Posted on

IT Project Manager (Healthcare/Medicaid) – Mahantech Corporation

 
 

Role: MES IT Project Manager (657899)

Duration: 12 Months+

Location: 100% Remote

Interview Mode: Webcam Interview Only

Type: Contract

Start Date: Immediate

NOTE: This role will be 100% remote and candidates located anywhere in the US are encouraged to apply.

DHHS seeks a Project Manager (PM) to join the Medicaid Enterprise System (MES) Program. Leadership, facilitation, PMBOK and Agile experience are key.

The Project Manager (PM) will be responsible for leading the efforts associated with procurement, design, development and implementation of a large, complex IT system. The PM will be accountable for developing all project management artifacts in a waterfall-agile hybrid environment, so experience and knowledge of both PM methodologies is essential. The role additionally is critical in partnering with Product Managers and business leaders, so stellar facilitation and presentation skills are also essential. Empathy for the business experience of undergoing a substantial change while being resource constrained is also an important competency. Knowledge of Organizational Change Management (OCM) is a highly desired attribute. The role will work with the business change and process improvement teams to support and guide them through the required steps. The PM will monitor, track, schedule, document, assess quality, and articulate the way changes affect the users on a day-to-day basis and ensure that thorough testing of systems and scenarios occurs throughout the implementation. This role will also support the federal certification exercise and associated planning processes. ITSM/ITIL knowledge and working in a multi-vendor matrix resource environment are paramount as well.

This resource will interface with Division Leadership and DHHS Subject Matter Experts (SMEs) as required to complete the work. Participation in drafting procurement documentation, Request for Proposals (RFPs) are also helpful areas of expertise that will strengthen a candidacy. Interface with business stakeholders at all levels of the organization will occur daily.

Required Skills

  • Leadership, persuasion, negotiation, relationship management, conflict resolution, and effective oral and written communication expertise Required 15 Years
  • Demonstrated PMBOK subject matter expertise AND experience Required 10 Years
  • Demonstrated Agile (preferably SAFe and Scrum) expertise AND experience Required 5 Years
  • Demonstrated proficiency in using online collaboration tools, particularly Microsoft Sharepoint and Teams Required 3 Years
  • EXPERT use of Microsoft Project, Word, Excel, PowerPoint, Visio, and Adobe software Required 15 Years
  • Knowledge of Enterprise IT Systems, system integration principles, and associated change management best practices. Required 7 Years
  • Ability to provide project management support and manage the day-to-day vendor and contract activities to ensure desired outcomes Required 7 Years
  • Demonstrated ability to manage multiple priorities and projects, function in a fast-paced, continually changing, deadline driven environment Required 7 Years
  • Extensive knowledge of test management principles and best practices Required 7 Years
  • Demonstrated ITIL/ITSM knowledge Required 2 Years
  • Experience on a prior or current MMIS, HIT, HIE, Eligibility or other related implementation project requiring federal oversight Highly desired 7 Years
  • Has an understanding of CMS’ Seven Standards and Conditions and Medicaid IT systems or HIT Highly desired 7 Years
  • Knowledge of Managed Care or the Medicaid Program Highly desired 7 Years

 
 

Clipped from: https://www.dice.com/jobs/detail/2265c3118b407fec2bf13e27a62497e4?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Medicare/Medicaid Implementation & Integration Advisor| Humana Inc.

 
 

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

Responsibilities

As the Implementation & Integration Advisor you will provide expertise in executing implementations that focus on:

  • Managing and executing implementations (including Medicaid & Medicare) from end to end, including developing structure and strategies, managing timelines, reducing risks, ensuring for successful implementations
  • Helping deliver cross-functional, enterprise projects executed in partnership with corporate development opportunities and senior leadership
  • Being responsible for a detailed understanding of the business being acquired or implemented
  • Leveraging Best Practices and developing repeatable and scalable technical and business processes
  • Working with leadership to promote stakeholder awareness via formal engagement management and communication processes
  • Developing and managing implementation/integration plans to support business thru run-out and/or sun-setting of systems as required

Based on current guidance from the CDC, local and state governments, and Humana leadership related to the coronavirus (COVID-19) outbreak have extended travel restrictions until further notice. The policy will be reassessed as the situation warrants. Once these restrictions are lifted this role may require up to 15% travel depending on business needs.

Required Qualifications

  • Bachelor’s degree or equivalent related work experience
  • 8+ years of operations, project/program management, implementation and/or consulting, corporate strategy, acquisition experience – and ability to “flex” between what is necessary for each project
  • 3+ years’ experience leading large scale, highly visible enterprise programs with responsibility for cross functional work streams/project teams
  • Strategic thinker – proven ability to apply foundational strategy principles to a variety of business problems
  • Excellent organizational, written and oral communication and presentation skills
  • Exceptional interpersonal skills with ability to quickly build rapport. Strong collaboration and facilitation skills
  • Ability to influence at all levels of the organization
  • Proven experience interacting directly with and presenting to Senior Leadership internally and externally
  • Advanced proficiency in MS Office applications including Project, PowerPoint, Visio, SharePoint and Excel
  • Strong business acumen with ability to interrupt analytics
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  • Ability to travel up to 15%

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

  • Possess solid understanding of how organization capabilities interrelate across operational work streams
  • PMP certification
  • Advanced degree

Scheduled Weekly Hours

40

 
 

Clipped from: https://getwork.com/details/97d874ba36a890b1e20e9eef264d0a5e?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Posted on

Market Development Advisor – Louisville | Humana

 
 

Description

The Market Development Advisor provides support to assigned health plan and/or specialty companies relative to Medicare/Medicaid/TRICARE product implementation, operations, contract compliance, and federal contract application submissions. The Market Development Advisor works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Market Development Advisor serves as the primary resource on regulations for all assigned health plans. Ensures that assigned health plans are meeting or exceeding corporate Medicare/Medicaid/TRICARE performance benchmarks. Maintains relationships with regulators within a region. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties

 
 

Clipped from: https://careers.humana.com/job/13582535/market-development-advisor-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Posted on

Supervisor, Enrollment Systems Analysts – Medicaid Products – Tufts Health Plan

 
 

We enjoy the important work we do every day on behalf of our members.

Job Summary

Remote Role but must reside in one of the following approved states: MA, RI, NH, CT

Under Direction of the Manager, oversee the team that performs analytical functions, problem resolution, reporting, develop Business Requirements and perform UAT. Additional duties include identifying system issues, reviewing functional specifications, recommending systems enhancements, and developing and validating test plans for changes to all Enrollment and EDI systems and administrative platforms.

Job Description

KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS*Implementations

  • Oversee the implementation and testing process for each new vendor/employer group interested in utilizing the EDI enrollment process.

 
 

  • Ensure customer implementation meetings are properly facilitated for activities with customer representative and IS, ensuring that all action items are clearly delegated and completed.

 
 

  • Ensure changes/enhancements are launched into production on time and then properly transitioned to the department with documentation and training.

Production Systems Maintenance & Enhancements (Following duties apply to all EDI and enrollment systems)

  • Maintain a solid and thorough understanding of the Enrollment and EDI systems and Tufts HP eligibility policies/rules by line of business to identify system problems and develop recommendations for solutions.
  • Analyze error reports and trends to determine when service requests are necessary.
  • Act as the subject matter expert to develop all necessary business requirements for service requests, corporate initiatives and/or department-sponsored enhancements that require updates to any Enrollment/EDI system.
  • Create and validate test plans for system changes and analyze actual results to determine if logic changes meet established requirements or require additional modification.

Daily Production Support

  • Oversee daily production and maintenance of EDI enrollment files and provide additional assistance to staff during high volume, open enrollment periods.
  • Respond to escalated and complex issues timely and accurately by using all available resources including partner departments.

Team Organization and Staff Development

  • Schedule and delegate all tasks and special projects
  • Interview, hire, and ensure training of new staff on all aspects of the EDI enrollment process.
  • Mentor, motivate, and develop staff to obtain maximum performance; address individual performance issues in a timely and effective manner.
  • Write annual performance appraisals and salary reviews
  • Facilitate regular staff meetings to share knowledge of new processes, procedures, and corporate directives and solicit recommendations for continuous improvement.
  • Meet on a regular basis with each report on an individual level to provide focused feedback, career direction, discuss specific concerns or ideas and/or other issues as they arise.

Additional Duties

  • Maintain thorough knowledge of HIPAA standards and regulations for 834 Benefit Enrollment & Maintenance transactions.
  • Project manage changes required to EDI systems to remain compliant with HIPAA regulations.
  • Provide back-up support, as requested, for other areas within the department.

 
 

  • Special projects as requested by management

Requirements

Qualifications (Minimum education & experience level required):Bachelor’s degree, preferably in Business Administration, with 5 – 8 years work experience in operations required. Prior health care experience preferred.Ideal candidate is familiar with working in a legacy/mainframe business environment and has extensive knowledge of the TPA eligibility EDI process and/or implementation experience with the 834 Benefit Enrollment & Maintenance transaction (HIPAA Standard).

  • Intermediate knowledge of SQL and MS Office applications (specifically Excel, Word, and Access) required.

Skill requirements (include complexity of position):Requires excellent organizational, problem solving and analytical skills. Excellent judgment and decision-making ability must be displayed at all times. Interpersonal skills (include personal interaction):Requires the ability to effectively and diplomatically deal with sensitive issues. Must be able to work independently and cooperatively as a team member. Must be able to communicate effectively with internal and external customers in verbal and written format. Must display a professional demeanor at all times.Confidential data:All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Will be exposed to and required to deal with highly confidential and sensitive material. Must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.Working Conditions or Additional requirements (include special requirements, e.g., lifting, travel, overtime)Must be able to be flexible to travel to customer sites, have a valid Massachusetts driver’s license and reliable automobile. Must be able to work non-standard hours whenever necessary, including but not limited to evenings and weekend hours.

What we build together changes our customer’s health for the better. We are looking for talented and innovative people to join our team. Come join us!

Tufts Health Plan is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here. If you’d like more information on your EEO rights under the law, please click here.

 
 

Clipped from: https://www.milwaukeejobs.com/job/detail/55873484/Supervisor-Enrollment-Systems-Analysts-Medicaid-Products?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Economist – CMMI

 
 

Department of Health And Human Services
Center for Medicare and Medicaid Innovation (CMMI)
  • Videos

 
 

Duties

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation(CMMI), Research and Rapid Cycle Evaluation Group (RREG) .


As a Economist, GS-0110-13, you will perform economic analysis of healthcare financing issues and assess their impact upon the CMS programs.

Learn more about this agency

Responsibilities

  • Designs, conducts and performs studies that address economic issues related to CMMI models (development, model implementation, evaluation), CMS proposed regulations, or final regulations.
  • Provides technical consultation and leadership on complex health economic studies and consults with and collaborates with other researchers on aspects of study design, analysis, and interpretation.
  • Examines reports and articles prepared by others within and outside of the organization. Interprets technical data and prepares briefing materials, memorandums and reports for CMS leadership.
  • Presents summaries and relevant results of research in progress or completed to appropriate officials in CMS and DHHS, before scientific groups or interested agencies.
  • Maintains continuing contacts and working relations with health care providers, economists, health and social scientists in other government agencies.

Travel Required

Not required

Supervisory status

No

Promotion Potential

13

  • Job family (Series)

0110 Economist

Similar jobs

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-13, 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-12 grade level in the Federal government, obtained in either the private or public sector, to include:
(1) Designing and conducting predictive or explanatory models of health care programs and expenditures AND;
(2) Applying statistical, econometric, or financial economic techniques to analyze health care programs and draw conclusions AND;
(3) Preparing and presenting economic research summaries or technical reports to stakeholders.


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.

Education

Education Requirement: In addition to meeting the qualification requirements, all candidates must have the following educational requirements:

  1. Degree: Economics, that included at least 21 semester hours in economics and 3 semester hours in statistics, accounting, or calculus. (TRANSCRIPTS REQUIRED AT TIME OF APPLICATION).

    OR

  2. Combination of education and experience: courses equivalent to a major in economics, as shown in A above, plus appropriate experience or additional education. Examples of qualifying experience include: individual economic research assignments requiring planning, information assembly, analysis and evaluation, conclusions and report preparation; OR supervisory or project coordination assignments involving a staff of professional economists, and requiring the evaluation and interpretation of economic information; or teaching assignments in a college or university that included both class instruction in economics subjects and one of the following (1) personal research that produced evidence of results, (2) direction of graduate theses in economics, or (3) service as a consultant or advisor on technical economics problems. (TRANSCRIPTS REQUIRED AT TIME OF APPLICATION).

TRANSCRIPTS are required to verify satisfactory completion of the educational requirement listed above. Please see “Required Documents” section below for what documentation is required at the time of application.


Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11217323

Additional information

Bargaining Unit Position: Yes

Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Not Required



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.

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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):

  • Economics
  • Oral Communication
  • Technical Competence
  • Written Communication

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Background checks and security clearance

Security clearance

Not Required

Drug test required

No

Position sensitivity and risk

Moderate Risk (MR)

Trust determination process

Credentialing, Suitability/Fitness

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.


3. College Transcripts. Since this position requires specific education, you must submit a transcript attesting to your possession of the required education. You may submit an unofficial transcript or a list of college courses completed indicating course titles, credit hours, and grades received. An official transcript is required if you are selected for the position. If selected, you must provide an original document before the final job offer may be extended. If you do not submit a transcript indicating your possession of the required education, you will not be considered for this position.


College Transcripts and Foreign Education: Applicants who have completed part or all of their education outside of the U.S. must have their foreign education evaluated by an accredited organization to ensure that the foreign education is comparable to education received in accredited educational institutions in the U.S. For a listing of services that can perform this evaluation, visit the National Association of Credential Evaluation Services website. This list, which may not be all inclusive, is for informational purposes only and does not imply any endorsement of any specific agency.


If you are applying for a position for which a state license is issued (e.g., physician, engineer, attorney) possession of a valid and current U.S. professional license by a graduate of a foreign professional school or program is sufficient proof that the foreign education has been determined to be equivalent to the requisite U.S. professional education in that occupational field.


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.

If you are relying on your education to meet qualification requirements:

Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

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.

How to Apply

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 09/14/2021 to receive consideration.


IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.


We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month and year (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.

  • To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  • Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
  • After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
  • You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.

To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to ashley.randall@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

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Agency contact information

Ashley Randall

Email

ashley.randall@cms.hhs.gov

Address

Center for Medicare and Medicaid Innovation
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

Once your online application is submitted, you will receive a confirmation notification by email. Your application will be evaluated to determine your eligibility and qualifications for the position. After the evaluation is complete, you will receive another email notification regarding the status of your application.


Within 30 business days of the closing date,09/14/2021, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

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  • Fair & Transparent

The Federal hiring process is setup to be fair and transparent. Please read the following guidance.

Equal Employment Opportunity Policy

The United States Government does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

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Reasonable Accommodation Policy

Federal agencies must provide reasonable accommodation to applicants with disabilities where appropriate. Applicants requiring reasonable accommodation for any part of the application process should follow the instructions in the job opportunity announcement. For any part of the remaining hiring process, applicants should contact the hiring agency directly. Determinations on requests for reasonable accommodation will be made on a case-by-case basis.

A reasonable accommodation is any change to a job, the work environment, or the way things are usually done that enables an individual with a disability to apply for a job, perform job duties or receive equal access to job benefits.

Under the Rehabilitation Act of 1973, federal agencies must provide reasonable accommodations when:

  • An applicant with a disability needs an accommodation to have an equal opportunity to apply for a job.
  • An employee with a disability needs an accommodation to perform the essential job duties or to gain access to the workplace.
  • An employee with a disability needs an accommodation to receive equal access to benefits, such as details, training, and office-sponsored events.

You can request a reasonable accommodation at any time during the application or hiring process or while on the job. Requests are considered on a case-by-case basis.

Learn more about disability employment and reasonable accommodations or how to contact an agency.

Read more

Legal and regulatory guidance

 
 

 
 

Clipped from: https://www.usajobs.gov/GetJob/ViewDetails/612596900?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Posted on

Medicaid Eligibility Specialist

 
 

 
 

Website
State of Georgia

Job Description:

The Medicaid Eligibility Specialist (MES) position is part of DBHDD’s SSI/SSDI Outreach, Access, and Recovery (SOAR) Program. SOAR is a federal program designed to increase access to SSI/SSDI for eligible adults and children who are experiencing or at risk of homelessness and have a serious mental illness, medical impairment, and/or a co-occurring substance use disorder.

Job Responsibilities:

  • Completion of the SSI/SSDI application according to established policies and procedures of the project.
  • Hand deliver/electronic transfer of all needed application forms and information.
  • Collection of existing medical evidence, including visiting treating sources.
  • Coordination and communication with social workers and case managers.
  • Linkage and coordination with SSA, referral to and linkage with other needed services, e.g., housing, health care (physical and mental), other supportive services as needed.
  • Coordination with representative payee service.
  • Ongoing follow-up as needed to ensure individuals are not lost to services.
  • Utilizing substantial independent judgment in prioritizing and problem-solving issues.
  • Organizing and recording data consistent with project goals and priorities.

Job Requirements:

  • Preference will be given to candidates, who in addition to meeting the qualifications listed above possess the following:
  • Completion of the National 4-day SOAR “Train the Trainer” training conducted by the authors of the SOAR curriculum and Policy Research Associates.
  • Experience in completing SSI/SSDI applications using SOAR strategies for homeless individuals with mental illness.
  • Demonstrate two (2) years experience and knowledge in working with homeless persons and veterans with mental illness in accessing mainstream resources including Social Security Disability Benefits.
  • Basic computer skills and able to access and use web-based technology, including the online SSA application
  • Experience in collecting data to track performance outcomes.

Job Details:

Company:  State of Georgia

Vacancy Type: Full Time

Job Functions: Information Technology

Job Location:  Thomasville, GA, US

Application Deadline: N/A

Apply Here

jobbry.com

 
 

Clipped from: https://www.jobbry.com/job/state-of-georgia-jobs-15?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

EPSDT/MCH Coordinator

 
 

EPSDT/MCH Coordinator

AHCCCS

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs, and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona.

EPSDT/MCH Coordinator

AHCCCS

Posting Details:

Salary: $64, 575 
 

Grade: 22

Job Summary:

The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a EPSDT/Maternal Child Health Care Coordinator. After extensive training, this position has the potential of being worked from home with some in office meetings. Under the leadership of the Managed Care Program Administrator, this position provides oversight of the Early and Periodic Screening Diagnosis and Treatment (EPSDT), Preventive Health, Family Planning, Special Needs Populations and Maternal Health programs within the statewide managed care and fee for-service AHCCCS programs. This position will provide leadership and support to ensure the development of a fully integrated Clinical Quality Management Unit within the Division of Health Care Management.

Job Duties:

* Monitoring of EPSDT, well woman preventive health, maternity, and family planning programs to ensure that state and federal requirements are met.

* Participates in operation reviews, administrative reviews, technical assistance, and focused studies/reviews to ensure compliance with contractual and policy requirements for all lines of business.


* Represents the CQM Unit in developing and providing input to contracts, amendments and policy revisions.


* Provides technical assistance to Contractors and FFS providers, as appropriate regarding contractual and/or policy requirements, accurately and consistently to improve compliance with AHCCCS requirements to improve EPSDT and maternal child health services to AHCCCS Members.


* Collaborates with state and local health and social service agencies, including ADHS, DES/DDD, DCS, Head Start, etc. as well as community and private health care providers.


* Coordinates and completes tracking, evaluations, and responses to Contractor deliverables.


 

Knowledge, Skills & Abilities (KSAs):

* State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, LTC and Tribal lines of business.

* Knowledge of medical/nursing practice, medical case management protocols, quality management and utilization review protocols as related to the all populations including maternal and child health services, well woman preventive health, family planning services, EPSDT, acute, LTC, chronic long-term elderly and physically disabled, developmentally disabled, behavioral/mental health, children in the foster care system and Tribal lines of business.


* Current quality improvement and health care theories and practices.


* Background in and knowledge of quality management principles and accreditation bodies’ review processes.


* Organizational skills that result in prioritization of multiple tasks including project management to meet goals and deadlines.


* Effective communication with all levels of professionals, corporate and agency officers and members.


* Develop, implement, and review case management and utilization review systems and the ability to offer technical assistance to Acute, LTC, Sister Agency and/or tribal Contractors.


 

Selective Preference(s):

* Certified Professional in Healthcare Quality

* Current Arizona nurses license


* Baccalaureate degree in nursing (preferred)


* At least one year experience working in a managed care environment


 

Pre-Employment Requirements:

In accordance with CFR §432.50 FFP, skilled professional medical personnel must have professional education and training in the field of medical care or appropriate medical practice. “Professional education and training” means the completion of a 2-year or longer program leading to an academic degree or certification in a medically related profession. For this position, a licensed Registered Nurse, Physician’s Assistant, Nurse’s Practitioner is required. Experience in the administration, direction, or implementation of the Medicaid program is not considered the equivalent of professional training in a field of medical care.
 

Benefits:

At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

 
 

Clipped from: https://jobs.azahcccs.gov/epsdt-mch-coordinator/job/17298011?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Senior Health Information Management Professional/ HQRI Medicare Submissions

 
 

Found in: Talent US

Description:

About this job

Description

The Senior Health Information Management Professional ensures data integrity for claims errors. The Senior Health Information Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Health Information Management Professional develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare. Ensures encounter submissions meet or exceed all compliance standards via analysis of data, and develops tools to enhance the encounter acceptance rate by Medicaid/Medicare. Looks for long term improvements of encounter submission processes. Begins to influence department’s strategy. Makes decisions on moderately complex to

Description

The Senior Health Information Management Professional ensures data integrity for claims errors. The Senior Health Information Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Health Information Management Professional develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare. Ensures encounter submissions meet or exceed all compliance standards via analysis of data, and develops tools to enhance the encounter acceptance rate by Medicaid/Medicare. Looks for long term improvements of encounter submission processes. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

  • Bachelor’s degree or 5 years of equivalent job experience
  • 2 years of SQL experience, Netezza or PL/SQL build and query
  • Prior experience in a fast paced insurance or health care setting
  • Prior experience with Medicare and Medicaid programs
  • Medicare and/or Medicare-Medicaid claim processing expert
  • Financial or Metric analysis and reporting experience
  • Ability to manage multiple tasks and deadlines with attention to detail
  • Experience leading meetings and department initiatives focused on process improvements
  • Experience leading successful small teams or successful small team projects
  • Proven experience investigating / researching problems and identifying root cause analysis along with presenting to leadership using metrics
  • Excellent communication skills
  • Self-starter, ability to work independently
  • Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

  • Master’s Degree in Business Administration or a related field
  • 2+ years’ experience pulling big data and developing and presenting data visualizations that enable analysis and decisions
  • EDW knowledge
  • X-12 experience / MRA submission encounter experience
  • Power BI experience or other dashboard experience
  • Experience with Tableau or Qlikview
  • Prior demonstrated experience with project management
  • Six Sigma certification

Additional information

  • Schedule: Monday to Friday from 8 am to 5 pm. S ome additional time is required throughout the year
  • Training: Virtual
  • Work Location (Address): Work at home Nationwide or from an office ( 321 W Main Street
    Louisville, KY 40202. Waterfront Plaza 5th floor west)
  • % Travel: Depends on new hire location

Scheduled Weekly Hours

40

Clipped from: https://us.bebee.com/job/20210830-8e26c82bef2dcb3da040c8eb46fd53ad?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Behavioral Health Case Manager l – Medicaid job in PA | Anthem, Inc.

 
 

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Empire Blue Cross, a proud member of the Anthem, Inc. family of companies, 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.

Behavioral Health Case Manager l – NY Medicaid – Adult Population (PS56943)

Location: This position will be 100% telephonic and [email protected] Must reside in New York or Pennsylvania, New Jersey, Connecticut or contiguous state. Requires NY clinical license.

The Behavioral Health Case Manager l is responsible for performing telephonic case management within the scope of licensure for members with behavioral health and substance abuse disorder needs. Primary duties may include, but are not limited to:

  • Uses appropriate screening criteria, knowledge and clinical judgment to assess member needs. Conducts assessments to identify individual needs and develops care plan to address objectives and goals as identified during assessment.
  • Monitors and evaluates effectiveness of care plan and modifies plan as needed.
  • Supports member access to appropriate quality and cost-effective care.
  • Coordinates with internal and external resources to meet identified needs of the members and collaborates with providers.

Qualifications

  • Requires MS or MA in social work, counseling, nursing or a related behavioral health field; 3 years clinical experience in social work, counseling with broad range of experience with complex psychiatric and substance abuse or substance abuse disorder treatment; or any combination of education and experience, which would provide an equivalent background.
  • Current active unrestricted license as an RN, LCSW, LMHC, LMSW, LMFT, or Clinical Psychologist to practice as a health professional within the scope of licensure in New York.
  • Experience working with a range of complex psychiatric / substance abuse and/or medical disorders preferred.

Preferred:

  • Experience in case management (Adult population) and telephonic coaching.

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

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

 
 

Clipped from: https://getwork.com/details/1eee7442f0bad654d92befd474d19d0d?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Director of Payer Relations – Medicaid – iRhythm Technologies

 
 

About iRhythm:

iRhythm is a leading digital healthcare company focused on the way cardiac arrhythmias are clinically diagnosed by combining our wearable bio sensing technology with powerful cloud-based data analytics and Artificial Intelligence capabilities. Our goal is to be the leading provider of ambulatory ECG monitoring for patients at risk for arrhythmias. iRhythm’s continuous ambulatory monitoring has already put over 2 million patients and their doctors on a shorter path to what they both need – answer.

About this role:

iRhythm is currently seeking an experienced Director, Payer Relations, Medicaid. Our work environment is fast-paced, with a collaborative atmosphere. Most of all, we are passionate about delivering innovations that improve the quality of health care and the patient experience. We are looking for like-minded individuals to join our team today!

The Director, Payer Relations will be responsible for ongoing strategic innovation, cross-functional collaboration and the development and execution of pricing and market access strategies. This role will create and deliver Managed Market and Market Access strategies that differentiate and demonstrate a patient-centered approach, while leading and managing reimbursement. This role reports directly to the VP Market Access and Health Policy.

Specific job responsibilities include:

Contracting – Health plan

  • Develop strong relationships with target payer organizations that help iRhythm achieve revenue/EBIDTA goals
  • Determine important payer contacts at various levels within the health plan, and engage with iRhythm employees to establish relationships with peer counterparts.
  • Develop and manage relationships with executives at multiple health plans, locally and nationally.
  • Successfully negotiate value based contracts with various health plans using a diverse range of techniques and contracting best practices.
  • Manage contractual relationships and ensure accurate administration of contract terms including informing the various contracted health plans about newly credentialed providers.

Strategy and Pricing

  • Execute payer strategies with overall company direction and corporate goals
  • Work collaboratively with Sales/Marketing to connect payer, provider and related marketing strategies.
  • Work with VP of Health Policy and Market Access to analyze, evaluate and execute regional and national payer approach. Prioritize payer targets to maximize value for iRhythm.
  • Proactively identify and recommend new growth opportunities (primarily within the payer community), creating the required business case and gaining approval.
  • Lead key meetings with customers on how to maximize the value proposition.
  • Act, along with the VP of Health Policy and Market Access, as one of the primary liaisons between iRhythm and payer organizations, strengthening our overall relationship and creating a mutual loyalty.
  • Ensure that all payer relationships are managed in accordance with iRhythm standards.
  • Support regional sales management to quickly impact new high potential accounts and assure that billing and reimbursement issues are appropriately managed at the outset and payer contracts are in place.

Operations

  • Liaison with marketing to create best of class support materials for field sales, payer advocates, and customer service
  • Provide market knowledge to assist in the development of physician advocacy, gather key data resources and/or acquire analytical tools necessary to better evaluate the effectiveness of customer messaging.
  • Partner with Sales on value proposition discussions and develop messaging and tools that drive coverage and reimbursement growth and achieve overall financial goals.
  • Identify and recommend appropriate operational changes to achieve maximum efficiency with payers.

About you:

A dynamic leader, networker and influencer, a strong communicator with both internal and external stakeholders. The person will play a key role in guiding the strategic direction of the organization, be responsible for driving growth in new business areas and devising creative solutions to overcome obstacles to facilitate patient access. We are looking for passionate and collaborative professionals with proven experience in their field.

  • Bachelor’s degree, with at least 8-10 years of payer relations and reimbursement experience; field sales experience preferred
  • 5-7 years’ experience in medical device industry with similar reimbursement criteria.
  • Demonstrated experience working with executive level groups within large health institutions to influence reimbursement coverage decisions.
  • Self-motivated and disciplined to meet deadlines in the context of competing priorities and projects.
  • Intermediate to advanced skills with Microsoft Office programs.
  • Must be able to travel at least 50% of the time.

What’s in it for you:

This is a full-time position with competitive compensation package, excellent benefits including medical, dental, and vision insurance (all of which start on your first day), paid holidays, and PTO!

iRhythm also provides additional benefits including 401K (with company match), an Employee Stock Purchase Plan, paid parental leave, pet insurance discount, Cultural Committee/Charity events, and so much more!

FLSA Status: Exempt

As a part of our core values, we ensure a diverse and inclusive workforce. We welcome and celebrate people of all backgrounds, experiences, skills, and perspectives. iRhythm Technologies, Inc. is an Equal Opportunity Employer (M/F/V/D). Pursuant to San Francisco Fair Chance Ordinance, we will consider for employment all qualified applicants with arrest and conviction records.

Make iRhythm your path forward.

#LI-AS1

#LI-Remote

 
 

Clipped from: https://www.sanfranjobs.com/job/detail/57018707/Director-of-Payer-Relations-Medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic