Category: Curator- Job Hunter

 
 

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

 
 

What you’ll do:

 
 

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

 
 

Experience we’re looking for:

 
 

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

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

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

 
 

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Senior Client Manager, Government Programs (Medicare/Medicaid)

SEE how you can make a difference! Be part of an innovative company that cares about its associates and helps members enjoy the wonders of sight through healthy eyes and vision.
 

Versant Health provides vision care to 37 million members nationwide! To ensure your continued success we provide opportunities for advancement and development. Our associates remain engaged through a comprehensive compensation and benefits package which includes health and dental insurance, tuition reimbursements, 401(k) with company match, pet insurance and FREE vision insurance for you and your family.

Scope and Purpose of Position

Develop strong external and internal relationships to achieve client satisfaction, revenue objectives for existing customers in an assigned segmentation and geography of Business.
 

Manage, retain and grow assigned book of business, including large high profile and complex Government Sponsored clients (i.e. Medicaid/Medicare lines of business), to achieve individual and corporate goals. Internal liaison to implementation and operations areas for clients. Coordinate introduction/orientation/implementation meetings with internal business partners when applicable for new/existing groups.

 

Essential Functions

• Provides strategic leadership and solution based support to expand and maintain business relationships with existing large and complex accounts
• Demonstrates individual ownership and accountability in development client and broker relationships
• Communicate effectively, consistently and frequently with assigned client base. Continuously working to improve customer loyalty
• Ongoing liaison/consultant through meetings, plan reviews, care calling, etc. in accordance with Client Service guidelines to ensure client loyalty, retention and satisfaction
• Lead implementation from a client management team perspective, partnering with internal departments, with the responsibility of successful implementation
• Ability to effectively manage high profile and complex clients in a book of business encompassing $15,000,000 to $40,000,000
• Meet all assigned revenue, client retention and profitability goals
• Notify Team leader of potential growth opportunities as well as escalated client concerns, continued negative feedback or ‘red flags’ within assigned book of business
• Present renewals and recommendations and coordinate implementations for renewals, benefit changes and unit adds with Implementation and Contracting teams
• Coordinate implementations for new sales with Sales Team as overall project manager through completion of implementation
• Determine growth opportunities and benefit design, coordinate proposal and finalize sale, as well as, group communication needs (summary plan descriptions, provider lists, etc.) and benefit fair needs and expectations
• Review and assure that client receives all requested reports, satisfaction results and performance guarantees within the timeframe requested
• Inform senior management of market trends that affect the management of assigned book of business
• Strategic support for sales presentations and marketing, when needed
• Adhere to privacy and confidential and proprietary company policies and procedures (i.e. HIPAA)
• Participate in any/all training and educational activities necessary to fulfill at least the minimum requirements as specified within your departmental goals. This is in addition to the completion of any activities necessary for the maintenance of professional affiliations or organizational requirements
• As required by changing business needs, complete additional responsibilities as assigned
• Maintain appropriate insurance licenses
• Ability and willingness to travel as required

Education and Experience

• Bachelor’s Degree preferred
• Knowledge and experience in the insurance, health, or vision care industry
• Years of experience 3-5
• Prior Account Management or Customer Service experience desirable
• Life/health insurance license required (within 6 months of hire)
• Computer knowledge/skills needed
• Travel domestically: valid driver’s license required

Competencies

• Collaboration
• Communication
• Consultation
• Customer Focus
• Financial Management
• Negotiation
• Relationship Management
• Results Oriented
• Strategic Thinking
• Team work
• Time Management

Essential Responsibilities related to Physical Demands/Work Environment

The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the associate is required to stand, use hands and fingers to handle, feel, pick or pinch, and talk or hear most of the time. The associate is occasionally required to stand, walk, and reach with hands and arms. The associate must frequently lift and/or move up to 20 pounds. The noise level in this location is moderate (use of computers, printers and machines). Ability and willingness to travel as required.
 

HIPAA & Security Requirements

All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.
 

 
 

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Marinus Pharmaceuticals, Inc

Full Time
Radnor, PA, US| Remote, Remote, US
Management
1073

Marinus Pharmaceuticals is a clinical stage biopharmaceutical company committed to developing breakthrough therapies to improve the quality of lives of patients and their families as they battle rare and life-threatening diseases.

Based in Radnor, PA we are a team of dedicated and talented professionals who value innovation and commitment to developing new therapies for CNS disorders and are passionate about making a positive difference in the lives of our patients.

We are currently searching for an experienced professional to join our growing commercial team as a:

Sr Director, Government Accounts-Medicaid

Reporting to the Vice President of Market Access, the Senior Director, Governments Accounts role is a highly visible and critically important position within the company. The Sr Dir will develop working relationships with key decision makers in formulary and medical management within designated target accounts to ensure patient access to Marinus portfolio of products. These accounts include State Medicaid Agencies and may include Medicaid ACOs, Medicaid MCOs, Medicaid PBMs, VA/DoD and other public payer and Federal accounts, as appropriate. This individual will place themselves in a position to influence and educate the formulary, purchasing and/or reimbursement decision-making processes at all levels, including Directors/VPs of Pharmacy, Medical, Clinical, Policy, Care Management, Quality, Innovation and State Medicaid Directors.

Key Responsibilities include but not limited to the following:
 

• Responsible for developing and implementing the company’s strategic market access and reimbursement objectives and providing cross-functional leadership and collaboration with external and internal stakeholders, including Marinus Executive Team.
• Demonstrate specific competencies through influence selling, utilizing clinical knowledge and value propositions, health economic and real world evidence, marketing resources, executive level relationship building and leveraging and negotiating contracts which may include outcomes based rebates.
• Will demonstrate strong financial stewardship for the company. Additionally, this individual will be involved in high level, cross functional decisions working with Sales, Marketing, Contracting, Corporate Accounts and other internal departments.
• Work collaboratively with internal and external stakeholders to develop and implement the company’s strategic market access and reimbursement objectives and providing cross-functional leadership.
• Develop and implement strategic plans for optimum product coverage positioning within each targeted public payer customer in assigned geography including State Medicaid Agencies and other regional or Federal accounts as defined by Marinus market access leadership
• Build strong account relationships at all levels, including executives, advocacy groups and agency heads, to enable sales growth
• Collaborate across all relevant business units within the organization to establish strategies and plans aligned with managed care execution of overall corporate strategy Support strategic plans with defined tactics and objectives to move government payer decisions in a direction that continues to open access for the appropriate patients
• Be a trusted advisor and expert in Marinus portfolio and disease states with the ability to educate and ensure optimal pull-through effectiveness for access program offerings and workflow implementations
• Assess competitive market landscape and opportunities for improved or expanded market penetration and adoption
• Collaborate with Provider Sales organization to educate on regional public payer access and coverage for Marinus products in addition to helping resolve unique reimbursement challenges that may arise Implement and lead customer level strategic plans that are aligned with the brand strategy
• Effectively communicate this knowledge to Sales, Marketing, Medical Affairs and other core cross functional teams
• Demonstrate interpersonal skillfulness that fortifies working relationships with Sales, Marketing, Contracting, Medical Affairs and other key departments to ensure adoption and execution of overall strategic plan and exceeding sales targets Serve as Player-Coach, in line management and with accountability for a defined government account set, while providing management and leadership support to the Head of Market Access.

Qualifications:
 

• Minimum Bachelor’s degree required, degree in Science, Business, Marketing or related technical field is preferred
• A minimum of 12 years pharmaceutical, biotech or payer industry experience in sales, marketing, managed care, contracting or other relevant commercial function
• A minimum of 5 years in Government Payer Account Management experience, including proven market access success and current organizational agility with State Medicaid Agencies and Federal Accounts
• Proven ability to work independently, adhere to specific timelines and execute on business plan initiatives
• Deep knowledge of the CMS and Medicaid rules, regulations standards and processes
• Strong account management skill set with extensive experience in strategic and tactical planning, execution and negotiation skills with proven track record of success
• Proven teamwork and collaboration skills with a demonstrated track record leading highly matrixed, cross-functional work teams comprised of high-level managers and executives
• Able to effectively manage competing priorities with strong sense of urgency and work ethic
• Innovative thinker with an understanding of legal/regulatory environment
• Thrives in a dynamic, fast paced environment utilizing decision making skills to interpret the business quickly and pave new pathways
• Exceptional written and verbal communication skills
• Up to Up to 50% travel may be required based upon business needs

At Marinus, we celebrate diversity and are committed to creating an inclusive environment for all employees; providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates without regard to race, color, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information, military and veteran status, and any other characteristic protected by applicable law.

All employment is decided on the basis of qualifications, merit, and business need.

Search Firm Representatives Please Read Carefully

Marinus Pharmaceuticals does not accept unsolicited assistance from search firms for employment opportunities. All CVs / resumes submitted by search firms to any employee at our company without a valid written search agreement in place for this position will be deemed the sole property of our company. No fee will be paid in the event a candidate is hired by our company as a result of an agency referral where no pre-existing agreement is in place. Please, no phone calls or emails.

Please see job description



 

PI144715612

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Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

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

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

Staff VP Compliance (Medicaid)

Role

The Staff VP Compliance is the senior leader responsible for oversight of compliance and regulatory functions for Anthem’s Medicaid West region and the Compliance teams that support each health plan. The individual in this position partners closely with the Compliance market and team leads for each market to (a) lead the strategic compliance direction for the plan, (b) guide proactive compliance oversight and State relationship management; and (c) engage in effective escalation and business area engagement to resolve issues and mitigate risks. This is in addition to serving as the key Compliance resource for the West Region Medicaid President as well as a critical and collaborative partner to the individual plan presidents. This position reports directly to the Medicaid Chief Compliance Officer.

Key Responsibilities

The position is also engaged in driving important strategic projects and priorities across regions, including but not limited to:

• Engagement with business partners and functional area leads to ensure effective action plans for issues impacting multiple markets
• Liaison with Cost of Care workstream leads to shed light on regulatory considerations and engagement needs for initiatives to ensure compliant implementation
• Vetting of mandate funding requests to confirm alignment with regulatory requirements
• Developing and driving implementation of compliance and regulatory “best practices” across markets (examples being audit support, mandate implementation oversight, etc.)
• Strategic advisory and consulting for business partners related to federal regulations and changes
• Active contribution to compliance and business governance committees, including compliance program reporting to business leadership.
• May be regularly engaged in day-to-day compliance and regulatory support at the health plan level if needed during staff shortages, team member LOA, or as business needs demand during periods of high activity (such as significant audits).
• Collaborates with management to set strategic vision; may oversee a manager(s)/director(s) with direct reports.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Location

Within commuting distance to an Anthem office preferred.

Qualifications

Requires a BA/BS and minimum of 10 years health care, regulatory, ethics, compliance or privacy experience, including minimum of 8 years management experience; or any combination of education and experience, which would provide an equivalent background. Ability to travel may be required.

Preferred

• Compliance knowledge and experience within managed care/health insurance industry.
• Knowledge and understanding of Medicaid regulatory compliance requirements.

Skills and Attributes

• Strong leadership/managerial skills and ability to motivate/coach other staff.
• Be a strategic thinker with a broad and deep understanding of healthcare from various vantage points.
• Demonstrated analytical skills, a sense of curiosity, and effective problem-solving.
• Ability to work through ambiguity putting structure to broad enterprise initiatives.
• Exceptional oral, written, and interpersonal communication, persuasion, and negotiation skills.
• Demonstrated ability to motivate, build consensus, and drive change.

Applicable to Colorado Applicants Only

Annual Salary Range*: $155,232 – $194,040

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

• The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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.

 
 

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About the job

Requisition No: 454781


Agency: Agency for Health Care Administration


Working Title: 68019253 – ADS FOR MEDICAID FIN & ANALYTICS


Position Number: 68019253


Salary: $4,615.38 – $5,000.00 / Bi-Weekly


Posting Closing Date: 09/13/2021


This is an exciting opportunity to help shape the quality of health care in Florida. The Agency for Health Care Administration (AHCA) is the State of Florida agency responsible for oversight of the Medicaid program. The Medicaid program provides low income families and individuals with access to health care. If you have a desire to use your talent and skills at an organization that provides critical services to millions of individuals and families across the state, AHCA invites you to apply to become an essential member of our team. As one of Florida’s leading state agencies, AHCA’s diverse workforce community of more than 1,400 employees is proud of its efforts to serve the people of Florida.


The Agency is seeking to hire an Assistant Deputy Secretary for Medicaid Finance and Analytics who desires to work to enhance the delivery of health care services through the Florida Medicaid program. This position requires a candidate who is creative, flexible, innovative, and who will thrive in a fast paced, team-based work environment.


Duties Of This Position Include, But Are Not Limited To


This position is located in the Division of Medicaid and is one of three Assistant Deputy Secretaries reporting to the Deputy Secretary for Medicaid. This position has full line authority with respect to the Bureaus of Medicaid Program Finance and Medicaid Data Analytics.


Establishing goals, objectives and priorities for Medicaid that are consistent with Agency goals and mission;


Directing the development of comprehensive Medicaid strategic and program plans that will efficiently and effectively carry out Agency goals and objectives;


Participate in the development and implementation of uniform policies and administrative rules for Medicaid Program Finance and Medicaid Data Analytics;


Direct the development of procedures and guidelines with respect to Medicaid Program Finance and Medicaid Data Analytics;


Plan for and review procurement documents and contracts within the areas of responsibility, ensuring appropriate coordination with the Centers for Medicare and Medicaid Services (CMS) and other parties;


Direct the planning, preparation, presentation and monitoring of the Medicaid budget to ensure consistency with Agency goals, objectives and priorities, and the most efficient and effective use of local, state and federal resources. Review and approve Medicaid program spending plans, corrective action plans, and proposed budget amendments;


Represent the Agency before the Legislature and other governmental and non-governmental entities. This includes representing the Deputy Secretary for Medicaid in meetings or conferences where authority to make decisions on behalf of the Agency may be required;


Communicate with, motivate, train, and evaluate employees, and plan and direct employees’ work. Employee has the authority to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, and discipline subordinate employees or effectively recommend such action, including employees serving as supervisors, administrators, and directors.


Knowledge, Skills, And Abilities

• Strong working knowledge of health care systems;
• Excellent communication skills, with the ability to communicate effectively both verbally and in writing;
• Strong management skills, with knowledge of management principles and practices;
• Ability to analyze data in order to develop alternative recommendations, solve problems, document work flow and other activities relating to the improvement of operational and management practices;
• Ability to conduct fact-finding research;
• Ability to utilize problem-solving techniques;
• Ability to work independently, as well as in a group setting;
• Ability to understand and apply applicable laws, rules, regulations, policies and procedures relating to operational and management analysis activities;
• Ability to plan, organize and direct work assignments, while motivating and developing staff;
• Ability to establish and maintain effective working relationships;
• Ability to travel with or without accommodations.
   

Minimum Qualification Requirements


At least four years experience managing large programs and initiatives;


At least four years of experience in health care systems or Medicaid preferred;


A Master’s degree is preferred. However a Bachelor’s degree from an accredited college or university in a related field and applicable work experience can substitute on a year-for-year basis.


Licensure, Certification, Or Registration Requirements


N/A


CONTACT: BRITTANY GRAY 850-412-3695


The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.


Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.


The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

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About the company

State of Florida

47,920 followers

Government Administration 10,001+ employees 10,439 on LinkedIn

Join Florida’s talented workforce to fulfill your professional goals and achieve a meaningful career. Our talented public servants work hard to serve more than 19 million residents across Florida, and you, too, can realize success in the Sunshine State.

Working in Florida’s state government means being responsive to the issues impacting the taxpayers of our state. Florida’s state government boasts both fast-paced work environments in which critical thinking and creative problem-solving are a must as well as steady employment opportunities that prize consistent service to our state’s residents. In some positions, state employment means being able to influence policy decisions and help implement change. In others, state employment means being the reliable resource that our taxpayers have come to expect from Florida’s public servants. All positions offer the ability to gain valuable experience quickly, improving your overall skillset. The State of Florida is seeking individuals with leadership skills, creativity and dedication to their fellow Floridians and individuals who recognize the professional development opportunities and achievements possible through state service.

Florida boasts the third largest population in the country and is richly diverse in both population and landscape. With an award-winning park system, warm weather and beautiful bodies of water, Florida is the perfect environment for recreational activities and outdoor enthusiasts. Our favorable tax climate means your income goes further and our business-friendly policies foster private sector growth. Joining Florida’s talented, diverse workforce provides the opportunity to achieve your professional goals while living in a state that values quality of life, culture and recreation. For employment opportunities with the State of Florida, visit https://jobs.myflorida.com. …

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Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

Improving Members’ experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

 
 

Clipped from: https://jobs.communityhealthchoice.org/senior-hris-analyst-supplemental/job/16627071?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Requisition No: 454741


Agency: Agency for Health Care Administration


Working Title: 68019502 – CHIEF OF MEDICAID PROGRAM FINANCE


Position Number: 68019502


Salary: $3,846.16 / Bi-Weekly


Posting Closing Date: 09/13/2021


This is an exciting opportunity to help shape the quality of health care in Florida. The Agency for Health Care Administration (AHCA) is the State of Florida agency responsible for oversight of the Medicaid program. The Medicaid program provides low-income families and individuals with access to health care. If you have a desire to use your talent and skills at an organization that provides critical services to millions of individuals and families across the state, AHCA invites you to apply to become an essential member of our team. As one of Florida’s leading state agencies, AHCA’s diverse workforce community of more than 1,400 employees is proud of its efforts to serve the people of Florida.


We are seeking to hire the Chief of Medicaid Program Finance who desires to work to enhance the delivery of health care services through the Florida Medicaid Program. This position requires a candidate who is creative, flexible, innovative, and who will thrive in leading a fast-paced, team based work environment.


This position is located in the Bureau of Medicaid Program Finance (MPF) and a part of AHCA. This position reports directly to the Assistant Deputy Secretary for Medicaid Finance and Analytics. MPF manages and projects Florida’s $34.4 billion Medicaid Services budget, oversees financial reporting of the Agency’s contracted Medicaid health plans, calculates both institutional and non-institutional Medicaid reimbursement rates, and disburses supplemental payments to Medicaid providers.


This position is responsible for but not limited to, the following: Estimating, implementing and tracking the budget and caseloads for the Medicaid program as well as projecting and presenting expenditure and caseload forecasts for consideration by the principals of the Social Services Estimating Conference.


Overseeing the financial reporting process for Medicaid health plans as well as reviewing the reporting of the Medical Loss Ratio and Achieved Savings Rebate.


Preparing analyses for potential financial budgetary impacts of changes in laws, rules, regulations, or policy on the Medicaid program.


Overseeing the rate-setting process for institutional providers in the fee-for-service Medicaid program, including inpatient and outpatient hospitals, nursing facilities, county health departments, federally qualified health centers and intermediate care facilities for individuals with intellectual disabilities. This includes both prospective rate-setting and cost-based reimbursement methodologies.


Overseeing the operations of the Low Income Pool, Disproportionate Share Hospital and Graduate Medical Education Statewide Medicaid Residency programs.


Maintaining relationships with key Medicaid stakeholders in relation to the duties of this position, including relationships with the Governor’s office, legislative staff, provider organizations, advocacy groups and the health plans representing Medicaid enrollees. This involves representing the Division of Medicaid before these groups.


Working closely with the Agency for Health Care Administration’s executive management team and Division of Medicaid leaders to identify interactions between and impacts of budgeting/rate-setting/financial monitoring and the Division’s policy and operational functions.


Oversees coordinating and supervising activities of the 53 staff members in the Bureau of Medicaid Program Finance to ensure continuing operations, compliance with state and federal mandates, and maximizing productivity and efficiency.


AHCA Offers An Excellent Array Of Benefits, Including

• Health insurance
• Life insurance
• Dental, vision and supplemental insurance
• Retirement benefits
• Vacation and sick leave
• Paid holidays
• Opportunities for career advancement
• Tuition waiver for public college courses
• Training opportunities
   

For more information about the Bureau of Medicaid Program Finance, please visit our website at http://ahca.myflorida.com/Medicaid/index.shtml.


Join us at the Agency for Health Care Administration in fulfilling our mission to provide “Better Health Care for all Floridians.”


Knowledge, Skills, And Abilities

• Ability to supervise people and communicate effectively.
• Ability to develop and present written analyses and reports relating to rates, budgets and management/facility utilization.
• Ability to conduct research, review, analyze, evaluate and interpret financial, operational and statistical data with accuracy.
• Ability to determine work priorities by coordinating, assigning work and ensuring proper completion of work assignments.
• Ability to solve problems and make decisions.
• Ability to provide technical assistance and advice to hospital staff.
• Ability to establish and maintain effective working relationships with others.
• Ability to travel with or without accommodations.
   

Minimum Qualification Requirements


A Bachelor’s degree in the field of finance, accounting, economics, mathematics or other related business field is preferred.


Licensure, Certification, Or Registration Requirements


N/A


CONTACT: BRITTANY GRAY 850-412-3695


The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.


Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.


The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

 
 

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Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Anthem, Inc. is an innovative company dedicated to total personal health by making insurance more accessible. Through our affiliated companies, Anthem serves more than 106 million people, including more than 42 million within our family of health plans – that’s one in eight Americans. 

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

Responsible for managing or co-managing research projects from inception to results reporting in support of Anthem’s Government Business Division (GBD).  

 
 

Primary duties may include, but are not limited to:

• Assess and consult on the business situation, information needs, and scope appropriate methods and approaches to address business stakeholder needs.   

 
 

• Design data collection tools and works with in-house software tools and/or vendors to collect and interpret qualitative and quantitative data. 

 
 

• Determine sources of secondary data, including pre-existing primary research, and retrieves and analyze data to synthesize a summary of findings. 

 
 

• Collaborate with data science teams on larger quantitative surveys to elicit deeper insights gained from internal databases for profiling and predictive models.

 
 

• Create PowerPoint results reports of findings with implications and recommendations incorporating findings from both primary and secondary research. 

 
 

 
 

Qualifications

• Requires a BA/BS degree in marketing or business; 3 years of experience; or any combination of education and experience, which would provide an equivalent background. 

Perferred skills:

• Experience with common research software, such as qualitative community platforms, and/or Qualtrics (or similar), and/or SPSS or SAS is required.

 
 

• Familiarity with research practices for advertising messaging, value proposition, concept development and testing, member experience, user experience, or human-centered design practices is preferred. 

 
 

• Health insurance industry or managed care experience – particularly for Medicare Advantage or Medicaid – is preferred. 

 
 

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


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://anthemcareers.ttcportals.com/jobs/7290930-marketing-research-analyst-senior-medicare-and-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Mercer is seeking candidates for the following position. Candidates can be based in the Phoenix, Minneapolis, Atlanta office or remote:


Government Health Actuary Consultant

What can you expect?


 

• Be a part of the team that leverages our knowledge and expertise to help states manage the challenges and complexities of the health care world
• Work alongside passionate, critical-thinking colleagues to assist government-sponsored programs in becoming more efficient purchasers of health services
• Be on the cutting edge of health care reform . We partner with states and the Federal government on implementing a wide variety of health care and human services issues, including actuarial, data/systems analysis, clinical, policy, pharmacy, operations, and procurement
• Beyond the in-depth training provided, new employees are included on client teams immediately, providing unique opportunities to learn more while helping team members with critical workloads and making a difference to our clients
• As part of Mercer, the Government Human Services Consulting team offers its expertise within a small business atmosphere
  
  
   

What’s in it for you?


 

• Be a part of the team that has the world’s largest and most influential benefits brokerage and consulting capabilities
• Our competitive programs, entrepreneurial spirit and team-oriented culture offer a richly rewarding and exciting environment where you can excel and achieve your professional goals
• We run many social and new-hire events, outings, and employee networks, having fun in the work you do comes from being a part of a client team and contributing to its success
  
  
   

In this role you will be responsible for:


 

• Serve as lead or co-lead actuary on large and complex state managed health and welfare capitation projects. These capitation projects are commissioned by government entities to determine the rates that they will pay for health and welfare services covered by their plans
• In conjunction with the project leader, work with the client to define the scope of the project and serve as an expert on rate structure and methodology and ensure consistency with federal regulations and actuarial standards
• Provide actuarial oversight and guidance in developing the data model
• Develop the rate setting assumptions that are built into the data model and informs client and project team on impact of data assumptions and provide on-going review and guidance during the data analysis process
• Collaborate with client team and project team to finalize rates and educate client on the impact of their policies on the data and rates
• Draft project communications, including rate capitation letters and act as actuarial authority that signs and certifies rate capitation letters
  
  
   

What qualifications are necessary to have for the role?


 

• BA/BS degree
• Actuarial credentials (ASA or FSA, MAAA) required
• 5+ years of Health & Benefits or relevant actuarial experience
  
  
   

What makes you ideal for the role?


 

• Excellent interpersonal skills; strong oral and written communication skills
• Ability to prioritize and handle multiple tasks in a demanding work environment
• Strong critical thinking and analytical problem-solving skills
  
  
   

This role is not eligible to be performed remotely from Colorado.

To learn more about Mercer’s GHSC practice, please visit www.mercer-government.mercer.com

Mercer believes in building brighter futures by redefining the world of work, reshaping retirement and investment outcomes, and unlocking real health and well-being. Mercer’s more than 25,000 employees are based in 44 countries and the firm operates in over 130 countries. Mercer is a business of Marsh & McLennan (NYSE: MMC), the world’s leading professional services firm in the areas of risk, strategy and people, with 76,000 colleagues and annual revenue of $17 billion. Through its market-leading businesses including Marsh, Guy Carpenter and Oliver Wyman, Marsh & McLennan helps clients navigate an increasingly dynamic and complex environment. For more information, visit https://www.me.mercer.com/. Follow Mercer on Twitter @Mercer.

Clipped from: https://www.linkedin.com/jobs/view/2653662205/?recommendedFlavor=IN_NETWORK

 
 

Mercer is seeking candidates for the following position. Candidates can be based in the Phoenix, Minneapolis, Atlanta office or remote:


Sr. Government Health Actuary Consultant


What can you expect?


 

• Be a part of the team that leverages our knowledge and expertise to help states manage the challenges and complexities of the health care world
• Work alongside passionate, critical-thinking colleagues to assist government-sponsored programs in becoming more efficient purchasers of health services
• Be on the cutting edge of health care reform. We partner with states and the Federal government on implementing a wide variety of health care and human services issues, including actuarial, data/systems analysis, clinical, policy, pharmacy, operations, and procurement
• Beyond the in-depth training provided, new employees are included on client teams immediately, providing unique opportunities to learn more while helping team members with critical workloads and making a difference to our clients
• As part of Mercer, the Government Human Services Consulting team offers its expertise within a small business atmosphere
  
  
   

What’s in it for you?


 

• Be a part of the team that has the world’s largest and most influential benefits brokerage and consulting capabilities
• Our competitive programs, entrepreneurial spirit and team-oriented culture offer a richly rewarding and exciting environment where you can excel and achieve your professional goals
• We run many social and new-hire events, outings, and employee networks, having fun in the work you do comes from being a part of a client team and contributing to its success
  
  
   

In this role you will be responsible for:


 

• Work with client and Mercer’s H&B Government Project Managers to clearly define the scope, timelines and deliverable(s) of the project; ensure development and proposes essential project documents, including the budget and work plans
• Provide oversight of actuarial work and guidance in developing the data model for the project
• Review data modeling, data assumptions and analysis results for actuarial soundness
• Collaborate with client team and project team to finalize rates; educate and consult with client on the impact of their policies on the data and rates; act as actuarial authority that signs and certifies rate capitation letters
• Manage the relationship with the key client stakeholders and oversee client engagements including: overseeing multiple project managers; ensuring the team is within budget, on time and producing work consistent with the scope of work; ensuring communication with client, project team and senior client leader
• Define the strategy for and leads the RFP process; develop cost proposal; evaluate conversion/recovery/ aspects of RFP; evaluate risk and manage RFP through Mercer internal legal and executive approval process
• Have full authority for the following people management responsibilities: assigning, directing, and evaluating work; conducting performance evaluations, progressive counseling and career development discussions; and ensuring appropriate orientation and on-going education/training
  
  
   

What you need to have:

 

• BA/BS degree
• Minimum 12 years of relevant experience required
• Medicaid background and experience
• Actuarial credentials (ASA, FSA) required
  
  
   

What makes you stand out?


 

• Excellent project management and interpersonal skills; strong oral and written communication skills
• Excellent project management, presentation and interpersonal skills; strong oral and written communication skills
  
   

This role is not eligible to be performed remotely from Colorado.

To learn more about Mercer’s GHSC practice, please visit www.mercer-government.mercer.com

Mercer believes in building brighter futures by redefining the world of work, reshaping retirement and investment outcomes, and unlocking real health and well-being. Mercer’s more than 25,000 employees are based in 44 countries and the firm operates in over 130 countries. Mercer is a business of Marsh & McLennan (NYSE: MMC), the world’s leading professional services firm in the areas of risk, strategy and people, with 76,000 colleagues and annual revenue of $17 billion. Through its market-leading businesses including Marsh, Guy Carpenter and Oliver Wyman, Marsh & McLennan helps clients navigate an increasingly dynamic and complex environment. For more information, visit https://www.me.mercer.com/. Follow Mercer on Twitter @Mercer.

Clipped from: https://www.linkedin.com/jobs/view/2653658598/?recommendedFlavor=IN_NETWORK