Duties
Provide clarification, interpretation, and explanation of financial policies and instructions in light of special programs or program relationships.
Examine costs and estimates, and develop alternative or new cost methodologies to produce independent cost estimates.
Prepare special financial materials as requested by managers or other senior staff.
Develop comprehensive tabular or “figure” portions of financial documents, exhibits, and other supporting documentation.
Analyze specific fiscal areas of concern and recommend procedures and methods for change.
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.
This is a remote position; however, the position reports to a CMS Office on a periodic basis. Requirements to report to the office will vary and can be discussed at the time of interview.
Qualifications
ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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) Analyzing financial proposals, budgets or reports to ensure adherence to requirements; (2) Applying regulations of financial management to recommend or implement financial policies; AND (3)Preparing financial reports, briefings, or cost estimates. .
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.
Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11814836
Education
This job does not have an education qualification requirement.
Additional information
Bargaining Unit Position: Yes- American Federation of Government Employees, Local 1923
Tour of Duty: Flexible
Recruitment/Relocation Incentive: Not Authorized
Financial Disclosure: Not Required
This position will be in direct support of the Inflation Reduction Act of 2022. This Act increases healthcare spending by nearly $100 billion, mainly by extending the American Rescue Plan’s temporarily-expanded Affordable Care Act (ACA) premium tax credits for an additional three years, through 2025. The bill will also allow Medicare to negotiate prescription drug prices, implement improvements to Medicare Part D including a benefit redesign and new manufacturer discount program, impose inflation rebates for Part B and Part D drugs, and other miscellaneous changes in Part B and Part D to improve the affordability of prescription drugs.
To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply.
Remote-Out Positions at CMS: This is a remote position; however, the position reports to a CMS Office on a periodic basis (e.g. 1-2 times per year). Requirements to report to the office will vary and can be discussed at the time of interview. As such, your pay will be based on your home address. For more information on locality and pay scales, please click here. Your worksite must be within the United States and you must adhere to all regulations and policies regarding remote work at CMS and in the federal government, including the signing of a remote work agreement.
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.
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 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 from this announcement for similar positions within CMS with the same remote/telework designation and same geographical location, if applicable. For example, for Woodlawn, MD vacancies the “same geographical location” includes Baltimore, Maryland; Bethesda, Maryland; and Washington, D.C.
Traditional rating and ranking of applications does not apply to this vacancy. Applications will be evaluated against the basic qualifications. Qualified candidates will be referred for consideration in accordance with the Office of Personnel Management direct hire guidelines. Veterans’ Preference does not apply to direct hire recruitment procedures. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would, therefore, be given new appointments to the civil service; however, benefits, time served and all other Federal entitlements would remain the same.
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.
Required Documents
As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have – whether you’re a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you’re eligible under their policies.
The following documents are REQUIRED:
1. Resume showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/
2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.
PLEASE NOTE: A complete application package includes the online application, resume, 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 and CMS required documents, will result in you not being considered for employment.
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.
If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.
How to Apply
Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 02/08/2023 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 IRADHACandidate@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.
Commissioned Corps 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. Please send all documents in 1 PDF file. 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.
Agency contact information
CMS IRA
Email
IRADHACandidate@cms.hhs.gov
Address
Center for Medicare
7500 Security Blvd
Woodlawn, MD 21244
US
Next steps
Once your online application is submitted, you will receive a confirmation notification by email. Within 30 business days of the closing date,02/08/2023, 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.
Fair and Transparent
The Federal hiring process is set up to be fair and transparent. Please read the following guidance.
Equal Employment Opportunity (EEO) Policy
Reasonable accommodation policy
Financial suitability
Selective Service
New employee probationary period
Signature and false statements
Privacy Act
Social security number request
Required Documents
The following documents are REQUIRED:
1. Resume showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/
2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.
PLEASE NOTE: A complete application package includes the online application, resume, 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 and CMS required documents, will result in you not being considered for employment.
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.
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.
Help
This job is open to
Career transition (CTAP, ICTAP, RPL)
Federal employees who meet the definition of a “surplus” or “displaced” employee.
The public
U.S. Citizens, Nationals or those who owe allegiance to the U.S.
Clarification from the agency
This announcement is advertised under Direct Hire Authority and is open to all United States Citizens or Nationals.
Category: Curator- Job Hunter
FL Blue Medicare- Medicaid Eligibility Associate job in United States | Business Operations jobs at GuideWell
Job Summary
Responsible for working directly within the state of Florida FLMMS portal. In charge of providing on the spot verification of Medicaid eligibility to prospective Dual Eligible Special Needs Plans (DSNP) to the Medicare sales agents, required to verify monthly Medicaid eligibility of the currently enrolled Dual Eligible Special Needs Plan (DSNP) members. Responsible for working alongside the Department of Families and Children (DCF) to obtain the annual Medicaid recertification dates and required documentation for currently enrolled DSNP members to ensure members continue enrollment and maintain their eligibility with the plan. Responsible for identifying members who are at risk or who have lost their Medicaid eligibility and work alongside DCF and the member to submit all required paperwork and try to get them re-certified for Medicaid. Responsible for obtaining necessary paperwork from the members and/or additional resources such as the Social Security Administration and DCF to reinstate member’s Medicaid Eligibility or prevent members from losing Medicaid eligibility. Assist with outreach calls to members as needed.
Essential Functions
- Determines Medicaid qualification status for prospective Dual Eligible Special Needs Plan (DNSP) members using the State Medicaid Portal FLMMS.
- Verifies Medicaid eligibility for currently enrolled DSNP members on a monthly basis.
- Performs on the spot verification of Medicaid eligibility for DSNP enrollment of prospective members.
- Obtains annual Medicaid Re-certification for currently enrolled DSNP members.
- Works with currently enrolled DSNP members who have lost their Medicaid eligibility during the deeming process to assist with re-certifying them for the DSNP.
- Submits paperwork to DCF and other entities as needed to maintain or regain eligibility. Evaluates and monitors the process until benefits are approved
- Effectively manage Medicaid caseload. Follows up with clients on a weekly basis.
- Work alongside DSNP team to obtain and provide necessary information as needed.
- Responsible for working with Social Security Administration to obtain proof of income and complete representative payee form
Required Work Experience
5+ years related work experience. Experience Details:
Required Management Experience
No supervisory/management experience required
Required Education
High school diploma or GED
Additional Required Qualifications
Bilingual English and Spanish Ability to maintain and multi-task with a significant caseload Knowledge of adult Medicaid Excellent problem-solving skills and resourceful Strong organizational skills and detail oriented Extraordinary interpersonal and creative skills Excellent writing and verbal communication skills Knowledge of Google platform, MS word The following certifications: Department of Children and Families Community Partner Certification ACCESS Certification Completion of the following training required for DCF Community Partners: Additional DCF Required Training for DCF Community Partners: ACCESS Civil Rights Training- Community Partners ACCESS Program Overview ACCESS Self-Service Portal Training Online Email Notification Customer Training Service Delivery for the Deaf and Hard-of-Hearing Limited English Proficiency Update Language Limitations and Customer Rights Security Awareness Training
Additional Preferred Qualifications
Prior experience working with the Department of Children and Families (DCF) Prior experience working with the state Medicaid portal FLMMS Prior experience/knowledge of Florida State Medicaid Prior experience working with the Agency for Health Care Administration (AHCA) Prior experience working for the Social Security Administration (SSA)
General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
Physical/Environmental Activities
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.
Medicaid Eligibility Specialist, FT, Mon – Broward Health Corporate | Fort Lauderdale, FL
Privacy Preference Center
SimplyHired may store or retrieve information on your browser, mostly in the form of cookies. Cookies are text-only pieces of information that a website transfers to an individual’s hard drive or other website-browsing equipment for record-keeping purposes. Cookies allow SimplyHired to remember important information that will make your use of the site more convenient and give you a more personalised web experience. Cookie and Privacy Policy
Manage Consent Preferences
Strictly Necessary Cookies
Always Active
Strictly Necessary Cookies
These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms. You can set your browser to block or alert you about these cookies, but some parts of the site will not then work.
Performance Cookies
Always Active
Performance Cookies
These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.
Targeting Cookies
Targeting Cookies
These cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.
Medicaid Program Monitor Job Opening in Baton Rouge, LA at State of Louisiana
Baton Rouge, LA Other
Job Posting for Medicaid Program Monitor at State of Louisiana
This position is located within the Louisiana Department of Health / Medical Vendor Administration / Eligibility Field Operations / East Baton Rouge Parish
Announcement Number: MVA/CSH/169914
Cost Center: 3052050400
Position Number(s): 50656481, 50656480, 50656482
This is a promotional opportunity open only to classified employees with permeant status with Louisiana Department of Health.
These positions will be filled as:
Medicaid Program Monitor (Quality Assurance Specialist)
Medicaid Program Monitor (Trainer)
No Civil Service test score is required in order to be considered for this vacancy.
To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.
*Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.*
A resume upload will NOT populate your information into your application. Work experience left off your electronic application or only included in an attached resume is not eligible to receive credit
For further information about this vacancy contact:
Casey Hickman
Casey.Hickman@la.gov
LDH/HUMAN RESOURCES
BATON ROUGE, LA 70821
225 342-6477
This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218.
MINIMUM QUALIFICATIONS:
A baccalaureate degree plus three years of professional level experience in administrative services, economics, public health, public relations, statistical analysis, social services, or health services.
SUBSTITUTIONS:
Six years of full-time work experience in any field may be substituted for the required baccalaureate degree.
Candidates without a baccalaureate degree may combine work experience and college credit to substitute for the baccalaureate degree as follows:
A maximum of 120 semester hours may be combined with experience to substitute for the baccalaureate degree.
30 to 59 semester hours credit will substitute for one year of experience towards the baccalaureate degree.
60 to 89 semester hours credit will substitute for two years of experience towards the baccalaureate degree.
90 to 119 semester hours credit will substitute for three years of experience towards the baccalaureate degree.
120 or more semester hours credit will substitute for four years of experience towards the baccalaureate degree.
College credit earned without obtaining a baccalaureate degree may be substituted for a maximum of four years full-time work experience towards the baccalaureate degree. Candidates with 120 or more semester hours of credit, but without a degree, must also have at least two years of full-time work experience tosubstitute for the baccalaureate degree.
Graduate training with eighteen semester hours in one or any combination of the following fields will substitute for a maximum of one year of the required experience on the basis of thirty semester hours for one year of experience: public health; counseling; social work; psychology; rehabilitation services; economics; statistics; experimental/applied statistics; business, public, or health administration.
A master’s degree in the above fields will substitute for one year of the required experience.
A Juris Doctorate will substitute for one year of the required experience.
Graduate training with less than a Ph.D. will substitute for a maximum of one year of experience.
A Ph.D. in the above fields will substitute for two years of the required experience.
Advanced degrees will substitute for a maximum of two years of the required experience.
NOTE:
Any college hours or degree must be from an accredited college or university.
Function of Work:
To perform advanced research, analyses, and/or policy management activities for Medicaid programs.
Level of Work:
Advanced.
Supervision Received:
Broad from a Medicaid Program Supervisor or above.
Supervision Exercised:
None.
Location of Work:
Department of Health and Hospitals, Medical Vendor Administration.
Job Distinctions:
Differs from Medicaid Program Specialist 2 by the presence of advanced research, analysis and policy management responsibility.
Differs from Medicaid Program Supervisor by the absence of supervisory responsibility.Conducts audits of eligibility enrollment applications; prepares reports on results of each audit.
Prepares, interprets and clarifies eligibility policies and procedures.
Revises rules, regulations, and procedures to meet changes in law or policy.
Compiles data and proposes budgets for subprogram studies and proposed legislation; determines programmatic impact and composes response for
fiscal statements and fiscal notes.
Reviews current and proposed state and federal regulations and/or revisions to those regulations for hospitals and home health providers.
Evaluates new and/or revised regulations to determine the impact to the state Medicaid program.
Reviews audits performed by the contracted auditor to determine compliance with federal and/or state policies and regulations, which affect allowable costs.
Coordinates compliance monitoring of Medicaid Application Centers statewide.
Receives, approves and schedules all requests for Application Center Representative training.
Advises and assists field staff in performing on-site monitoring reviews to ensure that the Application Centers adhere to federal, state and agency
rules and regulations.
Assist in negotiating contractual agreements between the Department of Health and Hospitals and the Application Centers.
Provides functional supervision over contract staff.
Monitors and evaluates training provided by contract staff.
Prepares the annual budget request utilizing the prescribed format and addendums issued by the Office of Planning and Budget. Prepares detailed analyses
and narratives supporting and/or justifying the request as submitted. Responds to requests for additional information and modifications to the budget during
the legislative approval process.
Trains staff of all Medical Vendor Administration sections in fiscal management, budget development and variance reporting.
Develops training module and provides essential guidance to managers regarding preparing accurate, pertinent and substantiated data.
Director,Technology: Health Plan CIO Medicaid Job Missouri
Clipped from: https://www.learn4good.com/jobs/online_remote/info_technology/2035910765/e/
Position: Director, Technology: Health Plan CIO – Missouri Medicaid
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale.
Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and
** your life’s best work. (sm)
** As an individual contributor you will be part of the local leadership team working with internal and external partners to support the successful delivery and maintenance of Information Systems that support the United Healthcare Missouri Medicaid business.
You will also be part of a broader team of individual contributors who provide thought leadership and strategic alignment across the Medicaid technology organization. The successful candidate with have demonstrated experience in leading matrixed teams, proven skills driving implementation of programs and initiatives, experience in working with senior leadership and strategic planning in the healthcare industry.
This role requires excellent communication, problem solving skills, curiosity and the ability to be both a doer and a leader. The quality candidate can leverage their business knowledge in the healthcare industry to support daily efforts, innovative IT efforts, and must excel in high impact and escalated crisis situations. This position will be a key contact for IT efforts and will work with the appropriate delivery areas for Community & States IT projects for our Missouri business.
The overall goal of this position is to provide executive oversight and leadership in United’s strong matrix environment, so the IT needs of the business and state partners are met, and contractual compliance are achieved.
If you are located in the St. Louise area, you will have the flexibility to work remotely 1-2 days a week*, as well as work in the office as you take on some tough challenges.
*
* Primary Responsibilities:
**+ Relationship Building:+ Build and improve state, Health plan, IT and service unit partnerships to build long-lasting transparent and trusting relationships+ Represents United Healthcare at State meetings; interacts with Community & State senior health plan and shared services leaders+ Leadership:+ Influence, negotiate effectively, and provide recommendations to arrive at win-win solutions with our state partner, Health plan, IT and business service partners related to IT initiatives+ Lead change and innovation by demonstrating emotional resilience, managing change by proactively communicating the case for change and promoting a culture that thrives on change+ Influence Health Plan, Business Service units, State partners, IT teams employees by fostering teamwork and collaboration, driving employee engagement and leveraging diversity and inclusion+ Provide leader oversight and direction to ensure that the IT applications and operations are working effectively, through high levels of engagement with Health Plan leaders and service units+ Develop and mentor others while also building awareness to your own strengths and development needs+ Active participant in local/regional health plan leadership, operational leadership group, business goals and strategic initiatives+ Be a strategic leader contributing to the growth agenda+ Regulatory and Growth Effectiveness:+
Provides SME (Subject Matter Experience) on business capabilities, such as claims, member, clinical, provider, X.12 transactions, etc to provide a translation of business need into technical requirements for both Growth and regulatory IT initiatives+ Strategize and review with business leaders to identify and frame their IT needs, mapping them to strategic plans and prioritizing them+ Drive high-quality execution and operational excellence by communicating clear directions and expectations+ Play an active role in implementing innovation solutions by challenging the status quo and encouraging others to improve overall effectiveness+ Support Program and Project Managers to ensure that programs / projects are delivered on-time, on-budget, on benefit and on-quality and intervene to resolve issues as required+ Represent United at mandatory state meetings and influence the design and timeline of state requirements through written recommendations, questions and clarifications, and open feedback forums+ Collaborate with other MCOs (Managed Care Organizations) to drive common processes and timelines for state deliverables+ Performance & Satisfaction:+
Accountable for compliance with state requirements for transaction loading (834, 837, 820, provider files, etc) and compliance on our technology platforms with state needs+ Drive sound and disciplined decisions that drive action while effectively using IT and Healthcare business knowledge+ Provides…
Senior Business Analyst Medicaid ACO – Steward Health Care System
Position Purpose: Reporting to the Senior Manager of Analytics and in support of the Director of Medicaid ACO, the Senior Clinical Healthcare 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
- Other duties as assigned based on business needs
|
Education / Experience / Other Requirements |
|
Education:
|
|
Years of Experience:
|
|
Specialized Knowledge:
|
|
|
|
Physical and Mental Demands |
These physical and mental demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
|
☒ Talking |
☒ Hearing |
☠Standing |
|
☠Repetitive Motion |
☒ Visual Acuity |
☠Walking |
|
☠Lifting <20 lbs |
☠Lifting >20 lbs |
☠Reaching |
|
☠Climbing |
☠Pushing / Pulling |
☠Stooping / Crouching |
|
☠Sedentary Work |
☠Light Work |
☠Medium Work |
|
☒ Critical Thinking |
☒ Mental concentration |
☠Driving |
Medical Director- Utilization Review Management Medicaid Job North Carolina
Clipped from: https://www.learn4good.com/jobs/online_remote/healthcare/2035811060/e/
Position: Medical Director- Utilization Review Management for Medicaid
Position
Title:
Medical Director
– Utilization Review Management for Medicaid
Job Description:
Medical Director
Location:
Remote/Work from Home position. Strongly prefer candidates to live in North Carolina.
Must be able to work eastern time zone hours.
Build the Possibilities. Make an extraordinary impact.
Responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates.
May be responsible for an entire clinical program.
How you will make an impact:
- Supports clinicians to ensure timely and consistent responses to members and providers.
- Provides guidance for clinical operational aspects of a program.
- Conducts peer-to-peer clinical reviews with attending physicians or other providers to discuss review determinations, and patients’ office visits with providers and external physicians.
- May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations.
- Serves as a resource and consultant to other areas of the company.
- May be required to represent the company to external entities and/or serve on internal and/or external committees.
- May chair company committees.
- Interprets medical policies and clinical guidelines.
- May develop and propose new medical policies based on changes in healthcare.
- Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality cost and outcomes.
- Identifies and develops opportunities for innovation to increase effectiveness and quality.
Minimum Requirements:
- Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS), American Osteopathic Association (AOA) or National Board of Physicians and Surgeons (NBPAS).
- Must possess an active unrestricted medical license to practice medicine or a health profession.
- Must possess or have the ability to obtain a North Carlina medical license.
- Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
- Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- Additional experience may be required by State contracts or regulations if the Medical Director is filing a role required by a State agency.
- If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a sensitive position’ work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.
- Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties, principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions.
Preferred
Qualifications:
- Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
- Internal Medicine, Family Medicine, or OB/GYN specialties preferred. Other specialties will be considered.
Job Level:
Director Equivalent
Workshift:
Job Family:
MED >
Licensed Physician/Doctor/Dentist
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.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate.
Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at …
Medicaid Specialist – Sentara Health
At Sentara Healthcare, one of our values is to keep you safe.
Sentara Healthcare and many other companies across the US are being targeted by cyber criminals who are impersonating representatives of the company, claiming to have job offers. Sentara will never ask you for banking or personal identification information via email or text. We will never ask an applicant to pay money for training, supplies, or other so-called expenses. If you suspect you have received a fraudulent job offer, e-mail taadmin@sentara.com.
Award-winning: Sentara Healthcare is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering more than 500 sites of care including 12 hospitals, PACE (Elder Care), home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!
When you join Sentara in a professional or management role, you become part of a progressive team of business leaders and operational experts. Our organization and our people are highly respected for the knowledge and innovation that we demonstrate each day. Working with us is an opportunity to have a positive influence on our growth and the communities we serve.
Overview
Responsibilities
Qualifications
Overview
Responsibilities
Assists in gathering and processing intake and enrollment paperwork. Submits and completes follow-up of pre/post enrollment paperwork with state and federal agencies. Completes verification of Medicare and Medicaid coverages and coordination of annual Medicaid renewals. Works in collaborations with Account Executive, Enrollment Coordinator, potential participant, caregiver, and others to identify a potential enrollee’s current financial status through review of income sources, current insurance policies, bank accounts, and other areas. Assists the Account Executive and Enrollment Coordinator in explaining financial issues to potential enrollees and/or their caregivers related to enrollment in the SE PACE program. Assists with quarterly mailings to referral sources as assigned. Other projects and duties as assigned. Associates Degree, preferred and 1-2 two years of extensive knowledge of Virginia Medicaid
Qualifications
License/Certification
- Basic Life Support (BLS) – Other/National
Education
- Associate’s Level Degree
- High School Grad or Equivalent
Experience
- Medicaid 1 year
- Frail and Elderly Population Previous Experience
- Customer Service 3 years
Skills
- Microsoft Office
Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
Director, Medicaid Solutions | Centene Corporation
You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose Build the company’s market position and increase revenue by directing and performing activities to locate and develop new business opportunities.
Propose potential business opportunities by contacting potential stakeholders and partners, discovering and exploring opportunities
Screen potential business opportunities by analyzing market strategies, deal requirements, potential and financials, evaluating options, and resolving internal priorities
Develop business development strategies and positions by studying integration of new opportunities with company strategies and operations, examining risks and potentials, and estimating stakeholders’ needs
Formulate and communicate to stakeholders, including regulators or other government officials and providers, provide leadership and direction to functional leadership involved with stakeholders to ensure objectives are met
Coordinate requirements, develop and negotiate contracts, and integrate contract requirements with operations
Participate in developing business and operational delivery models
Ensure compliance with applicable laws, Medicare and/or Medicaid regulations
Serve as a contact for functional groups, various departments and external customers in the coordination of implementation for multiple projects
Travel 30% – 50%
Education/Experience Bachelor’s degree in Business Administration, Economics, Political Science or related field. Master’s degree preferred. 7+ years of business development, sales, government relations or legal affairs, mergers and acquisitions, or investment analysis experience. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. Experience with healthcare, managed care, Medicaid or Medicare preferred.
Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Provider Compliance Investigator – REMOTE OPTIONS
Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork
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.
AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. 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.
Come join our dynamic and dedicated team.
Provider Compliance Investigator
Office of Inspector General
Job Location:
Address: 801 E. Jefferson Street, Phoenix, AZ 85040
Posting Details:
Open until filled
Salary: 47,300 – 57,200
Grade: 21
This position may offer the ability to work remotely within Arizona based upon the department’s needs and continual meeting of expected performance measures.
Job Summary:
The Division of Inspector General is looking for a highly motivated individual to join our team as a Provider Compliance Investigator. This position is directly involved in negotiating the final determination of financial over-payments and recommending civil monetary penalties levied against providers participating in fraudulent billing practices. The information obtained by this position is used for a variety of activities such as: determination of fines, restitution and cost avoidance; internal deliberation’s regarding settlement amounts for fines and restitution, participate in the decisions regarding opening and closing of criminal and civil investigations.
Major duties and responsibilities include but are not limited to:
- Complete required health care fraud audits to establish if program violations have occurred through billing, health care records, financial documentation, access to mainframe computer systems at AHCCCS, DES, MVD and DPS.
- Develop and prepare complex spreadsheets and flow-charts indicating under payments, misuse of funding and billings obtained through the audit process.
- Develop overpayments: losses to the Medicaid Program through diligent research and review to present the evidence to the legal authorities for prosecution.
- Communicate effectively with the providers and contractors occasionally under adverse arid threatening circumstances. Authority to draft and serve subpoenas and take sworn statements.
- Conduct interviews and obtain written statements from providers and clients to determine if fraudulent activities have occurred. Prepare written reports for use in administrative or legal proceedings.
Knowledge, Skills & Abilities (KSAs):
Knowledge:
- Law Enforcement processes and protocols, Basic investigative techniques.
- Interviewing suspects, witnesses, and victims, and of the rules regarding the admissibility of statements, admissions, and confessions.
- Thorough knowledge of HIPAA and the rules pertaining to the sharing of investigative information, Relevant statutes and laws pertaining to the investigation of Medicaid fraud, waste, and abuse.
- Claims processing, procedures, financing and operations for Fee For Service and Medical Compliance Officers, preparation of computerized spreadsheets which support audit findings.
Skills:
- Legal decisions as they relate to the admissibility of evidence, confessions, admissions, and statements.
- Proper methods of interviewing suspects, witnesses, and victims, and of the rules regarding the admissibility of statements, admissions and confessions.
- Effective methods to conduct a covert operation to identify fraudulent activity, Investigative methods, techniques, and approaches, necessary to plan and conduct criminal, civil and administrative investigations relating to the operations and activities of AHCCCS, conflict resolution.
Abilities:
- Interpreting and applying Federal and State Statutes and Agency policies.
- Conduct investigations, Manage time effectively, deal with difficult situations in a calm manor.
- Effectively handle hostile situations.
- Function in a virtual office environment.
Qualifications:
Minimum:
- Bachelor’s Degree in accounting or closely related field or at least two years’ experience as an Auditor or equivalent.
Preferred:
- Certified Professional Coder (CPC), Certified Fraud Examiner Certification (CFE), and/or eligibility experience. Knowledge of Title 19, ASRS 13 and 36 (is preferred but not required)
Pre-Employment Requirements:
• Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
• Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
• Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.
Benefits:
Among the many benefits of a career with the State of Arizona, there are:
• 10 paid holidays per year
• Paid Vacation and Sick time off (13 and 12 days per year respectively) – start earning it your 1st day (prorated for part-time employees)
• A top-ranked retirement program with lifetime pension benefits
• A robust and affordable insurance plan, including medical, dental, life, and disability insurance
• Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
• RideShare and Public Transit Subsidy
• A variety of learning and career development opportunities
• Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office)
By providing the option of a full-time or part-time virtual/remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
Retirement:
Lifetime Pension Benefit Program
• Administered through the Arizona State Retirement System (ASRS)
• Defined benefit plan that provides for life-long income upon retirement.
• Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
• Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).
Deferred Retirement Compensation Program
• Voluntary participation.
• Program administered through Nationwide.
• Tax-deferred retirement investments through payroll deductions.
Contact Us:
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.
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.