Category: Curator- Job Hunter

 
 

Dice is the leading career destination for tech experts at every stage of their careers. Our client, Chandra Technologies, Inc., is seeking the following. Apply via Dice today!


Hourly Rate 71 W2 82 CTC1099 Job Description The NC Department of Health and Human Services (DHHS) Information Technology Division (ITD) is seeking Enterprise, Technical and Solutions Architects to perform work associated with the Medicaid Enterprise Systems (MES) project. This person will responsible for the architectural definition, procurement and implementation of highly complex and innovative Medicaid Enterprise Modular solutions. In addition, these roles will participate within an industry best-practice Enterprise Architecture methodology and will oversee the implementation and operation of various vendor-provided technology solutions. This role must be able to collaborate with product-, business- and process owners to evaluate their needs and to translate those needs into highly effective functional and non-functional requirements. This role is responsible for creating several comprehensive technology and information architectures related to various functional business solutions, while providing strategic direction throughout the development process and ensuring that the solution aligns with the Medicaid Enterprise Architecture Modular vision and strategy. In addition, the role will include oversight and compliance with Federal and Statewide Technical Architecture requirements, risk identification and planning. This role requires a person that possesses a strong and diverse background in both traditional and modern business solution- and application architecture concepts, tools and practices. This person must have hands on working knowledge of various platforms including legacy, service oriented and cloud-based solution architectures – Cloud based Architectures are required. Required Knowledge, Skills and Abilities Extensive ability to plan, design and implement complex Medicaid business solution in collaboration with functional solution vendors. Extensive familiarity with architectural evaluation, design and analysis of enterprise wide systems throughout the full implementation life cycle including procurement through operations Extensive hands on experience with overseeing and aligning vendor-based application solutions and architectures to deliver robust system solutions that will align with Medicaid Modular System Integration goals and objectives Extensive familiarity with application programming interfaces and service-oriented design and development to assure seamless integration between various Vendor Functional Modules offered as SaaS or Cloud Hosted Solutions. Ability to identify customer requirements, analyze alternatives and conduct product recommendations related to software, platform and network configurations. Ability to closely collaborate with Enterprise Architecture to ensure functional solutions comply with Enterprise Architecture and CMS 7 Standards and conditions Strong ability to perform as a high functioning architecture team member within a highly flexible and loosely coupled environment, supporting multiple concurrent business-oriented development workstreams. Extensive experience leveraging cloud technologies Strong leadership and guidance on test planning, automation and continuous improvement and deployment processes Superior communication to ensure stakeholders, project managers, developers, and software vendors are aligned with the software development process Extensive business continuity, backup, recovery, high availability and archiving implementation and oversight to ensure vendor solutions align with State expectations. Experience with data integration and data mapping to ensure interoperability between vendor solutions and MES modules Proficiency with the use of Microsoft Word, Excel, PowerPoint, Visio and Project Preferred Knowledge, Skills and Abilities Familiarity with healthcare and healthcare insurance solutions and information architectures, especially Medicaid or similar industry Familiarity with HIPAA rules and regulations Familiarity with CMS certification processes Experience drafting and evaluating RFP’s or other procurement documents Experience working within TOGAF, FEA or other Enterprise Architecture frameworks Required Skills Knowledge of the Medicaid Systems and Solutions (7 years) Knowledge of the MITA Business, Information and Technical architectures (7 years) Extensive familiarity with relational databases as well as other types (Graph Database, NoSQL) and the relative advantages and disadvantages of each (7 years) Extensive familiarity with business intelligence, analytical and reporting tools (7 years) Experience leveraging cloud technologies (5 years) Excellent general IT knowledge (applications development, testing, deployment, operations, documentation, standards, best practices. (7 years) Experience with Technical Proposal Evaluations (7 years) Excellent verbal and written communication skills with the ability present to both technical and business audiences. (7 years) Experience participating or leading projects using an Agile methodology. (7 years) Experience working with various vendors and coordinating with the Systems Integrator (7 years) Preferred Skills Experience with data integration and mapping (5 years) Knowledge on Claims and Financial Processing (5 years) experience in Data Governance, Modelling and Architecture (5 years) Medicaid Architect MITA Business Knowledge, Agile, Technical Proposal Evaluations Higher Competitive Rates will be considered for consultants with advanced skill set Corp to Corp Resumes are welcome Consultants may need a criminal background check

 
 

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The LA Medicaid CMO, RVP Health Services (CMO) relies on medical background to create and oversee clinical strategy for the region. The CMO requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.

Responsibilities

Job Title: Louisiana Medicaid CMO, RVP Health Services

Location: Work from Home in Louisiana Temporarily (Office will be opened in Baton Rouge)

Job Description

The CMO will provide medical leadership and strategy for the Health Services Operations with fiscal responsibility for trend management.

• Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF) according to the Humana’s Medicaid policies and procedures.
• Participate in Quality Operations including chair Quality Management Committee, complete initial peer review on quality of care complaints, complete peer-to-peer written and verbal communications.
• Oversee administrative budget for regional HSO & Quality Improvement including approve/deny expense reports & requisition requests for department members.
• Oversee Quality Improvement and HEDIS/STARS metrics improvement with PCP offices and IPAs.
• Participate in regional level committees and meetings setting medical necessity strategies.
• Provide oversight and direction for the implementation of regional clinical programs and strategies, as well as, developing and implementing market level strategies.
• Manage internal operational/functional relationships related to profitability.
• Assist with network development and provider contracting with various providers and ancillary providers.
• Serve as clinical liaison with inpatient facilities and joint operating committees to maintain facility relationship and problem solve; especially reviewing contracts as to clinical services.
• Well-versed on financial aspects of various levels of risk bearing contracts and possess the ability to gain traction and adoption of the providers.
• Ability to thrive in a highly matrix environment.

Required Qualifications

• 8 or more years of management experience
• A current and unrestricted license in Louisiana and willing to obtain licenses, as needed, for various states in region of assignment
• MD or DO degree
• Board Certified in an approved ABMS Medical Specialty
• Excellent communication skills
• 5 years of established clinical experience
• Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products
• Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
• Prior experience within the Louisiana Department of Health
• Experience working with the Medicaid population or Medicaid Managed Care, PEDS, OB-GYN, Drug Abuse/Addiction, or Behavioral Health
• Master’s Degree

#PhysicianCareers

Scheduled Weekly Hours

40

 
 

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MVP Consulting Raleigh, NC

NC Department of Health and Human Services (DHHS) Information Technology Division (ITD) seeks an IT Product Management Group Supervisor/Manager to join the Medicaid Enterprise System (MES) project. Technology, Business, and Policy expertise are key.
REQUIRED/DESIRED SKILLSSkillsRequired/
DesiredExperienceKnowledge of Enterprise IT Systems, system integration principles, and associated change management best practices.Required7 YearsHas an understanding of CMS’ Seven Standards and Conditions and the Medicaid programRequired7 YearsDemonstrated ability to manage multiple priorities and projects, function in a fast-paced moving constantly changing, deadline driven environmentRequired7 YearsProficient use of Microsoft Project, Word, Excel, PowerPoint, Access, and Adobe softwareRequired7 YearsSkills in persuasion, negotiation, relationship management, conflict resolution, and effective oral and written communication at all levelsRequired7 YearsProven track record of launching successful user-focused products preferably in the enterprise, analytics or healthcare space.Required7 YearsPrevious experience creating business use cases, requirements, and process maps/data flows.Required7 YearsExperience working in a combination of business analysis, product management, project management and/or software application development.Required7 YearsExcellent communication skills and attention to detail with specific experience developing, editing, and presenting summaries, reports, and complex inRequired7 YearsProven experience and working knowledge of agile development methodologies, environment and tools.Required7 YearsExperience using or implementing Cloud technologies IaaS, PaaS, SaaS.Highly desired7 YearsExperience handling HIPAA and PII data.Highly desired7 Years7+ years of experience in product management in a healthcare or government settingHighly desired7 YearsManaged Care knowledge or experienceHighly desired7 YearsMITA knowledge or experienceHighly desired7 YearsMedicaid Program knowledge or related HealthCare Information System experienceHighly desired7 Years

 
 

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Description of Work


THE STARTING SALARY FOR A NEW HIRE TO THIS POSITION IS LIMITED TO THE RECRUITMENT RANGE OF $ 33,960 to $ 46,713. Salary offers for the selected candidate are based on the candidate’s education and experience related to the position, as well as our agency budget and equity.


The North Carolina Department of Justice, led by the Attorney General of North Carolina, represents the State of North Carolina in court and provides legal advice and representation to most state government departments, agencies, officers, and commissions. The Department also represents the State in criminal appeals from state trial courts, and brings legal actions on behalf of the state and its citizens when the public interest is at stake.


This position is located in the Medicaid Investigations Division of the Department of Justice. The Attorney General’s Medicaid Investigations Division investigates and prosecutes health care fraud committed by Medicaid providers and the physical abuse of patients and embezzlement of patient funds in Medicaid-funded facilities. These cases protect and recover taxpayers dollars that can be used to provide needed medical services to Medicaid enrollees. These cases also protect our most vulnerable elderly and disabled citizens.


Our Medicaid Investigations Division (MID) is staffed by Department of Justice attorneys, investigators, auditors, analysts, and a nurse investigator, paralegals, and administrative staff. MID provides state and national training opportunities to aid employees in understanding the complexities of health care fraud investigations. This position has the opportunity to work cases in state and federal court in partnership with law enforcement agents with federal and state agencies such the Office of Inspector General, FBI, IRS, NC State Bureau of Investigations, Sheriff’s Offices, and Police Departments.


Over the past decade, the NC MID has recovered more than$500 million and helped winmore than 450criminal convictions in health care fraud and abuse cases.


The Attorney General’s office and the Medicaid Investigations Division are committed to ending Health Care Fraud. The link below is provided for your information.


https://www.ncdoj.gov/Top-Issues/Stop-Health-Fraud-(1).aspx


The primary purpose of this analyst position is to provide criminal intelligence and data analysis, data organization and data presentation assistance to Medicaid Fraud Financial Investigators pertaining to investigations of Medicaid fraud and abuse. The employee assists Medicaid Fraud Financial Investigators and one or more teams of attorneys and investigators in the detection, investigation, and punishment of fraudulent and non-fraudulent violations of applicable criminal and civil laws pertaining to fraud and abuse by Medicaid providers and in administration of the Medicaid Program.


This analyst will also support the investigation of Medicare and other federal health care fraud cases and investigations which are primarily related to Medicaid fraudinvolving complex financial analysis. This individual will

• prepare detailed spreadsheets and charts, review medical records, prepare written investigative reports, research public records, analyze facts and documents, and assist in the collection and storage of evidence.
• receive, document, research, gather information, and prepare reports of referrals from citizens, providers, recipients, and other professionals within and outside of the Medicaid agency who report Medicaid fraud abuse.
• must be able to suggest leads to investigators and assist in preparation of investigative requests for records, subpoenas and search warrants.
• must also perform administrative duties to include preparation of management reports and other duties as needed.
• This investigator typically works in the office, but may occasionally be required to work in the field to obtain pertinent information.
  
  

The successful candidate must undergo and successfully complete a comprehensive background check as part of the hiring process.


This position is subject to the Fair LaborStandards Act. Thisposition will require travel and overnight travel.


Note To Current State Employees


The salary grade for this position isGN08.State employees are encouraged to apply for positions of interest even if the salary grade is the same as, or lower than, their current position. Please detail ALL work history including non-state service experience. If selected for this position, a new salary will be recalculated taking into consideration the quantity of relevant education and experience, funding availability, and internal equity. Based upon these factors, a pay increase MAY or MAY NOT result.


The State of North Carolina offers employer paid health insurance plus ten paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information atEmployee Benefits.


Knowledge, Skills And Abilities / Competencies


Considerable knowledge of criminal justice and law enforcement procedure, terminology, and personnel policies and practices.


Ability to interpret, apply, and communicate statutory regulations of the assigned area.


Ability to analyze, interpret, recommend, and implement policy and procedural guidelines. Ability to instruct and explain standards and procedures.


Ability to establish effective working relationships, including seeking compliance with regulations.


Ability to express oneself clearly and concisely, tactfully and professionally in oral and written form,


Ability to work independently and use sound judgment in making decisions.


Strong skills in utilizing word processing, spreadsheet, and database software, email functions, and Internet Web browser skills.The employee must have knowledge of modern office procedures, practices, and equipment including Word, Excel, Access, email, Internet browsers, relational databases, and an effective working knowledge of Medicaid coverage policy and claims processing and data systems.


Strong organizational skills and file management skills.


Strong problem solving skills; the ability to make inferences and deductions from a vast array of intelligence sources pertaining to criminal activities and organizations.


Must have the ability to learn and adapt to ever-changing computer software; the ability to provide written and oral briefings, reports and training to law enforcement agencies on trends and patterns of criminal activity and new and existing analytical techniques in criminal intelligence; the ability to exercise judgment and discretion in establishing, applying and interpreting policies, procedures, and administrative rules; and the ability to establish and maintain effective working relationships with multi-agency personnel and administrators.


Must comply with rules and regulations regarding confidentiality and the dissemination of information using proper judgment with regard to sensitive and critical information and maintain confidentiality as required by applicable laws and regulations.


The employee must have a thorough knowledge of the intelligence process and methodology.


Minimum Education And Experience Requirements


Bachelor s degree from an appropriately accredited institution and two years of administrative and/or technical experience in criminal justice or law enforcement as it relates to the area of assignment, or an equivalent combination of education and experience.


Supplemental and Contact Information


Please be sure to complete the application in full.


Note the following: If multiple applications are submitted to an individual posting, only the most recent application received prior to the closing date will be accepted. Applications must be submitted by 5:00 PM on the closing date


Resumes and cover letters: To receive credit for your work history and credentials, you must list the information on the online application form. This information is used to determine if you meet the requirements of the position, and if you are selected, it is used to determine a salary offer.


Using the terms “See Resume” or “See Attachment” will not be accepted and your application will be rejected as incomplete. Cover letters are highly encouraged but not required.


Transcripts:Degrees must be received from appropriately accredited institutions. A copy of your transcripts indicating the degree received can be uploaded with your application.


If a transcript has been requested, your application will be considered incomplete if you do not provide one. Using a photograph of your diploma is not acceptable.


Credit forforeign degreeswill only be given if verification of degree certification is attached to your application. Transcripts for foreign degrees have to be evaluated by an organization like World Education Services to determine USequivalency.


Any licenses or certificates must be included in the appropriate section of the application form.


Veterans Preference:Applicants seeking Veteran’s Preference must attach a copy of their DD-214 or discharge orders.


Application status:To check the status of your application, please log in to your account. Upon the closing date, applications are “Under Review” and will be screened by Human Resources for the qualified applicants. The hiring process may take an average of 6 – 8 weeks. All applicants will be notified by email once a position is filled.


NeoGov Help Line:If you are having technical issues submitting your application, please call the NeoGov Help Line at 855-524-5627. If there are any questions about this posting, other than your application status, please contact the NC DOJ Human Resources office.


The NC Department of Justice is an Equal Opportunity Employer.The NC Department of Justice uses Merit-Based Recruitment to select from among the most qualified applicants to fill positions subject to the State Human Resources Act.


Contact Information


NC Department of Justice


Human Resources Office


Lisa Sasser, Recruitment Specialist


114 W. Edenton Street


Raleigh, NC 27603


919-716-6490

 
 

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Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

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

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

Receives a moderate level of guidance and direction in providing operational and administrative support for the implementation, auditing and resolution of loading issues for payment innovation programs.

Primary duties may include, but are not limited to:

+ Provides support for assigned provider contracts.

+ Obtains and analyzes financial performance and quality metrics.

+ Support and facilitates value-based JOCs (Joint Operating Committee meetings).

+ Develops and maintains contact database and disseminates communications to providers as necessary.

+ Aggregate and analyze provider data from various sources to recommend and implement solutions to assist with provider collaboration activities.

+ Collaborates with provider contractors and network relations reps to meet provider service needs.

+ Encourages providers to act on patient outreach opportunities.

+ Continues to build knowledge of the organization, processes and customers.

+ Performs a range of mainly straightforward assignments.

Qualifications

+ Requires a BA/BS degree; 3 years experience in database maintenance related to health care; or any combination of education and experience, which would provide an equivalent background.

+ Provider environment experience preferred.

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

REQNUMBER: PS48952-Kentucky
 

Clipped from: https://us.trabajo.org/job-822-20210721-36a28a530b7bad464b5971fe83b5f1d2?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

Company Description

Ask ITC Inc. which is backed by a $500 million Microtek group company, provides an industry leading blend of technology, business consulting, and outsourcing services. Ask IT is a minority-owed enterprise; it has been founded on providing the highest quality possible and on the devotion to customer satisfaction.
 

Job Description

Role Name: Mainframe Tester/Analyst

Duration: 12 Months

Location: Clemson, SC

REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):

MAINFRAME, MVS COBOL, JCL, SOFTWARE TESTING, CREATION OF TEST SCENARIOS

SOFT SKILLS REQUIRED:

EFFECTIVE COMMUNICATION SKILLS (WRITTEN AND ORAL), ADAPTABILITY, FLEXIBILITY, SELF-MOTIVATION, PROBLEM SOLVING, ANALYTICAL THINKING, TIME MANAGEMENT, ABILITY TO WORK EFFECTIVELY IN A STRESSFUL ENVIRONMENT

PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):

CA-ADS, SQL, SERENA CHANGEMAN OR OTHER

Additional Information

All your information will be kept confidential according to EEO guidelines.

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11 hours ago

 
 

Excelraise, LLC is a rapidly growing full service IT solutions integrator and talent management company headquartered in Denver, CO. Our valued client*s includes fortune 500 companies, Government Agencies.

Currently we are looking for a qualified individual to work as a MySQL Database Administrator with our direct client
in Clemson, SC.

***This is Onsite Position***

Our direct client is seeking a MySQL professional with the knowledge and experience along with comparable communication and interpersonal skills to enable success on this high-visibility project.

DAILY DUTIES / RESPONSIBILITIES:
The MySQL DBA is responsible for working closely with both the project development team (scrum/sprint teams) and with the Clemson Database Administrators to provide MySQL DBA support for numerous application and infrastructure databases.

REQUIRED SKILLS:

• The MySQL DBA role has four major attributes: software development leadership, project management skills, people skills, and domain knowledge in enterprise class multi-tier web-based application development projects. Candidates must display excellence in all areas.
• Previous experience in health care related information technology, insurance information technology, Medicaid Management Information Systems (MMIS), Medicaid eligibility, or social services eligibility, while not absolutely necessary, will be helpful.
• Proven MySQL DBA experience in supporting enterprise applications in Linux environments, preferably Redhat or Oracle Linux.
• Experience with MySQL cluster
• Understanding of IT development and implementation projects.
• Understanding of database scalability and operations.
• Project planning experience, including effort estimation on technical tasks and resource allocation.
• Strong written and oral communications skills, including the ability to give presentations to project management. Strong proficiency in English is required.
• Impeccable integrity. This project will have very high visibility and will impact significant expenditures of public funds. Candidates must be confident with their abilities to make correct decisions and the courage to speak out when necessary.
• Willingness and ability to effectively engage with people and organizations on a continuous basis.
• Experience with Microsoft SQL Server is desirable, but not required.

PREFERRED SKILLS:

• Hands-on experience with managing MySQL performance and availability 24×7.
• Experience with configuring monitoring and alerting for MySQL databases and clusters.
• Hands-on experience with MySQL upgrades, patching, and re-hosting.
• Healthcare industry experience and/or experience managing PHI/PII data.
• MS SQL Server knowledge and support experience is a plus, but not required.
• Vendor management experience.
• Medicaid Management Information System (MMIS) experience
• Medicaid operations experience.
• Public sector experience is a plus.

REQUIRED EDUCATION:

• Bachelor’s degree in a technical, business, or related field. Masters degree is desirable.

 
 

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Description:

Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortun

3 days ago

 
 

Clipped from: https://us.trabajo.org/job-640-20210711-3a42280daa28067334083869fafaf59a?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. In 2020, ODM introduced a new vision for Ohio’s Medicaid program — one that strengthens Ohio’s future and ensures everyone has the chance to live life to its full potential.


Today, more than 90 percent of Ohio Medicaid members are supported by managed care organizations. During the year ahead, ODM will begin implementing a new vision for care; focusing on the individual, a strong partnership among MCOs and the department, and supporting specialization in addressing critical needs.


A program that puts the individual first


They Are


Adopting Governor DeWine’s philosophy of service to Ohioans, ODM embarked on an aggressive effort to redesign its managed care program. The goal is to provide more personal, holistic care and supports for millions of Ohioans served by Medicaid. Listening to feedback from more than 1,100 individuals and organizations we identified five procurement goals that would put the individual front and center of Medicaid’s program and policy decisions.

• Emphasize a personalized care experience,
• Improve care for children and adults with complex behavioral health needs,
• Improve wellness and health outcomes,
• Support providers in better patient care and
• Increase program transparency and accountability.

 
 

Unless required by legislation or union contract, starting salary will be set at step 1 of the pay range.


Job Overview


Office: Health Innovation & Quality


Bureau: Clinical Operations


Working Title: Medicaid Health Systems Administrator 2 (PN 20099227)


As the Incident Operations Manager in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include:

• Developing and overseeing health and safety Incident requirements for Ohio Medicaid Waiver programs, Ohio Managed Care programs, and the OhioRISE program
• Planing, coordinating and ensuring appropriate program requirements and oversight activities are in place for the Medicaid Incident program
• Ensuring the health and safety of Ohio Medicaid members and compliance with state and Federal regulations
• Tracking business requirements and updates for the Ohio Medicaid Incident Management System (IMS)
• Evaluating data submitted to the IMS, to identify trends and patterns
• Serving as the Bureau of Clinical Operations Liaison with the MCO, MCO Waiver, and OhioRISE Incident Management Programs
• Making recommendations for program and operational changes as needed, and for sharing information about program performance with each external incident program to drive continuous improvement
• Reviewing, analyzing, and interpreting data (e.g., IMS data and oversight activity results) and reports, and provide recommendations for follow up activities related to program performance
• Working collaboratively with the supervisors in the Care Coordination Section as well as other internal and external stakeholders across a variety of departments, levels, and state agencies to conduct and develop review tools

 
 

Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 24 months of experience in planning & administering health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data analysis).


 

• Or 24 months experience as a Medicaid Health Systems Administrator 1, 65295.
• Or equivalent of Minimum Class Qualifications for Employment noted above.
  
  
   

Primary Location


United States of America-OHIO-Franklin County-Columbus


Work Locations


Lazarus 5


Organization


Ohio Department of Medicaid


Classified Indicator


Classified


Bargaining Unit / Exempt


Exempt


Schedule


Full-time


Work Hours


8am -5pm


Compensation


$35.94/hour


Unposting Date


Jul 23, 2021, 11:59:00 PM


Job Function


Health Administration


Job Level


Individual Contributor


Agency Contact Information


HumanResources@medicaid.ohio.gov

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By clicking the “Apply” button, I understand that my employment application process with Takeda will commence and that the information I provide in my application will be processed in line with Takeda’s Privacy Notice and Terms of Use. I further attest that all information I submit in my employment application is true to the best of my knowledge.


Job Description


Are you looking for a patient-focused, innovation-driven company that will inspire you and empower you to shine? Join us as a Medicaid Analyst I in our Exton, Pennsylvania office.


At Takeda, we are transforming the pharmaceutical industry through our R&D-driven market leadership and being a values-led company. To do this, we empower our people to realize their potential through life-changing work. Certified as a Global Top Employer, we offer stimulating careers, encourage innovation, and strive for excellence in everything we do. We foster an inclusive, collaborative workplace, in which our global teams are united by an unwavering commitment to deliver Better Health and a Brighter Future to people around the world.


Here, you will be a vital contributor to our inspiring, bold mission.


POSITION OBJECTIVES

End-to-End Processing of Medicaid Rebates

• Process rebates invoiced to Takeda under the Medicaid Drug Rebate Program (MDRP), including Federal Medicaid (FFS), Medicaid Managed Care (MMC), State Pharmaceutical Assistance Programs (SPAP), and Supplemental programs
• Validate and analyze utilization trends against prescribing methods, generic substitution, and eligible payors
  
  

Ensure payments are submitted within aggressive deadlines


Position Accountabilities

• Perform all aspects of the Medicaid Drug Rebate process
  
  

 
 

• Process invoice in Flex MRB; Validate claim level data for accuracy; Dispute invalid claims; Review utilization trends; Submit claims for payment; Remit payments

• Coordinate payment approval with Takeda C&P Management, Finance, and Accounts Payable
• Negotiate dispute resolutions with state personnel ensuring accurate and efficient documentation of payments and present to C&P management
• Responsible for ensuring compliance with all state-mandated due dates and avoiding interest penalties
• Proactively notify Takeda Contracts and Pricing (C&P) management of state issues/trends that could have a significant impact on our financials
• Perform a variety of ad-hoc reporting related to Medicaid Rebates contracts
• Foster and develop relationships with third party processors and state agencies
  
  
   

Education, Behavioral Competencies, And Skills

• Bachelor’s Degree or Associate’s Degree and 2 years experience in the area of rebate processing or 4 years experience in the area of rebate processing
• Effectively manage multiple priorities to maximize results. Pays close attention to project deadlines and schedules
• Health care business acumen with a comprehensive understanding of the pharmaceutical industry
• Proficiency with Microsoft Office Suite
  
  
   

Travel Requirements

• Relevant travel less than 20%
  
  

This role excludes CO Applicants


What Takeda Can Offer You

• 401(k) with company match and Annual Retirement Contribution Plan
• Tuition reimbursement Company match of charitable contributions
• Health & Wellness programs including onsite flu shots and health screenings
• Generous time off for vacation and the option to purchase additional vacation days
• Community Outreach Programs
  
  
   

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