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IT SPECIALIST (OPERATING SYSTEMS)

 
 



Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Information Technology (OIT), Enterprise Systems Solutions Group, Division of Medicare Systems Support, Woodlawn, MD.


As an IT Specialist (Operating Systems), GS-2210-13, you will provide technical direction to contractors in the design, development and implementation for release management of maintenance and system enhancements.

Learn more about this agency

Responsibilities


  • Direct the work of system contractors through release management processes in the design, development, and implementation of advanced systems in area of responsibility.
  • Design, develop, and implement system enhancements and maintenance changes to the MA and Part D family of systems through providing technical guidance and direction to system contractors.
  • Act as a Government Task Leader (GTL) for contracts that focus on the design, development, and implementation of maintenance and system enhancements for MA and Part D software applications.
  • Interface with other Federal/State/local governmental agencies, MA and Part D plan sponsors, and private sector organizations in the coordination of the Medicare program.

Travel Required

Occasional travel – You may be expected to travel up to 5% for this position.

Supervisory status

No

Promotion Potential

13

Job family (Series)

2210 Information Technology Management

Similar jobs

  • Information Technology Specialist (It Specialist)

Requirements


Conditions of Employment

  • You must be a U.S. Citizen or National to apply for this position.
  • You will be subject to a background and suitability investigation.
  • Time-in-Grade restrictions apply.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.


Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.


In order to be considered, you must have IT-related experience demonstrating each of the four competencies listed below:
1) Attention to Detail – is thorough when performing work and conscientious about attending to detail;

2) Customer Service – Works with clients and customers (that is, any individuals who use or receive the services or products that your work unit produces, including the general public, individuals who work in the agency, other agencies, or organizations outside the Government) to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations; knows about available products and services; is committed to providing quality products and services;


3) Oral Communication – Expresses information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information (for example, technical, sensitive, controversial); makes clear and convincing oral presentations; listens to others, attends to nonverbal cues, and responds appropriately; and


4) Problem Solving – identifies problems; determines accuracy and relevance of information; uses sound judgment to generate and evaluate alternatives, and to make recommendations.



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) Implementing IT program projects related to system lifecycle (including initiation, development life cycle; 2) Managing projects that include cloud services; 3) Providing recommendations to management for improvements to IT projects, contracts, systems and/or operations; and 4) Ensuring compliance with CMS contracts management practices.


Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (eg, Peace Corps, AmeriCorps) and other organizations (eg, professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.


Time-in-Grade: To be eligible, current Federal employees must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.

Click the following link to view the occupational questionnaire: (see application details)

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: Yes

Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Not Required



Full-Time Telework Program for CMS Employees: CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page .


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 (see application details) .


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 . Read more

How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

Once the announcement has closed, your online application, resume, and CMS required documents will be used to determine if you meet eligibility and qualification requirements listed on this announcement. If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration. Please follow all instructions carefully. Errors or omissions may affect your rating.


Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):

  • Analysis
  • Oral Communication
  • Project Management
  • Writing

Additional selections may be made from this announcement for similar positions within CMS in the same geographical location. For Central Office vacancies, the “same geographical location” includes Baltimore, Maryland; Bethesda, Maryland; and Washington, D.C. Read more

Background checks and security clearance

Security clearance

Not Required

Drug test required

No

Position sensitivity and risk

Moderate Risk (MR)

Trust determination process

Credentialing, Suitability/Fitness

Required Documents

The following documents are REQUIRED:

1. Resume showing relevant experience; cover letter optional . Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: (see application details)
2. CMS Required Documents (eg, SF-50, DD-214, SF-15, etc.). Current CMS employees are REQUIRED to submit a copy of their most recent Notification of Personnel Action (SF-50) at the time of application. Additional documents may also be required 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.

 
 

Clipped from: https://www.jobserve.com/us/en/JobLanding.aspx?r=1&jid=AE4573F1C946181C6C&src=

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Associate Actuary, Medicaid Trends – Louisville | Humana

 
 

 
 

Description

The Associate Actuary, Medicaid Trend will lead the Inpatient Early Indicator Report process for all Medicaid markets in order to analyze emerging experience, identify opportunities for trend-bending initiatives, and guide market strategic decisions. Manages one analyst to build reporting tools and models and to provide insight on trends across various markets. Leads a monthly call with key stakeholders to report data findings and facilitate discussion of market opportunities.

Responsibilities

Analyzes and forecasts utilization and financial data to provide accurate and timely information to Medicaid market leaders to make strategic and operational decisions. Establishes metrics, provides data analyses, and evaluates market trends to forecast the organization’s

Clipped from: https://careers.humana.com/job/13387931/associate-actuary-medicaid-trends-louisville-ky/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Pharmacy Benefits Solutions Professional / Pharmacy Benefits Management Project Mgr /Medicaid Implementation Specialist | Conduent

 
 

Location: Remote

Categories: Client Relationship Management / Service Delivery


Req ID: 2021-42228

Job Description

About Conduent

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

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

Job Description

Seasoned pharmacy professional required to provide expert leadership and support for sales efforts. Supports sales processes as a Subject Matter Expert, with a deep understanding of current and near-future product and service offerings. Researches and analyzes competitor products and service offerings. Partners with technology and operational teams to improve & transform business (processes), optimize knowledge, skills, productivity, and quality. Contributes to and assists in any aspect of the sales, product or account management lifecycle.

***Position is “remote”–”work from home”and can be located anywhere, US***

Responsibilities Include:

  • Manage and drive work across multiple functional teams on projects related to service delivery.
  • Partners with technology and operations teams to define requirements and support offerings for PBM projects and business processes, including but not limited to, pharmacy claims, prior authorization, drug rebate, drug utilization review, and clinical services.
  • Responsible for developing and maintaining a deep understanding of our solution set.
  • Understands new software requirements and potential impacts to upstream and downstream users, stakeholders, and applications.
  • Selects solutions appropriate to business opportunities and client needs.
  • Understands and articulates the business value and impact of pharmacy offerings.
  • Makes recommendations on future products and/or business offerings.
  • Interprets business challenges and recommends best practices to improve products, processes or services.
  • All other duties as assigned.

Experience and Education:

  • 3+ years of Managed Care or PBM or pharmacy-related operations process improvement experience, with a preference for experience with Government Programs (Medicare, Exchange and/or Medicaid)
  • Minimum 5 years of Medicaid Experience
  • Minimum 5 years of Pharmacy Payer Experience
  • Bachelor’s Degree Required

#techjobs

• Assists in researching technologies, best practices and market demand to put forth products to be sold to clients and prospects.

• Thought Leadership Development – collaborate on writing white papers, case studies and blogs.

• Sales Collateral Development – works with sales leadership and marketing to write client-facing collateral.

• Solution Development / Proposal Development – supports solution architects and delivery to address existing customer requirements.

• Represents the company at industry events.

• Developing industry knowledge expert.

 
 

Clipped from: https://jobs.conduent.com/job/13282260/pharmacy-benefits-solutions-professional-medicaid-implementation-specialist-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Contracts and Policy Analyst

 
 

Contracts and Policy Analyst

AHCCCS

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

Contracts and Policy Analyst

AHCCCS

Posting Details:

Salary: $47,476 – $50,000 
 

Grade: 21

Job Summary:

The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a Contract and Policy Analyst. This position is responsible for the tracking and maintenance of managed care contracts, medical and/or operational policies, guides and manuals and requires that numerous actions be accomplished to ensure that all aspects of the process are completed in a timely and accurate manner. This position is responsible to maintain ongoing working knowledge of policies and contracts in order to ensure provisions remain accurate across policies and contracts, as appropriate. Although this position may work on both contract and policy, it may be required to maintain an area of focus on one or the other for a period of time.

Job Duties:

* Overseeing the preparation, distribution and tracking of AHCCCS managed care contractor policies, forms, attachments, guides and manuals and other materials for Policy Committee review, public comment feedback and/or AHCCCS review and approval.

* Solicit input on critical contract provisions/revisions from stakeholders within and outside DHCM, arrange meetings with stakeholders incorporate input into solicitations and/or contract amendments and track contract revisions for future contract cycles.


* Assist in preparing the required documentation for the Centers for Medicare and Medicaid Services (CMS) to obtain approval of new and renewal contracts within established timeframes.


* Assists with contract development/amendments and/or RFP process as needed within the unit.


* Manages ad hoc administrative projects and conducts other duties as assigned.


 

Knowledge, Skills & Abilities (KSAs):

* Extensive knowledge of technical writing and editing, contract and policy development and distribution processes.

* Knowledge of Medicaid managed care program and managed care principles.


* Ability to synthesize and consolidate technical information into clear and concisely written guidance documents.


* Must possess organizational skills to manage multiple projects simultaneously, and the ability to prioritize projects and manage competing deadlines to ensure successful project completion.


* Work cooperatively with others (internal and external customers and stakeholders) and to provide guidance to other unit or division staff as needed.


 

Selective Preference(s):

* Bachelor’s degree in a field related to the functions of this position

* Direct experience (2-4 years) in a health care environment or health care administration.


* Two to three years experience in a regulatory environment and experience with Medicaid managed care contracting.


 

Pre-Employment Requirements:

Arizona Drivers License

Benefits:

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

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

Contact Us:

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

 
 

Clipped from: https://jobs.azahcccs.gov/contracts-and-policy-analyst/job/17121648?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Posted on

Marketing Research Analyst Senior (Medicare and Medicaid)

 
 

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.

Clipped from: https://anthemcareers.ttcportals.com/jobs/7290806-marketing-research-analyst-senior-medicare-and-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Nurse Medical Management l (Telephonic) Medicaid Outpatient

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time


 

Your Talent. Our Vision. At UniCare, a subsidiary of 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. 

 
 

RN Utilization Management – Medicaid Outpatient (PS55376)

 
 

Location: This position will allow you to work from your home office. You must reside in the state of West Virginia.

 
 

Work Hours: Regular business hours

 
 

The Nurse Medical Management l position for Unicare (Medicaid West Virginia) is responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of outpatient services and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers or programs. Works with medical directors in interpreting appropriateness of care. Primary duties may include, but are not limited to: 

 
 

  • Conducts pre-certification for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract.
  • Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
  • Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.
  • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

 
 

Qualifications

  • Current active unrestricted RN license to practice as a health professional within the scope of practice in the state of West Virginia.
  • Must reside in the state of West Virginia.
  • 2 or more years of acute care clinical experience.
  • Experience using multiple computer programs simultaneously.

 
 

  • Knowledge of substance abuse disorders.

 
 

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

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/7267461-nurse-medical-management-l-telephonic-medicaid-outpatient?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Babylon – Community Health Worker (Medicaid)

 
 

About the Community Health Worker position:  

 
 

Babylon Health is recruiting for multiple full-time Community Health Worker positions that will join our population health team and have the opportunity to support our Medicaid patients.  

 
 

This position is currently remote but as public health guidelines evolve, there will be a requirement to travel from time to time.

 
 

Start Date:

Early September

 
 

Schedule:

You will be scheduled for shifts Monday to Friday from 8 AM – 5PM and 9 AM – 6PM (1 hour for lunch)

WHAT YOU’LL WORK ON

  • Our Community Health Workers will join a multidisciplinary team of physicians, nurses and social workers to provide comprehensive care to our Medicaid patients.
  • You’ll have the opportunity to work with underserved populations and be an advocate for those who need support and resources.  We provide care in a variety of ways – you’ll connect with our patients in-person (once public health guidelines change), on the phone, embedded (on site) in the physician office or hospital or in the home as needed.
  • You’ll have the opportunity to work closely with our integrated care team to improve patient access to community and government service agencies.
  • Be a part of our mission to put an affordable and accessible health service in the hands of every person on earth.

WHAT WE’RE LOOKING FOR

  • Experience working with Medicaid/Medicare/Vulnerable Populations
  • Experience as a Community Healthcare Worker or similar position – being an advocate for patients and underserved communities
  • The ability to navigate multiple computer systems and software (we use G-Suite, Slack and an EHR)
  • Experience working with the aged, blind and disabled (ABD) would be considered an asset

WHO YOU ARE (optional)

  • The compensation range for this role will be shared during the early interview stages.
  • 4 weeks’ paid vacation
  • 401k’ with employer matching contribution
  • Benefits include bonus, medical insurance, vision, and dental coverage
  • Incredible growth opportunities with a global health tech startup with a meaningful mission

WHAT WE OFFER 

Whether you work in one of our amazing offices or a distributed team, Babylon is highly collaborative and fun! You’ll have a chance to work in a fast-paced environment with experienced industry leaders. We have a learning environment where you can make an impact.

 
 

WHO WE ARE

We are a team on a mission, to put accessible and affordable healthcare in the hands of every person on earth. Our mission is bold and ambitious, and it’s one that’s shared by our team who shares our values, to dream big, build fast and be brilliant. To achieve this, we’ve brought together one of the largest teams of scientists, clinicians, mathematicians and engineers to focus on combining the ever-growing computing power of machines, with the best medical expertise of humans, to create a comprehensive, immediate and personalized health service and make it universally available.

 
 

At Babylon our people aren’t just part of a team, they’re part of something bigger. We’re a vibrant community of creative thinkers and doers, forging the way for a new generation of healthcare. We’re only as good as our people. So, finding the best people is everything to us. We serve millions, but we choose our people one at a time…

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Posted on

Medicaid Specialist I

 
 

Job Details

Medicaid Specialist I

This listing closes on 8/20/2021 at 11:59 PM Central Time (US & Canada).

Salary

$27,346.56 Annually

Location 41 – LEE COUNTY, MS

41 – LEE COUNTY, MS

Job Type

Full-Time

Department

0665 – MEDICAID DIVISION

Job Number

3103-0665-20210816le

Closing date and time

8/20/2021 at 11:59 PM Central Time (US & Canada)

Characteristics of Work

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

Examples of Work

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

 
 

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

 
 

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

 
 

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

 
 

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

 
 

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

 
 

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

 
 

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

 
 

Performs related or similar duties as required or assigned.

Minimum Qualifications

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

EXPERIENCE/EDUCATIONAL REQUIREMENTS:

Education:

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

OR


Education:

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

AND


Experience:

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

Substitution Statement
:

Above an Associate’s Degree or completion of sixty semester hours from an accredited college or university, related education and related experience may be substituted on an equal basis.

Essential Functions

Additional essential functions may be identified and included by the hiring agency. The essential functions include, but are not limited to, the following:

1. Maintains caseload for Medicaid eligibility.


2. Maintains good public relations and customer service.


3. Collects eligibility data information.


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

Health/Prescription Insurance

Eligible employees have the opportunity to participate in the state’s health and prescription insurance program. Employees may select either single or family coverage with affordable co-payments. More detail can be found at Know Your Benefits.

 
 

Wellness Benefits

Employees are eligible for a wellness and health promotion program. This plan provides annual benefits for certain services with first-dollar coverage with no deductible.

 
 

Life Insurance

All eligible employees receive an actual term life insurance policy upon employment. The policy coverage is two times the employee’s annual salary to a maximum of $100,000. More detail can be found at Life Insurance Choices.

 
 

Optional Insurances

Many agencies offer discounted premiums for dental, vision, and cancer insurance.

 
 

Flexible Spending Accounts

Many state agencies provide opportunity for employees to participate in pre-tax spending accounts. These accounts allow employees to withhold childcare expenses and unreimbursed medical expenses prior to application of state and federal taxes.

 
 

 
 

Paid Personal Leave and Sick Leave

Full-time employees receive paid time off for personal needs and for sick leave. Leave begins accruing after one month of employment and may be used as it is accrued. Employees earn approximately 18 days of personal leave annually and 12 days of sick leave annually.

 
 

Military Leave

In accordance with federal law, all employees serving in the armed forces or the military reserves are entitled to 15 days per year for military training.

 
 

Holidays

Employees receive up to 10 paid holidays to enjoy many of our nation’s celebrations with family and friends.

 
 

Retirement Programs

The State of Mississippi provides all its employees a Defined Benefit/Defined Contribution Retirement Program. Employees become vested in the State’s retirement system after 8 years of employment. Both you and your employing agency contribute toward your retirement.   More detailed information regarding the State’s retirement program can be found at http://www.pers.state.ms.us

 
 

Deferred Compensation

State agencies offer several opportunities for their employees to participate in a deferred compensation voluntary retirement savings plan. More information can be found at Deferred Compensation.

 
 

State Credit Union

All state employees are eligible to participate in the Mississippi Public Employees’ Credit Union. This organization offers state employees special savings and borrowing plans. For more information about this program, call 601.948.8191.

 
 

 Tuition Reimbursement

Many state agencies provide opportunities for their employees to achieve higher education through tuition reimbursement. Common programs include medical and nursing fields, accounting, and business/administrative fields.

 
 

Career Development and Training

The Mississippi State Personnel Board offers several management and administrative certification programs, as well as professional development courses to enhance employee value to the agency. Individual agencies also offer technical training and allow membership in professional organizations to employees in their specific fields of employment.

 
 

Promotional Opportunities

Employees who have completed 6 or more months of service are eligible for promotional opportunities within state government employment. Minimum qualifications must be met.

 
 

Career Ladders

Many job classifications provide career-ladder opportunities based upon attainment of competencies. These career ladders can increase an individual’s salary, provided funds are available within the agency.

 
 

01

What is the highest level of education (or semester hours of college) you have completed from an accredited college or university?

  • None
  • GED or High School Equivalency Diploma / High School
  • 30 semester hours
  • Associate’s Degree / 60 semester hours
  • 90 semester hours
  • Bachelor’s Degree
  • Master’s Degree
  • Specialist Degree
  • Doctorate Degree

02

How many years of related experience do you have? (refer to the job posting for an explanation of related experience)

  • No experience
  • 1 year of experience
  • 2 years of experience
  • 3 years of experience
  • 4 years of experience
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Agency State of Mississippi Phone 601-359-1406 Website http://agency.governmentjobs.com/mississippi/default.cfm

Address 210 East Capitol Street
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Jackson, Mississippi, 39201

Clipped from: https://www.governmentjobs.com/jobs/3193199-0/medicaid-specialist-i?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organicv

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RN Nurse Utilization Management l (Inpatient) Medicaid in Memphis, Tennessee, United States

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time


 

Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.  It’s 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. 

 
 

RN Nurse Utilization Management l (Inpatient) (PS56458)

 
 

Location: Residence in the state of Tennessee is required for this position. This is a work@home position but qualified candidates must reside within a reasonable commute to an Anthem office for training and technical needs.

 
 

The Nurse Medical Management l for the Tennessee Health Plan is a member of the UM
In-Patient Team and responsible for collaboration with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources for more complex medical issues. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient  admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately  interpreting benefits and managed care products, and steering members to appropriate providers, programs or community   resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment.  May also manage appeals for services denied.

 
 

Primary duties may include, but are not limited to:

  • Conducts review of initial concurrent authorization requests for skilled nursing, acute in-patient rehabilitation, long term acute care reviews, and acute in-patient to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
  • Collaborates with providers to assess member’s needs for early identification of and proactive planning for discharge planning.
  • Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.
  • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

 
 

Qualifications

  • Requires current active unrestricted RN license to practice as a health professional in state of residence and 2 years acute care clinical experience or case management, utilization management or managed care experience, which would provide an equivalent background.
  • Must reside in the state of Tennessee.

 
 

  • Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products.
  • Prior managed care experience preferred.
  • Strong computer skills

 
 

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

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/7359894-rn-nurse-utilization-management-l-inpatient-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic