong knowledge of data mining
• Tableau, Qlikview, Qlik Sense, and/or other data presentation and analytical tools experience
• MS Project experience
• State Medicaid and/or Medicare experience
• Project leadership experience
• Experience preparing and communicating analysis to senior leaders
• Provider Network Operations End to End process and system knowledge

Scheduled Weekly Hours

40

 
 

Clipped from: https://getwork.com/details/75c67438662c38a1cb92674e504b16a3?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. The Care Manager – Quality focuses on ensuring Medicaid and Medicare members medication adherence on NCQA Stars and HEDIS measures. Uses expertise in HEDIS and other technical quality measures and advanced member engagement techniques to ensure improved population health and accreditation results.

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.

Experience: 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience.

Licenses/Certifications: RN – Registered Nurse – State Licensure And/or Compact State Licensure RN- Registered Nurse in MD, VA or Washington, DC Upon Hire Req

Preferred Qualifications

• Bachelors degree in nursing.
• Medicaid and/or Medicare experience.
• Knowledge and experience with CQA .
• Previous experience in member and provider engagement to influence behavior change and improved health outcomes.

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: MD Medicaid -QUALITY

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: 10/07/21

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://getwork.com/details/04b1ce79af6d174c6f3d2986b3d0b2e5?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

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.


Nurse Utilization Management l – In-Patient (Medicaid) – PS57281


Location: This is a work@home role but qualified applicants must reside within a 50 mile commute to our Tampa, or Miami, Florida, offices. While the position is remote, occasional meetings and/or training are required in the office.


Work Hours: Monday – Friday, 8am – 5pm or 7am – 4pm with availability to 5pm required.


Primary Duties May Include, But Are Not Limited To


The Nurse Medical Management l for Florida Medicaid is responsible to collaborate with healthcare providers and members to promote quality member outcomes, optimize member benefits, and promote effective use of resources. Accurately interprets benefits and managed care products, and steers members to appropriate providers, programs, or community resources. This role includes some utilization management and in-patient case management responsibilities.

• Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
• Ensures member access to medically necessary, high-quality healthcare in a cost-effective setting according to contract.
• Consult with clinical reviewers and/or medical directors daily to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process.
• Collaborates with providers to assess members’ needs for early identification of and proactive planning for discharge planning.
• Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.
• Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
• Works with medical directors in interpreting appropriateness of care and accurate claims payment.
• May also manage appeals for services denied.
   

Minimum Requirements


Qualifications

• Current, unrestricted RN license from the state of Florida.
• 3+ years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Experience using Microsoft Word.
   

Preferred Qualifications

• Knowledge of the Utilization Management and/or Utilization Review process (within managed care or provider setting) experience is strongly preferred.
• Prior Medicaid and/or managed care experience is preferred.
• Experience using MS Excel and Outlook 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://www.linkedin.com/jobs/view/nurse-utilization-management-l-medicaid-at-anthem-inc-2713780162/?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 and
• Increase program transparency and accountability.
  
  

Unless required by legislation or union contract, starting salary will be set at step 1 of the pay range.


Office: Health Innovation & Quality


Bureau: Clinical Operations


Working Title: Medicaid Health Systems Specialist (RN) (PN:20043101)


Job Overview

• As a Compliance & Safety Check Nurse/Reviewer, this position requires travel throughout Ohio, some of which will include overnight stays. ***
  This position will be temporarily working/teleworking from home and will be expected to return to the office in Columbus once normal business operations are resumed.
  
  
  Responsibilities
  
  
  As the Compliance & Safety Check Nurse/Reviewer in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include
  
  
  This position is headquartered in Franklin County.
  
  

 
 

• Conducting compliance and safety check surveys, many of which occur in the consumer’s home
• Conducting oversight activity to include medical & programmatic document review & face to face (e.g., may be conducted on-site) assessments &/or reassessment (e.g., questionnaires & documents to review programs) & all oversight activity of all Medicaid programs (e.g., PACE, PASSARR, Waiver) administered by other state agencies (e.g., Ohio Department of Education [ODE], Ohio Department of Health [ODH], Mental Health and Addiction Services [OMHAS], Ohio Department of Youth Services [ODYS], Ohio Department of Aging [ODA], Ohio Department of Developmental Disabilities [DODD]) & ODM Ohio Home Care/State Plan, Managed Care
• Reviewing & evaluating medical & programmatic documents developed by contractors, county boards & providers to determine quality assurance of health & safety & clinical &/or programmatic appropriateness of services &/or payment policies.
  
  

As the Compliance and Safety Check Nurse/Reviewer, you will be required to possess a current and valid license to practice professional Nursing as a Registered Nurse (RN) in Ohio as issued by the Board of Nursing in order to conduct


compliance and safety check surveys of Ohio’s Medicaid consumers.


Current & valid license to practice professional Nursing as a Registered Nurse (i. e., RN) in Ohio as issued by the Board of Nursing pursuant to Sections 4723.03 to 4723.09, inclusive of Ohio Revised Code; additional 24 months of experience in Nursing.


Training & Development Required to Remain in Classification After Employment: Biennial renewal of license in practice as Registered Nurse per Section 4723.24 of Ohio Revised Code.


Primary Location


United States of America-OHIO-Franklin County-Columbus


Work Locations


Lazarus 5


Organization


Ohio Department of Medicaid


Classified Indicator


Classified


Bargaining Unit / Exempt


Bargaining Unit


Schedule


Full-time


Work Hours


8:00 a.m. – 5:00 p.m.


Compensation


$29.16/per hour


Unposting Date


Ongoing


Job Function


Nursing


Job Level


Individual Contributor


Agency Contact Information


HumanResources@medicaid.ohio.gov

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About the company

 
 

Ohio Department of Medicaid

2,219 followers

Hospital & Health Care 501-1,000 employees 296 on LinkedIn

Becoming a cabinet-level agency in 2013, the Ohio Department of Medicaid (ODM) delivers health care coverage to more than three million residents of Ohio on a daily basis.

Working closely with stakeholders, advocates, medical professionals, and fellow state agencies, the agency continues to find new ways to modernize Medicaid in Ohio.

Some recent accomplishments include:

• enhancing investment in home-based and community-based setting for long-term care
• implementing a new Medicaid managed care program that brings a new level of choice to residents across Ohio
launching a comprehensive primary care (CPC) program to pay for value rather than volume
• integrate physical and behavioral health care and enhance the quality of care delivered to Ohioans through the Behavioral Health Redesign

We are dedicated to being a national leader in health care coverage innovation that improves the lives of Ohioans and strengthens families.

If you have any questions about Ohio Medicaid covered services, call 800-324-8680. …

 
 

 
 

Clipped from: https://www.linkedin.com/jobs/view/compliance-safety-check-nurse-reviewer-medicaid-health-systems-specialist-rn-at-ohio-department-of-medicaid-2706581372/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

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: Reporting to the Senior Manager of Analytics and in support of the Director of Medicaid ACO, the Senior Analyst will demonstrate strong knowledge of performance indicators and deliver actionable data and key business insights to the Steward Health Care Network (SHCN)’s Medicaid Accountable Care Organization.

• Conducts sophisticated business analyses to support Medicaid ACO program development and ongoing operations, grounded in deep expertise and functionality with both SHCN Enterprise data warehouse and publicly available Medicaid-related health care data sources
• Analyze and recommend opportunities and financial impacts of strategic partnerships, new Medicaid programs, and key Medicaid ACO related initiatives
• Build predictive models that provide Operations and Clinical Care Management Teams with targeted member outreach and engagement activities for improved health outcomes
• Respond to government requests for data that demonstrate statistically significant health outcomes towards program improvement goals in the areas of cost-effectiveness and quality
• Collaborate with Steward’s Analytics, and Informatics teams to maintain proper data governance oversight and data integrity management of the MassHealth data

Education / Experience / Other Requirements

Education:

• Bachelor’s degree required; Master’s preferred

Years of Experience:

• 3-5 years of relevant experience in healthcare, analytics, or informatics

Specialized Knowledge:

• Demonstrated knowledge of health plan claims data and familiarity with Medicaid and other public programs
• Possess strong skills in SQL, Excel, Access, PowerPoint, and BI visualization tools, preferably tableau
• Data science applications (e.g. R, Python, etc.) to build predictive models
• Strong understanding of statistical concepts
• Organizational and project management skills to manage projects effectively
• Excellent verbal and written communication skills, including data visualization to present complex data analysis; outstanding interpersonal skills; and ability to relate positively with individuals at all levels of the organization
• Commitment to service excellence

 

Clipped from: https://shcnjobs.steward.org/senior-clinical-healthcare-analyst/job/16134270?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Status Category:

Full-Time

Exempt/Non-Exempt:

Non-Exempt

Scheduled Hours Per Week:

40

Job Code:

FS200

With over 100 offices and nearly 5,000 associates in major metropolitan areas and suburban cities throughout the U.S. CBIZ (NYSE: CBZ) delivers top-level financial and employee business services to organizations of all sizes, as well as individual clients, by providing national-caliber expertise combined with highly personalized service delivered at the local level.

CBIZ has been honored to be the recipient of several national recognitions:

* 2020 Best Workplaces in Consulting & Professional Services by Great Place to Work
* 2020 Workplace Excellence Seal of Approval by the Alliance for Workplace Excellence
* Top 101 2020 Best and Brightest Companies to Work For in the Nation
* 2020 Healthiest 100 Workplace in America
* 2021 Top Workplaces USA

CBIZ Benefits & Insurance Services is a division of CBIZ, Inc., providing benefits consulting, HRIS technology, payroll, human capital management, property and casualty, talent and compensation solutions, and retirement & investment solutions to organizations of all sizes. CBIZ is ranked as a Top 20 Largest Broker of U.S. Business (Business Insurance Magazine) and a Top 100 Retirement Plan Adviser (PLANADVISER).

Essential Functions and Primary Duties:

• Assisting patients in applying for financial assistance through Medicaid on behalf of our client facility.
• Interviewing patients or authorized representatives via phone or in person to gather information to determine eligibility for medical benefits.
• Obtaining, verifying, and calculating income and resources to determine client financial eligibility.
• Documenting case records using automated systems to form a record for each client.
• Following up with applicants to obtain accurate and complete information within strict timeframes.
• Completing/following up on all forms related to Medicaid eligibility.
• Performing any additional tasks related to the position assigned by the Manager.

Preferred Qualifications:

• Bachelor’s degree.
• Knowledge of Medicaid and Charity Care.
• Experience working in a hospital environment.
• Ability to speak and read Spanish.

Minimum Qualifications:

• High school diploma/GED.
• Must be ambitious and self-directed in a fast-paced environment and can perform in a high volume, multitasking setting.
• Must be trustworthy, professional, detail and goal oriented.
• Must have exceptional customer service and excellent verbal/written communication skills.
• Must be able to learn and work with Medicaid eligibility regulations.

Clipped from: https://www.dcjobs.com/job/detail/58868889/Medicaid-Eligibility-Specialist?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

As a Supervisory Health Insurance Specialist, you will serve as a Group Director, who leads a staff responsible for identifying innovations in the payment and delivery of health care.

 
 

What you’ll do:

 
 

• Plans work to be accomplished by subordinates, sets and adjusts short-term priorities, and prepares schedules for completion of work.
• Resolves emerging complex issues, advising leadership of potential and emerging problem areas, including the formulation of recommendations for appropriate program responses.
• Prepares budget and resource requests, including estimates of costs and benefits for each model.
• Exercises administrative, technical direction and control over the front office and division staff, contractor support staff and Deputy Director.
• Monitors the ongoing operation of models in testing phase, including application processes, performance of contractors and model participants providers, payment and financial management, data exchange, etc.

 
 

Experience we’re looking for:

 
 

1) Providing technical expertise on the design, implementation, or evaluation of models improving health care outcomes.

2) Planning, organizing, or assessing work activities for teams to ensure that program operational goals are met; AND

3) Coordinating projects and resources that aim to improve quality and access to a healthcare program.

 
 

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

 
 

Clipped from: https://www.linkedin.com/jobs/view/health-insurance-specialist-at-centers-for-medicare-medicaid-services-2699790112/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic