Clipped from: https://www.linkedin.com/jobs/view/test-engineer-healthcare-medicaid-testing-at-gainwell-technologies-3455166540/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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


Your role in our mission


Essential Job Functions

• Performs testing, troubleshooting and analysis tasks on various phase(s) of network systems development including integration, systems testing, interoperability testing, field test plans and customer acceptance plans to maintain the credibility/viability of the system.
  
• Provides support for monitoring the initial configuration and parameters of equipment for system credibility. Assists in the investigation and resolution of matters of significance in conjunction with other engineering and technical support to ensure cost effective and efficient resolution of problems.
  
• Designs, develops, implements and maintains test processes and diagnostic programs for assigned projects. Works closely with team lead towards the completion of specifications and procedures for new products.
  
• Participates in writing test plans for assigned projects. Maintains record of test progress, documents test results, prepares reports and may present results as appropriate.
  
• Defines test cases and creates integration and system test scripts and configuration test questionnaires from functional requirement documents. Maintains defect reports and updates reports following regression testing efforts.
  
• Adheres to and advocates use of established quality methodology and escalates issues as appropriate.
  
• May work with clients to determine systems requirements. Assists lead engineer/management in writing proposals to recommend process/program and follows through on implementation.
  
   
  

Basic Qualifications

• Bachelor’s degree or equivalent combination of education and experience
  
• Bachelor’s degree in computer science or engineering or related field preferred
  
• Three or more years of network testing experience
  
• Experience working with computer systems and their uses
  
• Experience working with telecommunications systems and their corresponding principles
  
• Experience working with network management and protocol system testing
  
• Experience working with scripting languages such as TCL, PERL, HP, etc
  
• Experience working with data transmission protocols such as TCP/IP, etc.
  
• Experience working with operating systems
  
• Experience working with protocols and technologies such as HTTP, SSL, FTP, SMTP, POP3, etc
  
• Experience working with network equipment: switches, routers, firewalls, intrusion detection systems, etc.
  
   
  

Other Qualifications

• Good analytical and problem solving skills
  
• Good organization and time management skills
  
• Interpersonal skills to interact with customers and team members
  
• Communication skills
  
• Ability to work independently and as part of a team
  
• Willingness to travel
  
  
   
  

Work Environment

• Office environment
  
• May require shift or weekend work
  
  
   
  

What we’re looking for


What you should expect in this role


Competency1


Competency2


Competency3


Competency4


Competency5


The pay range for this position is [[$63,130]] – [[$78,957]] 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 at Gainwell. You’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.indeed.com/viewjob?jk=45f0de9a09b28376&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Benefits

Pulled from the full job description

Health insurance

Loan forgiveness

Comagine Health is looking for a remote Clinical Reviewer RN to support Alaska Medicaid and private contracts. In this role, you will work with a variety of patient populations across the organization, providing utilization management and care planning as needed. You will perform utilization management using evidence-based clinical criteria and guidelines to determine the safest and most appropriate medical services for patient populations. While working remotely, you will need to picture yourself at the hospital or bedside to successfully perform this work. You’ll be a part of a remote team working across the country that prides themselves on their collaboration and communication. If this sounds like a role you’d be interested in, we encourage you to read on and apply!

 
 

Who is the Comagine Health?

Comagine Health is a non-profit consulting firm that seeks to improve health and to increase the effectiveness and quality of health care. As a recognized Quality Improvement Organization (QIO), we support providers, plans, purchasers, and consumers, and offer services to state and federal agencies and others to help them better manage health care under the existing system and to assess, plan for and implement broader system transformation. We collaborate with academic, government, and nonprofit partners on initiatives funded by NIH, CDC, AHRQ, BJA, SAMHSA, and others. In short, we are changing healthcare at a fundamental level.

 
 

What you’ll be doing for us:

• Participate in a multi-disciplinary team to improve the quality of healthcare for individuals and populations.
  
• Apply nationally-recognized clinical criteria and guidelines to determine the medical necessity of inpatient admissions, outpatient procedures, and other healthcare services.
  
• Consult with physicians or refer cases to others, when indicated.
  

 
 

Required Competencies:

• Professional curiosity and lifelong learner mindset-we cover many contracts with this team and there is always something new!
  
• Excellent written communication.
  
• Ability to document critical thinking and develop questions for providers regarding decision-making and plan of care.
  

 
 

Required Qualifications:

• A degree or diploma in Nursing.
  
• Current, active, unrestricted RN licensure in good standing.
  
• 3+ years of clinical (direct patient care) work experience that includes critical care, ED, and/or intensive care.
  

 
 

Desired Qualifications:

• 1+ years of utilization review (or other medical management experience) preferred.
  

 
 

Salary Range: $69,000 – $95,000

The salary range posted reflects the range that Comagine is willing to pay for this position. Salary is determined by many factors, including but not limited to geographic location of where the employee will perform their job duties in addition to their knowledge, skills, education, and relevant work experience.

 
 

We offer competitive pay and benefits. Additionally, employment with Comagine Health qualifies if you apply for the Public Service Loan Forgiveness (PSLF) Program!

 
 

Comagine Health’s mission is to work together with our partners to improve health and create a better health care system so that people and communities will flourish. As part of our mission and values, we recognize the importance of having our employees vaccinated against COVID-19- both as a protection for our larger community and to keep our employees and their families safe.

 
 

As a federal contractor, and in compliance with Executive Order 14042, Comagine Health requires its employees and contractors to be fully vaccinated against COVID-19 (including any booster shots if required), unless they are approved for a reasonable accommodation based on medical condition or religious belief that prevents them from being vaccinated. Being fully vaccinated against COVID-19 is a condition of employment at Comagine Health.

• If you are fully vaccinated, you will be required to provide proof of your completed COVID-19 vaccination prior to the first day of your employment. Failure to provide timely proof of your COVID-19 vaccination status may result in your offer of employment being rescinded or your start being delayed.
  
• If you are unable to be fully vaccinated due to medical condition or religious belief, you will be required to request an exemption upon acceptance of the offer of employment. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an exemption is not approved, then your offer of employment may be rescinded.
  

Required Skills

Required Experience

Clipped from: https://www.glassdoor.com/job-listing/senior-business-analyst-medicaid-gainwell-technologies-JV_KO0,32_KE33,54.htm?jl=1008445206818&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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 a Senior 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 workstreams 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

• 5+ 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

• Fully remote, only US location options will be considered
  
• Client is in Central time zone
  
• #LI-HC1
  

The pay range for this position is $63,100.00 – $90,200.00 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 at Gainwell. You’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.azstatejobs.gov/jobs/special-projects-advisor-housing-phoenix-arizona-united-states?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

AHCCCS

Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.

AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

The Division of Health Care Management

Special Projects Advisor – Housing

Job Location:

Address: 801 East Jefferson Street. Phoenix, Arizona 85034 

Posting Details:

Open Until Filled

Salary: $68,000 – $77,000

Grade: 23  

Job Summary:

The Division of Health Care Management is seeking a Special Projects Advisor. Under the direction of the Integrated Care Administrator, this position will serve as the primary contact and operational/programmatic subject matter expert for housing and homelessness related supportive services for Transition Aged Youth (TAY) aged 16-26 who are homeless or at risk of homelessness, including runaway minors, abandoned youth or youth who were expelled from their homes, youth who have aged out of child foster care or who been released from juvenile detention facilities. This position will oversee the managed care organizations service delivery and monitoring of the community based Coordinated Entry process and Homeless Management Information System (HMIS), to ensure members are connected to supportive service providers. This position will participate in community-wide efforts to address homelessness and related factors for the TAY population, facilitate regular meetings with MCOs and community stakeholders, and oversee operational and programmatic compliance for related deliverables. This position will also be responsible for participating in case conferencing with internal and external partners and providing support and technical assistance to MCOs in implementing initiatives related to H2O supportive services.

Knowledge, Skills & Abilities (KSAs):

Knowledge of:
* Clinical expertise in the delivery of behavioral health services and programs, including but not limited to; evidence based practice for permanent supportive housing, homelessness, Child and Family Team Practice, First Episode Psychosis, human trafficking, Substance Use Disorder, etc.
* Arizona Public Behavioral Health system, including AHCCCS/Administrative policies and procedures
* Principles and practices of program planning; assessment skills; Person Centered Planning and mechanisms of managed (prepaid) health care systems; preventative health practices; organization of health care systems and current trends that affect the systems; and research methodology and process
* Medicaid regulations
* Health care delivery systems, complex populations and unique applications in rural as well as urban areas.
* The roles and responsibilities of state agencies that serve AHCCCS members.
* The basic principles and practices of medical management/case management
* In depth knowledge of problem solving and technical writing
* Clinical knowledge of conducting case reviews/member case staffing
Ability to:
* Interpreting existing and new rules, laws and agency policy pertaining to the delivery of behavioral health services
* Monitoring policies and procedures that result in integrated behavioral health services with physical health care services, and/or enhance existing processes to achieve better outcomes
* Organizational skills that result in prioritization of multiple tasks
* Providing effective guidance and technical assistance regarding health care issues and the administration of AHCCCS behavioral health and integrated care programs.
Ability to:
* Produce effective written communication
* Multi-task in a fast-paced environment
* Produce work products with limited supervision
* Understand and communicate data/health analytics
* Improve processes/systems
* Collaboratively develop and implement new concepts
* Analyze barriers or problems and make recommendations for improvements
* Analytically review and evaluate program activities
* Establish and maintain effective working relationships, especially in a changing health care environment
* Communicate effectively with all levels of health care professionals and community partners/stakeholders

Qualifications:

Minimum:
Five years clinical and/or programmatic experience in behavioral health service delivery systems including experience in a
public managed care environment;

Preferred:
A licensed clinical social worker (LCSW); a Registered Nurse or Nurse Practitioner with Psychiatric-Mental Health specialty
or a Master’s or higher degree in a behavioral health or health related field

Pre-Employment Requirements:

• Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
• Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
• Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.

Benefits:

Among the many benefits of a career with the State of Arizona, there are:
• 10 paid holidays per year
• Paid Vacation and Sick time off (13 and 12 days per year respectively) – start earning it your 1st day (prorated for part-time employees)
• A top-ranked retirement program with lifetime pension benefits
• A robust and affordable insurance plan, including medical, dental, life, and disability insurance
• Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
• RideShare and Public Transit Subsidy
• A variety of learning and career development opportunities
• Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office)

By providing the option of a full-time or part-time virtual/remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement:

Lifetime Pension Benefit Program
• Administered through the Arizona State Retirement System (ASRS)
• Defined benefit plan that provides for life-long income upon retirement.
• Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
• Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program

• Voluntary participation.
• Program administered through Nationwide.
• Tax-deferred retirement investments through payroll deductions.

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

Clipped from: https://careers.lilly.com/us/en/job/R-43009/Associate-Director-Contract-Administration-Medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

At Lilly, we unite caring with discovery to make life better for people around the world. We are a global healthcare leader headquartered in Indianapolis, Indiana. Our 35,000 employees around the world work to discover and bring life-changing medicines to those who need them, improve the understanding and management of disease, and give back to our communities through philanthropy and volunteerism. We give our best effort to our work, and we put people first. We’re looking for people who are determined to make life better for people around the world.

Overview

The overarching goal of this position is to ensure quality, speed, and consistency in the delivery and execution of Lilly USA, LLC’s contractual obligations by uncovering insights and driving business results. A varied set of capabilities, including technology-first forward thinking, operational excellence, and disciplined execution, will help Contract Management & Analytics (CMA) drive innovation and growth to lead within the dynamic nature of customers and technology.

The Contract Administration (CA) Associate Director role aids in minimizing the financial and legal risks associated with sales reductions by ensuring all contract payments are appropriately administered, analyzed, documented, controlled, and reported on a consistent and timely basis. Responsibilities include, but are not limited to, oversight of day-to-day payment operations, supervision of area teams and prioritization of their activities, implementation of performance management, and coordination of Lilly Value and Access systems priorities/issues. This position serves on the staff of the CMA Associate Vice President. This position will also be involved in internal and external audits.

Primary Responsibilities

The Contract Administration (CA) Associate Director acts as the controller for Lilly Value and Access contract administration activities, balancing valid customer needs and obligations with appropriate financial controls with the Medicaid and Co-Pay segments. The CA Associate Director is responsible for ensuring operational efficiencies and consistency across customer segments, as well as payment system ownership. The CA Associate Director will clearly define expectations and instill a sense of ownership, responsibility, and accountability within the team. The Associate Director will also lead CA’s newly created Center of Excellence (CoE) which will drive special projects to conclusion utilizing SME’s across CA and IDS.

Key Objectives

• Staff Development/Supervision – Lead, coach, and develop a team of direct reports. Responsibilities include a) developing a high performing team that effectively responds to an evolving business environment and exceeds business needs; b) driving industry leading service and operations through exceptional leadership; c) fostering an inclusive environment which builds trust, coaches, develops, and empowers team members; d) ensuring all training is complete; e) executing Performance Management.
  
• Implementation of CMA Leadership Initiatives – as a member of the CMA Leadership Team, has shared responsibility for attaining alignment across functional boundaries and achieving CMA business goals and strategic objectives.
  
• Contract Administration Operations – responsible for establishing processes to validate both contract proposals and payments, ensuring that Lilly is not exposed to unnecessary risk. As necessary, provide input on new contracting possibilities, patient affordability programs, and help resolve escalated payment disputes.
  
• Authorization of Customer Payments/Contractual Commitments – responsible for accurate, timely, and compliant rebate payments across Medicaid and CoPay segments. Optimize payment and administration business practices as well as monitor compliance with established metrics. Evaluate and address potential impact to internal operations resulting from updates to the Medicaid Drug Rebate Program (MDRP) and Lilly’s patient affordability programs.
  
• CoE Lead & Special Projects – Facilitate the analysis and implementation of various special projects. Establish processes for prioritization, communication, and escalation between CA and Information & Digital Solutions (IDS). Other potential projects may include revenue leakage activities, participation in industry trade group initiatives, implementation of governmental regulations, organizational efficiency improvements, etc.
  

Basic Qualifications

• Bachelor’s Degree with a concentration in Accounting, Finance, Economics, Information Technology, Marketing, or relevant field of study that includes quantitative analysis
  
• 5+ years of relevant contracting, accounting, finance or similar experience
  
• Qualified candidates must be legally authorized to be employed in the United States. Lilly does not anticipate providing sponsorship for employment visa status (e.g., H-1B or TN status) for this employment position.
  

Additional Skills/Preferences

• High learning agility
  
• Demonstrated business acumen and analytical skills
  
• Strong communication, interpersonal, and leadership skills
  
• Ability to engage and motivate team members with a focus on inclusion
  
• Demonstrated ability to translate organizational goals into specific actions
  
• Demonstrated ability to deliver projects/tasks on-time and within budget
  
• Controllership experience
  
• Negotiation/Conflict resolution
  
• Previous direct and/or indirect supervisory experience
  
• Knowledge of Model N or Flex Medicaid revenue system (or other comparable system)
  
• Experience leveraging technology in business operations
  
• Internal or external audit experience
  
• Financial and/or IT Certification (e.g., CPA, CMA, CIA, CISA)
  
• Previous experience with customers in pharmacy distribution channel or payer environment (Wholesalers, PBMs, Payer Customers, Pharmacies, CoPay Vendors)
  
• Experience with and understanding of Sarbanes-Oxley requirements
  

Location: LTC-South

Travel Percentage: 0-10%

Additional Information

Lilly is an EEO/Affirmative Action Employer and does not discriminate on the basis of age, race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, protected veteran status, disability or any other legally protected status.

Qualified candidates must be legally authorized to be employed in the United States. Lilly does not anticipate providing sponsorship for employment visa status (e.g., H-1B or TN status) for this employment position.

Eli Lilly and Company, Lilly USA, LLC and our wholly owned subsidiaries (collectively “Lilly”) are committed to help individuals with disabilities to participate in the workforce and ensure equal opportunity to compete for jobs. If you require an accommodation to submit a resume for positions at Lilly, please email Lilly Human Resources ( Lilly_Recruiting_Compliance@lists.lilly.com ) for further assistance. Please note This email address is intended for use only to request an accommodation as part of the application process. Any other correspondence will not receive a response.

Lilly is an EEO/Affirmative Action Employer and does not discriminate on the basis of age, race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, protected veteran status, disability or any other legally protected status.

Our employee resource groups (ERGs) offer strong support networks for their members and help our company develop talented individuals for future leadership roles. Our current groups include: Africa, Middle East, Central Asia Network, African American Network, Chinese Culture Network, Early Career Professionals, Japanese International Leadership Network (JILN), Lilly India Network, Organization of Latinos at Lilly, PRIDE (LGBTQ + Allies), Veterans Leadership Network, Women’s Network, Working and Living with Disabilities. Learn more about all of our groups.

As a condition of employment with Eli Lilly and Company and its subsidiaries in the United States and Puerto Rico, you must be fully COVID-19 vaccinated and provide proof of vaccination satisfactory to the company (subject to applicable law). 

#WeAreLilly

Clipped from: https://texas.talentify.io/job/oag-civil-medicaid-fraud-assistant-attorney-general-iii-iv-23-0505-job-number-00030387-austin-texas-texas-department-of-public-safety-45877?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

• Job Description
  

 
 

Req#: 45877

Civil Medicaid Fraud (302-056-1) (302TX-056-1)
300 W. 15th St
Austin, 78701

!*!

GENERAL DESCRIPTION

• The Office of the Attorney General is seeking attorneys licensed in Texas to join the agency’s Civil Medicaid Fraud Division to engage in the exciting and fulfilling work of investigating and evaluating whistleblower lawsuits filed under the Texas Medicaid Fraud Prevention Act. The work will include coordinating with state agencies, the federal government, and other state governments and will involve complex legal analysis of state and federal regulatory schemes as they relate to the Texas Medicaid Fraud Prevention Act. The selected candidate will be expected to conduct witness interviews and utilize other methods of discovery, review data and data trends, negotiate potential settlements, monitor ongoing litigation to protect the State’s interests, and draft memoranda and case recommendations for management and Executive Administration. Work also involves limited to moderate motion practice in federal and state courts, drafting of legal briefs and preparations for court hearings. Knowledge of, or interest in, healthcare law is a plus.
  
• The OAG is a dynamic state agency with over 4,000 employees throughout the State of Texas. As the State’s law firm, the OAG provides exemplary legal representation in diverse areas of law. OAG employees enjoy excellent benefits (https://ers.texas.gov/Benefits-at-a-Glance) along with tremendous opportunities to do important work at a large, dynamic state agency making a positive difference in the lives of Texans. Assistant Attorneys General (AAGs) experience the challenge and honor of public service while enjoying a healthy work-life balance; hands-on legal experience; and engaging camaraderie in Austin, the scenic and lively capital of Texas.
  

  ESSENTIAL POSITION FUNCTIONS
  

• Assistant Attorney General (AAG) III:
  
• Initiates and conducts Civil Medicaid Fraud and related law investigations. Analyzes factual and legal issues and develops evidence for pursuit of Civil Medicaid Fraud cases, including performing legal research, conducting interviews, and directing investigator activity. Reviews data and documentation from client agencies and other resources, coordinates with the federal government and other state governments to evaluate and potentially resolve pending whistleblower lawsuits, and reports findings and analysis to management and Executive Administration.
  
• Monitors pending cases in which the State has declined to intervene, preparing legal briefs independently and in coordination with other AAGs where needed to protect the State’s interests.
  
• Prepares pleadings and other legal documents; prepares and negotiates settlement documents. May assist with bill review and legislative inquiries. Represents the Office of the Attorney General before state or federal district courts.
  
• Performs related work as assigned
  
• Maintains relevant knowledge necessary to perform essential job functions
  
• Attends work regularly in compliance with agreed-upon work schedule
  
• Ensures security and confidentiality of sensitive and/or protected information
  
• Complies with all agency policies and procedures, including those pertaining to ethics and integrity
  
• Assistant Attorney General (AAG) IV: All of the above qualifications for AAG III PLUS:
  
• Mentors and shares knowledge and experience with less tenured attorneys
  

  !*!
  

  MINIMUM QUALIFICATIONS
  

• Assistant Attorney General (AAG) III:
  

   
   

• Education: Graduation from an accredited law school
  
• Education: Graduation from an accredited law school
  
• Two years of full-time experience as a licensed attorney
  
• Licensed to practice law in Texas
  
• Member in good standing with the State Bar of Texas
  
• Skill in effective oral and written communication [Writing sample required at time of interview, if selected]
  
• Skill in using a computer for word-processing and data entry/retrieval
  
• Skill in working under pressure and cooperatively with other attorneys, supervisors, investigators and support staff
  
• Skill in handling multiple tasks, prioritizing, and meeting deadlines
  
• Skill in exercising sound judgment and effective decision making
  
• Ability to work in person at assigned OAG work location, perform all assigned tasks at designated OAG workspace within OAG work location, and perform in-person work with coworkers (e.g., collaborating, training, mentoring) for the entirety of every work week (unless on approved leave)
  
• Ability to receive and respond positively to constructive feedback
  
• Ability to provide excellent customer service
  
• Ability to arrange for personal transportation for business-related travel
  
• Ability to work more than 40 hours as needed and in compliance with the FLSA
  
• Ability to lift and relocate 30 lbs.
  
• Ability to travel (including overnight travel) up to 20%
  
• Assistant Attorney General (AAG) IV – All the above qualifications for an AAG III, PLUS:
  

   
   

• One additional year of full-time experience as a licensed attorney
  

  PREFERRED QUALIFICATIONS
  

• Experience: Working on complex civil litigation in both state and federal courts.
  
• Experience: Summation, Concordance, Relativity or Clearwell legal review software.
  
• Experience: Conducting legal analysis involving complex statutory and regulatory schemes at the state and federal levels, including applying legal analysis to fact situations and making recommendations.
  
• Knowledge of law, legal principles, and practices relevant to Civil Medicaid Fraud statutes.
  
• Knowledge of Texas Rules of Civil procedure, Texas Rules of Evidence, Federal Rules of Procedure, and Federal Rules of Evidence.
  

  TO APPLY
  To apply for a job with the OAG, electronic applications can be submitted through either CAPPS Recruit or Work in Texas. A State of Texas application must be completed to be considered, and paper applications are not accepted. Your application for this position may subject you to a criminal background check pursuant to the Texas Government Code. Military Crosswalk information can be accessed at https://hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_Legal.pdf
  
  THE OAG IS AN EQUAL OPPORTUNITY EMPLOYER
  

• About the company
  

 
 

Texas is a state in the South Central region of the United States.

Clipped from: https://www.ziprecruiter.com/c/HealthCare-Partners/Job/Senior-Risk-Adjustment-Analyst-Medicaid/-in-Garden-City,NY?jid=00a24d959e131173&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products.

Our MSO employs 200+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources. HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care.

Interested in joining our successful Garden City Team? We are currently seeking a Senior Risk Adjustment Analyst – Medicaid. Position Summary: The position will support revenue program management activities around data management and submissions to NYSDOH.

Serve as a subject matter expert to management and stakeholders around end-to-end process of data management, data processing, data analysis and submissions. Interface with different business areas on the execution of data submissions, identifying and applying best practices and processes to ensure efficiency and accuracy of end-to-end operation of risk adjustment programs. Identify and recommend both strategic and tactical improvements, and contribute to compliance to all applicable laws, guidance, and regulations.

Develop and sustain a long-term optimal structure and processes around emerging encounter data submission requirements; analyzing, monitoring, and planning key risk adjustment milestones and identifying and recommending opportunities for improvement. Assist in designing an overall suite of analytic capabilities and actionable reports to solve problems, provide data-driven guidance, and monitor risk adjustment performance. Work closely with end-users to gather reporting requirements and analyze internal reporting tools; to ensure proper testing and validation of data elements on the finished product; to participate in the resolution of reporting problems; to build, perform, and maintain reporting analysis and modeling; to provide analytical support on various strategies to ensure organizational goals are met; to propose opportunities in maximizing reimbursement based on the NYSDOH Risk Adjustment model; to propose innovative approaches to create or improve automation and optimize processes data and analytic processes as well as reporting; and to lead cross-functional analytical and operational teams toward the goal of improved risk adjustment scores.

Essential Position Functions/Responsibilities: Data Management & Submissions: Identify, promote and execute program activities around data submission and management to ensure maximum efficiencies, accuracy and completeness. Define strategic and tactical approaches to improve risk adjustment operations across the enterprise to support the underlying workflow of these systems. Oversee the development of requirements, testing and refinement of the underlying data and systems.

Partner with other business units to deliver requirements around necessary updates to underlying data and systems as used by the Risk Adjustment and Coding departments. Recommend, develop, and monitor processes around data collection, submission, and reconciliation to ensure full compliance with all applicable laws, guidance, and regulations. Provide detailed reporting and oversight for data submission activities.

Develop dashboards to report progress with sponsors and escalate issues with key stakeholders. Understand NYSDOH risk score methodology, including risk score calculation, financial risk receivable calculations, APD/OSDS processes and key regulator deadlines for data submission, APD/OSDS Return Files and Error Files, understand eligibility, ICD coding, claims, and provider data. Accurately monitor and reconcile submitted encounters against response files to ensure that submission gaps are addressed in a timely manner.

Interface with Quality, Finance, IT, Provider, Claims, Business Intelligence, and other HCP teams to improve and correct data. Analyze data flow and data integrity to identify areas for improvement in risk adjusted revenue. Complete routine quality assurance checks to ensure data accuracy and completeness and execute corrections as needed.

Update, create, and maintain business process and technical workflow documents. Analytics, Operational, & Project Management Duties: Operate risk adjustment analytic vendor platforms to assist with intervention tracking, monitoring, analysis and reporting of diagnosis codes that drive risk adjusted payments. Oversee the analysis and interpretation of provider-specific results and risk score trend information; develop dashboard reporting and a regular schedule for delivering the results of analyses to improve awareness and understanding of risk adjustment results and the quality, accuracy and identification of member health conditions.

Assist the Risk Adjustment Director in providing HCP Teams with appropriate tools, resources, and reports to help achieve success with downstream providers. Conduct analyses to develop a comprehensive understanding of a provider’s risk score trends, EMR systems, contracting arrangements, and business models to recommend generate provider-specific engagement plans. Support project management efforts including monitoring and evaluating progress against timelines, project milestones, key deliverables, and resource requirements.

Develop tracking and monitoring mechanisms for all Risk Adjustment and Coding programs. Support the Risk Adjustment Director in ensuring that key risk adjustment performance metrics and business objectives are defined and achieved. Collaborate across business units to coordinate the development of financial dashboards and models to identify and track revenue and ROI trends.

Work with team members to understand and monitor the financial impact of risk adjustment programs. Contribute to developing materials and presenting key updates to HCP leadership regarding risk adjustment programs and provider and member engagement initiatives. Qualification Requirements: Skills, Knowledge, Abilities Advanced proficiency in SQL (required).

Advanced proficiency in MS Excel (required). Direct experience with and aptitude for using data warehouse/data mart products (required). Direct experience with relational databases and knowledge of query tools, specifically SAS (required).

Ability to manage projects and project plans within stated time lines (required). Ability to communicate effectively, and work well in a team oriented environment (required). Resourceful and creative in solving complex issues and working collaboratively with others (required).

General knowledge of ICD-9/10 codes (optional). Training/Education: Bachelor or Associate degree in Computer Science, Management Information Systems or Health related field (required). Experience: A minimum of 5 years’ experience in managed care or other healthcare environment in an analyst role.

Direct experience with NYSDOH risk adjustment methodology and risk revenue financial analytics (optional). Direct experience with APD/OSDS data submission processes (required). Direct experience utilizing risk adjustment analytic vendor platforms (required).

HealthCare Partners, MSO provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, HealthCare Partners, MSO complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Department: Risk Adjustment This is a non-management position This is a full time position

Clipped from: https://jobs.wane.com/jobs/director-of-medicaid-home-and-community-based-services-hcbs-advocacy-washington-washington-dc/896333644-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

The Director of Medicaid Home and Community-Based Services (HCBS) Advocacy serves on a cross-functional legislative, regulatory, research, and policy development team, working closely with the President & CEO to expand access to the broad array of home and community-based services (HCBS) available under Medicaid.

 
 

Essential Job Duties:

• Development and advancement of Medicaid HCBS policy goals for NAHC through  engagement with Congress, Centers for Medicare, and Medicaid Services (CMS), the Medicaid Access and Payment Advisory Commission (MACPAC), and state Medicaid agencies in collaboration with state home care associations
  
• Develop research and policy-focused white papers relating to Medicaid HCBS
  
• Communicate and advocate policy objectives in federal regulatory and legislative forums
  
• Create alliances and collaborations with organizations that share common policy views on Medicaid home and community-based care
  
• Support grassroots efforts relating to Medicaid HCBS
  
• Integrate national Medicaid activities with the NAHC Forum of State Associations
  
• Assist NAHC members with state-specific Medicaid HCBS advocacy needs in collaboration with the state home care associations
  
• Proactively research and respond to requests, questions, and comments from NAHC members with state-specific Medicaid HCBS advocacy needs with timely, accurate, and courteous responses to members, committees, stakeholders, and NAHC staff  
  
• Participate in cross-functional NAHC team to develop and effectively schedule Medicaid HCBS education through in-person conferences, online seminar and/or podcast offerings
  
• Represent NAHC at state association speaking engagements
  
• Coordinate with NAHC President, Director of Communications, and cross-functional team on response to media coverage of homecare & hospice issues, as well as routine press inquiries
  
• Create & maintain relationships to expand communications with key stakeholder groups, other associations, as well as government representatives and government contractors to promote interests of homecare and hospice providers
  
• Support NAHC committee/advisory board needs.
  
• Work collaboratively with industry business partners and consultants
  
• Support member recruitment efforts
  
• Other duties, as assigned
  

 
 

Qualifications:

 
 

General

• Experience in a health care policy advocacy organization preferred
  

 
 

Education/Experience:

 
 

• Minimum of three (3) or more years of experience in healthcare policy and advocacy
  
• A background with Medicaid HCBS policy issues is highly preferred, including interaction with the Centers for Medicare and Medicaid Services, state Medicaid agencies, and/or Congress
  
• MA in Public Policy or Public Health or Juris Doctor preferred. Bachelor’s degree in health administration, political science public health, or related field required
  

 
 

Required Knowledge and Skills:

 
 

• Healthcare background and advanced knowledge of Medicaid HCBS policy affecting homecare and hospice
  
• A service-oriented focus on exceeding member’s expectations and delivering value
  
• Excellent interpersonal and presentation skills
  
• Demonstrated influencing skills and ability to collaborate with colleagues at all levels of the organization, including advising executive leadership and members 
  
• Ability to build effective coalitions and engagement on advocacy issues
  
• Strong project management skills to effectively deliver on tasks and project deadlines
  
• Demonstrated ability to contribute to cross-functional teams with various initiative leads (education, membership, policy, and others) to accomplish overall organizational goals 
  
• Ability to work independently to manage multiple concurrent and complex projects and initiatives with different stakeholders across the Association
  
• Excellent writing skills with the ability to effectively communicate information to diverse audiences
  

 
 

Clipped from: https://www.simplyhired.com/job/oEaGhD3_HSIDOoB44Xwo15ugUyqICwOs12lggrzvJOoAF6GMig4l-w?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Duties
Provide clarification, interpretation, and explanation of financial policies and instructions in light of special programs or program relationships.
Examine costs and estimates, and develop alternative or new cost methodologies to produce independent cost estimates.
Prepare special financial materials as requested by managers or other senior staff.
Develop comprehensive tabular or “figure” portions of financial documents, exhibits, and other supporting documentation.
Analyze specific fiscal areas of concern and recommend procedures and methods for change.

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.
This is a remote position; however, the position reports to a CMS Office on a periodic basis. Requirements to report to the office will vary and can be discussed at the time of interview.
Qualifications
ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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-13, 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-12 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Analyzing financial proposals, budgets or reports to ensure adherence to requirements; (2) Applying regulations of financial management to recommend or implement financial policies; AND (3)Preparing financial reports, briefings, or cost estimates. .

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.

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11814836

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: Yes- American Federation of Government Employees, Local 1923
Tour of Duty: Flexible
Recruitment/Relocation Incentive: Not Authorized
Financial Disclosure: Not Required

This position will be in direct support of the Inflation Reduction Act of 2022. This Act increases healthcare spending by nearly $100 billion, mainly by extending the American Rescue Plan’s temporarily-expanded Affordable Care Act (ACA) premium tax credits for an additional three years, through 2025. The bill will also allow Medicare to negotiate prescription drug prices, implement improvements to Medicare Part D including a benefit redesign and new manufacturer discount program, impose inflation rebates for Part B and Part D drugs, and other miscellaneous changes in Part B and Part D to improve the affordability of prescription drugs.

To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply.

Remote-Out Positions at CMS: This is a remote position; however, the position reports to a CMS Office on a periodic basis (e.g. 1-2 times per year). Requirements to report to the office will vary and can be discussed at the time of interview. As such, your pay will be based on your home address. For more information on locality and pay scales, please click here. Your worksite must be within the United States and you must adhere to all regulations and policies regarding remote work at CMS and in the federal government, including the signing of a remote work agreement.

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.

Benefits

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.

Additional selections may be made from this announcement for similar positions within CMS with the same remote/telework designation and same geographical location, if applicable. For example, for Woodlawn, MD vacancies the “same geographical location” includes Baltimore, Maryland; Bethesda, Maryland; and Washington, D.C.

Traditional rating and ranking of applications does not apply to this vacancy. Applications will be evaluated against the basic qualifications. Qualified candidates will be referred for consideration in accordance with the Office of Personnel Management direct hire guidelines. Veterans’ Preference does not apply to direct hire recruitment procedures. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would, therefore, be given new appointments to the civil service; however, benefits, time served and all other Federal entitlements would remain the same.

Benefits

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.

Required Documents

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.). Required documents may be necessary 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.

How to Apply

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 02/08/2023 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 IRADHACandidate@cms.hhs.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 CMSCorpsJobs@cms.hhs.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. Please send all documents in 1 PDF file. 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
CMS IRA
Email

IRADHACandidate@cms.hhs.gov

Address

Center for Medicare
7500 Security Blvd
Woodlawn, MD 21244
US

Next steps

Once your online application is submitted, you will receive a confirmation notification by email. Within 30 business days of the closing date,02/08/2023, 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.

Fair and Transparent

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

Equal Employment Opportunity (EEO) Policy
Reasonable accommodation policy
Financial suitability
Selective Service
New employee probationary period
Signature and false statements
Privacy Act
Social security number request

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.). Required documents may be necessary 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
This job is open to
Career transition (CTAP, ICTAP, RPL)

Federal employees who meet the definition of a “surplus” or “displaced” employee.

The public

U.S. Citizens, Nationals or those who owe allegiance to the U.S.

Clarification from the agency

This announcement is advertised under Direct Hire Authority and is open to all United States Citizens or Nationals.

Clipped from: https://careers.guidewell.com/us/en/job/30276/FL-Blue-Medicare-Medicaid-Eligibility-Associate?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Summary
Responsible for working directly within the state of Florida FLMMS portal. In charge of providing on the spot verification of Medicaid eligibility to prospective Dual Eligible Special Needs Plans (DSNP) to the Medicare sales agents, required to verify monthly Medicaid eligibility of the currently enrolled Dual Eligible Special Needs Plan (DSNP) members. Responsible for working alongside the Department of Families and Children (DCF) to obtain the annual Medicaid recertification dates and required documentation for currently enrolled DSNP members to ensure members continue enrollment and maintain their eligibility with the plan. Responsible for identifying members who are at risk or who have lost their Medicaid eligibility and work alongside DCF and the member to submit all required paperwork and try to get them re-certified for Medicaid. Responsible for obtaining necessary paperwork from the members and/or additional resources such as the Social Security Administration and DCF to reinstate member’s Medicaid Eligibility or prevent members from losing Medicaid eligibility. Assist with outreach calls to members as needed.

 
 

Essential Functions

• Determines Medicaid qualification status for prospective Dual Eligible Special Needs Plan (DNSP) members using the State Medicaid Portal FLMMS. 
  
• Verifies Medicaid eligibility for currently enrolled DSNP members on a monthly basis. 
  
• Performs on the spot verification of Medicaid eligibility for DSNP enrollment of prospective members. 
  
• Obtains annual Medicaid Re-certification for currently enrolled DSNP members. 
  
• Works with currently enrolled DSNP members who have lost their Medicaid eligibility during the deeming process to assist with re-certifying them for the DSNP. 
  
• Submits paperwork to DCF and other entities as needed to maintain or regain eligibility. Evaluates and monitors the process until benefits are approved 
  
• Effectively manage Medicaid caseload. Follows up with clients on a weekly basis. 
  
• Work alongside DSNP team to obtain and provide necessary information as needed. 
  
• Responsible for working with Social Security Administration to obtain proof of income and complete representative payee form 
  

 
 

 
 

 
 

Required Work Experience
5+ years related work experience. Experience Details:

Required Management Experience
No supervisory/management experience required

Required Education
High school diploma or GED

Additional Required Qualifications
Bilingual English and Spanish Ability to maintain and multi-task with a significant caseload Knowledge of adult Medicaid Excellent problem-solving skills and resourceful Strong organizational skills and detail oriented Extraordinary interpersonal and creative skills Excellent writing and verbal communication skills Knowledge of Google platform, MS word The following certifications: Department of Children and Families Community Partner Certification ACCESS Certification Completion of the following training required for DCF Community Partners: Additional DCF Required Training for DCF Community Partners: ACCESS Civil Rights Training- Community Partners ACCESS Program Overview ACCESS Self-Service Portal Training Online Email Notification Customer Training Service Delivery for the Deaf and Hard-of-Hearing Limited English Proficiency Update Language Limitations and Customer Rights Security Awareness Training

Additional Preferred Qualifications
Prior experience working with the Department of Children and Families (DCF) Prior experience working with the state Medicaid portal FLMMS Prior experience/knowledge of Florida State Medicaid Prior experience working with the Agency for Health Care Administration (AHCA) Prior experience working for the Social Security Administration (SSA)

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.