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Managed Care Contract Administrator (Medicaid Health Systems Administrator 1) | Ohio Department of Medicaid

 
 

The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. In 2020, ODM introduced a new vision for Ohio’s Medicaid program — one that strengthens Ohio’s future and ensures everyone has the chance to live life to its full potential.


Today, more than 90 percent of Ohio Medicaid members are supported by managed care organizations. During the year ahead, ODM will begin implementing a new vision for care; focusing on the individual, a strong partnership among MCOs and the department, and supporting specialization in addressing critical needs.


A program that puts the individual first


They Are


Adopting Governor DeWine’s philosophy of service to Ohioans, ODM embarked on an aggressive effort to redesign its managed care program. The goal is to provide more personal, holistic care and supports for millions of Ohioans served by Medicaid. Listening to feedback from more than 1,100 individuals and organizations we identified five procurement goals that would put the individual front and center of Medicaid’s program and policy decisions.


  • 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 and
  • Increase program transparency and accountability.


Unless required by legislation or union contract, starting salary will be set at step 1 of the pay range.


Working Title: Managed Care Contract Administrator

Classification:
Medicaid Health Systems Administrator 1 (PN 20096540)



Office: Managed Care


Bureau: Managed Care Compliance & Oversight


Job Overview


As the Managed Care Contract Administrator in the Office of Managed Care, Ohio Department of Medicaid (ODM), your responsibilities will include:


  • Managing program information and conducting analyses to inform and direct policy changes and updates
  • Conducting evaluations for managed care plans
  • Performing research and answering questions related to legislative and policy initiatives such as implementation and ongoing assessment of new programs, populations and/or initiatives
  • Leading on managed care related policy issues, implementations, and targeted reviews
  • Working with the managed care plans to identify areas of concern
  • Reviewing and approving policies
  • Ensuring system updates are implemented timely and accurately, and providing technical assistance when required
  • Communicating any compliance actions to the assigned Managed Care Plans


Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 months experience in the delivery of a health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data base analysis).


  • Or 12 months experience as a Medicaid Health Systems Specialist, 65293.
  • Or equivalent of Minimum Class Qualifications for Employment noted above.


Primary Location


United States of America-OHIO-Franklin County-Columbus


Work Locations


Lazarus 4


Organization


Ohio Department of Medicaid


Classified Indicator


Classified


Bargaining Unit / Exempt


Exempt


Schedule


Full-time


Work Hours


8:00AM – 5:00PM


Compensation


$33.69/hour


Unposting Date


Dec 6, 2021, 11:59:00 PM


Job Function


Health Administration


Job Level


Individual Contributor


Agency Contact Information


HumanResources@medicaid.ohio.gov

 
 

Clipped from: https://www.linkedin.com/jobs/view/managed-care-contract-administrator-medicaid-health-systems-administrator-1-at-ohio-department-of-medicaid-2799424605/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Director Quality Management Plan – Medicaid Job in International, WA

 
 

Location: Company:

International, WA

Anthem, Inc


Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health benefits companies and a Fortune T

 
 

Clipped from: https://www.adzuna.com/details/2658272004?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Vice President, Community & State (Medicaid), Provider Network Programs – SE Region | UnitedHealthcare

 
 

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


If you are located in FL or GA, you will have the flexibility to telecommute* as you take on some tough challenges.


Primary Responsibilities


  • Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management
  • Develop and execute strategies for a function or discipline that span a large business unit or multiple markets/sites
  • Apply network configuration and incentive-based payment models as appropriate to improve quality and efficiency
  • Direct others to resolve business problems that affect multiple functions or disciplines
  • Direct work that impacts entire functions and/or customer accounts (internal or external)


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


  • 8+ years of management experience in a network management-related role handling complex network providers with accountability for business results
  • 5+ years of experience developing product pricing and utilizing financial modeling in making rate decisions
  • 5+ years of experience with provider contracting
  • 3+ years of experience developing and managing a medical cost and administrative budget
  • Expert level of knowledge of Medicare Resource Based Relative Value System (RBRVS), Diagnosis Related Groups, Ambulatory Surgery Center Groups, etc.
  • Undergraduate degree or equivalent experience


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


Careers at UnitedHealth Group. We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these select few, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks. And we offer a world of rewards and benefits for performance. We believe the most important is the opportunity to do your life’s best work.(sm)


  • 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.

Job Keywords: Medicaid, Provider Network Contracting, Vice President, Community & State, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote, Tampa, FL, Miramar, FL, Jacksonville, FL, Atlanta, GA, Tallahassee, FL

 
 

Clipped from: https://www.linkedin.com/jobs/view/vice-president-community-state-medicaid-provider-network-programs-se-region-at-unitedhealthcare-2799470437/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Medicaid State Operations Analyst in , North Carolina, United States

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time


 

Responsible for researching, analyzing, documenting and coordinating the resolution of escalated and/or complex claims issues for the Health Plan and requires expert knowledge of all systems, tools and processes.

Primary duties may include, but are not limited to: 

  • Receiving and responding to state or federal regulatory complaints related to claims
  • Managing health plan dispute escalations
  • Quality review of various dispute outcomes
  • Managing complex system issues
  • Managing state updates

Qualifications

Requirements: 

  • BA/BS degree
  • Minimum of 5 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry
  • Or any combination of education and experience which would provide an equivalent background

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.


Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/7886612-medicaid-state-operations-analyst?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Product Manager/Owner- Medicare/Medicaid | Simplify Healthcare

 
 

Role:

The role of the Product Manager is to actively oversee software development and implementation projects through the initiation, analysis, execution and implementation phases. They will be assigned a team made up of Business Analysts. This role will engage with cross-functional and multi-national sales, business, and technology team members throughout the project life-cycle, developing and documenting business requirements to be used by the software development and delivery teams as well as the basis for test cases utilized by the QA team to ensure that solutions meet the original business requirements. The Product Manager will drive the Product Innovation objectives and manage the current product backlog.

Responsibilities:

  • Define the product vision, creating a product road map
  • Develop product knowledge
  • Manage the product backlog by anticipating the needs of the client (through forums with delivery organization, product support organization and internal brainstorming) and prioritize
  • Drive the Product Innovation objectives and release content (release notes and product documentation updates) via prioritized features following Agile best practices
  • Oversee development stages of the product and take full responsibility for implementation of those
  • Work with technical team on actionable user stories as needed and create use cases
  • Responsible for maintaining and updating functional test cases for features and functions per sprint, Program increment and releases
  • Participate and drive user group meetings and committees
  • Be the Point of contact (SME) for customers and internal stakeholders for questions/requests/issues on the working of the product
  • Manage a team of Business Analysts and Business Analyst 2s, performing their annual reviews, delegating tasks, and offering guidance for best-practices
  • Keep up to date on needs across all sectors of the healthcare payer industry
  • Prioritize bringing a competitive product to market quickly
  • Other duties as assigned

Required Skills:

  • Leadership skills and the ability to delegate tasks to more junior team members
  • Superior personal and interpersonal attributes (e.g. communication and soft skills, ability to work on a team, results-oriented and a performance-oriented work style, creativity, entrepreneurial qualities, personal maturity)
  • Ambitious, motivated, self-starter, with high energy & collaborative personality
  • High level of integrity and reliability

Qualifications:

  • Bachelor’s degree (technical degrees preferred)
  • 3-5+ years of Technology Product management experience
  • Experience in the healthcare payer industry (specifically in customer service)
  • 8-10+ years of customer service experience

 
 

 
 

Clipped from: https://www.linkedin.com/jobs/view/product-manager-owner-medicare-medicaid-at-simplify-healthcare-2798521921/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Medical Director (Medicaid) | CVS Health

 
 

Job Description


Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.


**This is a remote based (work from home) role and can be based anywhere in the US.**


Aetna Medicaid is looking for a Medical Director to support the Texas STAR Kids plan. The Medical Director will be based primarily at Aetna Better Health of Texas as part of a centralized team that supports Kansas, Texas, and Maryland Medical Management staff, ensuring timely and consistent responses to members and providers related to precertification, concurrent review, and appeal request.


Aetna operates Medicaid managed care plans in sixteen states: Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia and West Virginia.


The Medical Director is a work-at-home position supporting the Aetna Medicaid line of business in these sixteen states, offering a variety of physical and behavioral health programs and services to its membership.


Fundamental Components:


  • Utilization management – The medical director will perform concurrent and prior authorization reviews with peer to peer coverage of denials.
  • Appeals – The medical director will perform appeals in their “base plan” and in other plans based on “same or similar specialty” needs.
  • Pharmacy coverage – The medical director will perform pharmacy reviews.
  • The medical director will participate in and be able to lead daily rounds.


The medical director will participate in the rotating weekend on-call schedule for the region.


Required Qualifications


 

  • Minimum 3 years of clinical practice experience in the health care delivery field.
  • Board certification in pediatrics or med/peds and an active Texas license without encumbrances are required.
  • Multiple state licensure is a plus.
  • The Medical Director will need to obtain an administrative license in Kansas.


     

COVID Requirements


COVID-19 Vaccination Requirement


CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.


  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.


    Preferred Qualifications


     

 
 

  • Experience with managed care
  • Utilization review experience.


Education


The minimum level of education required for candidates in this position is MD or DO certification.


Business Overview


At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

 
 

Clipped from: https://www.linkedin.com/jobs/view/medical-director-medicaid-at-cvs-health-2804709886/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Health Policy & Research Assistant (Annual Medicaid MCO Survey) | Institute for Medicaid Innovation

 
 

Position Title: Health Policy & Research Assistant (Annual Medicaid MCO Survey) Position Information: Full-Time (12-Month Project with Potential Option to Renew)

Travel: None Required

Salary Range: $55,00 to $65,000

Location: Washington, D.C. (Telework with monthly in-person team meetings.)

Reports To: IMI Deputy Executive Director

 
 

About the Institute for Medicaid Innovation

The Institute for Medicaid Innovation (IMI) is a national 501(c)3 nonprofit, nonpartisan research and policy organization that provides independent, nonpartisan information and analysis to inform Medicaid policy and improve the health of the nation. The health policy and research assistant provides support on IMI’s Robert Wood Johnson Foundation (RWJF) funded project, “Annual Medicaid MCO Survey” and on Medicaid specific projects related to the mission and strategic priorities of the Institute for Medicaid Innovation (IMI). Topics may include consumer and stakeholder engagement, women’s health, child and adolescent health, behavioral health, disparities, inequities, structural racism, health system and payment reform, value-based purchasing and alternative payment models, social determinants of health, and other salient Medicaid topics. Potential candidates are encouraged to review the IMI website to learn more about the organization and the Annual Medicaid MCO Survey.

 
 

DUTIES AND RESPONSIBILITIES:

a) conduct literature reviews and data specific activities such as database development, tracking systems, data entry, and basic analysis (e.g., descriptive statistics) using SPSS;

b) develop outlines, draft text, and summarize project results for reports, policy issue briefs, manuscripts, and presentations;

c) research state and federal regulations specific to the topics in the annual Medicaid MCO survey;

d) mentor and manage student research assistants and interns by providing guidance on IMI procedures and policies, identifying opportunities to support professional and career goals, encouraging them to participate in internal and external meetings, and providing written and oral feedback on their assigned tasks and projects;

e) compile supporting documents and draft language for grant proposals and funder reporting requirements; and

f) serve as support staff for the Annual Medicaid MCO survey with responsibilities including:

-supporting the primary investigator, project director, and data and program manager in their efforts to the lead the execution and successful completion of projects;

-coordinating and managing project participants, project team members, consultants/contractors, project activities and deliverables, timelines, budget, and workflow to ensure that the project meets grant requirements and goals;

-drafting, editing, and coordinating internal and external review of final deliverables including reports, fact sheets, curriculum, tools, and others as applicable;

-coordinating calendars and scheduling meetings with internal and external stakeholders;

-drafting meeting agendas, supplemental meeting materials, and minutes;

-working with the communications team to update the website, develop social media outreach efforts, and newsletter publications related to assigned projects; and

-processing pay orders and expense reimbursements for projects and ensure timely execution and maintenance of study contracts. 

 
 

QUALIFICATIONS: Minimal qualifications include master’s degree with at least one year of experience as a research assistant utilizing SPSS software with demonstrated project management skills. 

 
 

TECHNICAL SKILLS/ EXPERTISE: • High proficiency with complete Microsoft Office suite (e.g., Word, Excel, Outlook, and PowerPoint). • Experience with database creation and utilization such as survey or large federal data sets. • Ability to maintain daily workflow while balancing multiple tasks. • Comfort with medical, policy, and research language. • Acute attention to detail and strong work ethic. • Flexibility and ability to consistently meet deadlines. • Familiarity with federal and state Medicaid policy.

 
 

PERSONAL QUALITIES/ ATTRIBUTES: • Commitment to and passion for improving access to high quality, patient-centered, evidence-based care for Medicaid enrollees to improve health equity. • Ability to problem solve independently. • Flexibility in managing multiple and competing demands simultaneously. • Strong organizational skills. • Ability to work in a fast-paced environment. • Strong presentation, oral, and written communication skills. • Ability to interact in a tactful and courteous manner. • Ability to effectively work with and support staff who are working remotely. • Ability to protect confidentiality and discretion regarding privileged and sensitive information.

 
 

The Perks of Working at IMI • Work-life balance design (i.e., flexible work schedule and telework). • Chestfeeding and child friendly workplace. • Ability to live/work in extended D.C. area (i.e., Delaware, Maryland, Pennsylvania, and Virginia). • Equitable (i.e., everyone receives regardless of title/position) 15 days paid vacation time. • Equitable (i.e., everyone receives regardless of title/position) 5 paid sick days. • Generous 19 paid holidays that reflect the equitable, diverse, and inclusive culture (i.e., Juneteenth, Yom Kippur, Eid, Diwali). • Expansive health insurance options (i.e., multiple insurance company options). • Generous 401(k) company contributions. • Paid training and educational opportunities. • Company-sponsored team outings and volunteer opportunities.

 
 

APPLICATION PROCESS To apply, e-mail a cover letter, resume, and two recent writing samples that reflect your data management skills to Dr. Nadia Glenn at NGlenn@MedicaidInnovation.org with subject line “Health Policy and Research Assistant (Annual Medicaid MCO Survey).” 

Clipped from: https://www.linkedin.com/jobs/view/health-policy-research-assistant-annual-medicaid-mco-survey-at-institute-for-medicaid-innovation-2798069526/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Proposal Director, Medicaid RFP Services, Government Programs – Telecommute, Atlanta, Georgia

 
 

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It’s an opportunity to do your life’s best work. sm

No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You’ll help improve the health of millions.

The health care markets are evolving in many different ways and the role and impact of the Medicaid is becoming increasingly important as health plans and providers look for new ways to grow and manage risk. In particular, the ability to manage medical cost through care management interventions or network management strategies is critical to the success of these organizations.

Optum is seeking a Proposal Director, Medicaid RFP Services, Government Programs to provide thought leadership and expertise in the Medicaid market. This position is responsible for the development of Medicaid-focused consulting solutions and responding to RFPs in all areas of TANF, CHIP, LTSS, ABD, Duals Population, Complex Care, Population Health, and provider-sponsored organizations taking on risk for Medicaid populations.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Proposal Management and Oversight/Proposal Writing (70% Time Allocation):

 
 

  • Complete and deliver strategic analyses, translating the data into client-specific requirements/specifications
  • Consult with clients regarding RFP and other business strategies, providing clients with recommendations and information regarding industry trends
  • Present information to, and effectively communicate with, client leadership and other key individuals
  • Support, be an advocate for, and manage (as needed), a defined proposal development process for responding to Medicaid RFPs
  • Participate in individual and group proposal reviews with senior leadership and other key individuals; incorporate changes and improvements to proposals
  • Assist as needed in general proposal activities, including proposal management, proposal writing, editing, proposal assembly, quality assurance, etc.
  • Complete projects on time/budget and in accordance with quality measures
  • Maintain or enhance trusted partner relationships to expand the Payer Consulting footprint at designated clients
  • Complete internal tracking and reporting
  • Conduct other duties as assigned
  • Develop and maintain client references
  • Sales and Strategy Support (30% Time Allocation):

 
 

  • Participate in and lead business development initiatives
  • Develop proposals and statements of work for client-specific engagements
  • Participate, support and complete RFI, RFP and sales process
  • Complete financial analyses for proposed solutions
  • Build Medicaid Marketing and Sales Collateral
  • Attend and participate in oral presentation

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:

  • 7+ years of experience in managed Medicaid, preferably with RFPs, government affairs and/or consulting
  • Project management experience – solid project tracking, presentation and reporting skills
  • Experience writing and executing business plans for new consulting solutions
  • End-to-End knowledge of Medicaid program implementation and operations
  • Ability to think strategically, proven experience laying out strategy, developing products and/or services from ground up that would be sold in the Medicaid market
  • Proficient in Microsoft applications
  • Travel 10-25% on average month, can be more depending on client needs/project phase
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Preferred Qualifications:

  • Bachelor’s degree
  • Shipley certification
  • APMP certification
  • 7+ years of Medicaid experience within a consulting or payer related organization
  • Prior experience working within a State Agency
  • Proven problem-solving skills (identification of issue, causes, solution, implementation plan)
  • Solid ability to influence and motivate
  • Solid interpersonal skills
  • Solid attention to detail and ability to meet deadlines

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination 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 Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work. sm

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $110,200 to $211,700. The salary range for Connecticut / Nevada residents is $110,200 to $211,700. 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 bylower 48 law.

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

Job Keywords: Proposal Director, Medicaid RFP Services, Government Programs,Telecommute, WFH, Work From Home, WAH, Work At Home

 
 

Clipped from: https://www.myvalleyjobstoday.com/jobs/proposal-director-medicaid-rfp-services-government-programs-telecommute-atlanta-georgia/425865686-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Supervisory Health Insurance Specialist- CMS

 
 

Department of Health And Human Services
Office of Financial Management

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Financial Management(OFM), Payment Accuracy and Reporting Group, Division of Medicare Advantage and Drug Error Rate.


As a Supervisory Health Insurance Specialist, GS-0107-15, you will be responsible for providing leadership and executive direction over the activities of Medicare Advantage and Medicare Prescription improper payment measurement program.

Learn more about this agency

Help

Overview

  • Accepting applications

 
 

  • Open & closing dates

11/19/2021 to 12/03/2021

  • Salary

$144,128 – $172,500 per year

  • Pay scale & grade

GS 15

Location

1 vacancy in the following location:

Yes—as determined by the agency policy.

  • Travel Required

Occasional travel – You may be expected to travel up to 5% for this position.

  • Relocation expenses reimbursed

No

  • Appointment type

Permanent

  • Work schedule

Full-time

  • Service

Competitive

  • Promotion potential

15

  • Job family (Series)

0107 Health Insurance Administration

  • Supervisory status

Yes

  • Security clearance

Not Required

  • Drug test

No

  • Position sensitivity and risk

Moderate Risk (MR)

  • Trust determination process

Credentialing

Suitability/Fitness

  • Announcement number

CMS-OFM-22-11298023-IMP

  • Control number

622986600

Videos

 
 

Help

Duties

  • As the MADER Director, the incumbent is directly responsible overseeing the budget and human resource activities for MADER to accomplish the Medicare Part C and Medicare Part D measurement development program missions.
  • Identifies and discusses with internal and external groups, problems, vulnerabilities, or potential changes.
  • Assigns work to subordinates based on priorities, selective consideration of the difficulty and requirements of assignments, and the capabilities of employees.
  • Communicate Medicare Part C and Medicare Part D improper payment findings to stakeholders throughout the agency so that steps can be taken to reduce errors and improve the integrity of the Medicare Part C and Medicare Part D programs.
  • Presents resource issues to senior management, including performing a gap analysis of current resources to projected needs based on the group’s workload and makes recommendation for what is needed for MADER to accomplish the program’s mission.

Help

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.
  • THIS POSITION IS SUBJECT TO THE COVID-19 VACCINE MANDATE AS A CONDITION OF EMPLOYMENT.

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-15, 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-14 grade level in the Federal government, obtained in either the private or public sector, to include:

1) Providing leadership in the operational review and administration of Medicare Fee For Service (FFS), Medicare Advantage (Medicare Part C), Medicare Prescription Drug (Medicare Part D), Medicaid, or Children’s Health lnsurance Program (CHIP) improper payment measurement programs; AND

2) Providing oversight to ensure that program integrity efforts to identify improper payments follow the applicable payment laws, regulations or policies; AND
3) Recommending improvements on improper payment measurement programs; AND
4) Briefing stakeholders on payment vulnerabilities.


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 Federal employees 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/11298023

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: No

Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Required



COVID-19 Vaccine Mandate: In accordance with Executive Order 14043, Federal employees are required to be fully vaccinated against COVID-19 regardless of the employee’s duty location or work arrangement (e.g., telework, remote work, etc.), subject to exceptions that may be required by law. If selected, you will be required to submit proof of vaccination by November 22, 2021 or before your entrance on duty if you are selected after the compliance date. Your HR Consultant will provide a list of documents acceptable as proof of vaccination and instructions for how to submit a request for a legally required exception, if needed, to comply with vaccination requirement.


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 within 30 calendar days of receiving notice to do so, 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 HHS Workplace Flexibilities policy.


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.

Read more

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.

Once the announcement has closed, your online application, resume, 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):


  • Building Coalitions/Communications
  • Business Acumen
  • Leading People
  • Managing Change
  • Results Driven

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

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.). Current CMS employees are REQUIRED to submit a copy of their most recent Notification of Personnel Action (SF-50) at the time of application. Additional documents may also be required 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.


PLEASE NOTE: A complete application package includes the online application, resume, 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 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.

  • Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 12/03/2021 to receive consideration.


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


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

 
 

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month 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 breanna.wells2@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. 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

Breanna Wells

Email

breanna.wells2@cms.hhs.gov

Address

Office of Financial Management
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,12/03/2021, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

  • 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.). Current CMS employees are REQUIRED to submit a copy of their most recent Notification of Personnel Action (SF-50) at the time of application. Additional documents may also be required 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.


PLEASE NOTE: A complete application package includes the online application, resume, 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 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.

Help

How to Apply

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 12/03/2021 to receive consideration.


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


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

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month 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 breanna.wells2@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. 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

Breanna Wells

Email

breanna.wells2@cms.hhs.gov

Address

Office of Financial Management
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,12/03/2021, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

Read more

 
 

Clipped from: https://www.usajobs.gov/GetJob/ViewDetails/622986600?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

SENIOR BUSINESS ANALYST (MEDICAID – MANAGED CARE) – (REMOTE POSITION) – Atlanta – CNSI

 
 

Today

Position Summary

This role involves managing requirement scope, determining appropriate methods on potential assignments, and serving as a bridge between information technology teams and the client through all project phases; providing day-to-day direction on State program activities.

Compliance

***In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification at the time of hire or transfer.

Position Details

The Senior Business Analyst is responsible for analyzing business problems, identifying gaps, and developing technical solutions involving complex information systems under no supervision for Contracts Managed Care and related subsystems.

Analysis

Demonstrates in-depth knowledge of business analysis related to Managed Care to ensure high quality. Demonstrates advanced expertise and contributes to the Business Analysis practice by publishing technology points of view through the creation of white papers. Uses cases, workflow diagrams, and gap analysis to create and modify requirements documents and design specifications.

Planning

Prioritizes and schedules work assignments based on the project plan, handling multiple tasks across project phases.

Process

Creates and modifies Business Process Models.

Technical

Works with customers on presenting technical solutions for complex business functionalities.

Management

Acts as the requirements subject matter expert and supports requirements change management.

Consulting

Analyzes user requirements and client business needs, leveraging expert opinion and expertise.

OPERATIONAL EXCELLENCE

Possesses unwavering commitment to customer service and operational excellence.

Support

Provides customer support through leading client demos and presentations.

Architecture

Understands the overall system architecture and cross-functional integration.Experience

Have 5+ years of experience at large complex organizations, including leading centralized or matrixed teams. Have 3+ years of Lead Business Analyst experience on large complex projects. Have 5+ years Medicaid / Medicare (healthcare) background. Experience facilitating and running JAD requirements design sessions etc.

Knowledge

Strong knowledge in Medicaid Management Information System around Managed Care and related subsystems. Strong knowledge and proficiency in SQL. Knowledge of the Quality-of-Care program is highly preferred. Knowledge of data integration and software enhancements/planning.

Skills

Excellent customer relation skills including presentation and meeting facilitation. Excellent requirements elicitation and validation skills. Preferred Skills:.

Values

CNSI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status, or any other status protected by applicable federal, state, or local law. We are proud of our diversity and encourage all qualified applicants to apply.

Degree

Bachelor’s Degree. Master’s Degree.

Technical

You have a high level of technical and database knowledge.

Analysis

Business Analysis Process (SDLC, documentation procedures) experience.

Clipped from: https://www.theladders.com/job/senior-business-analyst-medicaid-managed-care-remote-position-cnsinc-atlanta-ga_49466681?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic