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Proposal Director, Medicaid RFP Services, Government Programs – Telecommute, Atlanta, Georgia

 
 

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It’s an opportunity to do your life’s best work. sm

No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You’ll help improve the health of millions.

The health care markets are evolving in many different ways and the role and impact of the Medicaid is becoming increasingly important as health plans and providers look for new ways to grow and manage risk. In particular, the ability to manage medical cost through care management interventions or network management strategies is critical to the success of these organizations.

Optum is seeking a Proposal Director, Medicaid RFP Services, Government Programs to provide thought leadership and expertise in the Medicaid market. This position is responsible for the development of Medicaid-focused consulting solutions and responding to RFPs in all areas of TANF, CHIP, LTSS, ABD, Duals Population, Complex Care, Population Health, and provider-sponsored organizations taking on risk for Medicaid populations.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Proposal Management and Oversight/Proposal Writing (70% Time Allocation):

 
 

  • Complete and deliver strategic analyses, translating the data into client-specific requirements/specifications
  • Consult with clients regarding RFP and other business strategies, providing clients with recommendations and information regarding industry trends
  • Present information to, and effectively communicate with, client leadership and other key individuals
  • Support, be an advocate for, and manage (as needed), a defined proposal development process for responding to Medicaid RFPs
  • Participate in individual and group proposal reviews with senior leadership and other key individuals; incorporate changes and improvements to proposals
  • Assist as needed in general proposal activities, including proposal management, proposal writing, editing, proposal assembly, quality assurance, etc.
  • Complete projects on time/budget and in accordance with quality measures
  • Maintain or enhance trusted partner relationships to expand the Payer Consulting footprint at designated clients
  • Complete internal tracking and reporting
  • Conduct other duties as assigned
  • Develop and maintain client references
  • Sales and Strategy Support (30% Time Allocation):

 
 

  • Participate in and lead business development initiatives
  • Develop proposals and statements of work for client-specific engagements
  • Participate, support and complete RFI, RFP and sales process
  • Complete financial analyses for proposed solutions
  • Build Medicaid Marketing and Sales Collateral
  • Attend and participate in oral presentation

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • 7+ years of experience in managed Medicaid, preferably with RFPs, government affairs and/or consulting
  • Project management experience – solid project tracking, presentation and reporting skills
  • Experience writing and executing business plans for new consulting solutions
  • End-to-End knowledge of Medicaid program implementation and operations
  • Ability to think strategically, proven experience laying out strategy, developing products and/or services from ground up that would be sold in the Medicaid market
  • Proficient in Microsoft applications
  • Travel 10-25% on average month, can be more depending on client needs/project phase
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Preferred Qualifications:

  • Bachelor’s degree
  • Shipley certification
  • APMP certification
  • 7+ years of Medicaid experience within a consulting or payer related organization
  • Prior experience working within a State Agency
  • Proven problem-solving skills (identification of issue, causes, solution, implementation plan)
  • Solid ability to influence and motivate
  • Solid interpersonal skills
  • Solid attention to detail and ability to meet deadlines

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work. sm

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $110,200 to $211,700. The salary range for Connecticut / Nevada residents is $110,200 to $211,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected bylower 48 law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Proposal Director, Medicaid RFP Services, Government Programs,Telecommute, WFH, Work From Home, WAH, Work At Home

 
 

Clipped from: https://www.myvalleyjobstoday.com/jobs/proposal-director-medicaid-rfp-services-government-programs-telecommute-atlanta-georgia/425865686-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Supervisory Health Insurance Specialist- CMS

 
 

Department of Health And Human Services
Office of Financial Management

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Financial Management(OFM), Payment Accuracy and Reporting Group, Division of Medicare Advantage and Drug Error Rate.


As a Supervisory Health Insurance Specialist, GS-0107-15, you will be responsible for providing leadership and executive direction over the activities of Medicare Advantage and Medicare Prescription improper payment measurement program.

Learn more about this agency

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Overview

  • Accepting applications

 
 

  • Open & closing dates

11/19/2021 to 12/03/2021

  • Salary

$144,128 – $172,500 per year

  • Pay scale & grade

GS 15

Location

1 vacancy in the following location:

Yes—as determined by the agency policy.

  • Travel Required

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

  • Relocation expenses reimbursed

No

  • Appointment type

Permanent

  • Work schedule

Full-time

  • Service

Competitive

  • Promotion potential

15

  • Job family (Series)

0107 Health Insurance Administration

  • Supervisory status

Yes

  • Security clearance

Not Required

  • Drug test

No

  • Position sensitivity and risk

Moderate Risk (MR)

  • Trust determination process

Credentialing

Suitability/Fitness

  • Announcement number

CMS-OFM-22-11298023-IMP

  • Control number

622986600

Videos

 
 

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Duties

  • As the MADER Director, the incumbent is directly responsible overseeing the budget and human resource activities for MADER to accomplish the Medicare Part C and Medicare Part D measurement development program missions.
  • Identifies and discusses with internal and external groups, problems, vulnerabilities, or potential changes.
  • Assigns work to subordinates based on priorities, selective consideration of the difficulty and requirements of assignments, and the capabilities of employees.
  • Communicate Medicare Part C and Medicare Part D improper payment findings to stakeholders throughout the agency so that steps can be taken to reduce errors and improve the integrity of the Medicare Part C and Medicare Part D programs.
  • Presents resource issues to senior management, including performing a gap analysis of current resources to projected needs based on the group’s workload and makes recommendation for what is needed for MADER to accomplish the program’s mission.

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Requirements

Conditions of Employment

  • You must be a U.S. Citizen or National to apply for this position.
  • You will be subject to a background and suitability investigation.
  • Time-in-Grade restrictions apply.
  • THIS POSITION IS SUBJECT TO THE COVID-19 VACCINE MANDATE AS A CONDITION OF EMPLOYMENT.

Qualifications

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


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


In order to qualify for the GS-15, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-14 grade level in the Federal government, obtained in either the private or public sector, to include:

1) Providing leadership in the operational review and administration of Medicare Fee For Service (FFS), Medicare Advantage (Medicare Part C), Medicare Prescription Drug (Medicare Part D), Medicaid, or Children’s Health lnsurance Program (CHIP) improper payment measurement programs; AND

2) Providing oversight to ensure that program integrity efforts to identify improper payments follow the applicable payment laws, regulations or policies; AND
3) Recommending improvements on improper payment measurement programs; AND
4) Briefing stakeholders on payment vulnerabilities.


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


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

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11298023

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: No

Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Required



COVID-19 Vaccine Mandate: In accordance with Executive Order 14043, Federal employees are required to be fully vaccinated against COVID-19 regardless of the employee’s duty location or work arrangement (e.g., telework, remote work, etc.), subject to exceptions that may be required by law. If selected, you will be required to submit proof of vaccination by November 22, 2021 or before your entrance on duty if you are selected after the compliance date. Your HR Consultant will provide a list of documents acceptable as proof of vaccination and instructions for how to submit a request for a legally required exception, if needed, to comply with vaccination requirement.


Expanded/Maximum Telework Posture: Due to COVID-19, the agency is currently in a maximum telework posture. If selected, you may be expected to telework upon your appointment. As employees are permitted to return to the office, you may be required to report to the duty station listed on this announcement within 30 calendar days of receiving notice to do so, even if your home/temporary telework site is located outside the local commuting area. Your position may be eligible for workplace flexibilities which may include remote work or telework options, and/or flexible work scheduling. These flexibilities may be requested in accordance with the HHS Workplace Flexibilities policy.


The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.

Read more

A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

How You Will Be Evaluated

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

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


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


  • Building Coalitions/Communications
  • Business Acumen
  • Leading People
  • Managing Change
  • Results Driven

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

A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

  • As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have – whether you’re a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you’re eligible under their policies.

The following documents are REQUIRED:


1. Resume
showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Current CMS employees are REQUIRED to submit a copy of their most recent Notification of Personnel Action (SF-50) at the time of application. Additional documents may also be required to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


PLEASE NOTE: A complete application package includes the online application, resume, and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume and CMS required documents, will result in you not being considered for employment.


Additional Forms REQUIRED Prior to Appointment:

  • Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
  • Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
  • Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.

If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.

  • Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 12/03/2021 to receive consideration.


    IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.


    We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:

 
 

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month and year (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.

  • To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  • Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
  • After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
  • You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.

To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to br************@*****hs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CM**********@*****hs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

Agency contact information

Breanna Wells

Email

br************@*****hs.gov

Address

Office of Financial Management
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

Once your online application is submitted, you will receive a confirmation notification by email. Your application will be evaluated to determine your eligibility and qualifications for the position. After the evaluation is complete, you will receive another email notification regarding the status of your application.


Within 30 business days of the closing date,12/03/2021, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

  • The Federal hiring process is setup to be fair and transparent. Please read the following guidance.

 
 

Help

Required Documents

The following documents are REQUIRED:


1. Resume
showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Current CMS employees are REQUIRED to submit a copy of their most recent Notification of Personnel Action (SF-50) at the time of application. Additional documents may also be required to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


PLEASE NOTE: A complete application package includes the online application, resume, and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume and CMS required documents, will result in you not being considered for employment.


Additional Forms REQUIRED Prior to Appointment:

  • Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
  • Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
  • Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.

If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.

Help

How to Apply

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 12/03/2021 to receive consideration.


IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.


We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month and year (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.

  • To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  • Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
  • After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
  • You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.

To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to br************@*****hs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CM**********@*****hs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

Read more

Agency contact information

Breanna Wells

Email

br************@*****hs.gov

Address

Office of Financial Management
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

Once your online application is submitted, you will receive a confirmation notification by email. Your application will be evaluated to determine your eligibility and qualifications for the position. After the evaluation is complete, you will receive another email notification regarding the status of your application.


Within 30 business days of the closing date,12/03/2021, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

Read more

 
 

Clipped from: https://www.usajobs.gov/GetJob/ViewDetails/622986600?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

SENIOR BUSINESS ANALYST (MEDICAID – MANAGED CARE) – (REMOTE POSITION) – Atlanta – CNSI

 
 

Today

Position Summary

This role involves managing requirement scope, determining appropriate methods on potential assignments, and serving as a bridge between information technology teams and the client through all project phases; providing day-to-day direction on State program activities.

Compliance

***In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification at the time of hire or transfer.

Position Details

The Senior Business Analyst is responsible for analyzing business problems, identifying gaps, and developing technical solutions involving complex information systems under no supervision for Contracts Managed Care and related subsystems.

Analysis

Demonstrates in-depth knowledge of business analysis related to Managed Care to ensure high quality. Demonstrates advanced expertise and contributes to the Business Analysis practice by publishing technology points of view through the creation of white papers. Uses cases, workflow diagrams, and gap analysis to create and modify requirements documents and design specifications.

Planning

Prioritizes and schedules work assignments based on the project plan, handling multiple tasks across project phases.

Process

Creates and modifies Business Process Models.

Technical

Works with customers on presenting technical solutions for complex business functionalities.

Management

Acts as the requirements subject matter expert and supports requirements change management.

Consulting

Analyzes user requirements and client business needs, leveraging expert opinion and expertise.

OPERATIONAL EXCELLENCE

Possesses unwavering commitment to customer service and operational excellence.

Support

Provides customer support through leading client demos and presentations.

Architecture

Understands the overall system architecture and cross-functional integration.Experience

Have 5+ years of experience at large complex organizations, including leading centralized or matrixed teams. Have 3+ years of Lead Business Analyst experience on large complex projects. Have 5+ years Medicaid / Medicare (healthcare) background. Experience facilitating and running JAD requirements design sessions etc.

Knowledge

Strong knowledge in Medicaid Management Information System around Managed Care and related subsystems. Strong knowledge and proficiency in SQL. Knowledge of the Quality-of-Care program is highly preferred. Knowledge of data integration and software enhancements/planning.

Skills

Excellent customer relation skills including presentation and meeting facilitation. Excellent requirements elicitation and validation skills. Preferred Skills:.

Values

CNSI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status, or any other status protected by applicable federal, state, or local law. We are proud of our diversity and encourage all qualified applicants to apply.

Degree

Bachelor’s Degree. Master’s Degree.

Technical

You have a high level of technical and database knowledge.

Analysis

Business Analysis Process (SDLC, documentation procedures) experience.

Clipped from: https://www.theladders.com/job/senior-business-analyst-medicaid-managed-care-remote-position-cnsinc-atlanta-ga_49466681?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Missouri’s thin dental safety net stretched amid Medicaid expansion

[ MM Curator Summary] Missouri expansion is expected to place more strain on the dental network.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Only 27% of dentists in Missouri accept Medicaid, one of the lowest rates in the country

 
 

Dr. Elena Ignatova prepares to make an impression of a patient’s mouth to fit dentures at CareSTL Health in St. Louis. Only 27% of Missouri dentists accept Medicaid, and many of those who do work at safety-net clinics like CareSTL Health (photo: Bram Sable-Smith).

This story was originally published by Kaiser Health News and KSMU.

At the Access Family Care clinics in southwestern Missouri, the next available nonemergency dental appointment is next summer. Northwest Health Services, headquartered in St. Joseph, is booked through May. The wait is a little shorter at CareSTL Health in St. Louis — around six weeks.

Roughly 275,000 Missourians are newly eligible this year for Medicaid, the federal-state public health insurance program for people with low incomes, and they can be covered for dental care, too. Missouri voters approved expansion of the program in 2020, the latest of 39 states to do so as part of the Affordable Care Act, but politics delayed its implementation until Oct. 1. Adults earning up to 138% of the federal poverty level — about $17,774 per year for an individual or $24,040 for a family of two — can now get coverage.

But one big question remains: Who will treat these newly insured dental patients?

Only 27% of dentists in Missouri accept Medicaid, according to state data, one of the lowest rates in the country. Many of them work at what are known as safety-net clinics, such as Access Family Care, Northwest Health Services and CareSTL Health. Such clinics receive federal funds to serve uninsured patients on a sliding scale and was experiencing huge demand for dental services before expansion.

The reason so few Missouri dentists accept Medicaid is simple, according to Vicki Wilbers, executive director of the Missouri Dental Association: The state’s program pays dentists extremely poorly compared with private insurance or what a dentist could charge a patient paying cash. Adding to the strain, said Wilbers, dentists who do accept Medicaid often must deal with the state plus private insurers that administer Medicaid through a program known as managed care.

“You have more people on the rolls, you still don’t have reimbursement rates increase,” Wilbers said. “And it’s cumbersome.”

Still, for these new patients, the coverage can be life-changing.

Only 37% of adults in the state with incomes under $15,000 per year saw a dentist in 2018 compared with 76% of adults earning over $50,000, according to a state report. A survey by the American Dental Association found 53% of low-income Missourians have difficulty chewing, 43% avoid smiling because of the condition of their mouth and 40% experience pain.

“I just don’t think those stories are told enough,” said Steve Douglas, spokesperson for Access Family Care in Neosho.

Douglas described a patient of the clinic who believes his so-far-unsuccessful quest for higher-paying work has been hindered by the appearance of his teeth.

“We’re hoping that with the Medicaid expansion we can get him in for some care,” Douglas said. “He would like to save some of his teeth and not go to full dentures.”

About 62% of Missouri adults making under $15,000 per year have lost at least one tooth to decay or gum disease, and 42% of people 65 and older in that income range have lost all of them, according to the state report. For Missourians earning over $50,000, those rates are 34% and 8%, respectively.

Part of the dental care backlog at Access Family Care, which offers dental services at five locations around southwestern Missouri, is due to the pandemic. The clinic laid off all 95 of its dental staffers in March 2020 before gradually building back to full capacity. As with dental practices nationwide, many of their patients are now coming to get the dental work done that they delayed earlier over fears of exposure to the coronavirus.

But central to the huge demand is an overall need for more providers. Nearly 1.7 million Missourians live in a federally designated dental professional shortage area, one of the highest levels of unmet needs in the country. It’d take another 365 dentists to fill that void, at least one extra dentist for every 10 already practicing in the state.

“We could easily employ another four dentists and still have high demand,” Douglas said.

His clinic, Access Family Care, has indeed hired two new dentists to start in 2022. To manage the dental caseload until then, though, it had to temporarily stop seeing new patients.

In St. Louis, Dr. Elena Ignatova, director of dental services at CareSTL Health, had 18 patients scheduled on a recent Wednesday in November. About a quarter of them were insured through Medicaid.

By 10 a.m., she had cast a mold of one patient’s mouth to fit dentures, referred another to an oral surgeon for a root canal and prepped a fourth-year dental student for the extraction of a Medicaid patient’s remaining teeth. In Missouri, Medicaid covers simple tooth extractions for adults but not root canals or crowns.

“We remove teeth because the other treatment is too expensive and they cannot afford it,” Ignatova said. “Then it can take years for those patients to come up with the money for dentures.”

Ignatova is booked into February, but the clinic still takes walk-ins for dental emergencies. She’s also working her way through a waiting list of 39 patients who might be able to show up quickly if a cancellation or no-show opens a spot in her schedule.

There is easily enough demand for another dentist, but Ignatova said they’re still working on hiring the dental assistants and hygienists needed to reopen the school-based clinics for kids they operated before the pandemic. Those hirings are in the works, but it is slow going. As with many health care facilities, she and others said, President Joe Biden’s vaccine mandates have added an extra hurdle to recruiting and retaining staff.

One clinic that isn’t seeing a bottleneck of dental patients, though, is KC Care Health Center in Kansas City. Kristine Cody, the clinic’s vice president of oral health services, said a new patient could be seen there in about a week. The Kansas City region benefits from having the University of Missouri-Kansas City School of Dentistry, which offers reduced-cost care to patients at the clinic where its students are trained, plus several other safety-net clinics.

KC Care also added two dentists and extended its clinical hours in anticipation of Medicaid expansion.

“I just hope people look to use it,” Cody said.

 

 
 

 
 

Clipped from: https://missouriindependent.com/2021/11/16/missouris-thin-dental-safety-net-stretched-amid-medicaid-expansion/

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Florida- Medicaid modernization will take hundreds of millions and require more staff

[ MM Curator Summary] Florida is beginning the process to rebid its MMIS and downstream modules.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Florida’s health care regulation agency is setting the stage for an expensive rebuild of the computer systems that bind the state’s multibillion dollar Medicaid program even though state legislators have not agreed to pay for it.

The Agency for Health Care Administration has dropped three different invitations to negotiate with vendors that can update the state’s antiquated Medicaid management information systems and is expecting responses on the three requests by early- to mid-December.

In hopes of having contracts inked between the summer and fall of 2022, the agency is assembling for each Invitation to Negotiate (ITN) two multiagency teams — one to evaluate the vendors’ responses and the other to negotiate with vendors that received top evaluation scores.

Now all the agency needs is the Florida Legislature to approve its legislative budget request for $117.8 million so it can pay the vendors for the needed work. It’s a number that one top House Republican already suggested may be “excessive.” 

Currently, the Medicaid management information system is a single integrated system for claims processing and information retrieval. But AHCA wants to transform that into a modern modular system that connects with other data sources and programs.

 
 

Florida Health Care Connections, or FX, is the moniker AHCA assigned to the transformation of the system and the subsequent modular procurements necessary to make it happen. Florida lawmakers have already appropriated more than $158 million over the past five budgets for the replacement of the system responsible for billing and payment to the managed care companies, doctors and pharmacies providing health care to millions of Floridians enrolled in Medicaid.

FX Program Director Mike Magnuson told members of the FX Executive Steering Committee on Wednesday the latest budget request for the upcoming fiscal year 2022-2023 budget, “includes the funding to start the contracts that we now put out on the street. So the majority of it will be the fixed price deliverables for those functions.”

In addition to requesting the $117.8 million to help initially pay the three ITNs, Magnuson told FX Steering Committee members the agency requested another $1.97 million to hire 12 full-time employees who can provide ongoing support to the office that will be created to help with the system.

Without the funding, Magnuson said, the agency would be reliant on paying contracted staff in order to operate the FX updates.

But Rep. Bryan Avila, the South Florida Republican charged with leading efforts to assemble a health care budget in the House of Representatives, recently questioned the size of the agency’s legislative budget request by asking if the project total was inflated.

 
 

Meanwhile, the three ITNs AHCA published have a combined value of nearly $350 million over a seven-year period.

The first ITN AHCA will award is for modular “unified operations centers” services. The contract would be in effect between Aug. 1, 2022, and July 31, 2029, and could be worth more than $161 million.

The second ITN AHCA will award is for modular provider management services.The system must allow for concurrent processing of enrollment and plan credentialing activities for both initial enrollment as well as renewals. According to the ITN, the contract would be in effect from Sept. 1, 2022, through Aug. 31, 2029, and would be worth more than $33 million.

The third ITN the agency will award is for so-called core systems and is expected to be worth $154.5 million. According to the ITN, the contract would be in effect between Nov, 1, 2022, and Sept. 30, 2029. 

“We are getting to the point where the rubber is starting to meet the road,” AHCA Secretary Simone Marstiller told members of the FX Executive Steering Committee. “It’s all starting to come together.”

Clipped from: https://floridapolitics.com/archives/472301-medicaid-modernization-will-take-hundreds-of-millions-and-require-more-staff/

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Long Predicted Medicaid Specialty Drug Trend Finally Surpasses 50% of Pharmacy Spend in the Latest Magellan Rx Management Medicaid Pharmacy Trend Report

[ MM Curator Summary] New analysis of Medicaid rx spending shows similar trends as previous years, with specialty drugs accounting for more than half of all drug spending.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

PHOENIX–(BUSINESS WIRE)–Nov 15, 2021–

Magellan Rx Management, the full-service pharmacy benefits management division of Magellan Health, Inc. (NASDAQ: MGLN), released its sixth annual Medicaid Pharmacy Trend Report TM, the industry’s leading report exclusively detailing trends in the Medicaid pharmacy fee-for-service (FFS) space.

The Medicaid Pharmacy Trend Report highlights the evolving landscape of Medicaid, made even more dynamic from the events of the last two years. The report includes an in-depth analysis of class and drug trends, forecasting of Medicaid key conditions, drugs in the pipeline, and Medicaid pharmacy economics. This is also the only detailed industry source for the analysis of Medicaid pharmacy fee-for-service (FFS) gross, net, and forecasted drug cost trends.

“As our nation continues to navigate the lasting impacts of the COVID-19 pandemic, there is no doubt that states are facing unprecedented challenges across all areas of government, especially related to ensuring the mental and physical well-being of their citizens,” said Meredith Delk, PhD, MSW, general manager and senior vice president, government markets, Magellan Rx Management. “The Medicaid Trend Report illustrates critical data-driven observations and solutions. The valuable insights in this report can assist states on their mission to ensure a high quality and cost-effective prescription drug program for their most vulnerable populations.”

Key findings in this year’s report include:

  • In 2020, specialty drugs accounted for 51.4% of the net cost in Medicaid, a trend predicted for the last five years. A constant imbalance in spend, specialty drugs only accounted for 1.3% of utilization.
  • 2020 traditional net cost trend for Medicaid FFS was positive for the first time in five years with the introduction of new-to-market drugs.
  • Medicaid FFS top drug classes remained almost identical to previous years – with HIV/AIDS and antipsychotics accounting for more than 19.8% of the total net drug spend.
  • With a steady increase in pipeline drugs, most key conditions will experience increased trend over the next three years. Comparatively, conditions with generic drug introductions or specialized management strategies will see a decrease.

Many of the Medicaid FFS drug trends remained steady, but the drug pipeline, a concern for all lines of business and operating in a year unlike any other, forced states to consider alternative pathways to continuity of care for patients, largely focused on technology-based solutions.

“Our ability to offer comprehensive and configurable solutions that fundamentally connect the dots for our customers and their members around the efficacy of drugs, quality care and payments is key,” said Delk.

The Magellan Rx Management Medicaid Pharmacy Trend Report includes data from Magellan Rx’s Medicaid FFS pharmacy programs in 25 states and the District of Columbia. The material is reviewed and supported by a team of Magellan Rx experts with broad national expertise, including 369 years of combined pharmacy benefit administration (PBA) experience.

About Magellan Rx Management: Magellan Rx Management, a division of Magellan Health, Inc., is shaping the future of pharmacy. As a next-generation pharmacy organization, we deliver meaningful solutions to the people we serve. As pioneers in specialty drug management, industry leaders in Medicaid pharmacy programs and disruptors in pharmacy benefit management, we partner with our customers and members to deliver a best-in-class healthcare experience.

About Magellan Health:Magellan Health, Inc., is a leader in managing the fastest growing, most complex areas of health, including special populations, complete pharmacy benefits and other specialty areas of healthcare. Magellan supports innovative ways of accessing better health through technology, while remaining focused on the critical personal relationships that are necessary to achieve a healthy, vibrant life. Magellan’s customers include health plans and other managed care organizations, employers, labor unions, various military and governmental agencies and third-party administrators. For more information, visit MagellanHealth.com.

(MGLN-GEN)

View source version on businesswire.com:https://www.businesswire.com/news/home/20211115005141/en/

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KEYWORD: ARIZONA UNITED STATES NORTH AMERICA

INDUSTRY KEYWORD: PROFESSIONAL SERVICES HEALTH INSURANCE MANAGED CARE GENERAL HEALTH PHARMACEUTICAL

SOURCE: Magellan Health, Inc.

Copyright Business Wire 2021.

PUB: 11/15/2021 06:30 AM/DISC: 11/15/2021 06:30 AM

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Clipped from: https://tylerpaper.com/ap/business/long-predicted-medicaid-specialty-drug-trend-finally-surpasses-50-of-pharmacy-spend-in-the-latest/article_360c6494-eea7-5141-90c0-d131b94b6236.html

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NY- Former Employees At State Administrator Of Medicaid Transportation And Business Owner Charged With Submitting Fraudulent Claims

[ MM Curator Summary] 2 NY NET dispatchers routed trips to a company owned by a person they colluded with to commit fraud.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Damian Williams, United States Attorney for the Southern District of New York, Scott J. Lampert, Special Agent in Charge of the New York Regional Office of the U.S. Department of Health and Human Services, Office of the Inspector General (“HHS-OIG”), and Ricky J. Patel, Acting Special Agent in Charge of the New York Field Office of the Homeland Security Investigations (“HSI”), announced the unsealing of an Indictment charging PATRICK NDUKWE, DAVID TRAVERS, and MICHELLE MARTIN with participating in a fraudulent scheme in which TRAVERS and MARTIN improperly routed trips for Medicaid-funded transportation to NDUKWE’s company, Quality Service Medical Transportation (“Quality”) and facilitated fraudulent Medicaid claims by Quality.  The case is assigned to U.S. District Judge Denise L. Cote.

U.S. Attorney Damian Williams said: “Every day, thousands of government employees and private contractors around New York are entrusted with handling, disbursing, and guarding public funds.  As alleged, David Travers and Michelle Martin, who were employees at the state manager for Medicaid-funded transportation, abused their roles and the public’s trust when they took payments to steer business to a private company and helped that company submit fraudulent Medicaid claims.  This Office and our law enforcement partners will always investigate and prosecute the illegal abuse of public programs for unjust enrichment.”

HHS-OIG Special Agent in Charge Scott J. Lampert said: “The defendants in this case allegedly engaged in a greed-fueled fraud scheme that undermined the Medicaid program and diverted taxpayer funds from their intended purpose of providing health care benefits to low-income individuals and families.  Together with our law enforcement partners, HHS-OIG will continue to vigorously pursue those who steal from government health programs for personal gain.”

HSI Acting Special Agent in Charge Ricky J. Patel said: “As alleged, these defendants lined their pockets by abusing a program created to provide assistance to the sick and injured in our communities.  Working with our partners, HSI will seek out and bring to justice those that attempt to undermine any federal or state program, explicitly those designed to help millions of our most vulnerable in New York.”

As alleged in the Indictment, which was unsealed today, public filings, and statements in court:[1] 

In New York, individuals who are enrolled in the state’s Medicaid program are eligible to have Medicaid pay for their transportation to and from medical appointments if they are not able to safely take public transportation.  To obtain Medicaid-funded transportation, the enrollee or their health care professional must schedule transportation by contacting the private company that is contracted to manage Medicaid-funded transportation in the New York City area (the “Transportation Manager”).

NDUKWE, 56, was the owner and operator of Quality.  From in or about May 2017 to March 2020, Quality was paid more than $7.3 million for more than 120,000 trips the company purportedly provided for Medicaid-enrolled customers in the New York City area.  However, many of these trip claims were fraudulent and never actually performed.  In some instances, the Medicaid-enrollee who purportedly used Quality to travel to a medical appointment had, in fact, never heard of or used the company for any transportation services.  In other instances, the driver who Quality said performed the trip had never actually worked for the company.  In yet other instances, Quality paid a periodic “kickback” to a Medicaid enrollee to use that enrollee’s personal identifying information to submit a trip claim.

TRAVERS and MARTIN were customer service representatives at the Transportation Manager.  Both were responsible for, among other things, receiving calls from Medicaid enrollees who needed transportation and then randomly assigning those trips among the dozens of eligible transportation companies in the New York City area.  However, both TRAVERS and MARTIN steered a disproportionately high volume of their trips to Quality.  In addition, when certain enrollees requested to be moved from Quality to another transportation company, TRAVERS and MARTIN ensured that the customers were eventually reassigned back to Quality.  TRAVERS and MARTIN also scheduled trips for Quality that they knew would not be performed and would allow Quality to submit fraudulent claims for payment.  For their fraud, both TRAVERS and MARTIN received payments from NDUKWE.

*                      *                      *

NDUKWE was arrested this morning in the Bronx and will be presented later today before U.S. Magistrate Judge Ona T. Wang in Manhattan federal court.  TRAVERS was arrested this morning in Syracuse, New York, and Martin was arrested this morning in East Syracuse, New York.  Both TRAVERS and MARTIN will be presented later today before U.S. Magistrate Judge Therese Wiley Dancks.

NDUKWE, TRAVERS, and MARTIN are each charged with one count of theft of government funds, in violation of 18 U.S.C. § 641; one count of health care fraud, in violation of 18 U.S.C. § 1347; one count of conspiracy to commit health care fraud, in violation of 18 U.S.C. § 1349; and one count of violating the Anti-Kickback statute, in violation of 42 U.S.C. § 1320a-7b. In addition, NDUKWE is charged with one count of aggravated identity theft, in violation 18 U.S.C. § 1028A. In February 2020, as part of the same investigation, the Government charged 13 defendants involved in a different transportation company.

The crimes of theft of government funds, health care fraud, conspiracy to commit health care fraud, and violating the Anti-Kickback Statute each carry a maximum sentence of 10 years in prison.  The crime of aggravated identity theft carries a mandatory two years in prison.  The maximum potential sentences in this case are prescribed by Congress and are provided here for informational purposes only, as any sentencings of the defendants will be determined by a judge.

Mr. Williams praised the outstanding work of DHHS-OIG and HSI.  He also thanked the Office of the New York State Medicaid Inspector General, New York Attorney General’s Medicaid Fraud Control Unit, United States Customs and Border Protection, the Syracuse Police Department, the Onondaga County Sheriff’s Office, the Internal Revenue Service, the New York City Police Department, and the U.S. Probation Office for the Northern District of New York for their assistance in the case.

This case is being handled by the Office’s General Crimes Unit.  Assistant United States Attorneys Brandon D. Harper and Kedar S. Bhatia are in charge of the prosecution.

 
 

[1] As the introductory phrase signifies, the entirety of the text of the Indictment are herein are only allegations, and every fact described herein should be treated as an allegation.

 
 

Clipped from: https://www.justice.gov/usao-sdny/pr/former-employees-state-administrator-medicaid-transportation-and-business-owner-charged

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Anthem, Inc. to acquire Integra Managed Care

 
 

[ MM Curator Summary] Anthem will complete its purchase of an I/DD plan in NY by mid-next year.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

INDIANAPOLIS, November 10, 2021–(BUSINESS WIRE)–Anthem, Inc. (NYSE: ANTM) today announced that the company has entered into an agreement to acquire Integra Managed Care, a Managed Long-Term Care Plan in New York that helps adults with long term care needs and disabilities live safely and independently in their own home.

Integra currently serves 40,000 Medicaid members who benefit from a dedicated care management team that includes a Registered Nurse, Social Worker, and Coordinator who work in partnership with members, their families, and health care providers to ensure their long-term care needs are met.

“This acquisition aligns with our goal of growing Anthem’s Medicaid business, while serving our members with a comprehensive and coordinated approach to care,” said Felicia Norwood, Executive Vice President of Anthem’s Government Business Division. “Like Anthem, Integra has established connections with community groups to gain a deeper understanding of how to best support the whole-health needs of the people we are privileged to serve.”

Anthem is acquiring Integra from a wholly-owned indirect subsidiary of Personal Touch Holding Corporation. Integra has been serving communities by providing government sponsored coverage for a full range of long-term care services including services in the home, such as nursing, licensed physical, occupational and speech therapy services, and home health aide services. The acquisition is expected to close by the end of the second quarter of 2022 and is subject to customary closing conditions. Upon closing, Integra will join Anthem’s Government Business Division. Financial terms of the transaction were not disclosed. Anthem’s legal advisors are White & Case, Hinman Straub, and Lewis Rice. Ruskin Moscou Faltischek, Greenberg Taurig, and ESOP Law Group are acting as legal advisors for Integra. Stifel acted as the exclusive financial advisor to Integra in this transaction.

About Anthem, Inc.

Anthem is a leading health benefits company dedicated to improving lives and communities, and making healthcare simpler. Through its affiliated companies, Anthem serves more than 117 million people, including more than 45 million within its family of health plans. We aim to be the most innovative, valuable and inclusive partner. For more information, please visit www.antheminc.com or follow @AnthemInc on Twitter.

About Integra Managed Care

Integra Managed Care is a New York State Managed Long Term Care Plan designed for adults living with long-term disabilities. Integra’s goal is to help members live safely and independently in the comfort of their own home with a dedicated team of nurses and social workers who will ensure the care and services that will help individuals live as independently as possible.

 
 

Clipped from: https://finance.yahoo.com/news/anthem-inc-acquire-integra-managed-130000105.html

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Centene Will Address Serious Mental Healthcare in AZ Medicaid

[ MM Curator Summary] Centene has won a new BH contract in AZ.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

The payer’s contract to address serious mental healthcare needs in Arizona will last three years, with the opportunity to extend the contract.

By Kelsey Waddill

November 16, 2021 – Centene Corporation (Centene) will be expanding its Medicaid coverage in Arizona to provide serious mental healthcare services in a competitive contract expansion, the payer announced.

“We are honored to continue our long-standing partnership with the state of Arizona to provide access to comprehensive, quality healthcare to members living with serious mental illness and other complex situations and crisis,” said Brent Layton, president and chief operating officer of Centene. 

“Centene has a long history of coordinating integrated physical and behavioral healthcare in Arizona, and we look forward to continuing to work with local providers and community partners to help Arizonans live better, healthier lives.”

The plan’s subsidiaries, Arizona Complete Health-Complete Care Plan and Care1st Health Plan Arizona, will offer physical and behavioral healthcare services to individuals with serious mental health conditions. 

Specifically, the payer will provide services for individuals eligible for Title XIX and Title XXI services. These groups of beneficiaries may all under Medicaid or Children’s Health Insurance Program (CHIP) coverage. Centene’s plans will also address crisis system functions and court-ordered evaluations in addition to services that run on grant funding.

The payer will cover around 22,000 beneficiaries in 12 countiesseven counties in southern Arizona and five counties in the northern area of the stateas well as other regions that require crisis support.

The contract will last three years starting October 1, 2022. Arizona’s Medicaid program will have the option to renew the contract as a two-year contract twice.

“It is a privilege to have been selected to continue serving Arizonans living in crisis or with severe mental illness,” said Martha Smith, president and chief executive officer of Centene’s Arizona plan. 

“Our mission is to transform the health of our communities, one person at a time, which we believe requires a holistic approach to care that addresses mind, body, and social determinants of health, such as nutrition, housing, and employment. The result is improved health outcomes, lower costs, and a higher quality of life.”

The announcement comes shortly after Centene released a report on improving mental healthcare for children.

“Payers are uniquely positioned to play a critical role in advancing mental healthcare delivery through continued support of innovative technology, evidence-based clinical programs, educational programming, and community partnerships,” Centene’s report explained.

Centene is acquiring Magellan Health, a behavioral healthcare platform, in an effort to diversify and integrate its behavioral healthcare capabilities. The payer announced its plans to acquire Magellan Health in January 2021.

In Magellan Health’s 2021 second-quarter financial report, the behavioral healthcare company projected that the acquisition would finalize in the second half of 2021.

Integrating physical and mental or behavioral healthcare services is a key part of Centene’s behavioral healthcare strategy. 

Brett Hart, chief operating officer of medical strategy and former chief behavioral health officer at Centene, told
HealthPayerIntelligence that for the past three to four decades behavioral healthcare has been isolated from physical healthcare services. 

Thus, when instituting new efforts to bridge the gap between mental or behavioral healthcare and physical healthcare whether in the private payer setting or for a public payer such as Arizona’s Medicaid program, Hart noted that payers must address both historic barriers to integration as well as the new challenges that they face with new technologies and frameworks.

These efforts to integrate care are critical for Medicaid programs because Medicaid has proven instrumental in enabling access to substance abuse care and behavioral and mental healthcare treatment.

 
 

Clipped from: https://healthpayerintelligence.com/news/centene-will-address-serious-mental-healthcare-in-az-medicaid
 

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With big federal boost, Virginia shows Medicaid surplus this year, helping offset future costs

[ MM Curator Summary] Virginia predicts a Medicaid funding surplus next year, followed by a big jump to create nearly $1B more in Medicaid spending in the state within 2 years.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Governor Northam talks about the state’s budget reserves

Virginia is showing a surplus of almost $654 million in its Medicaid program, boosted by federal spending that will help offset future cost increases in the next state budget for the $18 billion program for poor, elderly or disabled Virginians.

Medicaid costs will go up by a net $821 million in the two-year budget for July 1, 2022, to June 30, 2024, which Gov. Ralph Northam will introduce on Dec. 16, but state officials also foresee a $124 million windfall if the federal government raises its share of the program expenses by almost 1% next year as tentatively proposed.

Program costs are projected to grow 1% in the first year and 5% in the second, administration officials said Wednesday.

“The numbers have come in lower than they have historically,” Secretary of Finance Joe Flores said in a briefing with leadership of the Department of Medical Assistance Services, the state Medicaid agency.

At the same time, Virginia will begin sorting out the effects of the COVID-19 pandemic, which added 392,000 people to the Medicaid rolls, some temporarily, as well as refugees from the Taliban takeover of Afghanistan who have settled in the state and qualify for health care assistance. Medicaid now serves more than 1.9 million Virginians in a state of 8.6 million.

The federal government has boosted emergency support of the program during the pandemic, extending a temporary 6.2% increase in its share of funding through March 31. The enhanced aid will reduce Virginia’s share by almost $146 million in the fiscal year that began July 1 and save the state more than $1 billion since the public health emergency began in March 2020.

 
 

Clipped from: https://richmond.com/news/state-and-regional/govt-and-politics/with-big-federal-boost-virginia-shows-medicaid-surplus-this-year-helping-offset-future-costs/article_4f2d1ca3-2c17-5c67-a0a1-86223fbea569.html