Today

Description

SHIFT: Day Job

SCHEDULE: Full-time

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

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

Growth Director – Medicaid

Responsible for leading the relationship of a business unit (Provider Network and Programs) with internal growth partners, to ensure effective articulation to state customers of our provider collaboration, contracting, and management strategies and value propositions.

Duties specific to this role:

• Supports Growth Director, Business Development, and Proposal Management processes related to the development of business unit responses to state procurements, requests for information and/or comment, policy position responses.
• Engages with the health plans, Provider Services Organization and other stakeholders to facilitate capture of strategic and tactical information for current market reprocurements and product expansion procurement opportunities
• For specified initiatives, leads business unit RFP response development process, including functional strategy sessions, gathering information, review, and editing of responses in development, collaborating with Proposal Management, Growth Directors to support the competitor and Anthem capability research, and populating the SharePoint libraries.
• Researches Anthem capabilities, new initiatives, competitor capabilities, and responses to RFIs/RFPs and other prospective revenue expansion opportunities.
• Evaluation of potential partnerships and business processes for provider related initiatives in Medicaid business unit
• Oversees, creates, identifies, and leads profit and growth initiatives that yield positive membership growth and positive operating gains as measured in the annual goals. Responsible for product strategy as it pertains to the line and region of business.
• Collaborates and coordinates work with other departments within the business unit, and many matrix partners within the company, including but not limited to Finance, Quality, DBG, Actuarial, IT, Specialized Populations, and HCM.
• Reports various results through various venues as well as to the leadership team.

Qualifications

Minimum Requirements

• Requires a BA/BS degree in a related field; 10 years of leadership/management experience in health care management including strategic planning and project/program management; or any combination of education and experience, which would provide an equivalent background.
• Medicaid provider network experience (contracting and/or servicing) is required.
• Experience with the RFP process is required.
• Must have strong PC skills (Word, Excel, Outlook, PowerPoint).
• Must have strong presentation skills.
• Must have excellent communication skills (written and verbal) and interpersonal skills
• Some travel may be required.

Preferred Qualifications

• MBA preferred.

Applicable to Colorado Applicants Only

Annual Salary Range*: \$152,880 – \$191,100

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

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

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

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and . An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

 
 

Clipped from: https://www.theladders.com/job/growth-director-medicaid-anthem-indianapolis-in_47596791?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Location: Columbus, OH

Candidate needs to have experience in Medicaid Policy and Operations, and primary responsibilities will include gaining business user consensus via JAD sessions to define interface requirements among disparate COTS applications used to manage Medicaid claims and peripheral interface applications.

Candidate is expected to have experience in technical aspects of the Business Analyst role, and will work with other system vendors and multiple State agencies to facilitate the requirements elaboration and the requirements traceability aspects of the project. You will be assisting a high-energy team in implementing an end-to-end cloud-based, integrated solution for our client in a role with very high potential for career growth.

Your future duties and responsibilities

• Lead Joint Application Design (JAD) sessions to gain consensus among multiple stakeholder groups
• Document business requirements by developing use cases and maintaining requirements traceability across the SDLC
• Act as a senior Subject Matter Expert to enable the client to define standard interface protocols
• Work with the technical team to translate requirements and use cases to effective design documents for downstream development activity
• Mentor and coach junior business analysts

Required qualifications to be successful in this role

• Minimum 10 years in Information Technology as a Business Analyst on large-scale, multi-vendor implementations
• A minimum of 5 years Medicaid (MMIS) or Healthcare payer background is required
• Demonstrated experience in conducting Joint Application Design (JAD) sessions and gaining consensus among multiple vendors and customer stakeholder groups
• Demonstrated working knowledge of XML, SQL and ETL tools to retrieve, view, and analyze data
• Demonstrated experience in developing use cases, managing requirements traceability, and a working knowledge of requirements management repository tools
• Experience in managing and mentoring teams of more junior Business Analysts
• Strong interpersonal and communication skills, including the ability to gain consensus among multiple stakeholder groups
• Strong verbal and written communication skills, with the ability to communicate abstract technical concepts to a business layperson audience

Desired Qualifications:

• Working familiarity with CMS (Center for Medicare and Medicaid Services) MITA framework and the MECT (Medicaid Enterprise Certification Toolkit)
• Familiarity with HIPPA-compliant messaging formats such as HL7, X12, NCPDP and NIEM

Education:
Bachelor’s Degree or equivalent experience

 
 

Clipped from: https://www.glassdoor.com/job-listing/business-analyst-with-medicaid-concinnate-partners-JV_IC1145845_KO0,30_KE31,50.htm?jl=3667957824&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Description

The Director, Provider Contracting- Behavioral Health Medicaid initiates, negotiates, and executes physician, hospital, and/or other provider behavioral health contracts for an organization that provides managed Medicaid health insurance. Requires an in-depth understanding of how organization capabilities interrelate across the Medicaid segment.

Responsibilities

The Director, Provider Contracting- Behavioral Health Medicaid communicates contract terms, payment structures, and reimbursement rates to behavioral health providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. Will be responsible for leading a team that works with providers of behavioral/mental health services, specific to managed Medicaid line of business. May assist with identifying and recruiting providers based on network composition and needs. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.

There are two openings for this position:

• One requires more network operational experience
• One requires more network development/RFP writing experience

Hiring leader will determine best fit based on skill set.

Dallas, TX is the preferred location for this position. Will consider remote for the right candidate.

Required Qualifications

• Bachelor’s Degree
• 5 plus years provider contracting experience, 3 specific to behavioral health Medicaid
• 3 plus years leadership experience, including teambuilding
• Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies
• Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Master’s or J.D. Degree
• Experience with ACO/Risk Contracting
• Value based contracting experience

Additional Information

Scheduled Weekly Hours

40

 
 

Clipped from: https://getwork.com/details/a183c6eb28af08e47efbad8bfcb73116?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Medical Eligibility Specialist

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.

Medical Eligibility Specialist

*This position will be stationed in the Chinle office*

AHCCCS

Posting Details:

Salary: $48,000 
 

Grade:20

Job Summary:

The Division of Member and Provider Services (DMPS) is looking for a highly motivated individual to join our team as a Medical Eligibility Specialist (PAS Assessor) for the Arizona Long Term Care System (ALTCS) in the Chinle Office. This position will assess customers of all potential populations, elderly and physically disabled (EPD), and developmentally disabled (DD) in both institutional and community-based settings to determine medical eligibility for long term care.

Job Duties:

* Assessing customers in a face-to-face interview using the Pre-Admission Screening (PAS) instrument to determine medical and occasionally financial eligibility for ALTCS.

* Reviewing medical records and interacting with customer’s family members, caregivers and/or physicians to identify and evaluate medical and psycho-social conditions.

* Driving to customer’s place of residence or various settings to conduct interviews and/or obtain pertinent medical documentation.

* Conducting interviews with persons who are physically disabled, developmentally disabled or those who are elderly.

* Referring customers to appropriate community resources, based on their needs.

* Managing a heavy caseload with clearly identified and regularly monitored productivity and quality requirements.

* Using a desktop computer/laptop and other computer programs for interviewing, updating, reviewing and completing medical eligibility determinations.

* Phase 1 of the Candidate selection process requires completion of a writing exercise within a required timeframe. Candidates are contacted by email.

* Due to COVID-19 precautions the recruiting process has been adjusted to meet the standard health guidelines outlined by the State. Interviews will be conducted virtually and may also be by way of video conference utilizing a platform like Google Meet/Hangouts or WebEx.

Knowledge, Skills & Abilities (KSAs):

* Demonstrated knowledge of medical, functional and psycho-social problems of the elderly, physically disabled and developmentally disabled children and adults.

* Demonstrated knowledge of medical terminology and procedures.

* Demonstrated knowledge of available community resources, crisis intervention, counseling, advocacy, community relationships, and referral methods.

* Fundamental principles of medical nursing services, alternatives to long term care, length of stay, pharmacology and equipment use.

* Experience with caseload management; schedules and timetables; effectively prioritizing; analyzing, assessing and evaluating service provisions and quality of care.

* Strong ability to establish and maintain effective working relationships with professional staff, caregivers, customers’ families, children and adults and with representatives of courts and various other agencies in the community.

* Strong ability to communicate effectively, both orally and in writing; reading, understanding and applying rules, regulations and policies.

* Ability to elicit information and gain insight into customers and families; using a personal computer/laptop and computer programs to document information.

* Ability to solve mathematic problems accurately.

* Ability to be fluent in Navajo.

Selective Preference(s):

* Meet at least one of the following qualifications: Possess an active Arizona RN license; OR a Bachelor’s or Master’s degree in Social Work or closely related field and 2 years of experience providing social service case management; OR 3 years of experience providing social service case management that included individual planning and delivery of health care services

* Must possess a current and valid Arizona driver’s license

* Experience with health care delivery systems and the use of appropriate channels to deliver health care services

* Understanding of various medical interventions that pertain to the customer’s diagnosis

 

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/medical-eligibility-specialist/job/16650498?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Dakotans For Health are hiring multiple temporary (10 week) Medicaid Expansion part time paid circulator positions/internships in South Dakota, located in high density population areas and tribal reservations. 10, 20, 30 hours per week.

 
 

Hourly wage starts at $15/hr and bonuses will be considered based on performance.

Clipped from: https://www.linkedin.com/jobs/view/paid-petition-circulators-internships-medicaid-expansion-at-dakotans-for-health-2667643245/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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.

 
 

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

 
 

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

 
 

 
 

DISYS – Digital Intelligence Systems, LLC

project manager, w2 only, medicaid

Contract W2, 3 Months

Depends on Experience

Job Description

Project Manager quick 3 month contract- Medicaid project. QUICK interviews and hire.

W2 only- no c2c

100% remote. Normal business hours.

Working on state medicaid project. Project plan is already built out.

Contract through 10/29. No extension or conversion.

Job Responsibilities: Develop, track and manage project budget, project plans, timelines and scope. Manage project resources including procuring project staff, developing, motivating, coaching and advising.

Partner closely with other members of functional project teams to define business requirements. Lead teams of developers in the delivery of high-quality software solutions that meet business needs. Define test plans and ensure that products are defect free before User Acceptance Testing. Facilitate the User Acceptance Testing process, developing rollout plans and procedures. Prepare and present cost-benefit analyses.

 
 

Clipped from: https://www.dice.com/jobs/detail/e1c7481f5048dc9e60ec8b639538b00f?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Description

The Director, Provider Contracting- Behavioral Health Medicaid initiates, negotiates, and executes physician, hospital, and/or other provider behavioral health contracts for an organization that provides managed Medicaid health insurance. Requires an in-depth understanding of how organization capabilities interrelate across the Medicaid segment.

Responsibilities

The Director, Provider Contracting- Behavioral Health Medicaid communicates contract terms, payment structures, and reimbursement rates to behavioral health providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. Will be responsible for leading a team that works with providers of behavioral/mental health services, specific to managed Medicaid line of business. May assist with identifying and recruiting providers based on network composition and needs. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.

There are two openings for this position:

• One requires more network operational experience
• One requires more network development/RFP writing experience

Hiring leader will determine best fit based on skill set.

Dallas, TX is the preferred location for this position. Will consider remote for the right candidate.

Required Qualifications

• Bachelor’s Degree
• 5 plus years provider contracting experience, 3 specific to behavioral health Medicaid
• 3 plus years leadership experience, including teambuilding
• Proven contract preparation skills, with an in-depth knowledge of Medicare and other reimbursement methodologies
• Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Master’s or J.D. Degree
• Experience with ACO/Risk Contracting
• Value based contracting experience

Additional Information

Scheduled Weekly Hours

40

 
 

Clipped from: https://getwork.com/details/0dee5bce6e8287834d8b827606bed0a8?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Executive works on problems of diverse scope and complexity ranging from moderate to substantial.

 
 

Responsibilities

The Provider Contracting Executive for Ohio Medicaid will communicate contract terms, payment structures, and reimbursement rates to providers. You will be responsible for Ohio Medicaid compliance with network adequacy standards. Maintains familiarity with Ohio Medicaid fee schedules and analyzes comparable Plan pricing guidelines. Ensures capitation, provider rosters, and RHC/FQHC reports are monitored and strategies are developed and plans are implemented to address outliers. Remains current in all aspects of Federal and State rules, regulations, policies and procedures and creates or modifies departmental policies to reflect changes. You will analyze financial impact of contracts and terms. Maintain contracts and documentation within a tracking system. Will identify and recruiting providers based on network composition and needs. Advise executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action.

               
 

Required Qualifications

• Bachelor’s degree
• Knowledgeable of Ohio Medicaid compliance with network adequacy standards
• Experience negotiating fee for service & capitated reimbursement methodologies for Hospital, Ancillary and Providers specific to Ohio Medicaid methodologies
• Experience communicating the implementation of capitation payments, provider rosters, and RHC/FQHC reports to internal load teams, able to address outliers with provider community
• 5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company
• 2 or more years of project leadership experience
• Minimum 1-2 years Ohio Medicaid experience
• Extensive provider contracting skills, including contract preparation and implementation, financial analysis and rate proposal development
• Excellent written and verbal communication skills and experience presenting to varied audiences
• Ability to manage multiple priorities in a fast-paced environment
• Knowledge of Microsoft Office applications
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

 
 

Preferred Qualifications

• Master’s Degree
• Experience with ACO/Risk Contracting
• Experience with Value Based Contracting

 
 

Additional Information

This position is considered “remote/work at home”, however, you must live in Ohio to be considered for this opportunity.

Work at Home/Remote Requirements Must ensure designated work area is free from distractions during work hours and virtual meetings Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10×1 (10mbs download x 1mbs upload) for optimal performance of is required

 
 

Scheduled Weekly Hours

40

 
 

Clipped from: https://www.linkedin.com/jobs/view/provider-contracting-executive-ohio-medicaid-at-humana-2627789646/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Description

SHIFT: Day Job


SCHEDULE: Full-time

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

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

The Government Relations Director is responsible for developing and implementing strategies to advocate enterprise and state specific legislative and regulatory positions in legislative and/or regulatory environments. Primary duties may include, but are not limited to:

• Develops and implements strategies to advocate enterprise and state specific legislative and regulatory positions to support business goals and objectives.
• Represents the enterprise and its specific businesses in advocacy efforts.
• Establishes and maintains strong relationships with legislators, regulators, other policymakers and their staff.
• Develops strategies for utilizing PAC and/or corporate political contributions.
• Maintains coalitions and target grassroots capabilities.
• Consults with SBUs and CEEs to inform and support business planning processes and proactively raise and address issues of concern.
• Makes internal and external written and oral presentations on behalf of the company.
• Develops and carries out tactics and strategies to influence trade associations and other advocacy organizations.
• Generally works with legislative sessions of less than 6 months and/or in less complex legislative and/or regulatory environments.

Qualifications

Requires a BA/BS in a related field; 8 years of legislative, regulatory, political, public affairs or industry experience; or any combination of education and experience, which would provide an equivalent background.

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://www.glassdoor.com/job-listing/government-relations-director-washington-medicaid-anthem-JV_IC1150386_KO0,49_KE50,56.htm?jl=1007205428067&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic