ACCENTURE’s Flexible Workforce solves clients’ toughest challenges by providing cross-industry expertise, unmatched innovation, World-class tech and talent. We help bring it all together to deliver tangible business outcomes for our clients with contractors and our extended workforce opportunities. Accenture is consistently recognized on FORTUNE’s 100 Best Companies to Work for and Diversity Inc’s Top 50 Companies for Diversity lists. And that’s just the beginning. Now is the perfect time for you to consider opportunities through our Flexible Workforce.


What’s In It For You

• Collaborate with a diverse network of people
• Actively deliver innovative solutions for Accenture’s clients
• Apply your skills and experience to help drive business transformation
• Work locally or remotely, significantly reducing or eliminating the demands to travel
  
  

Project Description


Medicaid Customer Service Agents provide unbiased assistance to Medicaid and Health Care Services Providers with questions regarding Medicaid and Program patient eligibility, medical claims, eligibility statuses, and other Health Care Services questions.


Responsibilities

• Handle customers, referral sources, and administrative department inquires
• Communicate with insurance companies and/or support prior authorization requests
• Document all providers/customers encounter in clear and concise logs
• Ensure customer satisfaction and assisting them with issues/concerns related to their health
• Transfer providers/clients to other Contact Center units as needed
• Develop knowledge of customer needs and trends to improve customer satisfaction and loyalty
• Meet individual performance standards/metrics
• Willing to perform other duties that may be assigned by management
  
  

Minimum Qualifications

• High School diploma or GED
• 6 months of Customer Service experience
• Proficiency with Microsoft Office
• Typing speed of at least 30 wpm
  
  

Preferred Qualifications

• Medicaid experience, or similar health care services
• 6 months experience in a professional call center environment
  
  

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States and with Accenture (i.e., H1-B visa, F-1 visa (OPT), TN visa or any other non-immigrant status).


Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.

Accenture is a Federal Contractor and an EEO and Affirmative Action Employer of Females/Minorities/Veterans/Individuals with Disabilities.


Equal Employment Opportunity

All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.


Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.


Accenture is committed to providing veteran employment opportunities to our service men and women.

Clipped from: https://www.linkedin.com/jobs/view/medicaid-customer-service-agent-at-accenture-2673480466/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Resp & Qualifications

 The Hospital Transitions Coordinator (HTC) is assigned to a specific hospital, facility or region to oversee the Total Care and Cost Improvement (TCCI) Program, as follows:  

1. Supports the Hospital Transition of Care Program for targeted enrollees including acute, post-acute, ensures the coordination and continuity of health care as enrollees transfer between different locations or levels of care.
2. Accountable for improving coordination between enrollees, providers and caregivers through communication and follow up
3. Provides rapid triage to the appropriate TCCI, including but not limited to Complex Care Management, Wellness Navigation, Disease Management, Home Based Services, and Medication Therapy Management Review to best address ongoing health needs of the enrollee.
4. Supports the TCCI Program for all hospitalized CareFirst enrollees, ensures the coordination and continuity of health care as enrollees transfer between different locations or levels of care
5. Ensure Enrollees have a Primary Care Provider (PCP) or Specialist appointment scheduled for a post-discharge appointment before the Enrollee is discharged from the hospital.
6. Conduct a clinical assessment of the Enrollee and determine if the Enrollee has ongoing care needs.
7. Performs concurrent review for CareFirst enrollees in accordance with the length of stay guidelines outlined for the Hospital Transition of Care Program.
8. Consults with the Medical Directors for medical necessity determinations and appropriateness of care.

PRINCIPAL ACCOUNTABILITIES:  Under the general direction of the Manager of Care Management, the incumbent’s accountabilities include, but are not limited to, the following:

(Note: Incumbent may be assigned to work onsite at one or more hospitals or may be assigned to one or more hospitals to perform the essential job functions and engage with enrollees, families, and providers telephonically.)

– Rapidly triages enrollees into identified levels of care, as appropriate.

• Understands the Total Care and Cost Improvement (TCCI) Program concept and protocols and can advocate for the enrollee.
• Contemporaneously, identifies enrollees for program participation based on program guidelines, analytics and use of sound clinical judgment.
• Engages enrollees to participate in appropriate TCCI programs, establishes relationship and follows up for ongoing coordination and assessment
• Assures enrollee understanding of adequate support upon transition and knowledge of who to call if problem arise. Collaborates with facility staff as necessary to close gaps when identified.

– Implements an effective TCCI program for enrollees identified based on their appropriate level.

• Works with the hospital Admitting Office, Emergency Department, Registration and with CareFirst’s iCentric Portal/CRISP to identify CareFirst Enrollees who have been admitted
• Depending on whether the HTC is onsite or telephonic, meets/engages with identified enrollees while hospitalized.  Discusses and reviews the discharge plan, addresses enrollee concerns, and proactively anticipates enrollee needs at hospital discharge.
• Contacts hospital discharge planner, liaison, case manager or Local Care Coordinator/Behavioral Health Care Coordinator during the triaged enrollee’s hospitalization. Discusses and reviews the discharge plan.
• Contacts identified CareFirst enrollees post discharge and actively follow up to verify the transition plan and care connections.
• Coordinates necessary interventions.
• Communicates with Case Management when enrollees are attributed to improve the care connections. Aids those enrollees who do not have a primary care practitioner to select a provider for care coordination and improved outcomes through the CareFirst website.
• Primary role as coordinator/facilitator—proactively guiding enrollees to the appropriate CareFirst programs and resources, to achieve program goals of reduced readmissions, cost-efficiency and quality outcomes. 
• Ensures the transition of care from one setting to another for identified CareFirst enrollees.  Provides enrollee interventions such as verifying appointments and coordinating medically necessary home health services.
• Aids enrollees and providers for alternative settings of care.

– Communicates and interacts professionally with physicians, other providers, and enrollees.

• Builds and maintains a solid professional relationship with all targeted facilities (especially with hospitalists and Emergency Department physicians) and is proficient and knowledgeable about the Care Transition model. Communicates regularly on operational issues/concerns and barriers.
• Improves communication during transitions between providers, enrollees and caregivers to assure smooth transitions.
• Provide timely and accurate communication of information as enrollees move from one level of care to another.

QUALIFICATION REQUIREMENTS:

Required Licensure/Education/Experience/Skills/Abilities: 

• Registered nurse, preferrably a BSN, with current Maryland, Virginia or DC license and with no restrictions.
• 5 years of clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review or Disease Management.

 
 

• Basic understanding of the strategic and financial goals of a health care system or payor organization. Basic understanding of health plan or health insurance operations (e.g. networks, eligibility, benefits).
• Must be capable of working with minimal oversight, showing keen attention to detail and making critical decisions to ensure enrollees have an effective plan of care that leads to optimal, cost-effective outcomes.
• Must have excellent analytical and problem-solving skills, excellent organizational, communication and coordination skills. 
• Must have effective presentation, negotiation and influencing skills to interface with all levels of management and physician practices. 
• Must be able to apply complex problem-solving abilities to achieve problem and process solutions.
• Excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for enrollees.
• Knowledgeable of available community resources and programs.
• Must be able to effectively work in a fast- paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
• Flexibility to work varied hours, and ability to travel by own means to a variety of locations to support business needs and to attend business meetings.

The incumbent is required to have had the vaccinations listed below and been appropriately screened (and cleared) for the items listed below.  If the incumbent has not had them or been screened and cleared, they must do so upon acceptance of offer:

• TB screening (and repeat annually)
• MMR-V Immunity
• Influenza Vaccine (Seasonal)
• COVID-19 vaccine series completed

The incumbent is required to complete the following training as assigned by Management, including, but not limited to:

• Infection control basics
• TB Awareness
• Bloodborne Pathogens (and repeat annually)

** Hospital Assignments are subject to change based on evolving business needs.

PHYSICAL DEMANDS:

• The physical demands described here are representative of those that must be met by the incumbent to perform the essential duties and responsibilities of the position successfully.  Requirements may be modified to accommodate individuals with disabilities.
• Must be able to provide face to face contact with inpatient enrollee at assigned hospital facility.
• Must provide own transportation to drive to satellite CareFirst Blue Cross Blue Shield offices and/or assigned facility and to attend onsite any required meetings, trainings, or other assigned functions, at designated CareFirst office.
• Walking and standing is required.  Lift weight up to 25 pounds on occasion.
• Hands are regularly used to write, type, key and handle or feel small controls and objects.  Must be able to type and to speak on the telephone simultaneously.
• Must have the ability to communicate verbally effectively. Auditory ability to actively listen.

Potential Job Hazards:

The position could be located within an inpatient hospital facility. 

• Incumbents are required to state their purpose upon arrival to the enrollee’s room so there is no confusion as to their role vs. the role of the direct care hospital staff. 
• Incumbents do not provide any form of direct patient care.

Airborne Exposure:

There is the potential for exposure to airborne illnesses, such as, but not limited to, tuberculosis, measles, mumps, rubella, varicella and influenza.  The following administrative controls are in place to limit or minimize exposure potential:

• Incumbents do not enter any inpatient rooms, or hospital rooms designated with Respiratory precautions, or where any procedures are being done that produce respiratory droplets.
• Incumbents are required to always remain at least 3 feet away from the inpatient enrollee.

Bloodborne Pathogens:

There is always the potential for exposure to Bloodborne Pathogens if not aware of surroundings.  The following administrative controls are in place to limit or minimize exposure potential:

• Incumbents do not touch enrollees;
• Incumbents must always practice Universal Precautions.

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 8.19.21

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

 
 

Clipped from: https://carefirstcareers.ttcportals.com/jobs/7209739-care-manager-dc-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

UPMC Health Plan is seeking an Administrator, Medicaid Compliance!


The Administrator, Medicaid Compliance reports to the Sr. Director, Medicaid & MLTSS Compliance. This position strategically ensures compliance with all relevant and applicable Medicaid and MLTSS laws, regulations, contractual agreements, standards, and requirements in a manner that continually supports the business and operational areas.

When work returns to normal post-COVID-19, there will be an option to remain home or work in the office. 


Responsibilities:
• Assists in the development of clear, effective, and timely reports and updates for senior management and/or the Board regarding Medicaid and CHC Compliance Program effectiveness, initiatives and issues, including all relevant metrics, dashboards, and information
• Develops, assesses, and adapts clear and effective Medicaid and CHC Compliance policies, procedures, training, communications and awareness materials, controls, and initiatives to ensure clear and consistent understanding and practices throughout internal operations
• Develops, assesses, and adapts clear and effective remediation and corrective action initiatives, protocols, and controls to ensure proper and timely compliance
• Effectively lives, models, communicates, and supports the values of UPMC and performs in accordance with UPMC system-wide competencies and behaviors
• Ensures strategic and operational partnership and collaboration with the business, operational, and additional compliance areas to leverage cross-departmental synergies and efficiencies
• Keeps abreast of changing industry requirements and regulations, including all relevant laws, industry standards, and company practices and initiatives
• Strategically works to ensure compliance with all relevant and applicable Medicaid and CHC/MLTSS laws, DHS and CMS regulations, and DHS contractual requirements and standards in a manner that continually supports the business and operational areas
• Works with Senior Director, Manager, and Senior Administrator(s) to complete ongoing and regular gap analyses, risk assessments, and program effectiveness assessments for the Medicaid and CHC Compliance Programs
• Works with Senior Director, Manager, and Senior Administrator(s) to conduct annual and ongoing Medicaid and CHC compliance training to UPMC ISD staff and applicable parties
• Ensures timely and appropriate notification and escalation to Senior Administrator, Manager, and/or Senior Director (as appropriate) of concerns, issues, or questions and works to support internal management team in addressing and resolving as needed
• Partners closely with assigned functional areas to ensure appropriate and effective compliance oversight is being conducted, including open discussion of compliance and operational concerns, review of key performance indicators as appropriate, review of DHS operational reports as appropriate, etc.
• Assists Manager with Medicaid Compliance Committee and CHC Compliance Committee preparation as needed, including updated key performance indicators, DHS reporting, and compliance-related topics of discussion
• Provides Manager with timely working draft of monthly Compliance updates related to Administrator’s assigned functional areas with minimal supervision and corrections
• Understands the Pennsylvania HealthChoices and Community HealthChoices agreements in good detail, particularly those sections pertaining to Administrator’s assigned functional areas
• Ensures timely communication and training of key department personnel impacted by new or changed contractual or other compliance requirements
• In collaboration with appropriate health plan departments and internal staff, including Compliance Senior Administrator(s), Manager, and Senior Director, develops and monitors implementation of corrective action plans to improve performance when necessary
• Works collaboratively with staff dedicated to the Medicaid and HealthChoices programs from other UPMC departments to ensure effective program compliance and integration
• Assist and support Senior Director in efforts to build, sustain, and expand (as needed) a cohesive and stable Compliance program
• Assist and support Senior Director in creating and maintaining positive trend of staff culture and employee engagement while growing Medicaid and CHC Compliance teams with minimal staff turnover
• In collaboration with appropriate health plan departments and staff, develop and monitor implementation of corrective action plans to improve performance when necessary
• Perform ongoing analysis of client business problems, participate in identifying solutions, and ensure that the appropriate resolution occurs
• Maintain Senior Director (and/or Manager/Senior Administrator(s)) apprised of relevant issues, questions, and/or concerns related to your assigned functional area. If necessary, Administrator should schedule additional time with Sr Director (and/or others if needed) to discuss issues in greater detail to ensure internal alignment and formulate any needed action plans

 
 

Clipped from: https://careers.upmc.com/jobs/7188084-administrator-medicaid-compliance?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Details

Medicaid Specialist I

This listing closes on 12/17/2021 at 11:59 PM Central Time (US & Canada).

Salary

$27,346.56 Annually

Location 69 – TATE COUNTY, MS

69 – TATE COUNTY, MS

Job Type

Full-Time

Department

0665 – MEDICAID DIVISION

Job Number

3103-0665-20210617Ta

Closing date and time

12/17/2021 at 11:59 PM Central Time (US & Canada)

• Description
• Benefits
• Questions

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
• 1 year / 30 semester hours
• Associate’s Degree / 2 yrs / 60 semester hours
• 3 years / 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
• 5 years of experience
• 6 years of experience
• 7 years of experience
• 8 years of experience
• 9 years of experience
• 10 years of experience

More than 10 years

* Required Question

Agency State of Mississippi Phone 601-359-1406 Website http://agency.governmentjobs.com/mississippi/default.cfm

Address 210 East Capitol Street
Suite 800

Clipped from: https://www.governmentjobs.com/jobs/3122316-0/medicaid-specialist-i?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

State of Alabama Medicaid Job Opportunities 2021

Hiring Jobs Near Me Birmingham, Alabama?

State of Alabama Medicaid company specialized in the industry of Government. The headquarters are in Birmingham

Location: Birmingham

SALARY: $60-$85 per HOUR

Field of activity: Government

Job type: Permanent

Posted: 2021-08-11

 
 

 
 

 
 

State of Alabama Medicaid is a Government company founded in 0 and specialized in the industry of Public Administration. The headquarters are in Birmingham.

The market type is the way that a company uses to make its commercial transactions. There are companies that operate B2B, B2C or both.

There are many cases when a company is operating both B2B and B2C. An example for this would be the real estate industry, where the agencies can land or sell to both businesses or consumers.

State of Alabama Medicaid is a (B2B & B2C) Business to Businness and Business to Client company, that has been known in the Government field as one of the best partners in business.

It would definitely be the care we take in delivering our products/services to our customers every day. We are working continually to improve the quality of our products/services. We always put the interest of our customers on the first place.

 
 

 
 

 
 

Company SIC is

As per SIC, our company can help you with services/products of:

• Government
• Administration of Social, Human Resource and Income Maintenance Programs
• State Government-Social/Human Resources
• Public Administration

Over the years we have recruited the best workers in the field of Administration of Social, Human Resource and Income Maintenance Programs. They are all certified State Government-Social/Human Resources, with over 2021 years of experience in the Public Administration industry.

Where can you find us State of Alabama Medicaid?

• 468 Palisades Boulevard
• Alabama
• City: Birmingham
• Zip code: 35209

Our company is available to contact on the phone number +12058 show phone from Monday to Friday between 9AM and 6PM. If you have any special queries, you can contact-us.

 
 

Clipped from: https://careers.centrehumanes.org/career-jobs/state-of-alabama-medicaid/al/265054

 
 

 
 

 
 

Description

The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Senior Provider Contracting Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

Assignment: Humana Behavioral Health

Location: WAH Remote (anywhere USA)

The Senior Provider Contracting Professional for SC Medicaid communicates contract terms, payment structures, and reimbursement rates to providers. Providing a comprehensive hospital network to consumers in the behavioral health arena and executing on Humana’s consumer-focused business strategy demands constant negotiation with a variety of provider constituencies and continual re-prioritization of corporate and consumer needs. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. In this role you will:

• Negotiate hospital and ancillary contracts at market competitive pricing.
• Initiate and maintain productive long-term relationships with key hospital and group practice administrators and members.
• Communicate proactively with other departments in order to ensure effective and efficient business results.
• You will handle services and levels of care and pricing on the behavioral health network side
• Subject matter expert on their assigned region or states on all things behavioral health networks
• Manage large accounts and/or provider relations
• Associate management oversight of 3-5 direct reports
• C-suite interactions both internally and externally

Required Qualifications

• 3-4 years of progressive network management experience including hospital contracting and network administration in a healthcare company or healthcare system
• Medicaid behavioral health contracting experience
• Medicaid provider relations experience (face to face provider visits required)
• Experienced in negotiating managed care contracts with large physician groups, ancillary providers and hospital systems.
• Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
• Excellent written and verbal communication skills
• Ability to manage multiple priorities in a fast-paced environment
• Proficiency in MS Office applications
• Previous leadership experience and oversight of Associates
• Ability to have difficult conversations with individuals at all levels of the organization internally and externally
• Ability to manage regional accounts
• Ability to adapt well when utilizing multiple new systems
• Strong negotiation skills

Preferred Qualifications

• Behavioral health contracting experience
• Bachelor’s Degree
• Experience with ACO/Risk Contracting
• Experience with Value Based Contracting

Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Scheduled Weekly Hours

40

 
 

Clipped from: https://getwork.com/details/26daa7b982b67dbf512c81c1822f92d2?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

The Health Resources Division seeks to provide health care for low-income and disabled Montanans through Medicaid and the Healthy Montana Kids (HMK) Plan. As the Section Supervisor, this position is responsible for the Indian Health Service (IHS) and Tribal Programs for Montana Medicaid. The IHS and Tribal Section Supervisor is a highly visible position that represents Montana Medicaid in American Indian policy related matters; coordinates Indian policy work across Medicaid divisions and with other agencies; organizes and leads meetings or advisory groups; provides expert consultation to executive staff to ensure recognition of tribal authorities, interests and agreements; works closely with the Director’s Office Tribal Relations Manager; and assists in the development and enhancement of programs. This position will report directly to the Health Resources Division Administrator and will have two direct reports. *Below are more detailed job duties:* * Assisting in providing strategic guidance on consideration and inclusion of IHS/Tribal/Urban Indian Health concerns and in development of agency plans, programs and policies. * Assisting in efforts to expand overall engagement and partnership with IHS/Tribal/Urban Indian Health. * Developing and maintaining internal resources for staff, such as protocols and training, and externally facing resources for tribes. * Serving as a point of contact and assisting IHS/Tribes/Urban Indian Health in navigating the Medicaid and related programs. * Developing and ensuring positive working relationships with IHS/Tribes and tribal health partners across the state. * Reviewing and providing recommendations as appropriate on IHS/Tribal-related policies, procedures, and agreements. * Serves as a valuable resource; externally and cross functionally within the organization. * Further develop and promote, effective working partnerships between tribal governments, Montana Medicaid and other relevant agencies. * Develops and implements program health benefit coverage and reimbursement procedures based on state and federal Medicaid requirements, Administrative Rules of Montana (ARM), State Plan and other regulations. * Writes and updates administrative rules, statutes, and policies concerning IHS/Tribal /Urban Indian Health services program payment methodology, billing, coding, and administration of benefits and payment services. * Develops, implements, and monitors attainment of program goals and objectives. * Conducts File Updates Requests (FUR), checks and approves system files for uploads and makes recommendations for system changes based on federal changes, errors, etc. * Provides testimony on reimbursement rules and coverage when required at rule hearings, administrative reviews and fair hearings. * Serves as liaison to address coverage, reimbursement or eligibility issues. * Analyzes various types of internal and external data to determine types of educational opportunities to develop and deliver presentations on opportunities during tribal consultations and monthly IHS/Tribes calls. * Coordinate the implementation of any new and/or modified benefits for the tribal FQHCs and provide education to clinical staff and members. * Maintains provider relations and information network through oral and written communications, including group presentations and meetings to ensure patient access to services. * Represents the Division and actively participate as a subject matter expert for department data and claims processing systems. Provides input and feedback for design of the new systems such as necessary features and display requirements and functionality tests. * Participates in medical coverage reviews, setting of medical procedure limits, and determination of medical necessity. *Physical and Environmental Demands:* Work is performed in a typical office environment with keyboarding responsibilities. *This position will directly supervise two employees.* * Knowledge of cultural diversity and issues that impact a tribal community. * Knowledge of Montana Tribes, cultures, histories and government relations, including concepts of sovereignty and self-determination. * General knowledge of Medicaid and medical terminology * Knowledge of program management principles and practices. * Ability to analyze math calculations. * Expertise in spreadsheet software (Excel). * Excellent interpersonal and customer service skills * Excellent written and verbal communication skills * Ability to interpret and apply laws, rules and regulations. * Ability to identify and solve problems. * Knowledge and understanding of large databases including manipulation of data and the impact of changes. *Minimum Qualifications:* * Bachelor’s degree in human services; business, public, or health administration; or other related fields. * Two years of job related work experience in health policy, health program development, or health administration. * Other combinations of directly related education and experience may be considered on a case-by-case basis. * Experience in the medical service delivery system is preferred. * One year of supervisory experience is preferred. * Combinations of education and experience will be considered on a case-by-case basis. For a full copy of the job description, please e-mail Kaley Argee atkaley.argee2@mt.gov. *This position is posted with a primary location of Helena. The Hiring Manager will consider a remote work agreement if the successful applicant is not located in Helena.* *To be considered for this position, please submit the following materials online through the State of Montana Careers site:* * *Cover Letter* * *Resume* * *Supplemental Question:* o *Tell us about your experience with American Indian health care policy, Medicaid or any relevant work that would make you a good candidate for this position. * (Please type responses in a Word document and attach to application. HELPFUL HINT: When attaching a document, you much check the “relevant document” box to ensure your attachments are uploading correctly to the specific application. Please do not attach more than requested. If you have more than 25 attachments in the system you will need to email these to: hhshumanresources@mt.gov. Failure to attach the required material will conclude in an incomplete application. You must also keep those relevant boxes checked once you submit your application; if you uncheck the box with an active application it will delete the attachment.) The State of Montana offers a comprehensive benefits package, which includes: • 15 paid vacation days • 12 sick days • 10 paid holidays a year *To view State of Montana’s medical, dental, vision coverage, and other offerings, you can visit our Health Care and Benefits website at, t.gov/.* This is an open until filled position. /*To be considered for any DPHHS Agency position, applicants must complete and submit their application online, as well as upload any required application materials. Successful applicant(s) are required to successfully pass all DPHHS specific background check(s) relevant to each position.*/ **Job:** **Community/Social Services* **Title:** *IHS/Tribal Health Program Manager (01007)* **Location:** *Helena* **Requisition ID:** *21141098*

Company Details

Company Name State of Montana

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Resp & Qualifications

This position services the following Maryland counties (and applicant must reside there): Dorchester, Talbot, Caroline, Queen Annes, Wicomico

Position Summary: Reports to the Clinical Operations Manager of Medicaid Case Management and Special Needs and performs under minimal supervision providing coordination of care, maintenance of databases, and the production of reports. Community Health Workers (CHWs) are frontline public health workers who have a close understanding of the community they serve.  Building trusting relationship enables CHWs to help individuals access resources including medical, social services, quality of care and health information.  The community health worker (CHW) is a remote position working with special populations who may have chronic physical conditions, serious mental illness, substance use disorders and/or homelessness.  This position assists the Integrated Care Team (Nurse Case Manager and Social Worker, Primary Care Physician, Behavioral Health Provider) by finding the member and proactively coordinating care for members facilitating the achievement of quality and cost-effective health outcomes.

Essential Job Duties and Responsibilities:
• Serves as a point of contact for health care services and referrals for members with medical and behavioral health needs.
• Locate members, at their home or in the hospital, who are difficult to contact or are under/over utilizers of health care services and offer face to face evaluation of needs.
• Provides a brief assessment for safety risks, health needs and barriers to care, offering resources as needed.
• Ability to quickly establish trust with people and build relationships.
• Working closely with case managers, social workers and special needs coordinators integrating case management to meet all medical, behavioral, and psychosocial needs. 
• Collaborates with members, families, and healthcare providers to enhance patient wellness and facilitate connecting members to care.
• Assess and refer members with psychosocial needs to DSS and/or social services programs.
• Helps individuals and families understand health conditions and develop strategies to improve their health and well-being. 
• Advocates for members coordinating appointments and accessing services.
• Monitors member compliance and is available to provide consultation as needed.
• Document all activities in the appropriate system(s) in a timely way.
• Some evening and weekend hours may be required.
• Other duties as assigned.

Education, Experience and Qualifications:

• High school diploma OR GED and minimum two years’ experience in behavioral health, social service, health care and/or education.
• Prefer an education level normally acquired with the completion of an AA degree or bachelor’s degree in human services, social work, sociology, or health care with a minimum of one years’ experience with the target population.
• Certified Community Health Worker preferred, but we will train and certify qualified candidates upon hire.
• Public health experience a plus.  
• Experience and a strong knowledge base of community resources.

Knowledge, Skills and Abilities:

• Strong work ethic built on a foundation of proactivity and teamwork.
• Prioritize and organize work to meet changing priorities.
• Knows and understands specific health issues and the health care /social services systems. 
• Must have the ability to perform complex and diverse administrative duties that involve application of procedures, interpretation of data, and demonstrate appropriate judgment.  
• Able to maintain professional boundaries with members and coworkers.
• Ability to monitor, review and resolve patient needs including addressing barriers to care.
• Working knowledge of social and health issues as well as familiarity of community resources.
• Communicates in an effective and professional manner, and maintains positive relationships with physicians, nurses, social workers, care management and community resources.
• Able to set and meet deadlines working independently, as well as on a team.
• A positive attitude, with an ability to work hard in a fast-paced, highly complex and dynamic movement for healthcare reform.
• Even-tempered and able to adjust tasks in accordance with changing priorities.
• Personal and professional record of accomplishment that demonstrates a commitment to quality in healthcare.
• Willingness to “think outside the box”, being a problem solver, accept feedback, and embrace the challenges working with special needs members.
• Accompany members to appointments as needed.
• Use critical thinking and defined policies and procedures to coordinate and manage the flow of information within area of responsibility.
• Compile, analyze, and organize data and information from multiple sources to carry out assignments.
• Ability to work with diverse individuals and groups demonstrating cultural competency. 
• Bilingual preferred. 

Computer Skills:

• Proficiency in Microsoft Office, Word, and Excel
• Experience with Electronic Health Records preferred.

Driving and other requirements:

• Required to use personal vehicle to carry out job duties.
• Must possess and maintain a valid driver’s license.
• Must provide a current motor vehicle record.
• Must provider current personal owner liability automobile insurance and maintain coverage throughout the course of employment in the position.

 
 

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Healthcare Product Owner – Must have MMIS or claims experience

Springfield, IL – Remote Possible

Cognizant will only consider applicants for this position whom are legally authorized to work in the United States without company sponsorship (H-1B, L-1B, L-1A, etc.)

The Company

We continuously seek exceptional associates when recruiting new employees. We pride ourselves on having extensive experience working with clients in all major markets. Cognizant’s delivery model is infused with a distinct culture of high customer happiness. We consistently deliver positive relationships, cost reductions and business results. Are you ready to be a change-maker? At Cognizant, we believe those who challenge the way they work today will own the way tomorrow. When was the last time you felt proud about your work?

About Cognizant Consulting

Cognizant Consulting combines deep domain expertise with advanced technology thinking to help global 2000 companies worldwide accelerate their digital journeys. By orchestrating capabilities across strategy, design, IT and industry /functional knowledge, we help, clients solve their toughest business-technology challenges at speed and scale, and lead in today’s dynamic digital age — while planning for whatever tomorrow brings. We do this by applying a keen understanding of the uniquely human aspirations, behaviors and needs of our clients’ customers and employees to first envision and specify, and then deliver and extend modern digital solutions that enable leading players to differentiate and ultimately separate from the competition. Learn more by visiting us at https://www.cognizant.com/consulting

Basic Requirements

Product Owner

• At least 5 years Medicaid/Healthcare/Insurance industry experience required.
• Must have in-depth Medicaid claims knowledge.
• Bachelor’s Degree in Business, IT, Engineering, or other relevant field (Required). Advanced Degree in Business (Preferred).
• Possesses the ability to strategize and help develop solutions to the client’s most challenging problems.
• Candidate works with leadership to understand the objectives of an engagement and works with the client to execute objectives from the Program Management Office perspective.
• Candidate will act as a liaison between the client and their product vendor to ensure critical milestone are being met, analyze the integrated master schedule, act as the keeper/developer of the schedule, and drive action items to closure to keep the project on track.
• Candidate will advise the client on strategy related to the overall project
• Knowledge of MMIS implementations is critical to this role to ensure the candidate knows the right questions to ask and understand the priority of certain tasks.
• Responsible for the development of key project controls and creation of governance documents.
• As a critical keystone to any engagement, candidate collaborates with others, listens up/down, effectively communicates and adapts to change
• Should have Product owner experience
• Should have worked in the dual roles of managing project teams and leading the Agile team
• Should have exp. working with client in getting requirements, grooming the product backlog with Scrum team
• Great communication skills
• Help create quality products and reviews of the teams work prior to delivery to the customer.
•  

Our strength is built on our ability to work together. Our diverse set of backgrounds offer different perspectives and new ways of thinking. It encourages lively discussions, inspires thought leadership, and helps us build better solutions for our clients. We want someone who thrives in this setting and is inspired to construct meaningful solutions through true collaboration.

If you are comfortable with ambiguity, excited by change, and excel through autonomy, we would love to hear from you!

Cognizant is an Equal Opportunity Employer M/F/D/V

Cognizant is recognized as a Military Friendly Employer and is a coalition member of the Veteran Jobs Mission. Our Cognizant Veterans Network Assists Veterans in building and growing a career at Cognizant that allows them to demonstrate the leadership, loyalty, integrity, and dedication to excellence instilled in them through participation in military service

Cognizant will only consider applicants for this position whom are legally authorized to work in the United States without company sponsorship (H-1B, L-1B, L-1A, etc.)

Job Location : Springfield, Illinois, United States || Chicago, Illinois, United States

Employee Status : Full Time Employee

Shift : Day Job

Travel : No

Job Posting : Jul 13 2021

About Cognizant

Cognizant (Nasdaq-100: CTSH) is one of the world’s leading professional services companies, transforming clients’ business, operating and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant is ranked 194 on the Fortune 500 and is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com or follow us @USJobsCognizant.

Cognizant is recognized as a Military Friendly Employer and is a coalition member of the Veteran Jobs Mission. Our Cognizant Veterans Network assists Veterans in building and growing a career at Cognizant that allows them to leverage the leadership, loyalty, integrity, and commitment to excellence instilled in them through participation in military service.

Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

If you have a disability that requires a reasonable accommodation to search for a job opening or submit an application, please email CareersNA2@cognizant.com with your request and contact information.

 
 

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Description

The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Senior Provider Contracting Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

Assignment: Humana Behavioral Health

Location: WAH Remote (anywhere USA)

The Senior Provider Contracting Professional for SC Medicaid communicates contract terms, payment structures, and reimbursement rates to providers. Providing a comprehensive hospital network to consumers in the behavioral health arena and executing on Humana’s consumer-focused business strategy demands constant negotiation with a variety of provider constituencies and continual re-prioritization of corporate and consumer needs. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. In this role you will:

• Negotiate hospital and ancillary contracts at market competitive pricing.
• Initiate and maintain productive long-term relationships with key hospital and group practice administrators and members.
• Communicate proactively with other departments in order to ensure effective and efficient business results.
• You will handle services and levels of care and pricing on the behavioral health network side
• Subject matter expert on their assigned region or states on all things behavioral health networks
• Manage large accounts and/or provider relations
• Associate management oversight of 3-5 direct reports
• C-suite interactions both internally and externally

Required Qualifications

• 3-4 years of progressive network management experience including hospital contracting and network administration in a healthcare company or healthcare system
• Medicaid behavioral health contracting experience
• Medicaid provider relations experience (face to face provider visits required)
• Experienced in negotiating managed care contracts with large physician groups, ancillary providers and hospital systems.
• Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
• Excellent written and verbal communication skills
• Ability to manage multiple priorities in a fast-paced environment
• Proficiency in MS Office applications
• Previous leadership experience and oversight of Associates
• Ability to have difficult conversations with individuals at all levels of the organization internally and externally
• Ability to manage regional accounts
• Ability to adapt well when utilizing multiple new systems
• Strong negotiation skills

Preferred Qualifications

• Behavioral health contracting experience
• Bachelor’s Degree
• Experience with ACO/Risk Contracting
• Experience with Value Based Contracting

Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Scheduled Weekly Hours

40

 
 

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