Author: MM_ADMIN

 
 

Are you interested in working in a dynamic environment that offers opportunities for professional growth and new responsibilities? Are you interested in helping clients drive transformative healthcare solutions? Are you interested in joining an actuarial practice that is a leading global advisor and implementation partner working with State and Federal governments, health plans, providers, drug and device manufacturers and other organizations around the world? If you are seeking a role that offers you the opportunity to advise Government and Public Services (GPS) clients through critical and complex issues, while allowing you to develop personally and professionally, consider a career in Deloitte’s Actuarial and Insurance Solutions practice.

Work you’ll do

The Senior Manager will be expected to lead complex client initiatives and engagement teams working on Medicaid related projects. They will support the development and maintenance of strong relationships with senior client leadership. They should help develop the more junior members of the engagement team and deepen their understanding of the political, policy, financial and business aspects of the Medicaid program.

Delivery expectations of the Senior Manager includes:

•Anticipates client needs based on a strong understanding of the client and its industry and marketplace.

•Determines client needs by guiding teams in selecting and applying the most appropriate tools, techniques, and approaches to understand the client’s issues and opportunities.

•Integrates recommendations into a total solution for the client that is consistent with the engagement strategy.

•Challenges and enhances quality by consistently striving for ways to improve deliverables.

•Directs the team to provide exceptional service to the client by responding with a sense of urgency, practicality, accountability, integrity, and respect.

•Communicates regularly with client management on a variety of business topics (e.g., trends, innovations, problem-solving discussions)

•Demonstrate specific service area/competency and/or industry expertise that resulted in tangible value for the client.

Market, Sales, and Communication: The Senior Manager will be expected to broaden relationships at the most senior levels within current and potential state and local healthcare clients and to translate this into new business opportunities. They will work closely with the practice to win additional consulting work with the existing accounts and to acquire new accounts.

The team

With more than 40 years of experience in assisting state health and human services agencies in nearly every state, Deloitte understands how delivery works-and how it can work better. Our state health team offers industry-leading insights, solutions, and business practices to help state health agencies solve their most difficult challenges, ranging from modernization of eligibility determination systems and compliance with Federal Health Insurance Exchange requirements to innovative Medicaid tools and services that can help states serve their constituents more effectively.

Deloitte helps state Medicaid agencies design and implement initiatives that improve upon the management of their health programs, overall financial performance, and health outcomes. Our advisory services and solutions focus on four critical areas: policy and program design, analytics, organizational transformation, and ongoing program evaluation. In an environment in which states are being asked to do more with less, Deloitte brings a wealth of knowledge, experience and solutions to help health agencies plan for the future.

Qualifications Required:

+ At least 10 years of healthcare experience working either with a state Health and Human Services agency or with a health plan or consulting company serving healthcare clients. Demonstrated experience working on Medicaid related issues including Medicaid managed care, value-based purchasing, 1115 transformation waivers, social determinants for health, managed long term services and supports, home and community based services, physical and behavioral health coordination, Medicaid enterprise solutions, quality measurement and analytics and fee for service operations

+ Track record of leading and growing strong teams of management consultants or other organizational groups, with ability to manage across multiple engagements

+ Outstanding leadership skills, verbal and written communication skills, presentation skills, team working skills and ethical standards. This individual should be looked upon as a role model who instills the pride, values and integrity of Deloitte in their team.

+ Experience supporting Medicaid programs

+ Experience mentoring and coaching others

+ Business development experience (pre-sales, proposal, and RFP experience)

+ Experience leading teams and managing client/executive relationships

+ Willingness to travel at least 25%

Proficient PowerPoint, Word, Visio, Access, and Project

For individuals assigned and/or hired to work in Colorado, Deloitte is required by law to include a reasonable estimate of the compensation range for this role. This compensation range is specific to the State of Colorado and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and delivery model. We would not anticipate that the individual hired into this role would land at or near the top end of the range, but such a decision will be dependent on the facts and circumstances of each case. A reasonable estimate of the range is $131,000 – $219,000. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.

Clipped from: https://www.mendeley.com/careers/job/senior-manager-medicaid-health-transformation-services-15176068?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

We are currently looking for a Senior UX Designer for one or our CMS Programs.

Ad Hoc is a digital services company that helps the federal government better serve people. Our teams use modern, agile methods to meet the needs of our users while closing the gap between consumer expectations and government. We’re looking for people with an entrepreneurial spirit and the desire to improve how the government serves people. If you thrive on change and can see the possibilities in ambiguity, then we want you here with us.

Work on things that matter Working at Ad Hoc means putting your time and skills towards helping the government better serve the public. Our teams connect Veterans with services designed for their needs, help millions of people access affordable health care, and support important programs like Head Start. As we work with agencies to deliver critical services, we’re also changing how the government thinks about and uses technology.

Built for a remote life
Ad Hoc is remote-first and remote-always. We’ve designed our culture, communications, and tools to support a nationwide team since the beginning. Being remote by design allows Ad Hoc to bring the best people onto our teams and give them the freedom to create a work environment that fits their lives. With a generous PTO policy and Slack channels for every interest (from bird watching to space nerds to home decor), our company culture acknowledges all the things happening in your life. Maybe you need to adjust your schedule to care for your family or take a bike ride. At Ad Hoc, that’s welcomed.

What matters most
Ad Hoc values acceptance, accountability, and humility. We aren’t heroes. We leave our egos at the door to learn from our mistakes and improve the process for the next time. We’re a team that loves the challenge of government-size projects and loves to see our customers succeed. We build small, inclusive teams to bring the best of consumer technology to the problems of government.

The CMS business unit covers our work with the Centers for Medicare & Medicaid Services, including HealthCare.gov , Medicare.gov , and the Blue Button API . Our team supports CMS in building and improving online public experiences and APIs that are reliable, accessible, and user-centered. We are deeply embedded within CMS, partnering agency-wide to include with the Office of Communications, Office of Enterprise Data and Analytics, Center for Medicaid and CHIP Services, and Center for Medicare and Medicaid Innovation. Our work includes helping millions of people enroll in healthcare and access Medicare and Medicaid benefits, as well as helping CMS improve the quality of Medicare and Medicaid services for beneficiaries and clinicians.

What you’ll do as a Senior UX Designer


As an Ad Hoc Senior UX Designer, you’ll be part of a cross-functional team, working closely with stakeholders, product managers, and software engineers. With projects spanning from user interface design to service design, our designers tend to be generalists, with some developing skills in accessibility or user research. No matter where your particular interests lie, we may have something for you. Some of your responsibilities will include:

• Delivering design work, including discovery artifacts, sketches and rough prototypes, wireframes, UX flows, and high fidelity prototypes
  
• Managing deadlines through teamwork
  
• Using your design skills to make strong typography, layout, and hierarchy choices
  
• Providing design critique, heuristic evaluations, and competitive analysis
  
• Providing and receiving mentorship from other designers
  
• Contributing to design libraries and providing visual design and brand artifacts
  
• Participating in company initiatives and recruiting efforts
  
• Creating business development materials
  

Some basic requirements

• All work must be conducted within the U.S., excluding U.S. territories
  
• As a government contractor, you may be required to obtain a public trust security clearance
  
• Some of our available roles are on federal contracts that require a degree or additional years of experience as a substitute
  
• Some federal contracts require U.S. citizenship to be eligible for employment
  
• Years of Experience: 10 years
  
• Degree requirement: Bachelors in Design
  

Tips for applying

• If your application seems like a good match, we’ll invite you to complete a quick writing assignment, which we evaluate blindly. This helps us have a greater understanding of how you approach design problems, while also reducing bias from our hiring process. We will not ask you to do any form of whiteboarding or spec work .
  
• Include a portfolio of 3-5 UX-focused work samples with your application. We want to understand how you think and solve problems. Clearly explain your process and the reasoning behind the decisions made, include visual artifacts, and identify both your role and the impact you had. Your portfolio can be anything from a website to a slide deck. How you build it is up to you.
  

Ad Hoc is a great place to be. Our benefits package includes:

• Company-subsidized health, dental, life, and vision insurance
  
• Use what you need vacation policy
  
• 401K with employer match
  
• Paid parental leave after one year
  
• $2,000 continuing education/annual conference attendance stipend
  

Ad Hoc LLC is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, sex, sexual orientation, gender identity or expression, religion, age, pregnancy, disability, work-related injury, covered veteran status, political ideology, marital status, or any other factor that the law protects from employment discrimination.

In support of theColorado Equal Pay Transparency Act, and others like it across the country, Ad Hoc job descriptions feature the starting range we reasonably expect to pay to candidates who would join our team with little to no need for training on the responsibilities we’ve outlined above. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and responsibility. The range of starting pay for this role is $108,006 – $122,023 and information on benefits offered is here. Our recruiters will be happy to answer any questions you may have, and we look forward to learning more about your salary requirements.

 
 

Clipped from: https://jobs.cbs17.com/jobs/senior-ux-designer-cms-remote-huntsville-alabama/657829446-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Requisition No: 693784


Agency: Office of the Attorney General


Working Title: MEDICAID FRAUD ANALYST II – 41000989


Position Number: 41000989


Salary: $32,697 – $37,000


Posting Closing Date: 07/24/2022


This position may be filled in Tallahassee, Fort Lauderdale, Jacksonville, Miami, West Palm Beach, Orlando, and Tampa.


Our Organization and Mission:
The Office represents the State of Florida in state and federal civil and criminal courts, from trial courts to the Supreme Court of the United States.


Pay: $32,697 – $37,000 Annually

Position Summary: This position is in the Medicaid Fraud Unit. The incumbent in this position provides analytical support for attorneys and investigators in Florida-specific and multistate health care fraud investigations and litigation matters. The incumbent also performs work conducting detailed research and analysis of investigative information relating to alleged violations of applicable laws pertaining to health care fraud, in the administration of the Medicaid program, and/or the alleged abuse or neglect of patients in health care facilities governed by the State Medicaid program. In addition, the incumbent may also perform as lead analyst on specialized complex civil enforcement investigations and litigation matters and analytical projects.


Qualifications: A bachelor’s degree from an accredited college or university and one year of professional experience in research, investigations, investigative analysis, or statistics.


Professional or nonprofessional experience as described above can substitute on a year-for-year basis for the required college education.


Preference will be given to candidates who have experience compiling and analyzing investigative information, or experience in the use of spreadsheets and relational database applications.

The Work You Will Do: The responsibilities of this position include, but are not limited to the following:

• 35% Create customized downloads from on-line Medicaid claims data warehouse as requested by investigators, attorneys, and multistate investigative and litigation teams.
  
• 25% Prepare reports/schedules/charts pertaining to all aspects of the analysis and research for use in criminal prosecution, civil actions, and administrative referrals.
  
• 20% Assists and supports Medicaid fraud investigators and attorneys in the compilation and analysis of investigative information and the development of damages models for use in Florida specific and multistate health care fraud investigations and litigation. Obtains and analyzes large amounts of data to interpret and summarize health care fraud activity, calculate damages sustained to the Florida Medicaid program, determine significance, completeness, and usefulness of data, recognize, and identify patterns and trends, and brief investigators and attorneys.
  
• 10% Extract information from investigative databases. Compile, analyze and disseminate intelligence information retrieved from various computer databases/systems. Perform various duties related to computers.
  
• 5% Assist in the prosecution of Medicaid fraud and/or patient abuse to include testimony in courts of law pertaining to the investigation.
  
• 5% Other duties as assigned.
   
  

Other Requirements: Experience in compiling and analyzing investigative information to include financial and/or statistical data. Experience in creating reports based on information analyzed for use in criminal, civil, and administrative proceedings. Must have strong computer knowledge in the use of spreadsheet and data base applications.

• SKILLS VERIFICATION TEST ** All applicants who meet the screening criteria/minimum job requirements will be required to take a timed Skills Verification Test. Applicants must receive a score of at least 70% to move to the interview phase.
  
  
  

The Benefits of Working for the State of Florida:
Working for the State of Florida is more than a paycheck. The State’s total compensation package for employees features a highly competitive set of employee benefits including:

• Annual and Sick Leave benefits.
  
• Nine paid holidays and one Personal Holiday each year.
  
• State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance option.
  
• Retirement plan options, including employer contributions (For more information, please click www.myfrs.com ).
  
• Flexible Spending Accounts
  
• Tuition waivers.
  
• And more! For a more complete list of benefits, visit www.mybenefits.myflorida.com .
   
  

IMPORTANT NOTICE: To be considered for the position, all applicants must:


Submit a complete and accurate application profile necessary for qualifying such as dates of service, reason for leaving, etc. In addition, all applicants must ensure all employment and/or detailed information about work experience is listed on the application (including military service, self-employment, job-related volunteer work, internships, etc.) and that gaps in employment are explained. NOTE: Any required experience and/or preferences listed in the advertisement must be verified at the time of application.

• Ensure that applicant responses to qualifying questions are verifiable by skills and/or experience stated on the employment application and/or resume. Applicants who do not respond to the qualifying questions will not be considered for this position.
  
• The elements of the selection process may include a skill assessment exercise.
  
• Current and future vacancies may be filled from this advertisement for a period of up to six months. Following the six-month period, a new application must be submitted to an open advertisement to be considered for that vacancy.
  
• OAG employees are paid biweekly. All state employees are required to participate in the direct deposit program pursuant to s. 110.113, FS.
   
  

CRIMINAL BACKGROUND CHECKS/ DRUG FREE WORKPLACE:
All OAG positions are “sensitive or special trust” and require favorable results on a background investigation including fingerprinting, pursuant to s. 110.1127(2)(a), F.S. The State of Florida supports a Drug-Free Workplace, all employees are subject to reasonable suspicion or other drug testing in accordance with section 112.0455, F.S., Drug-Free Workplace Act. We hire only U.S. citizens and those lawfully authorized to work in the U.S.


E-VERIFY STATEMENT:
The Office of the Attorney General participates in the U.S. government’s employment eligibility verification program (e-verify). E-verify is a program that electronically confirms an employee’s eligibility to work in the United States after completion of the employment eligibility verification form (i-9).


REMINDERS:
Male applicants born on or after October 1, 1962, will not be eligible for hire or promotion unless they are registered with the Selective Service System (SSS) before their 26th birthday, or have a Letter of Registration Exemption from SSS. For more information, please visit the SSS website at: https: //www.sss.gov. If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be canceled, suspended, or deemed ineligible depending upon the date of your retirement.


The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.


Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.


The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.


VETERANS’ PREFERENCE. Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans’ Preference documentation requirements are available by clicking here . All documentation is due by the close of the vacancy announcement.

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-fraud-analyst-ii-41000989-at-state-of-florida-3171447135/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Overview

About Fallon Health:

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

Summary:

The Senior Medical Director will work closely with other physician management staff in clinical integration activities with providers and provide clinical support for all Care Services functions, including Pharmacy Programs, Quality & Health Services activities, Network Management support and development of population health management programs. This physician executive will be looked upon to assist the Chief Medical Officer in collaborative development of the medical management model and new care management initiatives for the Health Plan. This individual will also work closely with the reporting and analytics department and represent the clinical team in clinical vendor relationships. Further, this individual will provide leadership and clinical mentoring for the care management professionals and must be skilled at working collaboratively with both clinical and non-clinical staff.

Responsibilities

• Provide input for all quality management and quality improvement programs (e.g., NCQA and CMS Stars) including policies, procedures, protocols, and systems to support and promote the consistent delivery of high-quality medical care and optimization of member health.
  
• Provide input for health and wellness programs, case management programs, disease management programs, program quality and support, and clinical program innovation.
  
• In collaboration with the Directors of Quality and Population Management support the Health Plan’s Quality and Chronic Condition Management programs. Functions as the medical director champion for all HEDIS activity. Focuses on the integration of HEDIS activities.
  
• Identify and develop business cases for initiatives to achieve clinically and cost-effective programs that improve member access, enhance customer satisfaction, lower medical costs, and maximize positive health outcomes and support the execution of these initiatives.
  
• Provide assistance and support for provider relations, network development and provider contracting activities including strengthening of provider communications, improving clinical linkages and relationships with network providers.
  
• Identify and prioritize the opportunities for appropriate Medicare Advantage and SCO provider groups to optimize care. The areas of focus will include inpatient and outpatient utilization, pharmacy utilization, and chronic care management among others.
  
• Collaborate with Medical Economics to create Medicare Advantage and SCO provider group specific reporting that will support all cost of care and care management activities for those provider and employer groups. Coordinate with these groups to achieve understanding of and how to effectively use the data.
  
• Represent Fallon Health at conferences and forums and with provider groups on a variety of topics as directed by the CMO.
  
• Provide support as needed to Utilization and Care Management activities especially as related to the clinically integrated provider groups.
  

Qualifications

• MD degree from accredited medical schoolwith license to practice medicine in MA (or licensable)..
  
• Masters in Business Administration, Masters in Health Services Administration, or equivalent highly preferred.
  
• Active certification by a member board of the American Board of Medical Specialties (ABMS).
  
• Quality Improvement experience including direct involvement with NCQA, CMS Stars
  
• Vendor management experience.
  
• Demonstrated success and experience with Medicare Advantage, Medicaid, and SCO populations.
  
• Ability to effectively develop and manage external relationships with providers and key stakeholders.
  
• History of active participation in CMS and Medicaid audits.
  

Location
US-MA-Worcester

Posted Date
10 hours ago
(7/14/2022 9:00 AM)

Job ID
6945

# Positions
1

Category
Medical Management

 
 

Clipped from: https://fallon-massachusetts.jobs/worcester-ma/sr-medical-director-growing-medicaidmedicare-health-org-hybridremote-work-model/112BFF18933E403790070D3388A2B820/job/?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 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. Read more about our benefits here: https://www.mathematica.org/career-opportunities/benefits-at-a-glance

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

• Master’s 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.

 
 

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A Bachelor’s degree in a related field and seven years of experience in the direction or management of a public health, health, human services or health regulatory program or community-based organization; OR an Associate’s degree in a related field and nine years of such experience; OR eleven years of such experience. The years of experience must have included policy formulation, program planning, design, implementation, evaluation, and allocation of resources. At least five years of experience must have included supervision of staff and program management. A Master’s degree in a related field may substitute for one year of experience.


Health Research, Inc.’s (HRI) mission is building a healthier future for New York State and beyond through the delivery of funding and program support to further public health and research programs. In support of our mission and our commitment to providing a safe workplace, we require employees to be fully vaccinated against COVID-19, unless approved for a religious or medical exemption.


This position requires that the incumbent will report to the official work location and live within commuting distance to the official work location. Telecommuting may not be available. If telecommuting is available, the incumbent will be required to have internet access.


Comprehensive knowledge of New York State’s health care system, including the Medicaid-financed system and the HIV health care delivery system. Knowledge of New York State Medicaid reform policy and programs. Knowledge of/experience in Medicaid reimbursement development. Knowledge of/experience in utilization and analysis of Medicaid data. Knowledge of/experience in quality management/improvement. Excellent communication, writing and interpersonal skills.


The Director is responsible for policy formulation, program planning, design and implementation, directing program evaluation, directing the management of programs, supervising staff, and representing the AIDS Institute. The position’s responsibilities relate to administration of the HIV components of the Medicaid program; AIDS Institute-specific Medicaid programs; health care analytics; HIV financial planning and research. The position provides leadership in building and modifying models of care and serves as liaison with other Department of Health units involved in health care regulation, payment, quality, and policy and program development. The position provides leadership on Medicare issues related to persons served through AIDS Institute programs. The position is responsible for direction and supervision of the Office of Medicaid Policy and Health Care Financing. Other related duties as assigned.


Health Research, Inc. (HRI) offers a robust, comprehensive benefits package to eligible employees, including

• Health, dental and vision insurance – Several comprehensive health insurance plans to choose from;
  
• Flexible benefit accounts – Medical, dependent care, adoption assistance, parking and transit;
  
• Generous paid time off – Paid federal and state holidays, paid sick, vacation and personal leave;
  
• Tuition support – Assistance is available for individuals pursuing educational or training opportunities;
  
• Retirement Benefits – HRI is a participating employer in the New York State and Local Retirement System and offers optional enrollment in the New York State Deferred Compensation Plan. HRI provides a postretirement Health Benefits Plan for qualified retirees to use towards health insurance premiums and eligible medical expenses;
  
• Employee Assistance Program – Provides educational and wellness programs, training, and 24/7 confidential services to assist employees, both personally and professionally;
  
• And so much more!
  
  
  

Grant funded position. Management/Confidential position. Compliance with funding requirements such as time and effort reporting, grant deliverables, and contract deliverables, is required.


This position requires that the incumbent will report to the official work location and live within commuting distance to the official work location. Telecommuting may not be available. If telecommuting is available, the incumbent will be required to have a telephone/mobile device, and internet access.


Health Research, Inc.’s (HRI) mission is building a healthier future for New York State and beyond through the delivery of funding and program support to further public health and research programs. In support of our mission and our commitment to providing a safe workplace, we require employees to be fully vaccinated against COVID-19, unless approved for a religious or medical exemption.


Valid and unrestricted authorization to work in the U.S. is required. Visa sponsorship is not available for this position.


HRI participates in the E-Verify Program.


HRI has a long-standing dedication to diversity, equity, and inclusion in our workforce. HRI is committed to the principle of non-discrimination in all phases of its employment procedures and practices.


Affirmative Action/Equal Opportunity Employer/Qualified Individuals With Disabilities/Qualified Protected Veterans


www.healthresearch.org

 
 

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Job Description


Trigyn’s direct government client has an immediate need for Business / Data Analyst in Menands, NY.


Description


The Business Systems Analyst will apply a wide range of specialized knowledge, skills, tools and techniques to elicit, analyze, communicate and validate requirements for the project. Specific duties include:

• Analyzes, develops, and revises flow charts, process models and technical specifications describing as-is or to-be Information Technology (IT) systems or business processes
  
• Prioritizes IT system requirements and gains stakeholder agreement for IT projects or business process change documents detailing the project
  
• Assists with developing presentations to justify and explain IT system or business process requirements
  
• Evaluates the outcomes of systems testing, and confirms that the results are consistent with the system or business process specifications
  
• Reviews proposals from staff and recommends to management the criticality of revising system or business process requirements during and after IT system implementation, if applicable
  
• Determines the impact of software and hardware releases on the IT system
  
• Assists with the development of training related to business systems implementation for users
  
• Writes Queries
  
• Assists in querying Data sources to determine the validity of project outputs
  
• Documents data architecture
  
  
  

Mandatory Qualification

• Analyzes an organization or business domain (real or hypothetical) and documents its business or processes or systems, assessing the business model or its integration with technology with distinct deliverables to a solution.
  
• Candidate is able to provide guidance to large teams and/or has extensive industry experience and is considered at the top of his/her field.
  
• Bachelor’s Degree in Information Technology or Computer Science or similar field of study.
  
• 84 months of experience in business analysis in Information Technology on SDLC projects; including developing business cases, gap analysis, functional and non-function requirements, test cases and plans; participating in User Acceptance Testing (UAT) and reviewing UAT results.
  
• 84 months of experience using recognized business analysis methodologies (such as JAD sessions) to elicit business needs and requirements from stakeholders, and developing/ revising flow charts, and process models describing as-is or to-be system and business processes.
  
• 60 months of Data analysis/Data and mining of complex systems and relational databases.
  
• 60 months of experience querying and interrogating data using complex SQL on DB2 or Oracle platforms using tools such as SQL query tools and using MS Access.
  
• 24 months experience with Medicaid and/or health care industry data and its analysis.
  
• 60 months of experience analyzing and developing reporting needs/reports from three perspectives: senior management, power user, and ad hoc, using industry standard (e.g. Cognos, OBIEE) reporting software.
  
• 24 months experience with working in a formal Project Management office, working with Project Managers and teams, and using standardized methodologies (such as waterfall and agile) and templates, participating in the evaluation of project readiness for deployment.
  
  
  

For Immediate Response call 732-640-2404, or send your resume to RecruiterPK@Trigyn.com

TRIGYN TECHNOLOGIES, INC. is an EQUAL OPPORTUNITY EMPLOYER and has been in business for 30 years. TRIGYN is an ISO 9001:2015, ISO 27001:2013 (ISMS) and CMMI Level 5 certified company.

 
 

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Overview

About Public Consulting Group

Public Consulting Group, Inc. (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has over 2,500 professionals in more than 60 offices worldwide. PCG s Technology Consulting practice offers a full spectrum of quality Information Technology (IT) services to help state and local government agencies at every stage of the IT life cycle. Through its specialized IT services, PCG s Technology Consulting team finds cost-effective ways to help agency partners deliver successful IT systems that enhance the lives of the user base. To learn more, visit

Responsibilities

Consultant/Analyst will provide a combination of Medicaid and Project Management expertise in monitoring project lifecycle implementations in waterfall, agile and/or hybrid methodologies and providing advisory services on best practices and problem remediation strategies. The incumbent will assess project status progress and quality in accordance with PMI standards as applied in the context of eligibility systems design, development, implementation, and operations. The successful candidate will have either state agency or vendor experience with state Medicaid eligibility systems which includes knowledge of eligibility programs and state options. Experience as an eligibility worker, supervisor, or state eligibility program or operations manager highly preferred. The Consultant will report to the team leader on project status through participation and observation of DDI activities in the requirements, construction, system integration testing, UAT, and go-live phases of DDi activites. Will contribute to deliverables and work products delivered by the by the team. These deliverables and work products will be completed in accordance with our overall strategy, approach, and methodology.

• Provides project management and technical expertise on large-scale IT projects
• Supports development of all deliverables, status reports and other work products
• Supports activities to plan and oversee all project work and develop/manage any potential organizational change management strategies or processes that might be needed
• Support the goals and outcomes of the project stakeholders
• Support Developing, managing, and updating Project Plan and other project documents (e.g., Communication Plan, Risk Plan, Stakeholder Register, Resource Plan)
• Support and or develop, manage, and update the execution of the Project Schedule to ensure project scope and applicable milestones are met
• Support or develop and deliver regular status reporting
• Identifies, tracks, and manages project risks; including coordination for risk mitigation
• Identifies, tracks, and manages project issues; including coordination for issue resolution
• Establish a response and track the response to project recommendations (e.g., Quality Assurance (QA) vendor recommendations)
• Provide ongoing communication (e.g., email, meetings) to provide project status
• Collaborate with the project s Communication Manager to enhance communication efforts
• Review project and related operational processes and provide input for improvement by implementing relevant lean or agile strategies
• Conduct Agile Project Management and Organizational Change Management workshops

Qualifications

Required:
•Direct experience with state Medicaid eligibility systems
•State agency work experience with Medicaid, SNAP, TANF or other health and human service programs

• Self-directed and reports to the Engagement Manager
• 3+ years of prior project management experience using both Agile and Waterfall techniques in IT related projects to include operations, infrastructure, and application development projects
• Demonstrated ability to work directly with diverse business and technical team members in a strong team-oriented environment

Desired:
• Certified Scrum Master or PMI Agile Certified Practitioner certification
• QA / IV&V experience preferred
• PMI Project Management Professional certification

EEO Statement

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

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Job Locations US-MS-Jackson US US-TX-Austin US-GA-Atlanta US-TN-Nashville
Posted Date 2 months ago (5/9/2022 7:04 PM)
Job ID 2 # of Openings 1 Category Consulting Type Regular Full-Time Practice Area Technology Consulting

Public Consulting Group is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, protected veteran status, or status as a qualified individual with a disability. VEVRAA Federal Contractor.

Clipped from: https://jobs.wfla.com/jobs/senior-business-analyst-medicaid-eligibility-systems-juneau-alaska/658139340-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description
 

Humana Healthy Horizons in Louisiana is seeking Population Health Strategy Lead who will be is responsible for improving the quality of care and outcomes while managing costs for a defined group of people. The Population Health Strategy Lead works on problems of diverse scope and complexity ranging from moderate to substantial.
 

Responsibilities
 

Humana’s Bold Goal is to improve the health of the communities we serve as evidenced by more healthy days. The Population Health Strategy Lead identifies health needs such as chronic diseases or disabilities, or the health needs of the underserved.

• Advises executives to develop functional strategies (often segment specific) on matters of significance.
  
• Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision
  
• Uses independent judgment requiring analysis of variable factors and determining the best course of action.
  
• Identifies health needs such as chronic diseases or disabilities, or the health needs of the underserved and influences department’s strategy
  
• Develops strategic design, operational implementation plan, and ongoing evaluation of population health initiatives based on a deep understanding of scientific population health principles
  
• Serve as the consultative subject matter expert and liaison to internal and external stakeholders on population health activities and established goals
  
• Provide insights required to improve coordination of care, access to care, member utilization of healthcare system and improve overall health outcomes
  
• Collaborates with cross functional team such as clinical, operational, financial to support Medicaid-wide initiatives
  

 
 

 
 

Required Qualifications

• Must reside in the state of Louisiana.
  
• Bachelor’s Degree in nursing, public health, social work, health services research, health policy, information technology, or other relevant field.
  
• Minimum five (5) years of progressively responsible professional experience in population health, service coordination, ambulatory care, community public health, case or care management, or coordinating care across multiple settings and with multiple providers.
  
• Experience working in Medicaid and preferably in a managed care setting.
  
• Proficiency in Microsoft applications including Word, Advanced Excel, and PowerPoint.
  
• Ability to analyze data and make data-driven recommendations for quality improvement.
  
• Excellent interpersonal skills; ability to develop effective relationships with a broad array of people internally and externally, including community partners.
  
• Experience with program planning, implementation, and evaluation.
  
• Ability to take personal initiative and work independently, as well as part of a team.
  
• Ability to meet deadlines in a complex and fast-paced environment.
  
• 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.
  
• This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
  
• Must have the ability to provide a high speed DSL or cable modem for a home office.
  
• 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.
  
• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
  

Preferred Qualifications

• Master’s Degree in nursing, public health, social work, health services research, health policy, information technology, or other relevant field.
  

Additional Information

• Workstyle: Hybrid Office – 3 -4days/week in Humana’s Metairie’s location and 1 – 2 days remotely.
  
• Travel: up to 25% in statewide in Louisiana.
  

 
 

Scheduled Weekly Hours
 

40
 

 
 

Clipped from: https://www.recruit.net/job/population-health-jobs/CB61B78EDC66CDC7?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

UnitedHealthcare is a company that’s on the rise. We’re expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn’t about another gadget, it’s about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life’s best work.(sm)

In this RN Nurse Care Coordinator role, will be an essential element of an Integrated Care Model by relaying the pertinent information about the member needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs.

If you are located within Rosenberg, Brazoria, Missouri City, TX you will have the flexibility to telecommute as you take on some tough challenges.

Primary Responsibilities:

• Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care
  
• Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services
  
• Manage the care plan throughout the continuum of care as a single point of contact
  
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
  
• Advocate for patients and families as needed to ensure the patient s needs and choices are fully represented and supported by the health care team Visit Medicaid members in their homes and/or other settings, including community centers, hospitals, or providers’ offices
  

You ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Current unrestricted RN license in the state of Texas
  
• 2+ years of experience working within the community health setting or in a health care role
  
• Intermediate Microsoft Office experience working with Microsoft Word, Excel, and Outlook (ability to create, edit, save and send documents, spreadsheets and emails)
  
• Reliable transportation and the ability to travel in assigned region to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, nursing facilities or providers’ offices
  
• High speed internet at residence
  
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
  

Preferred Qualifications:

• RUG certification or the ability to obtain within 30 days of employment
  
• Experience in case management and/or certification in case management (CCM)
  
• Experience with electronic charting
  
• Field-based work experience
  
• Background in managing populations with complex medical or behavioral needs
  
• Bilingual skills
  

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That’s why you’ll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life’s best work.(sm)

All Telecommuters will be required to adhere to UnitedHealth Group s Telecommuter Policy.

PLEASE NOTE The Sign-On Bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis (“Internal Candidates”) are not eligible to receive a Sign On Bonus.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

 
 

Clipped from: https://www.job-fox.com/job/rn-nurse-care-coordinator-in-atlanta-georgia-8627-1669499566AE?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic