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CMS- Health Insurance Specialist (Data Analysis and Studies)

 
 

Department of Health And Human Services
Policy and Programs Group (PPG)

COVID-19 Vaccination Requirement

The COVID-19 vaccination requirement for federal employees pursuant to Executive Order 14043 does not currently apply. Some jobs, however, may be subject to agency- or job-specific vaccination requirements, so please review the job announcement for details. Click here for more information.

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI), Policy and Programs Group (PPG).


As a Health Insurance Specialist (Data Analysis and Studies), GS-0107-11/12, you will perform limited data analysis related to national health insurance programs, such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), Marketplace Exchange/private health insurance.

Learn more about this agency

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Overview

  • Accepting applications

 
 

  • Open & closing dates

05/12/2022 to 05/26/2022

  • Salary

$74,950 – $116,788 per year

  • Pay scale & grade

GS 11 – 12

Location

Yes—as determined by the agency policy.

  • Travel Required

Not required

  • Relocation expenses reimbursed

No

  • Appointment type

Permanent

  • Work schedule

Full-time

  • Service

Competitive

  • Promotion potential

12

  • Job family (Series)

0107 Health Insurance Administration

  • Supervisory status

No

  • Security clearance

Not Required

  • Drug test

No

  • Position sensitivity and risk

Non-sensitive (NS)/Low Risk

  • Trust determination process

Credentialing

Suitability/Fitness

  • Announcement number

CMS-CMMI-22-11495501-ST

  • Control number

653967100

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Duties

  • Serves as a Health Insurance Specialist and designs, plans and conducts data and/or research studies concerning the trends and Impact to CMS programs.
  • Prepares and performs data studies that identify complex trends and outlines the potential impact to CMS programs.
  • Prepares analysis of organizational priorities related to healthcare and/or healthcare administration.
  • Conducts analysis of policy issues and topics, research background information, the origin of laws of laws, and the intended impact in order to make effective policy recommendations.

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Requirements

Conditions of Employment

  • You must be a U.S. Citizen or National to apply for this position.
  • You will be subject to a background and suitability investigation.
  • Time-in-Grade restrictions apply.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.


Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.


In order to qualify for the GS-11, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-09 grade level in the Federal government, obtained in either the private or public sector), to include: 1) Conducting data studies to identify trends in health insurance program or healthcare administration; AND 2) Conducting data studies related to a specific subject; AND 3) Using applications such as SAS/STATA/R/Python and database management systems, such as SQL to prepare summary reports based on analysis that provide metrics for decision makers.

– OR –

Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing 3 full years of progressively higher level graduate education leading to such a degree or Ph.D. or equivalent doctoral degree or LL.M., if related to the position being filled.
– OR –
Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at the grade GS-11. Therefore, only education in excess of a master’s or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree, may be used to combine education and experience.


TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see “Required Documents” section below for what documentation is required at the time of application.


In order to qualify for the GS-12, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-11 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Planning data studies to evaluate the effectiveness of health insurance program initiatives; AND 2) Contributing to data studies of operation procedures to recommend solutions to policy issues; AND 3) Utilizing applications such as SAS/STATA/R/Python and database management systems, such as SQL to prepare data into reports, charts, graphs or other formats to reflect to outcome of analysis.


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


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


Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.


Time-in-Grade: To be eligible, current or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.


Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11495501

Additional information

Bargaining Unit Position: Yes

Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized

Financial Disclosure: Not Required

Federal agencies may request information regarding the vaccination status of selected applicants for the purposes of implementing other workplace safety protocols, such as protocols related to masking, physical distancing, testing, travel, and quarantine.



Expanded/Maximum Telework Posture: Due to COVID-19, the agency is currently in a maximum telework posture. If selected, you may be expected to telework upon your appointment. As employees are permitted to return to the office, you may be required to report to the duty station listed on this announcement, even if your home/temporary telework site is located outside the local commuting area. Your position may be eligible for workplace flexibilities which may include remote work or telework options, and/or flexible work scheduling. These flexibilities may be requested in accordance with the CMS Master Labor Agreement.


Full-Time Telework Program for CMS Employees: CMS employees currently participating in the Full-Time Telework Program must discuss whether they can remain in the program with the hiring manager. If an employee in this program is selected, the pay will be based on the address on the current telework agreement (normally home address) and will be used as your official duty station for pay purposes. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page.


The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.

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A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

How You Will Be Evaluated

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

Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with any interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.


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


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


  • Decision Making
  • Problem Solving
  • Research
  • Written Communication

 
 

A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

  • As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have – whether you’re a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you’re eligible under their policies.

The following documents are REQUIRED:


1. Resume
showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


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


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


PLEASE NOTE: A complete application package includes the online application, resume, transcripts (if qualifying through education substitution or a combination of education and experience) and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume, transcripts (if applicable) and CMS required documents, will result in you not being considered for employment.


Additional Forms REQUIRED Prior to Appointment:

  • Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
  • Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
  • Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.

If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.

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

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

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

  • Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 05/26/2022 to receive consideration.


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


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

 
 

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month and year (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.

  • To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  • Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
  • After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
  • You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.

To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to ashton.bundy1@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

Agency contact information

Ashton Bundy

Email

ashton.bundy1@cms.hhs.gov

Address

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

Learn more about this agency

Next steps

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


Within 30 business days of the closing date,05/26/2022, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

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

 
 

Help

Required Documents

The following documents are REQUIRED:


1. Resume
showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


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


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


PLEASE NOTE: A complete application package includes the online application, resume, transcripts (if qualifying through education substitution or a combination of education and experience) and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume, transcripts (if applicable) and CMS required documents, will result in you not being considered for employment.


Additional Forms REQUIRED Prior to Appointment:

  • Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
  • Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
  • Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.

If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.

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

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

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

Help

How to Apply

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 05/26/2022 to receive consideration.


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


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

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month and year (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.

  • To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  • Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
  • After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
  • You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.

To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to ashton.bundy1@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

Read more

Agency contact information

Ashton Bundy

Email

ashton.bundy1@cms.hhs.gov

Address

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

Learn more about this agency

Next steps

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


Within 30 business days of the closing date,05/26/2022, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

Read more

 
 

Clipped from: https://www.usajobs.gov/job/653967100?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

External Auditor 2 | Ohio Department of Medicaid

 
 

This position may be telework eligible on a hybrid basis; the selected applicant must complete the initial training period prior to being eligible to telework. All requests to telework are reviewed on a case-by-case basis and must be approved by ODM’s Chief Human Resources Officer.

About Us



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


The goals of the next generation of Ohio Medicaid are:


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


What You Will Do At ODM


Office: Legal Counsel


Bureau: Program Integrity


Classification: External Auditor 2 (PN: 20042207)


Job Overview


The Ohio Department of Medicaid is seeking an audit professional to be part of our Bureau of Program Integrity. This position focuses on the prevention and detection of fraud, waste, and abuse. This position is in Franklin County and may require travel. As an External Auditor 2, your responsibilities will include:


  • Monitoring Medicaid providers for compliance through onsite and desk reviews
  • Audits and onsite reviews may include a variety of providers and partner state agencies and may have a higher concentration of effort with specific provider/agency types for certain periods depending on data analysis, risk assessment, known issues, changes in regulations, industry trends and/or overall complexity of the audits or reviews
  • Participating in monitoring efforts coordinated with other ODM or non-ODM teams
  • Working independently or collaboratively with bureau staff (e.g., reviewing provider payment claims and data related to payments or individual care)
  • Assisting with provider education and working collaboratively with other affected ODM bureaus
  • Handling confidential records and information, and using a variety of tools to analyze and understand relevant data


What’s In It For You


At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:


Medical Coverage


  • Quality, affordable, and competitive medical benefits are offered through the Ohio Med PPO plan.
     

Dental, Vision and Basic Life Insurance


  • Dental, vision and basic life insurance premiums are free after one year of continuous service.


Time Away From Work and Work/Life Balance


  • Paid time off, including vacation, personal, and sick leave
  • 11 paid holidays per year
  • Childbirth/Adoption leave


Ohio Public Employees Retirement System


  • OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of their salary towards their retirement. The employer contributes an amount equal to 14% of the employee’s salary. Visit the OPERS website for more information.
    Deferred Compensation


 
 

  • The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.Completion of undergraduate core coursework in accounting, business administration, computer science or related field; 24 mos. exp. in auditing or accounting which must have included 12 mos. auditing exp. in accordance with auditing standards or in accordance with prescribed management policies &/or procedures as specified on agency position description.


     
     

  • Or 4 yrs. exp. in auditing or accounting which must have included 2 yrs. auditing exp. in accordance with auditing standards or in accordance with prescribed management policies &/or procedures as specified on agency position description.
  • Or 12 mos. exp. as External Auditor 1, 66461.
  • Or equivalent of Minimum Class Qualifications for Employment noted above.


     
     

     
     

    Clipped from: https://www.linkedin.com/jobs/view/external-auditor-2-at-ohio-department-of-medicaid-3066168257/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Title IV-E Medicaid Eligibility Specialist (DCFS), Ogden | State of Utah

 
 

Job Description


Move forward in your career by applying for a Title IV-E Medicaid Eligibility Specialist for the Child & Family Services (DCFS) Ogden office! You’ll be working together with a team in administrative support services to achieve safety, well-being, and permanency for abused or neglected children; and success in providing services for families in our communities.


Principle Duties


They Also Achieve Success By Performing The Following Tasks


A Title IV-E Medicaid Eligibility Specialist works independently managing cases in an accurate and timely manner by collecting information required for Title IV-E and Medicaid eligibility for children in foster care, applying Title IV-E and Medicaid policy, procedure, and rules to determine eligibility, reviewing cases for continued coverage, entering data into relevant databases, and maintaining records. They are also responsible for Subsidized Adoption Medicaid, which includes subsidized adoption determinations, maintaining case files, and medical mileage reimbursement. They obtain documentation from caseworkers and other valid sources for verification of eligibility criteria; consult with Division staff regarding eligibility requirements and refer children/families to DWS for Medicaid application when the information indicates the family may be eligible for Medicaid or when children return or remain home.


  • Conducting eligibility reviews and updating case information when necessary.
  • Entering data into relevant database such as EREP, MMIS, and SAFE to ensure the availability of health care coverage and appropriate collection of funding for services.
  • Issuing medical cards.
  • Maintaining accurate and complete documentation in the case record to support eligibility.
  • Processing eligibility and adoption agreements for children who are receiving adoption assistance or processing eligibility for interstate placement for foster care or adoption assistance.
  • Referring clients to other available services to meet needs where appropriate.
  • Using MMIS (Medicaid Management Information System).
  • Using SAFE (i.e., State social services computer application program).
  • Using EREP (State benefit program).


Ideal Candidate


The model candidate for this position is someone who is:


  • A current employee of the State of Utah.
  • Detail oriented.
  • Organizationally sound.
  • Adept at communicating effectively, clearly, and concisely both verbally and in writing, in a manner which shows sensitivity, tact, and professionalism.
  • Strongly committed to providing excellent customer service.
  • Able to weigh relative costs and benefits of a potential action.
  • Accomplished in practicing great people skills.


Preference


Preference May Be Given To Candidates Who


  • Are current State employees
  • Have experience in or knowledge of Title IV-E and Medicaid
  • Have two years or more experience working in government or public programs
  • Have excellent accuracy in using Microsoft Word and Google


Why You Should Join Our Team


Be an integral part of DCFS working together to keep children safe and strengthen families in our communities. Experience a sense of accomplishment for a job well done and enjoy work life balance! We offer great health benefits and retirement plans, generous paid time off, and a balanced work schedule to afford quality time spent with your family. Click here to see what makes working for the State of Utah awesome: Compensation & Benefits.


The Agency


Contribute to our communities and proactively support the Division of Child and Family Services by helping us keep children safe and strengthen families. DCFS CLICK HERE

 
 

Clipped from: https://www.linkedin.com/jobs/view/title-iv-e-medicaid-eligibility-specialist-dcfs-ogden-at-state-of-utah-3071589396/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Associate Director Medicaid ValueBased Care Pharmacy Programs Virtual

 
 

Job Description

At UnitedHealthcare, a part of the UnitedHealth Group family of businesses, we’re dispensing with tradition. Join us as we take on the challenge of reinventing the health system. As a Value-Based Care Pharmacy Associate Director pharmacist, you’ll play an important role in enhancing clinical pharmacy programs such as and related to health outcomes, disease state management, care management and other specialty programs and the role of the ACO in pharmacy management for our members. You will be an integral part of UCS’s Population Health Management team, supporting the UHC Accountable Care Organizations with national value-based care programming, with a focus on Medicaid Value-Based Care strategy. You will have the opportunity to leverage powerful data and analytics to identify and intervene on pharmacy opportunities that impact the total cost of care and improve quality metrics at the ACO level as well as regionally and nationally. You will develop and implement national and local strategy and create innovative population health programs to improve therapeutic optimization, medication adherence, and improve clinical outcomes. In this unique role, you will also participate in and lead clinical leadership workgroups and strategy initiatives with a variety of different teams. Broad-based comprehensive knowledge related to pharmacy trends, population health programming and project improvement is critical to success in this role. You’ll need to be comfortable creating clinical models of care and supporting business plans and working in a highly matrixed environment for successful program delivery. It’s an exceptional opportunity to join a team with a focus on clinical and business collaboration. Join us today and start making a difference in the lives of millions. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Develop and implement national and regional Medicaid ACO pharmacy cost-savings and quality strategy and initiatives Partner with health plan leaders, CMOs and other clinical leaders to identify and develop pharmacy-related population health programs to improve formulary compliance, medication adherence, reduce excess and inappropriate prescribing and promote value-based pharmacy programming with our ACO partners Collaborate with cross-functional clinical, network, and medical economics teams to lead and support value-based care pharmacy reporting delivery, operations, enhancements, and development of new reports and outcomes analyses Present pharmacy data and actionable cost-savings and quality opportunities to ACO providers and clinical leadership Lead the end-to-end creation, execution, and evaluation of innovative initiatives and pilots Document clinical interventions and evaluate impact on outcomes and savings Act as the resource for medication and pharmacy benefit information for the ACO internal team Educate field-based teams on clinical guidelines and formulary updates, and act as a knowledge resource for physicians and other healthcare providers with respect to drug information and drug report requests Identify solutions to non-standard requests and problems Broad-based and comprehensive knowledge is critical to success in this role. You’ll need to be comfortable working with executive leaders and stakeholders across UHC and OptumRx. 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: Doctor of Pharmacy degree Current and unrestricted pharmacist licensure 4 years in a PBM or Managed Care plan 3 years of experience in patient care and working directly with clinicians or physician practices 2 years in Population Health or Disease Management programming Ability to travel nationally up to 25% Experience conducting data analysis 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: MBA or MPH Pharmacy residency or fellowship completed Board Certified Pharmacotherapy Specialist or equivalent expertise Medicaid health plan experience Medical informatics/analytics experience Demonstrated disciplined decision-making skills Demonstrated high quality execution of complicated and cross discipline programs Solid analytic skills, clinical knowledge, and business acumen Solid communication skills (written and verbal) Solid presentation skills High emotional intelligence and relationship building 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 with UnitedHealthcare. Let’s talk about opportunity. Start with a Fortune 5 organization that’s serving more than 85 million people already and building the industry’s singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they’re found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that’s second to none. This is no small opportunity. It’s where you can do your life’s best work.(sm) Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado/Connecticut/Nevada residents is $97,300 to $176,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. 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. Brand: UHC Clinical Services Job ID: 2067402 Employment Type: Full-time Job Area: Clinical

 
 

Clipped from: https://b-jobz.com/us/web/jobposting/3085894921?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Finance Director – Anthem

 
 

Description

SHIFT:

Day Job

SCHEDULE:

Full-time

Responsible for all financial reporting analysis/cost and budget functions for business unit. Provides financial leadership, decision support and strategic direction to support the senior management team’s achievement of the business plan. Primary duties may include, but are not limited to:

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

Requires a BA/BS in accounting or finance and a minimum of 5 years of progressively more responsible experience in a high level financial analysis position for a publicly held company; ination of education and experience, which would provide an equivalent background. MBA, CPA, CFM, erred. Experience supporting senior management and prior leadership experience 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 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply,

 
 

Clipped from: https://www.learn4good.com/jobs/waukesha/wisconsin/finance/1188653391/e/

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Medicaid Compliance Auditor Job in Palm Springs, FL at Retreat Behavioral Health

 
 

Job Description

The Medicaid Compliance Auditor is responsible for participating in auditing and contract adherence activities to ensure that Retreat adheres with applicable laws, regulations, and contractual requirements for the Florida Statewide Medicaid Managed Care (SMMC) program.

Primary duties may include, but are not limited to: 

·       Oversees Medicaid compliance in accordance to Retreat’s mission, code of ethics, and integrity

·       Prepares and ensures completion of internal and external audits, adherence reporting, and tracking/monitoring processes 

·       Audits work and charts to ensure appropriate and consistent administration of contract requirements and CMS guidelines. Works with executive leadership and management to drive compliance into Retreat’s business plans, metrics and processes

·       Responds to on demand state and/or federal audit requests.  

·       Responsible for quality reviews, audit participation, and presents audit results. Ensures compliance risks and audits are address and corrective action plans taken

·       Documents audit findings in a timely, accurate, and concise manner. Assures timely implementation of all state and federal regulations

·       Tracks and monitors activities including but not limited to critical incidents, patient experience, caseload track and NCI surveys 

·       Works with HR to ensures clinical licensure adherence with contract requirements.  

·       Maintains knowledge of tracking tools and databases and prepares reports to document contract adherence issues. 

·       Other duties as assigned by oversight board

Qualifications 

Minimum Requirements: 

·       AA/AS and minimum of 5 years related experience

or

·       BA/BS and minimum of 3 years related experience

Preferred Skills, Capabilities and Experiences: 

·       Florida SMMC experience preferred

·       Licensed RN, LPN/LVN, LSW, LCSW, LMSW, LBSW, BSW, or MSW in accordance with accordance with state law

·       Health care auditing certification preferred

·       Computer experience including Microsoft Office Suite including Outlook, Word and Excel preferred

Company Description

Retreat Behavioral Health is a respected provider of substance use disorder and mental health treatment services. With a number of locations along the East Coast and a multitude of inpatient and outpatient services, Retreat’s goal is to help people easily access the best quality of care in a holistic and peaceful environment. We are in-network with most major insurances, and our admissions department operates 24/7. Our on-site clinical and medical staff are leaders in their fields, committed to working tirelessly on behalf of our patients.

Retreat Behavioral Health

Retreat Behavioral Health is a respected provider of substance use disorder and mental health treatment services. With a number of locations along the East Coast and a multitude of inpatient and outpatient services, Retreat’s goal is to help people easily access the best quality of care in a holistic and peaceful environment. We are in-network with most major insurances, and our admissions department operates 24/7. Our on-site clinical and medical staff are leaders in their fields, committed to working tirelessly on behalf of our patients.

 
 

Clipped from: https://www.ziprecruiter.com/c/Retreat-Behavioral-Health/Job/Medicaid-Compliance-Auditor/-in-Palm-Springs,FL?jid=f755301ce69fe509&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Business Analyst with Medicaid Experience – Dedicated Tech Service

 
 

Medicaid, business analysis, mmis, pbm, mco, 365, requirements, business analyst, meetings, functional, non-functional

Full Time

$50 – $55

Work from home available

Job Description

Dedicated Tech Services, Inc. (DTS) is an award-winning IT consulting firm based in Columbus, OH. We now have an opening for a Business Analyst with Medicaid experience..

Job Description:

We are hiring an experienced Business Analyst with Medicaid experience to work for us as a direct W2 salaried or hourly employee for a potential long-term contract with our client. The selected candidate will work on projects related to the Single Pharmacy Benefit Manager (SPBM) and Pharmacy Pricing and Audit Consultant (PPAC) modules of our client’s management system replacement project. The projects have fast-approaching go-live dates, so candidates must be familiar with Medicaid concepts to quickly come up to speed. You will:

  • Author and update various trackers for use by our client’s staff
  • Conduct independent research
  • Be accountable for requirements deliverables, including eliciting, analyzing, validating, managing, and documenting system requirements
  • Develop functional and non-functional requirements documents
  • Assist with managing pending comments and final approvals from the client staff on any project documents, working in collaboration with client staff and module vendor.
  • Identify and communicate risks, constraints, obstacles, or other concerns which may jeopardize timely delivery with the Project Manager.
  • Assist with managing project action items, risks, issues, and decision logs.
  • Take notes and prepares meeting minutes.
  • Interact with State’s SharePoint sites to access, upload, and manage documents.
  • Manage assigned work according to pre-defined schedules and deadlines.
  • Ensure that work adheres to client quality expectations.

Required Skills and Experience:

  • Experience in Medicaid and related terminology. Previous work experience with Medicaid is required.
  • Willingness to quickly learn new concepts and terminology
  • Be flexible regarding job and task assignments and maintain a “can do” attitude.
  • Proficiency with Microsoft 365 suite
  • Must have consistent home internet connection that is capable of supporting video streaming.

Desired Skills and Experience:

  • Previous professional experience with a pharmacy benefit manager (PBM) or a Managed Care Organization (MCO).

This is initially a remote position, but the selected candidate will be expected to work on site in Columbus, OH when the client returns to the office.

s and those authorized to work in the US are encouraged to apply. We are unable to sponsor at this time.

 
 

Clipped from: https://www.dice.com/jobs/detail/735272393904fca1306d5158fbd01397?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Legislature delays negotiations of $4 billion Kansas Medicaid contracts until 2023

[MM Curator Summary]: The bill to handle MCO contract schedules directly by legislative power has moved forward in Kansas, but will be 1 vote shy of being veto proof from the Governor it is seeking to control.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Bill also restricts governor’s authority to close churches during emergency

 
 

Rep. Brenda Landwehr, second from the left, and Rep. Kathy Wolfe Moore, center, sparred over whether delaying the negotiation process over the state’s Medicaid contracts would open the door to possible corruption. Opponents, like Wolf Moore, argue the passing the bill is the equivalent to a one year, no-bid contract extension for the three organizations overseeing KanCare. (Sherman Smith/Kansas Reflector)

TOPEKA — Kansas Republican legislators moved Tuesday to delay negotiations of the nearly $4 billion contracts for insurance companies managing the state’s Medicaid system until 2023.

The bill blocks all requests for proposals for managed care organizations administering KanCare until at least Jan. 1, 2023. The GOP-controlled Legislature was eager to push the process of awarding the new KanCare contracts until January, after the gubernatorial election. 

However, Democrats argued this move allowed no competition and no accountability over the three companies overseeing KanCare. They noted a previous version of the provision heard earlier this year lacked support beyond Republican legislators. 

Opponents also argued the delay would force the equivalent of a no-bid, one year extension of contracts with Sunflower Health Plan, United Healthcare and Aetna Better Health of Kansas, even if it is not delineated in the bill.

“What we are doing here is altering the procurement process for just the three MCOs. Why would we do that?” said Kathy Wolfe Moore, D-Kansas City. “That’s kind of a slippery slope. How many other times is the Legislature going to get involved in this? This is black and white. This is not right.”

Representatives approved the measure 84 to 38, following the lead of the 26 senators who cast affirmative votes before adjourning the regular session in early April. Gov. Laura Kelly has not yet expressed if she will act to veto the measure. The bill was a vote shy of a veto-proof majority in the Senate.

The bill also contains an unrelated section limiting Kelly’s power to close or restrict capacity at Kansas churches during a state of emergency. Legislators combined both measures into the new bill during a conference committee last month.

Rep. Brenda Landwehr, R-Wichita, insisted the new language would not require an extension of current contracts and argued the proposal would ease concerns from the state’s Medicaid director.

She also questioned Kelly’s desire to have the KanCare system managed by nonprofit entities. She argued the current for-profit organizations overseeing KanCare have done a good job providing services. 

“I don’t care if they are profit or nonprofit,” Landwehr said. “What I care about is the citizens that we serve get their services and they get them without interruption. That’s why I’m here.”

Rep. Sean Tarwater, R-Stilwell, called into question Kelly’s handling of previous RFPs and issues in other departments. He lambasted the governor for her handling of the strain placed on the state’s beleaguered unemployment system and said he could not be sure she would manage this better.

Tarwater also noted that Nebraska put out a similar request for proposal a few weeks ago with a deadline of the end of the year.

“It’s a simple process,” he said. “It can be done in a shorter time period, and it can be done properly.”

Kelly is running for reelection in 2022 and should she lose, control over these KanCare contracts would likely go to presumptive Republican opponent Derek Schmidt. Schmidt, the state’s attorney general, previously weighed in on the issue, saying the Legislature did have the authority to delay this process. 

Rep. John Carmichael, who previously ripped this tactic as a corrupt, “pay-to-play” scheme, asked lawmakers to remember the 2014 investigation into whether KanCare contributors paid off lawmakers.

“Where did this idea come from? Who is the proponent of this idea?” the Wichita Democrat asked. “No one can explain a good, legitimate reason to do this.”

House and Senate leadership have denied any misconduct in seeking to delay the contracts.

Carmichael also argued the Kansas constitution already enshrined the ultimate right to practice religion and passing the provision barring the governor from closing churches would simply be duplicative.

However, House majority leader Dan Hawkins, a Wichita Republican, said the governor “closed” churches early in the pandemic, thus requiring this measure. Kelly didn’t close churches, but did issue an executive order limiting mass gatherings in houses of worship.

“It’s important for us to do this because she did not listen to the constitution,” Hawkins said. “Maybe she’ll listen to the statue, maybe she won’t, but it will be in two places now.”

 
 

 
 

Clipped from: https://kansasreflector.com/2022/04/26/legislature-delays-negotiations-of-4-billion-kansas-medicaid-contracts-until-2023/