Author: MM_ADMIN

 
 

Healthcare Business Analyst – Consultant Level – Medicaid/Medicare experience – Remote

The Company

We continuously seek exceptional associates when recruiting new employees. We pride ourselves on having extensive experience working with clients in all major markets. Cognizant’s delivery model is infused with a distinct culture of high customer happiness. We consistently deliver positive relationships, cost reductions and business results. Are you ready to be a change-maker? At Cognizant, we believe those who challenge the way they work today will own the way tomorrow. When was the last time you felt proud about your work?

About Cognizant Consulting

Cognizant Consulting combines deep domain expertise with advanced technology thinking to help global 2000 companies worldwide accelerate their digital journeys. By orchestrating capabilities across strategy, design, IT and industry /functional knowledge, we help, clients solve their toughest business-technology challenges at speed and scale, and lead in today’s dynamic digital age — while planning for whatever tomorrow brings. We do this by applying a keen understanding of the uniquely human aspirations, behaviours and needs of our clients’ customers and employees to first envision and specify, and then deliver and extend modern digital solutions that enable leading players to differentiate and ultimately separate from the competition. Learn more by visiting us at

Job Description:

Conduct workshops with business and IS stakeholders and create Business Requirements documents and process flows and have experience delivering in agile methodology
Provide project leadership and direction on one or more projects while maintaining a high-quality level of service. Ensure quality on all deliverables.
Manage delivery dates, resourcing and schedules
Facilitate project execution by providing support in project-level issue resolution and management of scope
Help build, lead, and develop team of onshore/offshore consultants
Deeply understand their client’s business challenges, and provide thought leadership in addressing these issues
Work proactively to bring the best of Cognizant expertise to their client(s)
Project/Program management experience

In addition to the above:

Prior project experience in Medicaid/Medicare/Care Management
Minimum 2-4 years’ experience in management consulting with a management and/or technology consulting firm

Our strength is built on our ability to work together. Our diverse set of backgrounds offer different perspectives and new ways of thinking. It encourages lively discussions, inspires thought leadership, and helps us build better solutions for our clients. We want someone who thrives in this setting and is inspired to construct meaningful solutions through true collaboration.

If you are comfortable with ambiguity, excited by change, and excel through autonomy, we would love to hear from you!

Cognizant is an Equal Opportunity Employer M/F/D/V

Cognizant is recognized as a Military Friendly Employer and is a coalition member of the Veteran Jobs Mission. Our Cognizant Veterans Network Assists Veterans in building and growing a career at Cognizant that allows them to demonstrate the leadership, loyalty, integrity, and dedication to excellence instilled in them through participation in military service

Cogniz+ant will only consider applicants for this position whom are legally authorized to work in the United States without company sponsorship (H-1B, L-1B, L-1A, etc.)

 
 

Clipped from: https://jobs.fox2now.com/jobs/healthcare-business-analyst-consultant-level-medicaid-medicare-experience-remote-teaneck-new-jersey/604875581-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Are you looking to make an immediate impact where you can help our clients solve their business challenges? Deloitte’s Core Business Operations (CBO) portfolio operates at the center of our client’s business. By joining our team, you could help C-suite and program leaders transform their organization and accelerate mission execution through emerging and disruptive technologies, innovative business models, retooled program operations and industry-driven solutions.

Work you’ll do
 

• Serve as a senior team leader on project engagements and lead the development and growth of the practice in support of state and federal government agencies, primarily on Medicaid related issues.
• Lead client service delivery, sales and marketing, and management of engagement teams
• Work 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.
• Work closely with the practice to win additional consulting work with the existing accounts and to acquire new accounts.
• Provide thought leadership expertise, such as leading the development of complex, market-valued intellectual capital, leverage business network for contacts in target market to generate leads and brings ideas on innovative ways to identify and pursue new cross-functional sales opportunities, where appropriate, lead development of the sales pursuit strategy and assembles and effectively manages the sales pursuit plan and work to successfully close the sale and generates enthusiasm in potential clients about working with the Firm.
• Lead engagement teams and support the development of more junior colleagues, plan for the long-term, cross-functional impact of decisions,, delegate appropriate level of decision making; helping team to make reasonable decisions and understand difficult decisions, leads engagement work planning, scoping, and budget development in line with engagement strategy and deliverables and provide overall engagement management, including work plan, issue resolution, and close management of scope change.
   

The team

Deloitte’s Government and Public Services (GPS) practice – our people, ideas, technology and outcomes-is designed for impact. Serving federal, state, & local government clients as well as public higher education institutions, our team of over 15,000+ professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise.

Deloitte’s Health Technology offering transforms the way the Healthcare IT market embraces modernization and modularization. Using our deep health, government, and technology consulting experience, our team strategically advises on design as well as implements and deploys solutions. In order to help clients reduce costs, improve health outcomes, and respond to public health crises, our Health Technology practice addresses critical health agency issues including: claims management, electronic health records, health information exchanges, health analytics, and health case management.

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.

Qualifications

Required:
 

• 10+ years of healthcare experience working either with State Health and Human Services agency or with a Health plan or Consulting company serving Healthcare clients.
• 6+ years of experience supporting Medicaid programs, working on Medicaid related issues including Medicaid managed care, value-based purchasing, Medicaid enterprise solutions, quality measurement and analytics and fee for service operations.
• 6+ years in leading operations and business teams.
• 6+ years of business development experience (pre-sales, proposal, and RFP experience
• Experience leading teams and managing client/executive relationships
• Bachelor’s degree
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future
• Willingness to travel at least 25% to 50%

 
 

Clipped from: https://www.linkedin.com/jobs/view/senior-medicaid-transformation-business-leader-at-deloitte-3088253706?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Clipped from: https://phf.tbe.taleo.net/phf01/ats/careers/v2/viewRequisition?org=CBIZ&cws=66&rid=13171

Exempt/Non-Exempt:

Exempt

Scheduled Hours Per Week:

40

Myers and Stauffer LC (MSLC) is a national Certified Public Accounting (CPA) and consulting firm with more than four and a half decades of experience working exclusively for state and federal agencies.  In addition to our work on behalf of all 50 states, we have provided health and human services audit, investigative, and consulting services to many federal agencies, including the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control & Prevention (CDC), the Office of the Inspector General, the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), and other health and human services branches.

At Myers and Stauffer you will have a career that is rewarding on every level of the organization. We are committed to providing our employees with:

• Professional growth and development opportunities
• Educational opportunities leading to certifications
• A diverse, dynamic, and challenging work environment
• Strong leadership, communication, and feedback
• A well-balanced lifestyle that includes personal and family time in addition to professional and networking opportunities
• Creative and innovative solutions to challenges facing our government clients

MSLC is seeking an experienced, senior-level business development/sales professional to help increase market share in the federal government health sector.  The Business Development Director is a new position and will be a core member of our business development team responsible for driving new business within the federal government market segment. The ideal candidate will have a proven track record of identifying and winning business opportunities within federal agencies, particularly Department of Health and Human Services Agencies, Department of Veteran’s Affairs, and Department of Defense, among others.

Essential Functions:

• Focus on identifying, developing, and leading federal business development opportunities within the federal government health sector.
• Develop detailed and actionable account plans that achieve growth targets.
• Develop, maintain, and expand productive relationships with Government decision-makers, project and program managers, and contracting officers.
• Identify opportunities through agency research, 3rd party market intelligence tools, client and partner networks.
• Coordinate meetings with customers, competitors, clients, partner firms, and service delivery teams to develop market insight on requirements, acquisition strategy, acquisition timing, and contract vehicle choices.
• Meet regularly with the service delivery teams to identify account challenges and help them find and win organic growth through mods, increased scope, and innovation.
• Participate as a key resource for federal government Sources Sought, Request for Information (RFIs), and Request for Proposal or Quote (RFP/RFQ) responses in conjunction with MSLC’s Marketing Team.
• Ensure the capture team’s strategy, themes, solution, and discriminators are reflected in the proposal.
• Provide pertinent market and competitive information to the organization.
• Support ad-hoc projects in coordination with upper-level management.

Requirements:

• Bachelor’s Degree required.
• Established network of contacts in applicable federal agencies.
• Demonstrated track record of designing and executing successful Business Development and Capture strategies that has led to profitable revenue growth with HHS, VA, DoD, DHS, and other agencies.
• Ten or more years of related recent business development/capture experience.
• Experience creating teaming agreements, managing vendor relationships, maintaining service level agreements, and operating successful contractor teaming arrangements.
• Excellent communication skills (both verbal and written) and highly effective interpersonal skills in order to carry-out daily interactions with technical leaders and business executives within the firm, affiliate corporation, and with customers, industry and subcontractors.
• Demonstrated working knowledge of the Federal Acquisition Regulations (FAR).
• Ability to use automated tools such as Microsoft Office to present ideas, information, and reports.
• Comfortable with all remote work and video conferencing platforms.
• Ability to travel as required.

 

 
 

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position PurposeConduct analysis, pricing and risk assessment to estimate financial outcomes. Provide expertise and technical support in matters related to the successful and financially sounds operations of the company’s health plan businesses.

In this Manager, Actuarial Services role, you will
 

• Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes.
• Negotiate capitation rates with State agencies
• Oversee health plan experience, identify trends and recommend improvements
• Research and identify new business opportunities
• Work with Health Plans to ensure soundness of capitation rates
• Work with State agencies to assess impact of program/policy changes
   

Our Comprehensive Benefits Package
 

• Flexible work solutions including remote options, hybrid work schedules and dress flexibility
• Competitive pay
• Paid Time Off including paid holidays
• Health insurance coverage for you and dependents
• 401(k) and stock purchase plans
• Tuition reimbursement and best-in-class training and development
   

Education/Experience
 

• Bachelor’s degree or equivalent experience.
• 5+ years of actuarial experience.
• License/Certification Fellow or Associate of the Society of Actuaries (or equivalent international certification). Member of American Academy of Actuaries (or equivalent international membership).
   

Within our actuarial department, your talents and skills will be challenged, recognized and rewarded. We are a pay-for-performance environment that promotes employees based on talent and contribution. In order to maintain our tremendous growth in this space, our over 400 member Actuarial team is growing. Located across the country, this team uses
 

• Technical skills to build leading edge models, predict outcomes and assess future impacts
• Business skills to develop strategy with senior leadership
• Personal skills to interact with state, federal and private employer customers
• Management skills to organize cross department projects
   

Areas of focus within our Actuarial Department includes Medicare / Medicaid / Marketplace / Commercial / Risk Adjustment / Reserving / Actuarial Analytics / Value-Based Care / Actuarial Reporting / Health Policy

About Us

Centene Corporation, a FORTUNE 25 company, is the leading national healthcare enterprise committed to helping people live healthier lives. We are revolutionizing the world of healthcare through digital transformation. Our world class teams use collective innovation to turn visions into action and challenge what is possible. We are an industry leader with a local focus and a global vison
 

• Listed on FORTUNE magazine’s World’s Most Admired Companies List for 2nd consecutive year.
• Ranked No.2 on the FORTUNE 500 Measure Up Initiative, a new benchmark to identify companies building inclusive and fair workplaces.
• National footprint in all 50 states, serving 1 in 15 individuals in the U.S.
   

Clipped from: https://www.linkedin.com/jobs/view/manager-actuarial-services-medicaid-at-centene-corporation-3088253281?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description
Job Summary
Responsible for continuous quality improvements regarding member engagement and member retention. Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the development/maintenance of Member Materials.

Knowledge/Skills/Abilities
• Serves as an advocate for members to resolve issues and complaints. Works with enrollees and providers to facilitate the provision of Medicaid benefits and ensure enrollee’s rights are upheld. Helps enrollees understand their rights and benefits in working through the system.
• Investigates and resolves access and cultural sensitivity issues identified by HMO staff, State staff, providers, advocate organizations, subcontractors and enrollees.
• Monitors all formal and informal grievances with Grievance personnel to identify trends or problem areas of access and care delivery. Assists enrollees in the grievance process at the HMO and State levels and monitors outcomes.
• Provides timely written responses to inquiries; prepares written analyses of advocacy issues; and assists with documentation preparation for appeals, fair hearings or other formal/informal dispute resolution process.
• Provides ongoing training and educational materials to HMO and relevant subcontractor employees and providers as needed.
• Works in collaboration with the Care Management department to help resolve member issues/concerns, ensure that trends are identified and solutions outlined.
• Provides information, guidance and assistance, over the phone or in person, to members with disabilities or BC+ who call for help related to their HMO participation. Analyzes internal HMO system functions that affect enrollee access to medical care and quality of care.
• Serves as a resource for Molina staff and members regarding community agencies, services and referrals for special needs, Medicaid in general, or other related needs.
• Participates in the Statewide Advocacy Program for Managed Care including working with the State External Advocate, Enrollment Specialist and Ombudsmen on issues of access to medical care, quality of care, enrollment and disenrollment.
• Participates in HMO internal Quality Assurance and Improvement Committees to ensure services to enrollees are provided in accordance with all State/HMO requirements..

Job Qualifications

Required Education
Bachelor’s Degree in Social Work, Human Services or related field.
Required Experience
3-5 years experience working with the Medicaid population, preferably in an HMO or MCO setting, with experience in working with disabled, underserved and/or disadvantaged populations.
Preferred Education
Graduate Degree in Social Work, Human Services or related field.
Preferred Experience
5+ years

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

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

Clipped from: https://jobs.myfox8.com/jobs/senior-member-engagement-specialist-st-george-ut-central-utah/604262246-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Found in: Lensa US Premium – 21 hours ago

Montebello, United States Anthem, Inc Full time

Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team

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?

This position requires that you live within the State of California.

The Program Director is responsible for the development and ongoing management of one or more external client facing programs that are multi-state, multi-function and multi-year in scope. Program directors typically support business strategies through an integrated portfolio of external client facing programs, projects and initiatives.

How you will make an impact:

Primary duties may include, but are not limited to:

• Represent Health Plan on special projects and growth initiatives that result in performance improvements.
  
• Enhance relationships with local elected officials and local stakeholders.
  
• Serve as liaison with County Health and Human Services Agency and County Behavioral Health Departments
  
• Prepare and monitor reporting of activities for submission to Regulatory & Compliance departments.
  
• Build and maintain provider relationships, support local and community health collaborative initiatives, and serve on managed care related committees.
  
• Develop and deliver highly engaging visual presentations on program performance and projects/initiatives to external and internal leaders.
  
• Provides subject matter expertise in response to day to day business issues; researches applicable subject matter practices; and remains aware of industry trends.
  
• Develops documentation to support meeting presentations and the tracking and reporting of the programs success.
  
• Provides day to day support and leadership to program managers
  
• Program directors typically manage external client facing programs that require managing activities and resources of multiple departments or business areas of the organization.
  

Qualifications

Requirements:

• Requires a BA/BS and minimum of 10 years experience in external client facing program management, business development, relationship building, complex business processes, strategic and business planning; or any combination of education and experience, which would provide an equivalent background.
  
• Resident of the State of California
  

Preferred skills and qualifications:

• MBA preferred.
  

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 Anthem. 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 Anthem approves a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 Worlds 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.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance

REQNUMBER: PS72268

 
 

 
 

Clipped from: https://us.trabajo.org/job-835-20220519-96253873679581c3fc83c11922bab3ee?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Testing Manager (Medicaid / MMIS)
 

Location: Remote

About Us:

Known for “Delighting the Client” through performance, innovation and an employee-centric culture, S2Tech is a fast-growing IT consulting company serving clients in over a quarter of the United States. We are widely recognized as a leading provider of both technical and business services in support of Health and Human Services related projects. Feel free to learn more at www.s2tech.com.

Why S2Tech?:

• Stable privately-owned company with a strong reputation for building long-term client relationships through the delivery of consistent value-based service
  
• 25 year history of providing IT and Business services to private customers and government programs throughout the United States
  
• Expansive client portfolio and active projects – employees benefit from innovative project exposure and in-house skill development training/courses  
  
• Corporate culture that emphasizes the importance of family and promotes healthy work-life balance
  
• Offer competitive pay and a range of benefits including:
  

 
 

• Medical / Dental / Vision Insurance – insurance premium assistance provided
  
• Additional Insurance (Life, Disability, etc.)
  
• Paid Time Off (Vacation & Sick Leave)
  
• 401(k) Retirement Savings Plan & Health Savings Account
  
• Various training courses to promote continuous learning
  
• Corporate Wellness Program
  
• Be part of a company that gives back through its non-profit organization, Fortune Fund, which was launched in 2001. The goal of the Fortune Fund is to close the rural/urban divide by ensuring children in rural communities in India and the United States understand the importance of education & are aware of professional career opportunities allowing them to link their professional & educational goals
  

Responsibilities:

• Develop and manage the quality management solutions on a Medicaid Management Information System (MMIS) program
  
• Coordinate testing efforts across all MMIS modules
  
• Use prior Medicaid Management Information System (MMIS) domain knowledge to develop testing methodologies, test estimations, test scheduling, and test results
  
• Create and document comprehensive test scenarios while understanding the system-wide impact to all relational systems and software applications
  
• Conduct testing scenarios within various application systems and sub-modules; document, review, and track results; and assist in remediation
  
• Demonstrate test results to project stakeholders
  
• Coordinate defect management
  
• Provide training/support for users, stakeholders, and contractors
  

Qualifications:

• Bachelor’s degree in Computer Science, Information Systems, or another similar STEM (Science, Technology, Engineering and Mathematics) discipline
  
• Previous experience working as a Testing Manager on large-scale projects
  
• Must have a minimum of six (6) years of experience with planning and executing all phases of system testing – unit testing, system testing, integration testing, user acceptance testing, regression testing, and performance testing
  
• Experience with and expertise in selection and use of automated test tools and other testing-related tools
  
• Experience managing test teams comprising individuals from multiple organizations
  
• Must have previous experience working on Medicaid Management Information System (MMIS) projects
  
• Must possess a strong understanding of the Medicaid Management Information System (MMIS) and other healthcare programs
  
• Strong analytical and problem-solving skills
  
• Excellent communication skills (oral/written) and the ability to interact with multiple teams in a diverse setting encompassing both technical and non-technical users
  
• Must be willing to work independently or as part of a team in an energetic, team-oriented environment managing systems of varying size and complexity with a fast turn-around time
  

S2Tech is committed to hiring and retaining a diverse workforce. We are an equal opportunity employer making decisions without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or any other protected class.

 
 

Clipped from: https://www.monster.com/job-openings/testing-manager-medicaid-mmis–e2cce9b6-fb70-4588-9f3a-12707c80f06a?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

• Humana • Sandy, UT 84090
  

Job #2188429090

•  
• Description
  

Humana Healthy Horizons is seeking a Technology Solutions Lead who will devise an effective strategy for executing and delivering on IT business initiatives. The Technology Solutions Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Technology Solutions Lead acts as a liaison and collaborates with the Medicaid business and functional stakeholders to identify and deliver strategic enablement solutions.

• Provides oversight of the project portfolio and associated budget, ensuring projects remain operationally sound and that resources are prioritized and managed appropriately.
  
• Leads and manages the project portfolio meetings, support strategic planning, and partner with business to ensure all products are delivered on time and within budget.
  
• Operates the project intake and review process (e.g., prioritization, backlog management, resource assignment, etc.).
  
• Oversees the annual project prioritization and budgeting process working with Corporate, IT, and Market leaders as appropriate.
  
• Provides portfolio-level status updates to leadership (e.g., project health, capabilities delivered, funding, etc.).
  
• Collaborates with leadership and key stakeholders to ensure processes, operating tools and templates, etc. are optimized to support operations and advance business objectives. Facilitate decision-making by providing leadership with data and analysis.
  
• 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.
  

Required Qualifications

• Bachelor’s degree in Business, Information Technology, OR a related field OR equivalent work experience.
  
• 3 or more years of project leadership experience.
  
• 3 or more years’ experience problem solving and consultation within complex environments and facilitating cross-functional teams’ efforts.
  
• Demonstrated ability to run large scale, highly visible programs with responsibility for multiple project teams.
  
• Extensive knowledge in Systems Development Life Cycle, Waterfall, and Agile Development Methodologies.
  
• Solid understanding of operations, technology, communications and processes.
  
• Strong influencing and process implementation skills.
  
• Ability to communicate effectively and deliver presentations to senior leaders.
  
• 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. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health screening questionnaire.
  
• 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

• Master’s Degree of Business Administration, Computer Science, or a related field.
  
• 2 or more years’ experience in IT business analysis, including artifacts development.
  
• Advanced experience leading special projects and producing metrics, measurements, and trend reports.
  
• Experience with QuickBase.
  

Additional Information

• Travel: up to 20%.
  
• Work Days/Hours: Monday – Friday; Eastern Standard Time (EST) Zone and Central Standard Time (CST) Zone.
  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

 
 

 
 

Clipped from: https://www.nexxt.com/jobs/technology-solutions-lead-medicaid-remote-us-sandy-ut-2188429090-job.html?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic&aff=2ED44C72-8FD2-4B5D-BC54-2F623E88BE26&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Found in: Appcast US Premium – 6 hours ago

Basking Ridge, United States Torrent Pharma Inc. Full time

Torrent Pharma Inc. is a multi-billion dollar company leading the way across the globe within the Biotech and Pharmaceutical industry. With a significant presence in over 40 countries, Torrent Pharma Inc. is looking to continue expanding its US base further. We are seeking a qualified Government Pricing/Medicaid Analyst to join our Finance Team in Basking Ridge, NJ.

JOB DESCRIPTION

This role will report into and will work collaboratively with the Head of the Government Pricing group, to ensure the company’s compliance with various government regulations. This employee would oversee the company’s Monthly and Quarterly AMP calculations and compliance with CMS and other various state/ federal government regulations related to Government pricing and Medicaid reimbursement.

The individual will be responsible for assisting the Company’s Manager in the overall management and facilitation of our government programs (Medicaid and 340B) and executing Government Price calculations (AMP, etc.). The individual will also be responsible for processing Medicaid rebate claims submitted by State agencies.

The ideal candidate is a someone, who has successfully managed government programs and calculated government pricing. This position requires building relationships with internal business partners, collaborating to deliver results, hitting key milestones, improving effectiveness, and delivering a high quality and focus on compliance.

Key Responsibilities:

· Manage key activities related to the Company’s government programs (Medicaid and 340B, and anticipated new Government Reporting Relationships as the company expands).

· Execute the calculations of government prices (AMP etc.) URA and as referenced above “anticipated” additional prices types such as ASP, NonFAMP, Best Price etc..

· Create and maintain work instructions and SOP processes for Government Pricing.

· Prepare Monthly and Quarterly variance commentary on fluctuations for government prices and Medicaid rebate amounts.

· Ensure compliance with contracting policies and procedures.

· Provide assistance and support in process improvements, projects and tasks as needed.

· Processing of State rebates.

· On an as needed basis, provide input to update and, as new regulations are either on the horizon or have passed, assist in the creation of new policies and procedures to reflect these changes

· Achieve all reporting deadlines and coordination of all government filings

· Work closely with other departments in the analyses of government filings

· Analysis of internally assigned customer classes of trade Provide assistance in the development of guidance on the impact of Federal or State agency pricing decisions on Government reporting/calculations

· Keep current with all Government Reporting regulations as they impact the Company Provide ad hoc analysis on various special projects as they arise Participate in other government activity as required

Additionally, as the regulatory landscape is rapidly changing, this position will require the ongoing analysis of new government regulations as they relate to reporting obligations. This individual will be encouraged to identify opportunities for process improvements and efficiencies.

Qualifications:

· Bachelor’s degree in Business, Finance, Accounting or related degree. CPA or MBA a plus.

· Government pricing experience in the pharmaceutical industry preferred. Excellent organizational and follow up skills. Strong problem solving and analytical skills.

· Strong computer skills, including Advanced Excel, Power Point and MS Access experience.

· Excellent written and oral communication skills. Ability to interact well with internal/external parties, including Sales, Rebates, Finance, IT, and Government Agencies

· Self-motivated and goal oriented with the ability to drive process change and meet deadlines with minimal assistance or guidance Working knowledge of OTC systems such as Vistex, Revitas, Model N or iContracts.

· Auditing, Compliance and Accounting experience

 
 

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Job Description

DescriptionHCR ManorCare provides a range of services, including skilled nursing care, assisted living, post-acute medical and rehabilitation care, hospice care, home health care and rehabilitation therapy.The Medicaid Specialist assists patients in the skilled nursing centers secure Medicaid benefits.In return for your expertise, you’ll enjoy excellent training, industry-leading benefits and unlimited opportunities to learn and grow.  Be a part of the team leading the nation in healthcare.Location556 – ProMedica Skilled Nursing and Rehabilitation – Chambersburg, PAEducational RequirementsHigh School plus additional training leading to an Associate’s Degree in Business or Social Services.Position RequirementsThree to twelve months with knowledge of medicaid rules and regulations. Job Specific Details:Medicaid experience required.Willingness to work well with others.

 
 

 
 

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