Category: MM Curator

Clipped from: https://www.glassdoor.com/job-listing/process-improvement-representative-medicaid-humana-JV_IC1154429_KO0,43_KE44,50.htm?jl=1008485047222&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

The Process Improvement Representative 2 analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

The Process Improvement Representative 2:

• Researches best business practices within and outside the organization to establish benchmark data
  
• Collects and analyzes process data to initiate, develop and recommend business practices and procedures that focus on enhanced safety, increased productivity and reduced cost
  
• Determines how new information technologies can support re-engineering business processes
  
• May specialize in one or more of the following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements
  
• Decisions are typically focus on interpretation of area/department policy and methods for completing assignments
  
• Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction
  
• Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
  

Required Qualifications

• Minimum of an Associate’s Degree
  
• 2 years of technical experience
  
• Experience with Excel (pivot tables, graphs, charts)
  
• Tableau or QlikView or PowerBI or SQL experience
  
• Health Plan Experience (preferably in Medicaid line of business)
  
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  
• Experience with job aid development, user training guides, Visio process flow development
  
• Must ensure designated work area is free from distractions during work hours and virtual meetings
  
• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
  

Preferred Qualifications

• Experience with Root Cause Analysis with large data sets
  

Additional Information

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates – ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
  
• Satellite, cellular and microwave connection can be used only if approved by leadership
  
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
  
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
  
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Clipped from: https://www.disabledperson.com/jobs/51250294-medicaid-rfp-development-director?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description

Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

Medicaid RFP Development Director is responsible for developing a comprehensive functional area market capture plans, built on deep market knowledge, trends and intelligence resulting competitive solutions and best-practices that meet state-specific needs and goals.
Primary duties may include, but are not limited to:
•Drives and facilitates the development and delivery of market-specific solutions, capabilities, partnerships, and innovations that strengthen competitive advantage and readiness for a health plans upcoming procurement.
•Builds, promotes, and secures agreement on the bid strategy; monitors, evaluates, and escalates the delivery of the strategy or given risks for the capture plan for the functional area.
•Accountable for translating the capture strategy to the proposal team to ensure its accurately represented and compelling to proposal evaluators; this includes providing significant input on assigned proposal sections, response messaging, content, and solutions throughout executive team reviews.
Qualifications:
•Requires a BA/BS degree in business, public health, nursing, medicine, health care delivery, or a related field and a minimum of 7 years work related experience in Medicaid business and a minimum of 5 years of experience leading cross functional teams; or any combination of education and experience, which would provide an equivalent background.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.



Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.


We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?


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.


The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.


Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

Clipped from: https://www.linkedin.com/jobs/view/medicaid-certification-consultant-at-public-consulting-group-3434195048/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Overview

 
 

About Public Consulting Group

 
 

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, technology, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG employs approximately 2,000 professionals worldwide—all committed to delivering solutions that change lives for the better. The firm has extensive experience in all 50 states, Canada, and a growing practice in Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com.

 
 

Responsibilities

 
 

The Medicaid marketplace is changing, and PCG is at the forefront. We are looking for an experienced Medicaid Consultant to join our team and help lead our growth efforts. Deep Medicaid experience is critical, as well as experience working with the Centers for Medicare and Medicaid Services (CMS) and the new streamlined modular certification (SMC) and outcomes-based certification (OBC). Our ideal Medicaid Consultant will provide oversight and direction for scope, schedule, , quality, , communications, risk, and , stakeholder management activities, all while adding deep Medicaid and Medicaid Enterprise Systems (MES) experience and thought leadership

 
 

Specific Responsibilities

 
 

• Demonstrated understanding and knowledge of Medicaid, CMS, SMC/OBC, and MES
  
• Conduct Medicaid System Assessments
  
• Help states plan for and execute SMC/OBC activities
  
• Help lead and provide expert level guidance on various projects
  
• Ensure planned results are achieved on time
  
• Work with clients, vendors, team members to establish and achieve project goals
  
• Address problems through risk management and contingency planning
  
• Plan, organize, execute, and monitor and control project activities
  
• Perform project assessments and report on project progress
  
• Facilitate meetings and present project information
  
• Identify, document, and/or escalate issues to appropriate levels
  

 
 

Qualifications

 
 

Required Skills/Experience:

 
 

• Bachelor’s degree or equivalent university degree
  
• 5+ years experience performing project oversight and assessments for a large enterprise grade information technology initiative
  
• 4+ years experience performing performance metrics measurements and reporting to management and executive level staff.
  
• Demonstrated experience working with SMC/OBC
  
• Demonstrated written and verbal communications skills
  
• Ability to influence internal and external stakeholders
  
• Ability to lead/manage others in a matrixed environment
  
• Proficiency in Microsoft applications (Outlook, Word, Excel, PowerPoint, Visio, Project) and project management tools
  

 
 

#D-PCG

 
 

Compensation

 
 

Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, PCG provides the following reasonable range of compensation for this role: $110,000-$130,000

 
 

EEO Statement

 
 

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

 
 

Clipped from: https://www.learn4good.com/jobs/nashville/tennessee/info_technology/2106712849/e/

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance.

We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As an Experienced Business Analyst
– Medicaid at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve – a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Your role in our mission

Take charge and focus on how we can meet critical needs to help clients deliver better health and human services outcomes.

* Coordinate work streams and teams on IT projects to align solutions with client business priorities

* Demonstrate your knowledge as SME and liaison for clients and internally between technical and non-technical workers to transform requirements into real results

* Delegate work across teams, and coach and monitor project team members to plan, design and improve complex business processes and modifications

* Streamline workflows across clients and technical personnel to determine, document and oversee carrying out system requirements

* Support quality control as you approve and validate test results to verify that all requirements have been met

What we’re looking for

* Nine or more years of experience working as a business analyst or ‘requirements translator’ between technical and non-technical personnel, with 3 or more years of Medicaid and Medicare experience preferred

* Knowledge of Microsoft Excel advanced features such as macros and/or relational database software

* Ability to clearly and concisely translate technical requirements to a non-technical audience

* Skills working with business processes and re-engineering

* Curiosity to solve complex problems and strong interpersonal skills to interact with and influence clients and team members

* A caring team leader who motivates and coaches less experienced resources

What you should expect in this role

* Opportunities to travel through your work (0-10%)

* Onsite, remote or Hybrid options may be available from US locations

#LI-HC1

#LI
– Medicaid

The pay range for this position is $86,800.00 – $124,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work ‘ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance.

We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

Clipped from: https://www.linkedin.com/jobs/view/nurse-at-centers-for-medicare-medicaid-services-3483343123/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

The most rewarding thing about being a nurse is making a difference in the lives of others. At CMS, nurses help protect our most vulnerable populations on a national scale and have the opportunity to make a positive impact in America’s health care system by advancing health equity, expanding coverage, and improving health outcomes.

 
 

As a nurse at CMS, you’ll provide your expertise and clinical experience across the agency. You’ll work closely with health policy experts to carry out job responsibilities such as:

 
 

• Conducting onsite surveys to evaluate the performance and effectiveness of health care providers.
  
• Provide clinical nursing perspective in the assessment of policies, projects, and data related to the measurement of quality, legislative and administrative proposals, and make recommendations to agency managers.
  
• Deliver clinical practice advice as part of CMS program policy or support teams responsible for interpreting applicable laws, regulations and policies regarding highly complex issues in CMS administered programs
  
• Provide expertise on the areas of clinical quality improvement programs; utilization management and clinical standards impacting health service delivery.
  

 
 

Salary:

 
 

$84,546 – $109,908 per year. This is the BASE salary. Final pay will be determined by experience and location.

 
 

***Multiple positions available throughout the U.S.***

 
 

**Important Note: Transcripts and Proof of Current Nursing License required at the time of application. You may visit www.nursys.com to download a copy of your current, active license and attach to your application package. Proof should include your name, license number, and expiration date showing license is current and active.***

 
 

Come see why over 6,000 employees say CMS is their employer of choice! In addition to dynamic and exciting opportunities, CMS offers generous compensation and benefits programs, an outstanding work-life balance, and most important, the opportunity to give back to your community, state and country by making a difference in the lives of Americans everywhere.

Clipped from: https://www.learn4good.com/jobs/online_remote/business/2110582147/e/

Job Description

Aetna Better Health Medicaid plans have a proven record as trusted managed care organization partners for 30 years, currently serving approximately 2.8 million members in 16 states. Aetna Inc.’s acquisition by CVS Health (a Fortune 4 company and the nation’s largest retail pharmacy) in 2018 resulted in the creation of a company characterized by innovation with a strong community-based footprint, market reach, financial resources, and name recognition to expand delivery of Medicaid managed care services.

Aetna Inc.’s health insurance plans and services include medical, pharmacy, and dental plans;
Medicare plans;
Medicaid services;
Duals programs; behavioral health programs; and programs tailored for foster youth, individuals with serious emotional disturbance, and the justice-involved. We are seeking to hire a Head of the Medicaid Proposal Development team will lead all activities related to the management of RFP responses. These responsibilities include designing and leading an innovative and efficient Proposal Development team that collaborates with subject matter experts across the organization to produce and submit innovative and winning Medicaid proposals.

This is a fantastic opportunity to be a part of growth focused Medicaid division passionate about healthcare innovation and integration between CVS and Aetna. Full accountability for directing the development, production, and submission of large, highly complex responses to state Medicaid Requests for Proposals (RFP) where revenue and membership growth is generated by winning and retaining strategic contracts through the competitive RFP process.

Works collaboratively with State CEOs, Medical Management, Legal, Compliance, Operations, Actuary, Network, Finance and Implementation to ensure strategic procurement solutions meet Aetna Medicaid’s model of care, are cost-effective, and compliant. Directs end-to-end continuum of the procurement process, following professionally recognized business processes, to determine gaps, develop solutions, draft the proposal, and obtain executive approval. Works with Finance and Actuary to submit competitive rates, produce final proposals, and conduct a thorough quality review to ensure submitted proposals are completed with all necessary information required in order to not be disqualified.

Establishes and manages relationships with Senior leaders across the enterprise and with outside consultants.

The Role ED, Head of the Medicaid Proposal Development Builds an effective proposal team and process through transformational leadership skills and compelling leadership capabilities. Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions, including employment, termination, performance reviews, salary reviews, and disciplinary actions. Performs other duties as required.

REMOTE – working East Coast hours

Pay Range The typical pay range for this role is:

Minimum: 131,500

Maximum: 289,300

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications Strong knowledge of Medicaid and the public procurement process Experience managing a proposal (RFP) team will be highly valued but not required Possess a strategic mindset with an understanding of what it takes to win and the ability to develop and execute a plan Strong operational mind, compliance management, strong project management skills

Ability to lead a team to support strategy development, competitive positioning, and differentiation within proposals to drive winning business Excellent writing and communication skills Strong problem solving, management skills, leadership skills Knowledge best practice of RFP database and process will be valued Familiarity with industry standards and nomenclature for proposal management such as Shipley or other similar training will be valued

Ability to respond to rapidly changing direction and priorities across multiple projects while overseeing team efforts Align with the Heart at Work Behaviors of CVS Health – Put people first;
Join forces;
Inspire Trust;
Rise to the Challenge;
Create Preferred

Qualifications Advanced Degree

Education Bachelor’s Degree Business Overview Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose:
Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand – with heart at its center – our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose.

We want everyone who works at CVS Health to feel em the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care…

Clipped from: https://www.goinhouse.com/jobs/198532969-assistant-attorney-general-medicaid-fraud-and-patient-abuse-division-at-state-of-utah?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Assistant Attorney General – Medicaid Fraud and Patient Abuse Division

 
 

The Office of the Utah Attorney General, Medicaid Fraud and Patient Abuse Division (also known as the Medicaid Fraud Control Unit), is seeking an attorney to prosecute and litigate cases involving fraud committed against the Medicaid program, and the abuse, neglect, or financial exploitation of vulnerable individuals. The position offers a unique opportunity to collaborate with attorneys, investigators, auditors, and nurses throughout the investigative and litigation processes. The focus of this position is criminal prosecution, but candidates will also have the opportunity to work on civil cases. This division works closely with State, local and federal partners to carry out its mission. Cases range from single provider home health fraud, abuse and neglect of vulnerable individuals, individual and corporate fraudulent activity, to national whistleblower actions.

 
 

The successful candidate should have significant litigation experience, excellent written and oral advocacy skills, outstanding legal acumen, a willingness to research diverse areas of law, effective communication abilities, and excellent interpersonal skills. Assistant Attorneys General have the opportunity to collaborate with the National Association of Medicaid Fraud Control Units through working on national cases, attending specialized training, and collaborating on complex cases.

 
 

Background checks are completed as a condition of employment. Salary is commensurate with experience in conjunction with the Attorney General’s Office career service matrix.

 
 

The responsibilities of this position include, but are not limited to, the following:

 
 

• Support investigations and prosecute fraud committed against Utahs Medicaid program and abuse, neglect, and financial exploitation committed against vulnerable individuals.
  
• Conduct legal research and analysis, gather evidence, and facilitate appropriate case outcomes.
  
• Determine discovery needs, and/or complete discovery; participate in decision making and strategy sessions in preparing cases for court and determining evidence to be utilized.
  
• Conduct conferences with defendants and/or attorneys, negotiate settlements, and attend court appearances throughout the State.
  
• Collaborate with and present information to sister agencies, providers, associations, and key stakeholders regarding Medicaid fraud and the abuse, neglect, and exploitation of vulnerable individuals and Medicaid recipients.
  

Example of knowledge, skills, and abilities which may be required upon entry into position or trainable after entry:


Knowledge
 

• Applicable laws, rules, regulations, and/or policies and procedures
  
• Compliance with laws governing access to public and private records (Government Records Access and Management Act)
  
• Knowledge of rules of evidence and civil and/or criminal procedure
  
• Principles, theories, and practices of judicial or administrative law
  

Skills/Abilities
 

• Read, interpret, and apply laws, rules, regulations, policies, and/or procedures
  
• Listen to, and understand, information and ideas as presented verbally
  
• Understand and apply case and statutory law
  
• Evaluate information against a set of standards
  
• Use logic to analyze or identify underlying principles, reasons, or facts associated with information or data to draw conclusions
  
• Research and understand laws, legal codes, precedents, government regulations, executive orders, the democratic political process, and legislative history
  
• Perform legal research using case law and appropriate techniques
  
• Make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions
  
• Deal with people in a manner which shows sensitivity, tact, and professionalism
  
• Provide consultation and/or expert advice
  
• Interpret and apply legal decisions and identify current and emerging trends in interpretation
  
• Understand how to research key information related to cases
  
• Excellent written and oral advocacy skills
  

 
 

• A Juris Doctorate is required.
  
• Risks found in the typical office setting, which is adequately lighted, heated, and ventilated; e.g., safe use of office equipment, avoiding trips and falls, observing fire regulations, etc.
  
• Typically, the employee may sit comfortably to perform the work. However, there may be some walking, standing, bending, carrying light items, driving an automobile, etc. Special physical demands are not required to perform the work.
  
• A conditional offer of employment will be made pending a satisfactory completion of a background investigation.
  
• Active membership in the Utah State Bar.
  
• Must be able to travel as required.
  
• Valid driver’s license required to drive a motor vehicle on a highway in this state per UCA 53-3-202(1)(a).