Posted on

SNP (Duals) Health Plan Director – Medicare and Medicaid Managed Care – Nashville, TN

 
 

Qualifications

  • Bachelor’s (Preferred)

About Monogram Health

We are dedicated to improving the well-being, quality of life and health outcomes for our patients by partnering with the nation’s leading kidney specialists to provide transformative kidney care. Monogram Health supports patients suffering from Chronic Kidney Disease and End Stage Renal Disease by forming deep rooted relationships and preparing them both emotionally and physically for the challenges of managing Kidney Disease. Monogram Health uses next generation artificial intelligence algorithms to predict necessary and timely care to promote the delay of Kidney Disease progression, seamless transitions to dialysis and/or pre-emptive kidney transplant as well as to optimize our patients’ health outcomes once on dialysis.

Position: SNP Program Manager/Director

The Special Needs Plan (SNP) (Duals), Program Manager is required to carefully monitor the performance and adherence to the Centers for Medicare and Medicaid Services (CMS) regulatory requirements based on an approved Model of Care (MOC).

In this role, the individual will be expected to provide a high level of program and product specific subject matter expertise. He or she will be responsible for intensive oversight of the program to ensure performance, quality, regulatory adherence and audit readiness.

The SNP Program Director reports directly to the VP, Enterprise Programs and works closely with the Clinical and Market Operations, and other teams across the organization.

Roles and Responsibilities

· Develop and implement programmatic requirements to meet SNP MOC requirements

· Oversee implementation and monitoring of Interdisciplinary Care Team (ICT) requirements and outcomes

· Continuous monitoring of compliance of SNP SLAs

· Continuous evaluation of effectiveness of SNP program

· Complete mock audits to ensure audit preparedness

· Support Monogram as necessary with any tasks required to deliver excellent personalized kidney care and perform all other duties as assigned

· Uphold the mission and values of Monogram Health in all aspects of your role and activities

Position Requirements

· Phoenix, AZ or Nashville, TN; office-based

· Bachelor’s degree from a four-year college

· 3+ years’ experience with program management, project management, or similar experience

· 3+ years’ experience working for a health plan, and/or vendor contracting with health plans delegated for services

· 3+ years’ experience with Medicare SNP programmatic requirements

· Detail oriented, excellent prioritization, and time management skills

· Expertise partnering with internal departments to drive collaboration and results

· Highly proficient in Microsoft Excel, Word, and Powerpoint

· Experience working in high-growth environment preferred

· Valid driver’s license

Benefits

· Opportunity to work in a dynamic, fast-paced and innovative care management company that is transforming the delivery of kidney care

· Competitive salary, commensurate with experience

· Comprehensive medical, dental, vision and life insurance

· Flexible paid leave & vacation policy

· 401(k) plan with matching contributions

At Monogram Health we believe in fostering an inclusive environment in which employees feel encouraged to share their unique perspectives, leverage their strengths, and act authentically. We know that diverse teams are strong teams, and welcome those from all backgrounds and varying experiences.

Job Type: Full-time

Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Disability insurance
  • Employee assistance program
  • Flexible spending account
  • Health insurance
  • Life insurance
  • Paid time off
  • Professional development assistance
  • Vision insurance

Schedule:

  • Monday to Friday

COVID-19 considerations:
We work from the office. We follow CDC guidelines to keep our employees and program members healthy and safe.

Education:

  • Bachelor’s (Preferred)

Work Location:

  • One location

This Company Describes Its Culture as:

  • Aggressive — competitive and growth-oriented
  • Outcome-oriented — results-focused with strong performance culture

Company’s website:

Work Remotely:

  • No

COVID-19 Precaution(s):

  • Remote interview process
  • Personal protective equipment provided or required
  • Social distancing guidelines in place
  • Virtual meetings
  • Sanitizing, disinfecting, or cleaning procedures in place

 
 

Clipped from: https://www.indeed.com/viewjob?ad=-6NYlbfkN0DVARdmeX_ROF5pf7lvQRg4TirPJSv0nNW_kyMAkJAkKoCvgGq4rngn8KXdTaF7DkTQ5IcrvwUPsrA0eo6lW5FaKAfGUSs-smsC8lmA-7QL6eNckI4khAwxlSjvSSVZmTJjs-GBn5ahhz-xHbCjDrT2CU6Blb3MRgt-VkWtH9f-QQcn5EoM2gdp47UZk0KNxn4mHglT3BnRK9rXAlO4ogb5HuapzbQi16JnvekQQOnuPM3_C1rIJUwk3H67M6341t_4tE0oJApoW8h1oM2U6B6hTdnGYsGMuyF-tTibjMW2vuFeK4G14nFxNdk0l7X9Nef4xsKOKjoLC6cdY7q1EBlA&adid=362652666&cmp=Monogram-Health%2C-Inc&from=iaBackPress&jk=4875868139cc68b9&pub=4a1b367933fd867b19b072952f68dceb&sjdu=QwrRXKrqZ3CNX5W-O9jEvWKcSsYF_EXfiEZCGQoVTCioUiBmHTwb00oP3m5W6wtNWklT6SCqiLegnXZwahzkzWxlEcfPSf3pduWI7aTmsDIgwc2TLryA3G7Rb4K_E8hJKCZkvS5jaLqBzT5tazmTdA&t=Snp%20Health%20Plan%20Director&tk=1erubfk32u4pi800&vjs=3

Posted on

Health Insurance Specialist (Program Policy / CMS)

 
 

Department of Health And Human Services
Center for Medicare and Medicaid Innovation (CMMI)

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI), Seamless Care Models Group (SCMG).


As a Health Insurance Specialist (Program Policy), GS-0107-12, you will perform program policy work related to national health insurance programs, such as Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).

Learn more about this agency

Responsibilities

  • Interpret statute and develop Federal regulations, policy statements, models and other program guidance.
  • Review and evaluate proposed, modified, or new legislation and regulations to assess the impact on CMS programs.
  • Establish and maintain relationships with key officials and groups within and outside CMS to resolve problems pertaining to program policies.
  • Prepare and coordinate a variety of written products, including position papers and briefing materials for senior officials to use as background information on program policy related activities.

Travel Required

Occasional travel – You may be expected to travel 10% for this position.

Supervisory status

No

Promotion Potential

12

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.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.

In order to qualify for the GS-12
, 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-11 grade level in the Federal government, obtained in either the private or public sector, to include:

(1) Researching and analyzing health insurance program policy issues (for Medicare, Medicaid or private health insurance companies) in order to make policy recommendations;
(2) Developing regulations, manuals, program guidelines, operational guidance documents or instructions to communicate health insurance program policies for the Medicare, Medicaid or private health insurance companies ; AND
(3) Presenting findings or recommendations to stakeholders based on analysis of health insurance programs.


Substitution of Education for Experience: There is no substitution of education to meet the specialized experience requirement at the GS-12 grade level.


Combination of Experience and Education: There is no combination of experience and education to meet the specialized experience requirement at the GS-12 grade level.


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/11002921

Education

Additional information

Bargaining Unit Position: Yes

Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Not Required



CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page.


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.


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.

Read more

How You Will Be Evaluated

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

If you meet the minimum qualifications and education requirements for this position, your application and responses to the online occupational questionnaire will be evaluated under Category Rating and Selection procedures for placement in one of the following categories:

  • Best Qualified – for those who are superior in the evaluation criteria
  • Well Qualified – for those who excel in the evaluation criteria
  • Qualified – for those who only meet the minimum qualification requirements

The Category Rating Process does not add veterans’ preference points or apply the “rule of three” but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans’ preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher).


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


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

  • Health Insurance
  • Oral Communication
  • Policy Analysis
  • Written Communication

This is a competitive vacancy announcement advertised under Delegated Examining Authority. 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.


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

Read more

Background checks and security clearance

Security clearance

Not Required

Drug test required

No

Position sensitivity and risk

Moderate Risk (MR)

Trust determination process

Credentialing, Suitability/Fitness

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/dd/yy) 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.


3. College Transcripts. Although this position does not require a degree, you may substitute college credit in whole, or in part, for experience at specified grade levels. You must submit a copy of your transcript at the time of application in order to substitute your education for the required experience. If you do not submit a transcript, your education will not be considered in determining your qualifications for the position. You may submit an unofficial transcript or a list of college courses completed indicating course title, credit hours, and grades received. An official transcript is required if you are selected for the position.


College Transcripts and Foreign Education: Applicants who have completed part or all of their education outside of the U.S. must have their foreign education evaluated by an accredited organization to ensure that the foreign education is comparable to education received in accredited educational institutions in the U.S. For a listing of services that can perform this evaluation, visit the National Association of Credential Evaluation Services website. This list, which may not be all inclusive, is for informational purposes only and does not imply any endorsement of any specific agency.


PLEASE NOTE: A complete application package includes the online application, resume, transcripts (if qualifying through education substitution or a combination of education and experience) 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, transcripts (if applicable) and CMS required documents, will result in you not being considered for employment.

If you are relying on your education to meet qualification requirements:

Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

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. Learn 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 to Apply

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 01/21/2021 to receive consideration.


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


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

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month, day and year (e.g. June 18, 2007 to April 05, 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 Amanda.sullivan@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. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

Read more

Agency contact information

Amanda Sullivan

Email

Amanda.sullivan@cms.hhs.gov

Address

Center for Medicare and Medicaid Innovation
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

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


Within 30 business days of the closing date,01/21/2021, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

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  • Fair & Transparent

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

Equal Employment Opportunity Policy

The United States Government does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

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Reasonable Accommodation Policy

Federal agencies must provide reasonable accommodation to applicants with disabilities where appropriate. Applicants requiring reasonable accommodation for any part of the application process should follow the instructions in the job opportunity announcement. For any part of the remaining hiring process, applicants should contact the hiring agency directly. Determinations on requests for reasonable accommodation will be made on a case-by-case basis.

A reasonable accommodation is any change to a job, the work environment, or the way things are usually done that enables an individual with a disability to apply for a job, perform job duties or receive equal access to job benefits.

Under the Rehabilitation Act of 1973, federal agencies must provide reasonable accommodations when:

  • An applicant with a disability needs an accommodation to have an equal opportunity to apply for a job.
  • An employee with a disability needs an accommodation to perform the essential job duties or to gain access to the workplace.
  • An employee with a disability needs an accommodation to receive equal access to benefits, such as details, training, and office-sponsored events.

You can request a reasonable accommodation at any time during the application or hiring process or while on the job. Requests are considered on a case-by-case basis.

Learn more about disability employment and reasonable accommodations or how to contact an agency.

Read more

Legal and regulatory guidance

 
 

Clipped from: https://www.usajobs.gov/GetJob/ViewDetails/588778500

Posted on

Medicaid Researcher at Mathematica Policy Research

 
 

Position Description:
 

Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding using data science and analytics. Our work yields actionable information to guide decisions in wide-ranging policy areas, from health, education, early childhood, and family support to nutrition, employment, disability, and international development. Mathematica offers our employees competitive salaries, and a comprehensive benefits package, as well as the advantages of being 100 percent employee owned. As an employee stock owner, you will experience financial benefits of ESOP holdings that have increased in tandem with the company’s growth and financial strength. You will also be part of an independent, employee-owned firm that is able to define and further our mission, enhance our quality and accountability, and steadily grow our financial strength. Learn more about our benefits here.

Mathematica is searching for professionals with experience generating insights from data on Medicaid policy and programs at either the state or federal level. In particular, we are looking for individuals who can apply data analytics to support current and emerging work across any number of areas related to monitoring and improving Medicaid programs such as: Value-based purchasing and alternative payment models, enrollment trends, measures of delivery and quality of services for beneficiaries, and to discern outcomes of innovative programs and policies.

The successful candidate will join our group of over 400 health policy professionals, including staff with degrees in data analytics, public health, public policy, economics, behavioral or social sciences, economics, and other relevant disciplines. We offer our employees a stimulating team-oriented work environment, competitive salaries, and a comprehensive benefits package, as well as the advantages of employee ownership.
 

Duties of the position:

  • Participate actively and thoughtfully in multidisciplinary teams, drawing on your past experience with Medicaid programs
  • Help conduct research and technical assistance projects on topics related to state and federal Medicaid policy
  • Apply rigorous analytic thinking to the collection and interpretation of quantitative data including analysis of Medicaid administrative data
  • Bring creative ideas to the development of proposals for new projects
  • Author project reports, memos, technical assistance tools, issue briefs, and webinar presentations
  • Contribute to the growth, expertise, and institutional knowledge of staff working in the Medicaid area

Position Requirements:
 

Qualifications:

  • 3-8 years of experience working in health policy or health research, with a substantial portion of that time related to some aspect of the Medicaid program at the state or federal level
  • Masters or doctoral degree or equivalent experience in data analytics, public health, public policy, economics, behavioral or social sciences, economics, or other relevant disciplines
  • Demonstrated ability at modeling program outcomes would be ideal
  • Strong foundation in quantitative methods and a broad understanding of health policy issues
  • Excellent written and oral communication skills, including an ability to explain observations and findings to diverse stakeholder audiences including program administrators and policymakers
  • Demonstrated ability to provide task leadership and coordinate the work of multidisciplinary teams

Strong organizational skills and high level of attention to detail; flexibility to lead and manage multiple priorities, sometimes simultaneously, under deadlines

To apply, please submit a cover letter, resume, writing sample, and salary expectations at the time of your application.

This position offers an anticipated annual base salary of $90,000 – $140,000. This position may be eligible for a discretionary bonus based on company and individual performance.

Available Locations: Washington, DC; Princeton, NJ; Cambridge, MA; Woodlawn, MD; Ann Arbor, MI; Chicago, IL; Oakland, CA; Seattle, WA

Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on a project. If you are assigned to such a project, you will be required to obtain the requisite security clearance.

 
 

Clipped from: https://careers.mathematica.org/job/-/-/727/3773820176?source=Indeed.com&sourceType=PREMIUM_POST_SITE

 
 

 
 

Posted on

Special Program & Population Manager

TO APPLY

 Please visit the DCH jobsite link to review the job posting and apply:

 https://www.governmentjobs.com/careers/dchga/jobs/2944169/special-programs-populations-manager-00209921

Applicants who do not apply using the dchjobs link provided above will NOT be considered.

 
 

Pay Grade N
The Georgia Department of Community Health (DCH) is one of Georgia’s four health agencies serving the state’s growing population of almost 10 million people. DCH serves as the lead agency for Medicaid, oversees the State Health Benefit Plan (SHBP), Office of Health Planning, and includes Healthcare Facility Regulation (HFRD) impacting one in four Georgians.  Through effective planning, purchasing and oversight, DCH provides access to affordable, quality health care to millions of Georgians, including some of the state’s most vulnerable and under-served populations. Six enterprise offices support the work of the agency’s four program divisions. DCH employees are based in Atlanta, Cordele and across the state.  The position is based in Downtown Atlanta, GA (Fulton County).


DCH is seeking a qualified Special Programs & Population Manager within the Performance & Care Management Office of the Medical Assistance Plans (MAP) Division.  The MAP Division, which accounts for approximately three billion dollars annually of the State’s budget, is dedicated to advancing the health, wellness, and independence of those they serve by providing access to quality care and resources statewide to approximately 1.7 million Georgians. 

Job Responsibilities:

The Special Programs & Populations Manager is responsible for assisting in improving health outcomes for special populations.
 

Roles and responsibilities:

  • Reports to Clinical Programs & Quality Planning Director on activities and initiatives, including escalating any risks, issues, or concerns
  • Assist offices, practices, and CMO’s to facilitate initiatives related to improving health outcomes for special populations 
  • Finds new opportunities to offer new services to Medicaid members based upon researching other agencies or state plans that are succeeding 
  • Provides specialty program direction and leadership
  • Develops clinical strategies for SD&A programs that serve specific populations (e.g. EPSDT, pregnant women, ABD, SMI)

Minimum Qualifications:

Bachelor’s degree in a related field from an accredited college or university AND Four years of experience managing professional level staff

OR

Eight years of related professional experience AND Four years managing at the level equivalent to area of assignment
OR
Four years of experience required at the lower level Mgr 2, Business Ops (GSM011) or position equivalent.
 

Note:

An equivalent combination of education and job specific experience that provided the knowledge, experience and competencies required to successfully perform the job at the level listed may be substituted on a year-over-year basis.

 

Key Skills and Qualifications:

  • Strong background in Healthcare, Public Administration, or other health-related field
  • Significant experience working with special population in a clinical/hospital
  • Strong knowledge of leading clinical program practices
  • Social Work background or related experience
  • Significant experience working with special populations
  • Significant knowledge and understanding of federal, state, and CMS policies and regulations
  • Ability to establish and maintain effective working relationships with providers, CMO’s, sister agencies, and other DCH divisions
     

    Key Competencies:  

 
 

  1. Core

 
 

  1. Purpose Driven
  2. Customer Focused
  3. Results Oriented
  4. Clear and Timely Communicator
  5. Encourages Teamwork and Collaboration
  6. Holds Employees and Self Accountable
  7. Willing to Learn
  8. Organized and Meets Expected Deadlines
     
  1. Managerial

 
 

  1. Measure employee performance and provides learning opportunities to improve performance
  2. Delegates and utilizes resources efficiently
  3. Builds a strategy and vision to drive positive change for the Division
  4. Inspires others to achieve goals and collaborate with others
  5. Prioritizes and manages multiple tasks without sacrificing quality
  6. Identifies, manages, and mitigates risk
     
  1. Functional

 
 

  1. Exhibits attention to detail
  2. Builds strong relationships with internal and external stakeholders
  3. Thinks analytically and makes informed, meaningful decisions
  4. Develops innovative solutions to solve problems

Additional Information:

EARN MORE THAN A SALARY! In addition to a competitive salary, the Georgia Department of Community Health offers a generous benefits package, which includes employee retirement plan; paid holidays annually; vacation and sick leave; health, dental, vision, legal, disability, accidental death and dismemberment, health and child care spending account.
 

Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail. All qualified applicants will be considered, but may not necessarily receive an interview. Selected applicants will be contacted by the hiring agency for next steps in the selection process. Applicants who are not selected will not receive notification.

 

THIS POSITION IS SUBJECT TO CLOSE AT ANY TIME ONCE A SATISFACTORY APPLICANT POOL HAS BEEN IDENTIFIED.  Current Georgia state government employees will be subject to State personnel board (SPB)  rule provisions.  The position may be filled at a lower or higher position level.

 
This position is unclassified and employment is at-will.
Candidates for this position are subject to a background history and reference check.

 
 

TO APPLY

 Please visit the DCH jobsite link to review the job posting and apply:

 https://www.governmentjobs.com/careers/dchga/jobs/2944169/special-programs-populations-manager-00209921

Applicants who do not apply using the dchjobs link provided above will NOT be considered.

 

Posted on

Quality Improvement and Population Health Manager

  • Everywhere you turn, you can feel it.  There’s an immeasurable level of enthusiasm at East Boston Neighborhood Health Center (EBNHC), one of the largest community health centers in the country.  From the nurses and physicians on the front line of patient care, to the managers who shape our policies, to the customer service representatives who keep our facilities running smoothly – everyone here has a role in making medicine better.
    Interested in this position?  Apply on-line and create a personal candidate account!
    Current Employees of EBNHC – Please use the internal careers portal to apply for positions.
    To learn more about working at EBNHC and our benefits, check out our Careers Page at careers.ebnhc.org.
    Time Type:
    Full time
    Department:
    Quality
    All Locations:
    East Boston
    Description:
    EBNHC is a member of Community Care Cooperative (C3), an organization formed by 13 Federally Qualified FQHCs located throughout the Commonwealth of Massachusetts. C3, a 501(c)(3) non- profit Accountable Care Organization (ACO), is taking responsibility for managing the cost and quality of health care for MassHealth enrollees. C3’s vision is transforming the health of underserved communities. As a member of C3, EBNHC is uniquely positioned to be a true innovator in meeting quality goals and reducing cost of care for a large Medicaid population.
    The Population Health Manager (PHM) will be responsible for driving value based care initiatives at EBNHC. Partnering closely with EBNHC leadership, providers, and staff, you will integrate C3’s clinical programs and resources into the practice workflows with the intent to optimize the enrollee experience, and positively impact provider engagement and quality of care provided.
    Education

  • Bachelor’s Degree
    Experience

  • 5+ years of leadership experience in practice management, provider relations and project management

 
 

<https://ebnhc.wd1.myworkdayjobs.com/EBNHC/job/East-Boston/Quality-Improvement-and-Population-Health-Manager_R0002612?source=Indeed>

Posted on

Manager, Network and Analytics, Government Programs

Description

Job Summary: Oversees network and analytics strategy and execution for Delta Dental’s government business, including delivery of Medicaid and Medicare population health strategies. Directs matrix-oriented delivery model that ensures enterprise is delivering government-specific solutions unique to federal and state regulations.

Primary Job Responsibilities

1. Directs the daily activities of the team responsible for government programs network management, clinical performance, social determinants of health (SDOH), and the application of data analytics in maintaining optimal results.


2. Develops, recommends, and implements short and long term action plans in order to ensure the achievement of business unit goals.


3. Serves as leader in the development and monitoring of Medicare and Medicaid networks.


4. Establishes analytics function within the government programs business unit that is integrated into decision-making.


5. Communicates with and advises executive management on the planning and activities of government business.


6. Create and maintains governance of operational issues pertaining to government programs.


7. Supports business development efforts and serves as primary point of contact for network issues with clients.


8. Interviews, hires, evaluates, manages, and develops staff in order to ensure accountability for the achievement of departmental and individual goals and objectives.


Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

Location

Delta Dental MI-Farm Hills-DDFH

Requirements

Position requires a bachelor’s degree with an emphasis in business administration or a related field, seven years of experience in Medicaid, Medicare, insurance and / or clinical operations, and three years of leadership experience.

Position requires experience in provider contract network development, management, optimization and familiarity of various provider compensation models including fee-for-service, capitation, value-based reimbursement, risk sharing, etc.

Position also requires advanced knowledge of the managed care industry, strong verbal and written communication skills; strong interpersonal skills; and the ability to resolve complex problems using independent judgment.

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.

 
 

Clipped from: https://recruiting.adp.com/srccar/public/RTI.home?c=1214201&d=TRI&rb=INDEED&r=5000670111306#/

Posted on

Director of Appeals and Grievances (REMOTE) at Molina Healthcare

Molina Healthcare Job ID 2006424

Apply Now

Job Description
Job Summary
This role will have a heavy focus on leading our reporting and analytics in A&G. Responsibilities include leading an audit and analytics team, managing/improving quality reporting, analyzing trends and ad hoc reporting. Ideal candidates would have experience in Appeals & Grievances, Medicaid reporting and analytics and reporting.

Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid.

Knowledge/Skills/Abilities

  • Reviews and analyzes collective grievance and appeals data along with audit results on unit’s performance; analyzes and interprets trends and prepares reports that identify root causes of member/provider dissatisfaction
  • Recommends and implements process improvements to achieve member/provider satisfaction of operational effectiveness/efficiencies.
  • Leads, organizes, and directs the activities of the Appeals & Grievance unit that is responsible for member and provider Appeals and Grievances for Marketplace. 
  • Provides direct oversight, monitoring and training of provider dispute and appeals units to ensure adherence with Marketplace standards and requirements.
  • Trains grievance and appeals staff and other departments within Molina Marketplace on early recognition an timely routing of member complaints
  • Trains provider dispute resolution unit on Marketplace standards and requirements, including the proper use of the Molina Appeals and Grievance system.

Job Qualifications

  • Strong claims background
  • Universal Claims, Stop Loss, Surgery, Anesthesia, high dollar complicated claims, COB and DRG/RCC pricing).
  • Management of 100+ employee’s experience.
  • 7 years’ experience in healthcare claims review and/or member appeals and grievance processing/resolution, including 2 years in a manager role.
  • Experience reviewing all types of medical claims (e.g. HCFA 1500, Outpatient/Inpatient UB92, 2 years supervisory/management experience with appeals/grievance processing within a managed care setting.

Required Education
Associate’s Degree or 4 years of grievance and appeals experience.

Required License, Certification, Association

None

Preferred Education
Bachelor’s Degree

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type: Full Time Posting Date: 01/11/2021

 
 

Clipped from: https://careers.molinahealthcare.com/job/-/-/21726/18446736?src=Indeed


Posted on

Sr Enroll Medicaid Spec job in New York, New York | Sales & Marketing jobs at Healthfirst

The Senior Enrollment Medicaid Specialist will be the first source of job-related information and will support and assist with tasks/training relating to Integrated Products (IP), Management Services Organizations (MSO), Marketing Specialists and the PHSP lines of business within enrollment and retention. This includes, but is not limited to train/teach product, process and policy information at the onset of the hiring process as well as on a continuous basis. Being proficient in their ability to communicate with impact, apply critical thinking and possess leadership skills. The Senior Enrollment Medicaid Specialist will act as a role model and provide continuous coaching and feedback to the team. They will also assist and work closely with the Quality Performance Team in monitoring the quality of application submitted, track enrollment performance behaviors, identify areas for improvement and recommend to the proper Management Team. Senior Enrollment Medicaid Specialist will develop talent by identifying the Specialist strengths and suggest them for project work.

  • Interprets product, procedural and regulatory information, and assists with the development of training curricula to provide field staff with available services
  • Administer new hire training and refresher training to the Marketing Specialists, Relationship Coordinators, and Enrollment Medicaid Specialist teams
  • Participates in the development, implementation, and updates provided by Healthfirst to ensure departmental compliance
  • Due to the nature of additional responsibility, their home visits will be substantially lower than any of the other Enrollment Medicaid Specialists but will be required to make visits when needed
  • Provide expertise and customer service support to the teams and consumers.
  • Conduct observational field visits and provide guidance and support to the teams
  • Aids in increasing individual and team effectiveness by creating and distributing training resources, learning aids and process documentation to learners
  • Prepares and maintains reports/records on training program attendance and programs offered
  • Participates in any training-related projects as scheduled or otherwise directed by the Director of Training and is expected to provide viable input for all projects and ensure that all assignments are completed with quality and accuracy
  • Serve as the subject matter expert in all services offered
  • Liaison between Local Department of Social Services, New York Medicaid Choice, and internal department
  • Assist in the scheduling of staff for training
  • Must have excellent listening, as well as written and oral communication skills
  • Must have strong interpersonal skills and professional attitude

Minimum Qualifications:

  • Associate’s Degree
  • Proficiency in navigating the Internet and multitasking with multiple software/electronic documentation systems simultaneously
  • Excellent written communication and the ability to document grammatically correct notes and correspondence
  • Ability to be independent in making sound decisions and proactive in identifying and implementing process improvements
  • Aptitude for using a fast-paced proactive vs. reactive approach, maneuvering multiple tasks simultaneously including seamlessly changing priorities
  • Establish credibility and trust along with positive and affable working relationships with internal and external clients

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.

 
 

Clipped from: https://careers.healthfirst.org/us/en/job/R009061/Sr-Enroll-Medicaid-Spec?mode=job&iis=Job+Board&iisn=Indeed.com

 
 

Posted on

Medical Director – Medicaid

Medical Director – Medicaid (Remote)

Job Locations

Remote

Job ID

 
 

2020-10798

 
 

Category

 
 

Product Development

Overview

As the Medicaid Medical Director, Medicaid you will to be a part of our innovative product solution development team. You will assist in crafting products tailored for individuals covered by Medicaid to afford them the opportunity to successfully live, heal and age at home. You will be an integral part of internal and external client meetings, sales opportunities, product implementation and quality processes. 

 
 

Responsibilities

  • Serve as the Medicaid clinical lead for all quality, clinical, utilization management, and policies for Medicaid and LTSS programs.
  • Provide leadership and coordination for the development and implementation of a cohesive approach to measuring and promoting quality, and lead priority-setting process for clinical quality improvement for Medicaid and LTSS programs.
  • Provide clinical support and expertise focusing on Medicaid and LTSS for program development.
  • Participate in leadership, stakeholder and Advisory Board meetings
  • Build and maintain effective working relationships with cross-functional leaders and teams in order to identify, explore, present and implement Medicaid program opportunities.

Qualifications

  • MD or DO with an active and unencumbered medical license.
  • 5 years’ plus  experience in an area of relevant clinical practice
  • 5 years’ plus experience with a Medicaid health plan, or a State Medicaid Agency. LTSS population experience preferred.
  • Excellent verbal and written communication skills and be able to communicate effectively in large and small group settings.
  • Medicaid thought leader with market intelligence.
  • Experience with Medicaid and LTSS program utilization management, clinical management, program development, or program evaluation—either with a health plan, Medicaid Managed Care organization or state Medicaid Agency
  • Ability to develop, collaborate with, and support relationships with key stakeholders internally and externally (client CMOs and Medicaid Associations)

 
 

 
 

 
 

 
 

 
 

Clipped from: https://careers-carecentrix.icims.com/jobs/10798/job?utm_source=indeed_integration&iis=Job+Board&iisn=Indeed&indeed-apply-token=73a2d2b2a8d6d5c0a62696875eaebd669103652d3f0c2cd5445d3e66b1592b0f&mode=job&iis=Indeed&iisn=Indeed.com&mobile=false&width=1479&height=500&bga=true&needsRedirect=false&jan1offset=-360&jun1offset=-300

Posted on

MEDICAID PROGRAM MANAGER 1–A

 
 

Supplemental Information

Job Number: MVA/SAG/1961
 
 This position is located within the Louisiana Department of Health l Medical Vendor Administration l Program Integrity  l  EBR Parish.
 
 Cost Center: 0305-7104
 Position Number(s): 50550788
 
This vacancy is being announced as a Classified position and may be filled either as a Probationary Appointment, Job Appointment or Promotional Appointment.  

(Job Appointments are Temporary Appointments up to 48 months)

 
****REVIEW YOUR APPLICATION TO MAKE SURE IT IS CURRENT. Failure to provide your qualifying work experience may result in your application not being considered.****
 
 
There is no guarantee that everyone who applies to this posting will be interview.  The hiring supervisor/manager has 90 days from the closing date of the announcement to make a hiring decision.  Specific information about this job will be provided to you in the interview process, should you be selected.

No Civil Service test score is required in order to be considered for this vacancy.  
 
To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.
 
*Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.*
 
For further information about this vacancy contact:
Sanaretha Gray @ Sanaretha.Gray@la.gov    
LDH/HUMAN RESOURCES
P.O. BOX 4818 BATON ROUGE, LA 70821
225 342-6477
 

 

Qualifications

MINIMUM QUALIFICATIONS:

A baccalaureate degree plus four years of professional experience in administrative services, economics, public health, public relations, statistical analysis, social services, or health services.

 
 

SUBSTITUTIONS:
Six years of full-time work experience in any field may be substituted for the required baccalaureate degree.

Candidates without a baccalaureate degree may combine work experience and college credit to substitute for the baccalaureate degree as follows:


A maximum of 120 semester hours may be combined with experience to substitute for the baccalaureate degree.


30 to 59 semester hours credit will substitute for one year of experience towards the baccalaureate degree.

60 to 89 semester hours credit will substitute for two years of experience towards the baccalaureate degree.
90 to 119 semester hours credit will substitute for three years of experience towards the baccalaureate degree.
120 or more semester hours credit will substitute for four years of experience towards the baccalaureate degree.

College credit earned without obtaining a baccalaureate degree may be substituted for a maximum of four years full-time work experience towards the baccalaureate degree. Candidates with 120 or more semester hours of credit, but without a degree, must also have at least two years of full-time work experience tosubstitute for the baccalaureate degree.

 
 

Graduate training with eighteen semester hours in one or any combination of the following fields will substitute for a maximum of one year of the required experience on the basis of thirty semester hours for one year of experience: public health; public relations; counseling; social work; psychology; rehabilitation services; economics; statistics; experimental/applied statistics; business, public, or health administration.

 
 

A master’s degree in the above fields will substitute for one year of the required experience.

 
 

A Juris Doctorate will substitute for one year of the required experience.

 
 

Graduate training with less than a Ph.D. will substitute for a maximum of one year of the required experience.

 
 

A Ph.D. in the above fields will substitute for two years of the required experience.

 
 

Advanced degrees will substitute for a maximum of two years of the required experience.

 
 

NOTE:
Any college hours or degree must be from a school accredited by one of the following regional accrediting bodies: the Middle States Commission on Higher Education; the New England Association of Schools and Colleges; the Higher Learning Commission; the Northwest Commission on Colleges and Universities; the Southern Association of Colleges and Schools; and the Western Association of Schools and Colleges.

Job Concepts

Function of Work:
To administer small and less complex statewide Medicaid program(s).

Level of Work:

Program Manager.

Supervision Received:

Broad from a higher-level manager/administrator.

Supervision Exercised:

May provide functional supervision in accordance with the Civil Service Allocation Criteria Memo.

Location of Work:

Department of Health and Hospitals.

Job Distinctions:

Differs from Medicaid Program Monitor by responsibility for administering small and less complex statewide program(s).

Differs from Medicaid Program Manager 1-B by the absence of supervisory responsibility.


Differs from Medicaid Program Manager 2 by the absence of responsibility for administering medium size and moderately complex statewide program(s).

Examples of Work

Supervises the auditing of eligibility enrollment of all Medicaid programs statewide.

Reviews work of eligibility review staff for quality assurance.


Plans, coordinates, and controls small or less complex statewide program(s).


Plans, develops, implements and monitors comprehensive Medicaid program policies.


Conducts and directs studies/special projects pertaining to the programs assigned.


Analyzes the impact of federal, state, and local legislation; advises agency officials; prepares position statements; presents testimony at hearings; writes legislation.


Reviews and analyzes complex data and system reports to ensure compliance with program regulations.


Administers the day-to-day operational functions of the Medicaid fee for service programs. Assures that program policy and procedures are properly applies in accordance with federal and state laws and regulations.


Develops and writes agency rules and regulations governing the administration of all supervised Medicaid programs and submit them for publishing in the official state publication in accordance with the requirements of the Administrative Procedures Act.


Implements Medicaid regulations directing provider participation standards and recipient benefits. Analyzes multi-mullion dollar Medicaid claim data and project the fiscal impact for budget forecasting.


Identifies, verifies and analyzes the various revenue sources for the program(s). Determines and/or confirms match requirements. Monitors availability of revenue sources and promptly identifies existing or potential financing problems.

Benefits

Louisiana State Government represents a wide variety of career options and offers an outstanding opportunity to “make a difference” through public service. With an array of career opportunities in every major metropolitan center and in many rural areas, state employment provides an outstanding option to begin or continue your career. As a state employee, you will earn competitive pay, choose from a variety of benefits and have access to a great professional development program.

Flexible Working Arrangements – The flexibility of our system allows agencies to implement flexible working arrangements through the use of alternative work schedules, telecommuting and other flexibilities. These arrangements vary between hiring agencies.

Professional Development – The Comprehensive Public Training Program (CPTP) is the state-funded training program for state employees. Through CPTP, agencies are offered management development and supervisory training, and general application classes on topics as diverse as writing skills and computer software usage.

Insurance Coverage – Employees can choose one of several health insurance programs ranging from an HMO to the State’s own Group Benefits Insurance program. The State of Louisiana pays a portion of the cost for group health and life insurance. Dental and vision coverage are also available. More information can be found at www.groupbenefits.org.

Deferred Compensation – As a supplemental retirement savings plan for employees, the State offers a Deferred Compensation Plan for tax deferred savings.

Holidays and Leave – State employees receive the following paid holidays each year: New Year’s Day, Martin Luther King, Jr. Day, Mardi Gras, Good Friday, Memorial Day, Independence Day, Labor Day, Veteran’s Day, Thanksgiving Day and Christmas Day. Additional holidays may be proclaimed by the Governor. State employees earn sick and annual leave which can be accumulated and saved for future use. Your accrual rate increases as your years of service increase.

Retirement – State of Louisiana employees are eligible to participate in various retirement systems (based on the type of appointment and agency for which an employee works).  These retirement systems provide retirement allowances and other benefits for state officers and employees and their beneficiaries. State retirement systems may include (but are not limited to): Louisiana State Employees Retirement System (www.lasersonline.org), Teacher’s Retirement System of Louisiana (www.trsl.org), Louisiana School Employees’ Retirement System (www.lsers.net), among others. LASERS has provided this video to give you more detailed information about their system.

Clipped from: https://www.governmentjobs.com/careers/louisiana/jobs/2949308/medicaid-program-manager-1-a