Clipped from: https://www.careerbuilder.com/job/J3S77570Z7GB018CPN5?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Finance Director – Medicaid

Elevance Health Atlanta, GA (On Site) Full-Time

Description

The Finance Director is responsible for supporting budgeting, forecasting, long-term planning, business strategic analysis of the team, month-end reporting, and corporate deliverables for Medicaid. Provides financial leadership, decision support and strategic direction to support the senior management team’s achievement of the business plan.

Primary duties may include, but are not limited to:

* Provides decision support/analysis and financial leadership to business unit President and senior management team.
* Conducts analysis and reporting to understand trends, variances and identify opportunities for margin and operational improvement.
* Leads the preparation of budget and forecasts that represent the best projection of future performance.
* Works with management to determine assumptions and identify new initiatives for the business unit.
* Ensures alignment of budget/forecast to business plan.

Minimum Requirements:

* Requires a BA/BS in accounting or finance and a minimum of 5 years of progressively more responsible experience in a high-level financial analysis position for a publicly held company; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experience:

* MBA, CPA, CFM, or CMA preferred.
* Experience supporting senior management and prior leadership experience preferred.
* Experience in Medicaid
* Hight proficiency in MS Office (Excel, PowerPoint, and Word)
* Strong analytical skills
* Strong communication skills (verbal and written)
* Knowledge of accounting principals

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 [ Email address blocked ] – Click here to apply to Finance Director – Medicaid for assistance.

Recommended Skills

• Accounting
  
• Analytical
  
• Communication
  
• Finance
  
• Financial Analysis
  
• Forecasting
  

Clipped from: https://www.sonicjobs.com/us/jobs/atlanta/full-time/public-sector-consulting-actuary-medicaid-63c9e5b7483fe56e8d0f4d0c?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Ideal candidate will have experience working with governments in a healthcare setting. Medicaid Experience Needed!

This Jobot Job is hosted by: William Zaranka
Are you a fit? Easy Apply now by clicking the “Apply Now” button and sending us your resume.
Salary: $80,000 – $140,000 per year

A bit about us:

Join a nationally recognized as an industry leader in the areas of healthcare data analysis, program evaluation, and quality improvement. We are in search of talented individuals who are interested in a leadership position as a Consulting Actuary in our Data Science & Advanced Analytics (DSAA) division. Together we can spread positive change to make healthcare better.

Why join us?

A comfortable work-life balance, including half-day Fridays and flexible work schedules.
Three weeks of paid time off and 15 company-paid holidays where staff leave two hours early prior to each holiday to get a jump start on holiday festivities.
They offer a competitive benefit package that includes medical, dental, vision, tuition reimbursement, 401(k) and an employee stock ownership plan.

Job Details
 

• Bachelors degree in actuarial or actuarial related science.
  
• Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA) designation.
  
• At least 5 years experience working in a healthcare setting (i.e., managed care plan, actuarial firm).
  
• Development and certification of Medicaid managed care rates for Medicaid populations.
  
• Understanding of Medicaid waivers and budget neutrality requirements [e.g., 1115, 1915(b/c) waivers].
  
• Use and applications of various risk adjustment mechanisms and tools.
  
• Serve as a senior leader within HSAGs DSAA division.
  
• Act in a liaison capacity between HSAG and outside agencies and organizations.
  
• Oversee communication with project partners, subcontractors, and other entities.
  
• Assign and oversee actuarial activities.
  

Interested in hearing more? Easy Apply now by clicking the “Apply Now” button.

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Benefits

Pulled from the full job description

Dental insurance

Flexible schedule

Flexible spending account

Health insurance

Health savings account

Life insurance

Job Summary

Inspire Case Management has the privilege of currently serving all 92 counties across central Indiana. Inspire Case Management is always looking for qualified individuals who have a passion for working with individuals with Intellectual Disabilities.

Please visit our website at https://www.inspirecm.com/ for more information regarding what we do and to complete our application process.

Responsibilities and Duties

Case Managers assist participants in gaining access to needed waiver and other Medicaid State Plan services, as well as needed medical, social, educational and other services, regardless of the funding source for the services to which access is gained.

Additional Responsibilities and Duties:

• Developing, updating, and reviewing the PCISP using the person-centered planning process.
  
• Convening team meetings at least every 90 calendar days and as needed to discuss the PCISP and any other issues needing consideration in relation to the participant.
  
• Completion of a DDRS-approved risk assessment tool during service plan development, initially, annually, and when there is a change in the participant’s status.
  
• Monitoring of service delivery and utilization (via telephone calls, home visits, and team meetings) to ensure that services are being delivered in accordance with the PCISP.
  
• Completing and processing the annual level of care determination.
  
• Compiling case notes for each encounter with the participant.
  
• Conducting face-to-face contacts with the individual (and family members, as appropriate) at least once every 90 calendar days in the home of the waiver participant and as needed to ensure health and welfare and to address any reported problems or concerns.
  
• Completing and processing the 90-Day Checklist
  
• Developing initial, annual, and update Cost Comparison Budgets using the State-approved process.
  
• Disseminating information including all Notices of Action and forms to the participant and the Individual Support Team (IST) within five business days of the IST meeting.
  
• Completing, submitting, and following up on incident reports in a timely fashion using the State approved process, including notifying the family/guardian of the incident outcome, all of which must be verifiable by documented supervisory oversight and monitoring of the Case Management agency.
  
• Monitoring participants’ health and welfare.
  
• Monitoring participants’ satisfaction and service outcomes.
  
• Monitoring claims reimbursed through the approved Medicaid Management Information System (MMIS) and pertaining to waiver-funded services.
  
• Maintaining files in accordance with State standards.
  
• .Cultivating and strengthening informal and natural supports for each participant.
  
• Identifying resources and negotiating the best solutions to meet identified needs.
  

Please visit our website at https://www.inspirecm.com/ for more information regarding what we do and to complete our application process.

Qualifications and Skills

Inspire Case Management requires at least 1 year of field experience working with individuals with Intellectual Disabilities and at least a bachelor’s degree from an accredited college or university in a related field. Inspire Case Managers must reside in Indiana and be able to travel locally. Please visit our website at https://www.inspirecm.com/ for more information regarding what we do and to complete our application process.

Benefits

Although Inspire’s headquarters is based out of the Indy area, we have the privilege of serving all 92 counties across central Indiana (with the hopes of expanding that as the need arises). Case Managers are hired geographically based off the need in particular areas. Case Managers work out of their home offices and travel locally. Flexible hours. Please visit our website at https://www.inspirecm.com/ for more information regarding what we do and to complete our online application process.

Job Type: Full-time

Salary: $30,000.00 – $51,000.00 per year

Benefits:

• Dental insurance
  
• Health savings account
  
• Life insurance
  
• Vision insurance
  

Schedule:

• 4 hour shift
  
• 8 hour shift
  
• Monday to Friday
  

Job Types: Full-time, Part-time

Pay: $30,000.00 – $51,000.00 per year

Benefits:

• Dental insurance
  
• Flexible schedule
  
• Flexible spending account
  
• Health savings account
  
• Life insurance
  
• Vision insurance
  

Schedule:

• Self-determined schedule
  

Work Location: On the road

Clipped from: https://www.linkedin.com/jobs/view/hybrid-clinical-authorization-review-nurse-medicaid-health-systems-specialist-rn-at-ohio-department-of-medicaid-3440882186/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

THIS POSITION MAY BE TELEWORK ELIGIBLE ON A HYBRID BASIS.


About Us


The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. ODM is implementing the next generation of Ohio Medicaid to fulfill its bold, new vision for Ohio’s Medicaid program – focusing on the individual rather than the business of managed care.


The goals of the next generation of Ohio Medicaid are:

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

What You Will Do At ODM


Working Title: Clinical Authorization Review Nurse


Classification: Medicaid Health Systems Specialist RN (PN 20046588, 20037628)


Office: Health Innovation & Quality


Bureau: Clinical Operations


Pay rate: $30.93/per hour


Job Overview


As the Clinical Authorization Review Nurse in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include:

• Monitoring and evaluating contractors, projects, programs or service delivery
  
• Participation in prior authorization and service authorization oversight and utilization activities
  
• Reviewing both physical and behavioral health clinical records and files, other medical and administrative data, and patient summary/profile reports to determine if providers or care delivery meets or equals the established care standards/clinical practice guidelines set forth in Medicaid programs, professional standards, and/or evidence-based best practices, and recommending health and safety process improvements
  
• Reviewing and approving claims for payment
  
• Working collaboratively with internal and external stakeholders across a variety of departments, levels, state agencies, and MCPs to improve health services for the individuals served by ODM
  
• Using your nursing expertise to evaluate authorization decisions for individuals served in both Managed Care, Fee for Service and Waiver populations
  
  
  

Must possess a current & valid license as registered nurse (RN) as issued by Ohio Board of Nursing, pursuant to Sections 4723.03 & 4723.09 of Ohio revised code.


Current & valid license to practice professional Nursing as a Registered Nurse (i. e., RN) in Ohio as issued by the Board of Nursing pursuant to Sections 4723.03 to 4723.09, inclusive of Ohio Revised Code; additional 24 months of experience in Nursing.


Training & Development Required to Remain in Classification After Employment: Biennial renewal of license in practice as Registered Nurse per Section 4723.24 of Ohio Revised Code.


Primary Location


United States of America-OHIO-Franklin County-Columbus


Work Locations


Lazarus 5


Organization


Ohio Department of Medicaid


Classified Indicator


Classified


Bargaining Unit / Exempt


Bargaining Unit


Schedule


Full-time


Work Hours


8:00 a.m. – 5:00 p.m.


Compensation


$30.93/per hour


Unposting Date


Feb 5, 2023, 10:59:00 PM


Job Function


Nursing


Agency Contact Name


ODM Human Resources


Agency Contact Information


HumanResources@medicaid.ohio.gov

Clipped from: https://www.nexxt.com/jobs/staff-vp-medicaid-risk-adjustment-denver-co-2423146381-job.html?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic&aff=2ED44C72-8FD2-4B5D-BC54-2F623E88BE26&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

• Staff VP Medicaid Risk Adjustment
  

 
 

• Job Family: Business Support
  
• Type: Full time
  
• Date Posted:Jan 18, 2023
  
• Req #: JR48772
  

Location:

• IN, Indianapolis
  
• National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
  

Description

Staff VP Medicaid Risk Adjustment

Location: Any US Location

Responsible for designing, implementing and directing programs and initiatives related to Medicaid Risk Adjustment. Accountable for the accuracy and completeness of risk scores for the health plan.

Primary duties may include, but are not limited to:

• Designs programs, policies and procedures related to risk adjusted revenue.
  
• Manages coding and auditing.
  
• Communicates best practices and opportunities for improvement.
  
• Collaborates with senior management to develop strategies and tactics that improve the accuracy of risk scores and reduce payment error risk.
  
• Monitors established operations, tracks performance, and resolve deficits.
  
• Evaluates, contracts, and manages vendors.
  
• Collaborates with senior leaders to drive business decision.
  
• Sets strategic direction for risk adjustment at the corporate and regional levels.
  
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
  

Qualifications

Requires a BA/BS and minimum of 10 years experience with healthcare economics and/or risk adjustment; or any combination of education and experience, which would provide an equivalent background.

Preferred knowledge, skills, and experience:

• Risk adjustment operations and data analysis experience.
  
• Medicaid risk adjustment helpful, but not required.
  
• Demonstrated leadership skills and experience.
  
• Ability to demonstrate competencies in business acumen, strategic thinking, influencing, and executive presence.
  
• CPC or CCS-P certification.
  

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $ $175,120 to $ $315,216.

Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
  

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 ~~~. 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 ~~~ for assistance.

EEO is the Law

Equal Opportunity Employer / Disability / Veteran

Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

• EEO Policy Statement
  
• EEO is the Law Poster
  
• EEO Poster Supplement-English Version
  
• Pay Transparency
  
• Privacy Notice for California Residents
  

Elevance Health, Inc. is an E-verify Employer

Need Assistance?

Email us (~~~) or call ~~~

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Neighborhood Health Association – Responsible for providing excellent customer service in delivering education, outreach and in-person assistance to patients to obtain Medicaid and/or other health coverage and benefits. Identify patient needs, screens for eligibility and provides assistance in obtaining resources through application process. Coordinates with team members to provide complete and positive services for the patients.

Duties and Responsibilities:
Meet with patients to identify relevant financial assistance resources and or payor sources. May provide assistance at various locations, including NHA clinic locations and community events.
Screens patients/clients for eligibility for entitlement programs and assists patients/clients in completing necessary applications to obtain the resources
Qualify applicable patients/clients for the appropriate health benefits. Ensures forms are fully completed and submitted in a timely manner and information is accurately entered into Patient Management System
Coordinates the provision of services provided to the patient/client including scheduling appointments in the Patient Management System
Call uninsured or underinsured patients who may qualify for health benefits to discuss possible benefit options and to offer assistance where needed.

Skills/Qualifications:
A high school diploma or equivalent, bachelor’s degree is preferred
Minimum 2 years of working with health insurance products, including Medicaid enrollment
Knowledge of current public coverage programs, including extensive knowledge of Medicaid
Ability to communicate effectively written and verbally, face-to-face and over the phone
A valid Ohio Driver’s License and auto insurance with an acceptable driving record. Reliable transportation and willingness to travel throughout Lucas County
Knowledge of basic computer programs (Microsoft Office Suite)
Ability to work closely and effectively as a team player with NHA staff, community leaders, and health professionals
Be required to keep up to date on any changes regarding Medicaid applications
Possess a strong desire to carry out and promote the mission and vision of Neighborhood Health Association

Full-time Monday – Friday, no evenings, weekends, or holidays.

We offer a competitive salary and benefits package including Health, Dental, Vision and Life Insurance, a matching retirement plan, Employee Assistance Program, 11 paid holidays and generous PTO.

Please provide your salary requirements when you apply to be considered for an interview for this position.

Neighborhood Health Association (NHA), a Federally Qualified Health Center (FQHC), is the largest community health center system in Northwest Ohio with partnerships that include ProMedica, Mercy Health, and University of Toledo Medical Center. NHA has grown from a single location in 1969 to 12 medical and dental clinics throughout Lucas County. Today we operate multiple health centers including pediatrics, adult medicine, dental services, health care for the homeless, women’s health center, senior centers, and a full-service pharmacy with lab services on site.

For more than 50 years, NHA has placed a strong focus on prevention and empowering individual responsibility in managing their health care and overall well-being. Our services are acutely responsive to the needs of everyone throughout the communities we serve, providing excellent care and the best health practices.

Our Mission: Through our exceptional health care services, we empower and educate, aggressively working to eliminate health care inequities, while supporting personal responsibility for one’s own health regardless of the ability to pay.

We are a drug free workplace, and an Equal Opportunity Employer

Clipped from: https://www.nexxt.com/jobs/medicaid-managed-care-medicare-advantage-sme-fairfax-va-2423139076-job.html?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic&aff=2ED44C72-8FD2-4B5D-BC54-2F623E88BE26&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

•  

General Dynamics Information Technology • Fairfax, VA 22037

Job #2423139076

•  
• Type of Requisition: Regular
  

Clearance Level Must Be Able to Obtain: None

Job Family: Research

GDIT is searching for a dynamic Medicare Advantage/Risk Adjustment Subject Matter Expert to join our growing team. You will support an exciting new program focused vulnerability risk assessments for the Centers for Medicare & Medicaid Services. The role will allow you to utilize in-depth knowledge of Medicare and/or Medicaid Managed Care policies, payment structures, risk adjustments processes, including claims and data analyses. You will conduct and document advanced research and analyses to perform risk assessment of Medicare Advantage or Medicaid Managed Care vulnerabilities to quantify and priority risk and provide recommendations for mitigation strategies to reduce or prevent future risk.

Required Skills:

• Bachelor’s degree and 5+ years of Healthcare Policy experience (or equivalent combination of education and experience)
  
• Experience documenting and presenting complex studies and analyses to a wide audience including senior leadership
  

Desired Skills:

• 5 years conducting regulatory or policy research related to Medicare and/or Medicaid. Medicare Advantage or Medicaid Managed Care experience is preferred.
  
• Strong interpersonal and communications skills, both written and oral
  
• Proficient in computer skills, e.g. Microsoft Office-Word, Excel
  
• Ability to conceptualize, solve problems and draw conclusions
  
• Highly organized, ability to multi-task and meet deadlines
  

#GDITHealthSystems

COVID-19 Vaccination: GDIT does not have a vaccination mandate applicable to all employees. To protect the health and safety of its employees and to comply with customer requirements, however, GDIT may require employees in certain positions to be fully vaccinated against COVID-19. Vaccination requirements will depend on the status of the federal contractor mandate and customer site requirements.

We are GDIT. The people supporting some of the most complex government, defense, and intelligence projects across the country. We deliver. Bringing the expertise needed to understand and advance critical missions. We transform. Shifting the ways clients invest in, integrate, and innovate technology solutions. We ensure today is safe and tomorrow is smarter. We are there. On the ground, beside our clients, in the lab, and everywhere in between. Offering the technology transformations, strategy, and mission services needed to get the job done.

GDIT is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.

Clipped from: https://www.linkedin.com/jobs/view/oag-sergeant-sergeant-oag-medicaid-fraud-control-unit-23-0420-at-texas-attorney-general-3440865727/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Please paste the following URL into a browser to view the entire job posting in the CAPPS Career Section: https://capps.taleo.net/careersection/ex/jobdetail.ftl?job=00029812 You may apply to the job directly through the CAPPS Career Section. It is not necessary to apply both through Work In Texas and CAPPS Career Section\ \ GENERAL DESCRIPTION Performs advanced criminal investigations of Medicaid provider fraud and nursing home related investigations for the Office of the Attorney Generals Medicaid Fraud Control Unit (MFCU). Work involves conducting criminal investigations of violations of various state and federal statutes and prosecution assistance as needed. OAG employees enjoy excellent benefits along with tremendous opportunities to do important work and make a positive difference in the lives of all Texans. JOB POSTING NOTICE Applicants for this position should be prepared to pass a background investigation. Applicants will also be subject to a motor vehicle registration check. The MFCU works cases jointly with other law enforcement agencies including the FBI, U.S. Department of Health and Human Services – Inspector General and IRS. In certain cases, it is necessary for our staff to have a Top Secret security clearance in order to fully participate in joint investigations or in task force activities. Top Secret clearances are not required prior to employment but in certain cases may be required at a later date. Since most security clearance problems arise from criminal records or unresolved bad credit issues, full criminal and credit checks will be run on all applicants prior to employment. Level of Supervision of State Classification: Works under limited supervision, with moderate latitude for the use of initiative and independent judgment. ESSENTIAL POSITION FUNCTIONS Conducts complex criminal investigations of Medicaid provider fraud, and/or assures that nursing home related investigations are addressed professionally and in a timely manner, utilizing a wide range of techniques, with the goal of accomplishing the primary mission of MFCU, bringing violators of state and federal law, over which MFCU has jurisdiction, to justice, and identifying Medicaid and Medicaid related overpayments to Medicaid providers Plans, participates in and conducts undercover investigations, surveillance operations, raids, and searches; identifies, gathers, and examines evidence, including complex records of Medicaid providers; executes court orders, warrants, and subpoenas; and reports investigative findings Establishes and maintains liaison with outside agencies, associations, groups, and the like whose assistance and cooperation can enhance the mission of MFCU, including but not limited to proactive generation of investigative targets; participates willingly in team investigative endeavors (intra-Team, inter-Team, inter-city, and inter-agency); and contributes to a positive work environment and high morale May train, lead, and/or assist with the work of others. Performs related work as assigned Responds to emergency situations by serving on-call twenty-four hours per day/seven days per week 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 Qualifications: MINIMUM QUALIFICATIONS Education: Graduation from high school or equivalent Education: Sixty credit hours from an accredited college or university; may substitute an associates or bachelors degree from an accredited college or university; or full-time investigations; law enforcement; auditing; accounting; compliance monitoring in Medicaid, Medicare, health care insurance, or closely related experience for the required education on a year-for-year basis Experience

 
 

Four years full time criminal investigative experience as a licensed peace officer or comparable federal law enforcement officer TCOLE certification Knowledge of TCOLE training requirements and healthcare fraud investigation training needs Knowledge of Microsoft Office products (i.e. Word, Excel, PowerPoint, Outlook) Knowledge of criminal investigative principles, techniques, and methodologies Knowledge of management and administrative principles, techniques, and methodologies Knowledge of agency goals, objectives, rules, regulations, policies, and procedures Knowledge of state and federal statutes, rules, and regulations pertaining to law enforcement activities Knowledge of criminal and civil court proceedings and rules of evidence Skill in effective oral and written communication (Writing sample will be required at time of interview, if selected) Skill in researching and interpreting complex rules and regulations Skill in applying investigative techniques and procedures Skill in handling multiple tasks, prioritizing, and meeting deadlines Skill in exercising sound judgment and effective decision making Ability to develop and implement strategic plans and budgets Ability to use and care for firearms Ability to use intermediate impact weapons and Oleoresin Capsicum spray Ability to use physical tactics Ability to conduct complex criminal investigations of Medicaid provider fraud and nursing home related investigations Ability to interpret and apply applicable provisions of the Texas Penal Code, the Texas Code of Criminal Procedure, and federal statutes pertaining to investigations Ability to interpret and apply department policies and procedures Ability to plan, assign, and supervise the work of others Ability to handle stressful situations Ability to receive and respond positively to constructive feedback Ability to work cooperatively in a professional office environment Ability to provide excellent customer service Ability to work in person at assigned OAG work location, perform all assigned tasks at designated OAG work space 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 arrange for personal transportation for business-related travel, with reimbursement Ability to work more than 40 hours as needed and in compliance with FLSA Ability to lift and relocate 30 lbs. Ability to travel (including overnight travel) up to 20% Ability to achieve 64% or better of VO2 max on the 2000-meter row, or meet a minimum score of 64% on the 500-meter row test or 4-minute row test, utilizing a Concept 2 Rower PREFERRED QUALIFICATIONS Experience conducting white collar/economic crime investigations Experience investigating healthcare provider fraud and working with state and federal prosecutors in criminal matters Accomplished practitioner of the MFCU documentation and report writing system or a like system Knowledge of healthcare fraud statutes (state and federal) 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 athttps://hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_LawEnforcement.pdf

Clipped from: https://www.gdit.com/careers/job/9492e4267/medicaid-managed-caremedicare-advantage-sme/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Travel Required: Less than 10%

Requisition Type: Regular

GDIT is searching for a dynamic Medicare Advantage/Risk Adjustment Subject Matter Expert to join our growing team. You will support an exciting new program focused vulnerability risk assessments for the Centers for Medicare & Medicaid Services. The role will allow you to utilize in-depth knowledge of Medicare and/or Medicaid Managed Care policies, payment structures, risk adjustments processes, including claims and data analyses. You will conduct and document advanced research and analyses to perform risk assessment of Medicare Advantage or Medicaid Managed Care vulnerabilities to quantify and priority risk and provide recommendations for mitigation strategies to reduce or prevent future risk.

Required Skills:

• Bachelor’s degree and 5+ years of Healthcare Policy experience (or equivalent combination of education and experience)
  
• Experience documenting and presenting complex studies and analyses to a wide audience including senior leadership
  

 
 

 
 

Desired Skills:

• 5 years conducting regulatory or policy research related to Medicare and/or Medicaid. Medicare Advantage or Medicaid Managed Care experience is preferred.
  
• Strong interpersonal and communications skills, both written and oral
  
• Proficient in computer skills, e.g. Microsoft Office-Word, Excel
  
• Ability to conceptualize, solve problems and draw conclusions
  
• Highly organized, ability to multi-task and meet deadlines
  

#GDITHealthSystems

The likely salary range for this position is $100,000 – $150,000, this is not, however, a guarantee of compensation or salary; rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

View information about benefits and our total rewards program.

 
 

About Our Work

We are GDIT. The people supporting some of the most complex government, defense, and intelligence projects across the country. We deliver. Bringing the expertise needed to understand and advance critical missions. We transform. Shifting the ways clients invest in, integrate, and innovate technology solutions. We ensure today is safe and tomorrow is smarter. We are there. On the ground, beside our clients, in the lab, and everywhere in between. Offering the technology transformations, strategy, and mission services needed to get the job done.

COVID-19 Vaccination

GDIT does not have a vaccination mandate applicable to all employees. To protect the health and safety of its employees and to comply with customer requirements, however, GDIT may require employees in certain positions to be fully vaccinated against COVID-19. Vaccination requirements will depend on the status of the federal contractor mandate and customer site requirements.

GDIT is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.