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Apply for this job Business Development Capture Director – Medicaid + Location: National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint + Job Family: BUS > Strategy, Planning & Execution + Type: Full time + Date Posted:Jul 27, 2022 + Req #: JR8096 Description Our Government Business Division’s Growth Team is looking for a Business Development Capture Director – Medicaid to join its Business Development and Capture Group. Our Business Development Capture Director is a high-performing individual contributor role responsible for positioning and capture execution of Medicaid health plan procurement and re-procurement opportunities. Responsible for managing the strategy and preparations for upcoming Medicaid RFPs. Partners with Plan Presidents to lead the cross-functional team of health plan leaders and business development to identify gaps, mitigate risks, and develop solutions and strategy in months before an RFP. [This position can work remotely from any US Anthem location] Responsible for positioning and capture execution of Medicaid health plan procurement and re-procurement opportunities. Primary duties may include, but are not limited to: Monitor and evaluate white space opportunities to make go/no-go recommendations to executive leadership. Develop and execute plans for the pursuit and capture of all Medicaid managed care procurement opportunities, including Alliance partnership opportunities. Leads the cross-functional team of Growth Partners, Health Plan leaders, and Alliance partners (as applicable) to develop winning strategies and identify and mitigate risks and opportunities. Participates in bid decisions and develops recommendations for gate reviews. Collaborates with Health Plan Presidents and Health Plan leaders to understand current and emerging customer needs and requirements. Obtains market intelligence and competitive data to develop a market strategy. Participates in all levels of proposal development and draft review, providing active feedback and recommendations for improvement. Provides mentorship and coaching to other members of the broader Business Development team. Requires a BA/BS degree in a related field and a minimum of 10 years of experience in strategic planning and business development in Medicaid programs; or any combination of education and experience, which would provide an equivalent background. Highly preferred experience: -Previous P&L and/or business development experience and project management experience in Medicaid managed care setting. -Experience leading capture and proposal activities for significant opportunities ($1B and more). -Experience in a capture function or executive leadership function for a managed care-based product for state Medicaid agencies. -State Medicaid agency experience or federal agency experience with CMS. -MBA, MPH, or MPP. 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.ElevanceHealthinc.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 contactability@icareerhelp.comfor assistance. EEO is the LawEqual 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 Postero + EEO Poster Supplement-English Version + Pay Transparency + Privacy Notice for California Residents Elevance Health, Inc. is an E-verify Employer Need Assistance?Email us (elevancehealth@icareerhelp.com) or call 1-877-204-7664 Apply for this job

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Apply for this job now Location Austin, Texas Job Type Permanent Posted 28 Jul 2022

Job/Position DescriptionThe Medicaid / CHIP IT Management Analyst performs highly advanced (senior-level) professional administrative and IT management analysis. This position serves as a consultative and coordinative lead between programmatic leadership. The person performs a complex evaluation and analysis of project plans, operational activity, and strategic objectives of the program and IT divisions. May supervise the work of others. Works under minimal supervision, with extensive latitude for the use of initiative and independent judgment. Work involves the following: and; Oversees, plans and directs the review and assessment of project plans, timelines, deliverables, and governance structures.and; Develops new or modifies existing program policies, procedures, goals, and objectives. and; Advises management on the progress of readiness of project deliverables and helps determine the priorities, scope, purpose, objectives, timeframes, and resources necessary for these reviews. and; Reviews and evaluates recommendations for improvement and corrective actions necessary to ensure successful system and program policy implementations. and; Reviews technical documents, records and reports; interprets this information to identify alternatives and makes and justifies contractor readiness recommendations. and; Reviews Medicaid IT operational processing and recommends changes to optimize this processing. and; Communicates orally and in writing with all levels of agency and contractor staff. Essential Job FunctionsEJF Perform IT oversight through the review and analysis of system readiness review deliverables including a review of the underlying program policies, procedures, goals and objectives of these deliverables. Determine whether the deliverables meet agency requirements. Review the technical records included in these deliverables to interpret data, identify alternatives, and make recommendations for improvements. Design, evaluate, recommend and approve changes to forms and reports that comprise these deliverables. Recommend whether the quality and completeness of the deliverables is sufficient to recommend implementation readiness and/or deliverable acceptance. (30%) EJF Represent IT equities in readiness meetings and annual deliverable checklist meetings with program partners. Oversee, plan and direct organizational studies of work problems to improve the processes for developing and reviewing these deliverables. Develop timelines for receiving deliverables and track deliverable receipt against these timelines. Provide management reporting showing contractor progress in completing the deliverables and submitting them to the agency. Communicate to contractors, program area staff and IT management if a contractor is not meeting agreed upon timelines for deliverable submission. (30%) EJF Review the IT MCO oversight process and evaluate business and management practices to streamline this process. Develop or modify IT MCO oversight policies, procedures, goals and objectives. (5%) EJF Review agency audit findings for Medicaid systems, provide recommendations for management responses to fulfill audit requirements including both business operations and system changes, and track the progress of remediation activities associated with these audits. Review Medicaid project information associated with the claims administration and enrollment broker contracts. Recommend changes to deliverables or recommend acceptance of these deliverables. Evaluate industry developments and make Copy the URL in the preceding sentence to an Internet Explorer browser to apply to the job directly through the Texas Health and Human Services Career Portal.

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Details

• Job Reference: 670359394-2
  
• Date Posted: 28 July 2022
  
• Recruiter: Texas State Job Bank
  
• Location: Austin, Texas
  
• Salary: On Application
  
• Sector: I.T. & Communications
  
• Job Type: Permanent
  

 
 

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Hours: Monday – Friday 8 am – 5 pm. Location: Onsite – Helena, MT – Pay: $17/hr. The primary focus of this position is the evaluation, development, implementation and maintenance of a complete, effective internal training, education and communication…Trainer, Instructor, Business Services, Training

 
 

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Resp & Qualifications


COMPANY SUMMARY:


CareFirst, Inc., and its affiliated companies, generally referred to as CareFirst BlueCross BlueShield (CareFirst), is the Mid-Atlantic region’s largest private sector health insurer, serving the healthcare needs of 3.5 million members in Maryland, the District of Columbia, and portions of northern Virginia. The Company offers a comprehensive portfolio of products and services to individuals and groups, as well as state and federal government sponsored plans. With a market share almost three times that of the closest competitor, the company commands 45 percent penetration across the region.


In July 2018, Brian D. Pieninck assumed the role of President and CEO after serving as the company’s COO of Strategic Business Units and IT Division. Under his leadership, the organization completed an extensive review of its operations and clinical programs, resulting in an expansive 3-year strategy to grow and diversify the company’s core business. Along with a 5-year vision to drive the transformation of the healthcare experience across the continuum of its members, partners, and communities, the company has placed a renewed and intentional focus on fostering a mission-based culture, which drives every decision the company makes. The organization employs over 5,600 full-time employees in Maryland, Northern Virginia, the District of Columbia, and West Virginia. CareFirst has earned multiple workplace awards recognizing its leadership in diversity and inclusion, wellness engagement, and creation of a supportive and equitable work environment for all employees.


At CareFirst, you are part of an inspired, collaborative team that is building the healthcare experience we want for our families and our future. Every day, we make a meaningful difference in the communities where we live and work.


We practice empathy, seek to understand, invest in inclusion, demand equity and nurture belonging every day for our employees and the communities we serve. We rely on the rich diversity of our employees’ experiences and backgrounds to achieve our mission. Every year we host a Week of Equity and Action where we deepen our investment and commitment to diversity, equity, and inclusion. During this week thousands of employees engage in workshops and volunteerism with the goal of bettering themselves and our community.

• Women make up around 70% of CareFirst’s employee population, and over 50% identify as BIPOC (Black, Indigenous, and people of color).
  
• We have 9 resource groups that connect employees over shared identities (LGBTQ, veteran status, race, etc.) and passions (climate change, healthy living, leadership development).
  
• Employees are encouraged to give back and volunteer in their communities with their civic engagement hours.
  
  
  

As a not-for-profit, CareFirst regularly ranks among the most philanthropic organizations with $65 million invested in the community in 2020 to improve overall health, and increase the accessibility, affordability, safety, and quality of healthcare throughout its market area. The company’s employees consistently add to this impact by devoting thousands of volunteer hours to numerous community organizations and social causes. The company’s continued efforts to reinvest in community health care programs has repeatedly earned CareFirst regional accolades as a leading corporate philanthropist, including the No. 2 and No. 7 spots on the Baltimore Business Journal and Washington Business Journal’s 2019 list of top corporate givers, respectively.


PURPOSE


Utilizing the population health frameworks provided by NCQA Accreditation, HEDIS and CMS, this position is responsible for delivering culturally appropriate health promotion information to members that helps increase their access & reduce their barriers to preventive care resulting in industry-leading outcomes at a population level. Uses expertise in HEDIS and other technical quality measures and advanced member engagement techniques to ensure improved population health and accreditation results.


Essential Functions

• Conducts member and provider outreach designed to close member gaps in care, documenting such efforts in a manner that allows collaboration with other team members and other member-facing care delivery staff.
  
• Analyzes quality reports and claims data to assess up-to-the-minute member compliance status to a wide variety of quality measures, utilizing this information to improve compliance and member health outcomes.
  
• Collaborates with a variety of in-home & community-based providers to locate non-compliant members, managing member referrals to those providers for a variety of gap-closing quality campaigns. Maintains access to provider reporting of gap-closure outcomes and facilitates the transmission of such information as supplemental data where allowed.
  
• Maintains ongoing subject matter expertise in population health, measurement science, accreditation, and quality improvement. Utilizes the framework of NCQA Accreditation, HEDIS & CMS quality standards to accomplish and document the work products.
  
  
  

Qualifications


Education Level: Bachelor’s Degree in population health, public health, healthcare administration, business administration, health policy, economics, statistics, mathematics, data science, or a related field OR in lieu of a Bachelor’s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.


Experience: 3 years professional experience in a business environment (public health, health insurance, management consulting fields preferred); evidence of progressing levels of responsibility.


Preferred Qualifications

• Previous experience in member and provider engagement to influence behavior change and improved health outcomes.
  
• Certification in Quality or Process Improvement Methods.
  
• Direct experience with accreditation, HEDIS, CAHPS and other quality related activities a healthcare related environment and/or payor organization.
  
• Data analytics experience working with large data sets to answer clinical, operational, or business questions; prior experience with healthcare data expected.
  
  
  

Knowledge, Skills And Abilities (KSAs)

• Ability to engage health care consumer and/or health care providers in outcomes driven assessment, planning and execution of improvement activities.
  
• Expertise in qualitative and quantitative data analyses and presentations.
  
• End-to-end experience designing, developing, and implementing innovative strategies to improve population health.
  
• Ability to conduct advanced analytics using SQL, Python, R, or similar.
  
• Fluent in the use of Microsoft tools including Excel, Word, Power Point and Outlook.
  
• Knowledge of healthcare claims, survey, clinical, and health data.
  
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
  
  
  

Department

Department: MD Medicaid -QUALITY

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

Physical Demands

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

 
 

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This position has the opportunity to work from home 2 days a week

Job Purpose

The Senior Business Consultant is responsible for driving Medicaid divisional strategies for the following areas: financial performance, operational performance and compliance. She or he will lead major, complex, and strategic cross-divisional and enterprise-wide projects from inception to completion. Some specific responsibilities include project management and process improvement.

Required Job Qualifications

Bachelor’s Degree and 4 years of experience in business analysis, process improvement, project management, business operations or relevant health care industry experience
3 years of experience in project management, business analysis, process improvement, strategic planning, product administration or other relevant healthcare function
Experience communicating with senior management from multiple divisions
Experience developing and delivering executive presentations, written analysis, financial analysis and other business process & control documentation.
Problem resolution experience and skills.
Negotiations skills.
Verbal and written communications skills including establishing working relationships across departments, preparing presentations to senior management, and establishing team environment.
Organizational skills.
Experience managing multiple complex projects successfully.
Detail oriented.
PC proficiency to include MS Office products and VISIO

Preferred Job Qualifications

Medicaid business experience or other healthcare regulatory experience (ideal)
Experience supervising project teams/personnel (internal teams and external vendors)
1 – 2 years vendor management experience

#LI-LI1

#LI-Hybrid

*CA

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Requirements:
Expertise Government Programs Job Type Full-Time Regular Location IL – Downers Grove, IL – Chicago, IL – Naperville

 
 

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The Field Care Manager Nurse 2 assesses and evaluates member’s needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.

Location Requirement
This role requires residence in the Western Kentucky Region.
Must reside within the following Counties: Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Livingston, Marshall, McCracken, and Trigg

Description
Collaborate with members of an inter-disciplinary team to meet the needs of the individual and the population
Identify problems or opportunities that would benefit from care coordination
Engage the member and complete a health and psychosocial assessment, taking into account the cultural and linguistic needs of each member
Engage with the member in a variety of settings to establish an effective, professional relationship. Settings for engagement include but are not limited to; hospital, provider office, community agency, member s home, telephonic or electronic communication
Identify and prioritize the individual s care management needs and goals in collaboration with the member and caregivers
Identify and manage barriers to achievement of care plan goals
Identify and implement effective interventions based on clinical standards and best practices
Maximize the client s health, wellness, safety, adaptation, and self-care through effective care coordination and case management
Educate the member and other stakeholders about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made
Employ ongoing assessment and documentation to evaluate the member s response to the plan of care
Evaluate client satisfaction through open communication and monitoring of concerns or issues
Collaborate with facility based case managers and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner
Appropriately terminate care coordination services based upon established case closure guidelines
Provide clinical oversight and direction to unlicensed team members as appropriate
Document care coordination activities and member response in a timely manner according to standards of practice and policies regarding professional documentation
Looks for ways to improve the process to make the members experience easier and shares with leadership to make it a standard, repeatable process
Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program

Required Qualifications
Registered Nurse Licensed in the State of Kentucky without restrictions.
Three to five (3-5) years varied experience in nursing/healthcare fields (discharge planning, case management, care coordination, and/or home/community health experience)
Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
Collaborate with team members to optimize outcomes for members
Strong advocate for members at all levels of care
Strong understanding and respect of all cultures and demographic diversity
Proven track record of demonstrating empathy and compassion for individuals
Exceptional communication and interpersonal skills with the ability to quickly build rapport
Ability to work with minimal supervision within the role and scope
Ability to use a variety of electronic information applications/software programs including electronic medical records

Additional Requirements/Adherence:

Work Style:
Combination remote work at home and onsite member field visits

Locations:
Must reside in or within a 50 mile radius of the following Western Kentucky counties: Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Livingston, Marshall, McCracken, and Trigg

Hours:
Monday through Friday 8:00 AM to 6:00 PM Eastern Time

Travel:
Must be willing to travel 25% to meet with members.

Humana’s Driver Safety Program:
This role is a part of Humana’s Driver Safety program and therefore requires and individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,00 limits
Valid driver’s license, car insurance, and access to an automobile

TB Screening:
This role is considered patient facing and is a part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Work at Home Requirement Internet and Home Office
requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications
Bachelor s of Science in Nursing (BSN) preferred
Five (5) years or more clinical experience is preferred
Three (3) years or more Medicaid and/or Medicare managed care experience is preferred
Certification in Case Management
Bilingual English and Spanish – Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in both languages.

Additional Information:

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

You will be able to respond to the recruiters preferred response method via text, video or voice technologies If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn t missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Covid Vaccination Processes:

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Job Type: Full-time

Schedule:
8 hour shift

License/Certification:
RN in the state of Kentucky without restrictions (Preferred)

Work Location: Multiple Locations

 
 

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Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
Performs technical work in obtaining Medicaid/Social Security (SSI) insurance coverage for indigent patients to expedite reimbursement for medical services. Positions take the patient through the entire Medicaid application process from application to award or denial. Positions have authority to represent the Health Care System at each of the four levels of appeals when applications are denied.

Responsibilities:
1. Obtains detailed personal, financial and asset information to determine if patient qualifies for one of ten Medicaid/SSI programs. Completes or assists the patient with completion of Medicaid application. Explains the programs and advises patients of methods to become eligible by rearranging finances and assets. Follows through with applicants to obtain accurate and complete information within strict timeframes. Positions must have substantive knowledge of various rules and regulations governing the ten Medicaid programs. Interprets and applies frequent changes in program regulations to expedite applications.
2. Reviews denials from Medicaid/SSI and researches denial information with patients. Advocates for patient coverage with local and state Medicaid offices to obtain reversal of initial denial. Abstracts information, prepares appeals and represents UNC Health Care System in appeal hearings at local, state (Division of Medical Assistance), Office of Administrative Hearings, and state court to present supportive evidence for patient’s denial reversal
 

Other Information

Education Requirements:

Associate’s degree in an appropriate discipline (or equivalent combination of education, training and experience).
Licensure/Certification Requirements:
No licensure or certification required.
Professional Experience Requirements:
If an Associate’s degree: Two (2) years of experience in a social services or healthcare organization.
If a High School diploma or GED: Four (4) years of experience in a social services or healthcare organization.
Knowledge/Skills/and Abilities Requirements:
Analytical, Customer Service, Direct Patient/Family Interaction/ Hospital/Healthcare Experience, Interpersonal, Report Preparation, Strong Written and Verbal Communication skills.
 

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services
 

Organization Unit: Medicaid Eligibility

Work Type: Full Time
 

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

 
 

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The Field Care Manager Nurse 2 assesses and evaluates member’s needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.

Location Requirement
This role requires residence in the Western Kentucky Region.
Must reside within the following Counties: Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Livingston, Marshall, McCracken, and Trigg

Description
Collaborate with members of an inter-disciplinary team to meet the needs of the individual and the population
Identify problems or opportunities that would benefit from care coordination
Engage the member and complete a health and psychosocial assessment, taking into account the cultural and linguistic needs of each member
Engage with the member in a variety of settings to establish an effective, professional relationship. Settings for engagement include but are not limited to; hospital, provider office, community agency, member s home, telephonic or electronic communication
Identify and prioritize the individual s care management needs and goals in collaboration with the member and caregivers
Identify and manage barriers to achievement of care plan goals
Identify and implement effective interventions based on clinical standards and best practices
Maximize the client s health, wellness, safety, adaptation, and self-care through effective care coordination and case management
Educate the member and other stakeholders about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made
Employ ongoing assessment and documentation to evaluate the member s response to the plan of care
Evaluate client satisfaction through open communication and monitoring of concerns or issues
Collaborate with facility based case managers and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner
Appropriately terminate care coordination services based upon established case closure guidelines
Provide clinical oversight and direction to unlicensed team members as appropriate
Document care coordination activities and member response in a timely manner according to standards of practice and policies regarding professional documentation
Looks for ways to improve the process to make the members experience easier and shares with leadership to make it a standard, repeatable process
Regular travel to conduct member visits, provider visits and community based visits as needed to ensure effective administration of the program

Required Qualifications
Registered Nurse Licensed in the State of Kentucky without restrictions.
Three to five (3-5) years varied experience in nursing/healthcare fields (discharge planning, case management, care coordination, and/or home/community health experience)
Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
Collaborate with team members to optimize outcomes for members
Strong advocate for members at all levels of care
Strong understanding and respect of all cultures and demographic diversity
Proven track record of demonstrating empathy and compassion for individuals
Exceptional communication and interpersonal skills with the ability to quickly build rapport
Ability to work with minimal supervision within the role and scope
Ability to use a variety of electronic information applications/software programs including electronic medical records

Additional Requirements/Adherence:

Work Style:
Combination remote work at home and onsite member field visits

Locations:
Must reside in or within a 50 mile radius of the following Western Kentucky counties: Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Livingston, Marshall, McCracken, and Trigg

Hours:
Monday through Friday 8:00 AM to 6:00 PM Eastern Time

Travel:
Must be willing to travel 25% to meet with members.

Humana’s Driver Safety Program:
This role is a part of Humana’s Driver Safety program and therefore requires and individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,00 limits
Valid driver’s license, car insurance, and access to an automobile

TB Screening:
This role is considered patient facing and is a part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Work at Home Requirement Internet and Home Office
requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications
Bachelor s of Science in Nursing (BSN) preferred
Five (5) years or more clinical experience is preferred
Three (3) years or more Medicaid and/or Medicare managed care experience is preferred
Certification in Case Management
Bilingual English and Spanish – Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in both languages.

Additional Information:

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

You will be able to respond to the recruiters preferred response method via text, video or voice technologies If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn t missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Covid Vaccination Processes:

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Job Type: Full-time

Schedule:
8 hour shift

License/Certification:
RN in the state of Kentucky without restrictions (Preferred)

Work Location: Multiple Locations

 
 

Clipped from: https://jobs.wavy.com/jobs/rn-field-case-manager-medicaid-western-kentucky-region-fulton-kentucky/670374543-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

• 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 companys 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. Read more about our benefits here:

About the opportunity:We currently have openings for Advisory Services/Project Management Analysts with a strong interest in project management in our Medicaid project area. This role blends management, research, and technical assistance. As such, we are seeking prospective employees with a passion for project management and an interest in improving government operations and health care delivery. In particular, we are looking for individuals who can support current and emerging work across any number of areas related to monitoring and improving Medicaid programs such as: Medicaid managed care programs, value-based purchasing and alternative payment models, long-term services and supports, measures of delivery and quality of services for beneficiaries, data analytics, and outcomes of innovative programs and policies. Advisory services analysts work on a variety of projects spanning policy and programmatic areas and are likely to be connected to 2-3 projects at a time. These projects range from data analytics to program evaluation to implementation support. Candidates do not need to have experience in all of these areas but should have experience in at least one of them.

Across all projects, Advisory Services/Project Management Analysts are expected to: Provide the direction and organization needed to help keep Medicaid projects on time and on budget and facilitate communications across and between internal and external stakeholders. Conduct project management activities, such as helping project directors plan, manage, and close out complex projects and designing, implementing, and monitoring tools and processes to help organize data and manage teams. Perform complex analyses of projects to monitor and evaluate project performance and progress, including monitoring project costs, assessing earned value, and overseeing subcontractors. Develop and maintain project collaboration tools, including Microsoft Project schedules, SharePoint websites, Jira trackers, and Excel spreadsheets. Provide technical assistance to state and federal health agencies or healthcare providers by designing webinars or responding to questions from stakeholders. Draft client memos, technical documentation, proposals and other contractual deliverables, such as chapters for reports, case studies, and/or data dictionaries.

• Position Requirements :
  

Masters degree in public policy, public administration, business, or related field; or commensurate experience in operations or management-oriented positions Strong management skills, including ability to monitor costs on multimillion-dollar contracts, mentor staff, and oversee small teams to complete work within tight timelines without compromising on quality. Strong organizational skills and high level of attention to detail; flexibility to manage multiple priorities, sometimes simultaneously, under deadlines. Excellent oral and written communication skills, for example the ability to write clear and concise technical documentation, and to communicate with clients diplomatically. Strong analytic and problem-solving skills, and ability to apply critical and creative thinking to identify solutions and respond to client requests in situations where guidance is unclear or absent. Professional experience in a similar field or position Interest in improving and researching Medicaid and other government programs, and/or providing technical assistance to health care entities. Some travel may be required

Desired Skills and Experience: Work experience with a state or federal agency, a foundation, or health care. program is highly desirable, as is prior experience working with Medicaid data. Knowledge of quantitative and/or qualitative research methods. Experience with management tools, such as Microsoft Project and Jira. Certifications demonstrating management proficiency and expertise, such as Project Management Professional (PMP) or Lean Six Sigma Experience engaging a range of client stakeholders by applying a variety of approaches (such as human-centered design). Experience bridging between business owners and technical staff Basic knowledge of software development lifecycles, and agile development.

Please submit a cover letter and your resume along with a work product that demonstrates analytic skills and reflects independent analysis and writing, such as a capstone project, analytic report, or a management plan (nothing company confidential, please).Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on the project. If you are assigned to such a project, you will be required to obtain the requisite security clearance.

This position is open in the following cities and states; however, we are all currently working from home and provide the support and flexibility needed to work from home. We ask the candidates to identify their preferred location for when we return to working in-person.

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

This position offers an anticipated annual base salary range of $60,000-$95,000.This position may be eligible for a discretionary bonus based on company and individual performance.

In accordance with Executive Order 14042 and its implementing guidelines, all Mathematica employees must provide documentation that they have been fully vaccinated or obtain an accommodation through Human Resources by providing documentation from a licensed health care provider that they are unable to be vaccinated against COVID-19 because of a disability (which would include medical conditions) or provide an attestation that they are entitled to an accommodation because of a sincerely held religious belief, practice, or observance.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
 

Clipped from: https://jobs.wgno.com/jobs/advisory-services-project-management-analyst-medicaid-princeton-new-jersey/670275804-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

Days: Monday – Friday

Shifts: 8:00am – 4:30pm (With a half hour lunch) and 2 company paid 15 min breaks

Hourly: Compensation is based on experience and will range from $13.50- $14.50

Bonus Potential: Average commissions range from $0-$300 per month after 90 days

Full Benefits after 90 days: Medical, Dental, Vision, Life Insurance, 401(k), PTO

 
 

No one wakes up in the morning and says, “Today I want to go to the hospital”. We are here to help when the unexpected happens. Hospital Referral Services (HRS) Insurance Representative will help patient’s via phone to see what assistance programs the uninsured or underinsured may be eligible to receive.
We are looking for self-motivated professional to add to our growing team. If helping people is something you enjoy, this may be the right job for you. HRS’s team of experts helps guide patients through the Medicaid process so the patient can focus on recovery.

 
 

• Screen/Interview patients for insurance eligibility in outbound dialer environment
  
• Research and respond to all medical billing inquiries or requests to obtain account resolution.
  
• Provide thorough, efficient, and accurate documentation in required systems for each work activity.
  
• Review open accounts to determine, take appropriate actions, distribute, and follow-up on all requests submitted.
  
• The Outpatient Medicaid Eligibility Representative is responsible for meeting goals and quality standards through efficient and accurate work activities.
  
• Knowledge, understanding, and compliance with all applicable Federal, State, and Local laws and regulations.
  
• Make recommendations to implement improved processes.
  
• The Outpatient Medicaid Eligibility Representative will perform other duties as assigned by management.
  

 
 

Requirements:

• 1-3 years Dialer call center environment – (minimum of 60 calls daily)
  
• 1-3 years of previous healthcare eligibility experience
  
• Intermediate knowledge and understanding of insurance/patient billing and collections.
  
• Ability to maintain the highest level of confidentiality, customer service, and knowledge of HIPAA.
  
• Proficient personal computer skills including Microsoft Office – able to type at least 40 WPM
  
• The Outpatient Medicaid Eligibility Representative must have the ability to multi-task and have good time management skills.
  
• High School Diploma or GED – (Associate’s degree preferred)
  

Training for the Outpatient Medicaid Eligibility Representative:

• In office training will include HIPAA regulations, Revenue Group procedures, Medicaid eligibility, role-playing, client systems and procedures.
  
• In office floor training: This will include observation of veteran representatives and supervised calls.
  

Clipped from: https://jobs.yourcentralvalley.com/jobs/outpatient-medicaid-eligibility-representative-cleveland-ohio/670608171-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic