Author: MM_ADMIN

 
 

MACPAC, a nonpartisan federal legislative branch micro agency that provides policy and data analysis to Congress regarding Medicaid and the State Children’s Health Insurance Program (CHIP), is seeking a chief information officer (CIO) to lead its small information technology (IT) team. The CIO performs macro-level agency duties as well as day-to-day network and user support duties required to ensure the confidentiality, integrity and availability of MACPAC’s network, computing and communications systems. This position has supervisory responsibilities and reports to the chief operations officer.


Major Duties


The CIO Will Provide And Implement The Strategic Vision For MACPAC Technology Resources, Ensure Its Information Resources Are Secure, And Provide Oversight And Management Of All MACPAC Technology Operations To Also Include, But Not Limited, To The Following

• develop goals and objectives for technology and information initiatives for MACPAC based on organizational needs;
• ensure the protection of IT assets and the integrity, security, and privacy of information entrusted to or maintained by MACPAC;
• develop and maintain information technologies policies and procedures, and associated documentation;
• provide advice and counsel concerning IT issues and industry trends to agency leadership;
• research, develop, and implement new services that can improve efficiency of MACPAC through the use of information systems;
• develop, plan, and manage the annual MACPAC information and technology resources and budget in consultation with leadership;
• work closely with all staff regarding technology needs and requests;
• ensure incident resolution in a timely manner;
• identify, develop, and manage vendors to provide MACPAC with necessary technology and information resources and services;
• ensure that all licensing and maintenance agreements are current;
• develop and implement technology and information disaster recovery strategies;
• supervise and direct the work of the senior information technology specialist and contract-based technical personnel;
• manage IT vendor contracts;
• manage the security and storage of sensitive statistical information in compliance with appropriate laws and data use agreement;
• Conduct annual IT policies, security controls and security reviews consistent with NIST guidance;
• Perform day-to day user, network, server and application support using a ticketing system and support application; and
• Perform other duties as assigned.
  
  

Knowledge and Skills


To perform the major duties listed above, the chief information officer must have:

• ability to assess agency evolving IT requirements, plan and implement technology improvements;
• strong knowledge of internal controls, risk assessment and security best practices per NIST guidance;
• ability to prioritize and manage multiple competing responsibilities and tasks;
• ability to balance macro-level agency duties as well as micro-level day-to-day network and user support;
• strong oral and written communication skills;
• an orientation toward problem solving, teamwork, and accountability;
• experience with cloud-based solutions and architectures, such as Amazon Web Services;
• ability to see color and to distinguish letters, numbers and symbols.
• ability to occasionally climb a ladder or stool, crawl or crouch on the floor, and lift and move up to 45 pounds; and
• willingness to engage in learning and development.
  
  

Qualified candidates should have a bachelor’s degree in a related field, with a master’s degree preferred and at least 10 years of experience performing duties listed above.

Clipped from: https://www.linkedin.com/jobs/view/chief-information-officer-at-medicaid-and-chip-payment-and-access-commission-2729371655/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

One Mission. More Than Half a Million Reasons.
As we empower every New Yorker
to live the healthiest life possible.

Job Ref: 64923

Category:
Professional

Department:
OPERATIONS EXCHANGE
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type:
Regular

Employment Type:
Full-Time

Hire In Rate:
$135,000.00

Salary Range:
$135,000.00 – $140,000.00

About NYC Health + Hospitals

MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.

As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics.

For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Reporting to the Head of Product, the Director of Medicaid ensures operational excellence and regulatory compliance of all Medicaid products, owning the full spectrum of product strategy and operations.

The Director will support key analytical activities to support the Plan’s strategic position, and will be proactive in identifying opportunities for performance improvement.

Job Description

 

• Provide oversight of Plan and vendor operations as they relate to the Medicaid line of business aligning outcomes to strategic goals & regulatory requirements.
• Develop & manage operational reports to track operational effectiveness.
• Partner with operational departments including Claims, Customer Service, Finance, Enrollment, Vendor Management, & Medical Management to design processes ensuring effective & efficient operations.
• Support key stakeholders in driving initiatives to meet quality & customer satisfaction goals.
• Maintain customer focus throughout Plan operations to ensure a seamless & excellent customer experience.
• Provide deep knowledge of & insight into the regulatory & market environment of Medicaid in New York to support the development of product strategy.
• Identify & integrate operational best practices, partnering with key departments to optimize processes across the organization such as benefits administration, risk adjustment, marketing & communications, customer experience.
• Monitor & analyze regulatory activity ensuring compliant operations & implementation.
• Perform competitive & market analysis.
• Partner with internal & external stakeholders on key strategic, regulatory, & operational projects.

Minimum Qualifications

 

• Bachelor’s degree from an accredited college or university in an appropriate discipline required.
• Master’s degree in business, healthcare or public administration strongly preferred.
• Minimum 5 years experience at a Health Plan with Medicaid Managed Care in a product management or compliance role.
• Thorough knowledge of Medicaid regulatory environment in NYS.
• Experience working with NYS enrollment transactions & encounter data submissions.
• Thorough understanding of interconnected managed care operations
• Demonstrated ability to develop workflows, policies, procedures.
• Demonstrated ability to identify opportunities for improvement & implement solutions.
• Excellent written & verbal communication skills.
• Excellent analytical skills demonstrated by an ability to use actionable data to support decisionmaking, and to proactively identify opportunities.
• Highly collaborative, and demonstrating good judgment in seeking consensus & input from multiple stakeholders to drive decision-making.
• Ability to take initiative & think independently
• Demonstrate understanding & acceptance of the MetroPlus Mission, Vision, & Values
• Leadership
• Results-driven
• Business acumen
• Systems orientation
• Process improvement
• Data-driven decision-making
• Customer focus
• Written/oral communication
• Resourcefulness
• Ability to work effectively in a fast-paced & constantly evolving environment

calendar_today 19 hours ago

 
 

Clipped from: https://us.bebee.com/job/20210921-2d8b28eba51ee8e249fb2e1b498e1a77?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

The successful candidate can be located anywhere in the U.S.A.

This position will be a point person for the Medicaid Actuarial team’s involvement with Revenue Integrity, a crucial initiative for the Medicaid Business Unit.

This position’s responsibilities will include (but are not limited to):
 

• Tracking performance of revenue integrity initiatives and building out the financial business case for newly introduced initiatives.
• Partnering with Medicare informatics to apply a revenue methodology that best forecasts the projected ROI to create chase lists for intervention programs.
• Constructing a database to calculate “should be” Medicaid revenue, which will allow for member-level valuation & prioritization to maximize ROI of revenue integrity efforts.
• Coordinating with Finance teams for risk score and revenue related SAIs.
• Aggregating and assessing risk score and pricing timelines for all Medicaid markets for purposes of initiative prioritization.

#AetnaActuary

Required Qualifications
7+ years actuarial work experience.

Must be an ASA or FSA and a member of the American Academy of Actuaries able to sign state rate filings and other required actuarial certifications.

Good communication skills and problem solving skills are essential.

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 30 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 60 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 30 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 in Medicaid, prior work on risk adjustment, and experience with project management is preferred but not required.

Education
A Bachelor’s degree is required.

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.glassdoor.com/job-listing/actuarial-director-cred-medicaid-cvs-health-JV_IC1130361_KO0,32_KE33,43.htm?jl=4168748205&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

 
 

Diana Vargas

Independent Recruiter

• OVERVIEW

RESPONSIBILITIES
Contacts and assists VNSNY CHOICE members with Medicaid applications and recertification. Enters and updates member demographic information into the Recertification Tracking Tool. Identifies and investigates problematic recertification cases and presents for resolution. Works under general supervision. Education: Associate’s Degree in health, human services, other related discipline or equivalent work experience required. Experience: Minimum two years experience in health care, insurance, or social services processing bills and Medicaid applications required. Effective oral, written, verbal communication and customer service skills required. Personal Computer skills including Microsoft Word and Excel required. Analytical skills, including compilation and analysis of data, report creation and recommendations based on findings preferred.

QUALIFICATIONS

 
 

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Position Description


Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding using data science and analytics. Our work yields actionable information to guide decisions in wide-ranging policy areas, from health, education, early childhood, and family support to nutrition, employment, disability, and international development. Mathematica offers our employees competitive salaries, and a comprehensive benefits package, as well as the advantages of being 100 percent employee owned. As an employee stock owner, you will experience financial benefits of ESOP holdings that have increased in tandem with the company’s growth and financial strength. You will also be part of an independent, employee-owned firm that is able to define and further our mission, enhance our quality and accountability, and steadily grow our financial strength. Learn more about our benefits here: https://www.mathematica.org/career-opportunities/benefits-at-a-glance.


Mathematica is searching for analysts with experience in Medicaid policy and programs at either the state or federal level. In particular, we are looking for individuals who can support current and emerging work across any number of areas related to monitoring and improving Medicaid programs such as: Medicaid managed care programs, value-based purchasing and alternative payment models, long-term services and supports, measures of delivery and quality of services for beneficiaries, data analytics, and outcomes of innovative programs and policies. Additionally, Medicaid analysts will work on or support project management, change management, and business development. Medicaid analysts work on a variety of projects spanning policy and programmatic areas. These projects range from data analytics to program evaluation and implementation support. Candidates do not need to have experience in all of these areas but should have substantial experience in at least one of them.


Across All Projects, Medicaid Analysts Are Expected To


Medicaid analysts will likely be connected to 2-3 projects at a time, with many projects requiring team leadership and direct-client contact.

• Lead or participate actively and thoughtfully in multidisciplinary teams to implement and monitor policy and programs, drawing on your past experience with Medicaid programs
• Apply rigorous analytic thinking to the collection and interpretation of quantitative and/or qualitative data, including analysis of Medicaid administrative data, managed care data, and site visits or telephone interviews with state and federal officials, health plan representatives, and providers
• Bring creative ideas to the development of proposals for new projects
• Provide the direction and organization needed to help keep projects on time and on budget and facilitate communications across and between internal and external stakeholders
• Contribute to the growth, expertise, and institutional knowledge of staff working in the Medicaid area
  
  

Specific Project Or New Business Development Activities May Include

• Conducting research projects on topics related to state and federal Medicaid policy
• Providing technical assistance to federal and state Medicaid stakeholders
• Assisting with quantitative analyses using Medicaid enrollment, claims/encounter, financial and program data to support program monitoring, improvement, or evaluation
• Developing technical specifications, user manuals, and other documentation to support the implementation of reporting systems and analytic tools
• Authoring client memos, technical assistance tools, issue briefs, chapters of analytic reports, and webinar presentations
  
  

Qualifications


Position Requirements:

• Master’s degree or equivalent in data analytics, public policy, economics, statistics, public health, behavioral or social sciences, or a related field, and at least 3 years of experience working in health policy or health research, with a substantial portion of that time focused on some aspect of the Medicaid program at the state or federal level; or a bachelor’s degree and at least 7 years of state or federal Medicaid experience.
• Strong foundation in quantitative and/or qualitative methods and a broad understanding of Medicaid program and policy issues
• Excellent written and oral communication skills, including an ability to write clear and concise policy and/or technical memos and documents for diverse stakeholder audiences including program administrators and policymakers
• Demonstrated ability to lead tasks or deliverables and coordinate the work of multidisciplinary teams
• Strong organizational skills and high level of attention to detail; flexibility to manage multiple priorities, sometimes simultaneously, under deadlines
  
  

To apply, please submit a cover letter, resume, transcripts (unofficial are acceptable), and contact information for for three references. Please also provide a writing sample that demonstrates policy analysis or program operation and monitoring skills, and reflects independent analysis and writing, such as a white paper or decision memo. You will also be asked to provide your desired salary range during the application process.

Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on a project. If you are assigned to such a project, you will be required to obtain the requisite security clearance.

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

This position offers an anticipated annual base salary range of $63,000 – $95,000. This position may be eligible for a discretionary bonus based on individual and company performance.

Mathematica has implemented a mandatory COVID-19 vaccine policy for all employees working in any of our office locations. Unless a position is office-based, employees are currently being provided the flexibility to work remotely. Those choosing to work in an office or who prefer a hybrid work arrangement will be required to certify that they have received a COVID vaccine.

Clipped from: https://www.linkedin.com/jobs/view/advisory-services-analyst-medicaid-at-mathematica-2698750790/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Description

The Medicaid Lead, Technology Solutions builds strategic partnerships and manages relationships between IT and the aligned business group(s). The Lead facilitates guidance to business partners on information technology (IT) solutions, stays current on and leverages industry trends, and challenges business and IT to drive for best outcomes by leveraging the best technology solutions. This is achieved by having a clear understanding of business, its strategic direction, and targeted outcomes along with technology trends both internal and external to the organization. The role serves as the Single Point of Contact representing assigned business area(s) to the IT organization and representing Humana IT with internal business partners along with State and Federal regulators. The Lead ensures RFP responses are accurate and reflect the true and competitive capabilities Humana brings to the table, ensures internal SLAs are in place to support contracts and technology is configured to operate within contractual obligations. The Lead drives solutions at an organizational level to provide maximum value and align to the overarching IT strategy. They measure value to demonstrate and promote the value of IT to their respective areas and the organization as a whole.

Responsibilities

• Builds and maintains relationships with regulators and business leaders to understand the business strategy and needs and to advocate technology solutions to deliver results.
• Acts as a trusted conduit – the voice of the customer to IT and the voice of IT to the customer, ensuring the objectives of both are met.
• Stays current on relevant technologies leading efforts to match business needs with best technology solutions.
• Ensures Technology investment roadmaps stay relevant and accurately reflect the investment plan and timing for assigned business areas.
• Owns end to end accountability for the ongoing quality control development and delivery of IT products and services for each assigned business area. Accountable for program execution and delivery in line with initiative objectives, benefits, and success criteria. Develops, shares, and leverages best practices across IT
• Works with the business to define, prioritize, and manage projects that align with the business and IT strategy, for annual strategic plan
• Leads teams to gathers business requirements and clarify scope during initial discovery by conducting meetings/interviews, and facilitating large group/cross-functional sessions with partners
• Effectively influences key stakeholders, team members, and peers outside of direct control of this role, to deliver optimal solutions in line with the best interests and expectations of the business partner.
• Conducts executive level briefings presentations and solution recommendations

Required Qualifications

• Bachelor’s degree
• Solid understanding of operations, technology, communications and processes
• Possess 10+ years of progressive experience leading continuous improvement efforts, evaluating existing systems and implementing process improvements.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Master’s degree

Scheduled Weekly Hours

40

 
 

Clipped from: https://getwork.com/details/c7678f78c898a6f4ab65b66974c49d8f?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

We enjoy the important work we do every day on behalf of our members.

Job Summary

Under the administrative oversight of the Director, Pharmacy Operations, the Manager of Pharmacy Operations is responsible for the oversight, development, implementation, and maintenance of Point32Health (P32H) systems, as well as policies and procedures related to pharmacy operations. Responsibilities also include oversight of the Pharmacy Program Specialists and Coordinators responsible for supporting the enterprise call centers. This individual serves as the primary liaison to operational counterparts at the pharmacy benefit management (PBM) vendors to ensure accuracy and execution of pharmacy-related initiatives, programs, and benefit designs developed and implemented by the Pharmacy Department for Commercial, and Medicaid. This individual collaborates with key stakeholders across P32H to develop and support administrative and medical cost savings opportunities. This individual manages the work of the Pharmacy Operations Team to ensure that business results are successfully achieved. This individual interprets and complies with regulatory, compliance, and accreditation requirements for pharmacy operations and programs. As a Manager in the Pharmacy Department, this individual is a strong leader who engenders confidence among internal and external constituents.

Job Description

Pharmacy Benefit Manager (PBM) oversight and performance

• Define, implement, and continuously monitor the performance of pharmacy operations to meet the needs of members, providers, and key stakeholders for Commercial, QHP, and Medicaid
• Manage PBM operational performance, process improvements, and service issue resolution
• Ensure metrics and service standards are met to optimize customer experience
• Ensure PBM performance guarantees are met
• Recommend enhancements and refinements as needed to mitigate compliance risks
• Serve as primary liaison to PBM operations counterparts, providing oversight with current and prospective process automation and services
• Develop and implement standard operating procedures, holding PBM accountable for all operational functions in accordance with contractual agreement

Performance Management

• Develop, monitor, and maintain key performance indicators including, but not limited to: operational effectiveness, quality assurance/regulatory compliance, and departmental service level agreements
• Oversee the ongoing evaluation of current operational strategy and programs, directing improvements and process reengineering to ensure customer satisfaction and operational efficiency and effectiveness
• Prioritize the department’s work (programs, services, policies, operations)
• Develop resource plans for planned and unplanned work related to changes in the business environment, resource availability, etc.
• Manage maintenance of business and day-to-day issues. Ensure appropriate testing is completed. Analyze root causes and identify solutions of issues. Establish actionable next steps and project accurate completion dates.
• Monitor progress and team productivity, report overall status/measures of success, and identify issues and risks
• Collaborate with other departments within Pharmacy Services (e.g., Clinical Pharmacy, Utilization Management, Reporting, Contracting) to develop and implement annual requirements and cost-savings initiatives as well as track results
• Collaborate with departments outside of Pharmacy such as:Member and Provider Services; Enrollment, Premium Billing, Plan Benefits; Business Implementation; Sales, Marketing & Product Strategy; and Compliance

Annual plan benefit changes

• Scope, plan, and implement formulary and benefits changes which may include:changes driven by Product Strategy ; regulatory/compliance changes (e.g., state mandates, federal mandates); custom requests from employer groups
• Assess impact of proposed changes on members
• Oversee communications to members and providers
• Ensure pharmacy operations goals are appropriately aligned with P32H business priorities

Process improvement

• Proactively identify and prioritize areas for process improvement to achieve operational excellence
• Scope, plan, and implement process improvements, including c hange management and influencing stakeholders

Strategic initiatives

• Serve as key member of pharmacy management team, providing input to future pharmacy management strategy and strategic operating priorities
• Participate in and chair task forces or committees concerning pharmacy initiatives
• Ensure that pharmacy operations goals are appropriately aligned with THP business priorities
• Scope, plan, and execute strategic initiative projects

Requirements

• 7-10 years of progressive business experience in health care and/or managed care. Experience in health care service delivery, customer relations, and regulatory/compliance. Possess a fundamental knowledge of health care delivery systems, managed care. Experienced with large-scale project implementation and project management is desired
• 7-10 years of management experience supervising high-level professionals required, with demonstrated success in program development and execution
• Experience with healthcare operations, pharmacy benefits, formulary administration, and data analysis
• Must be able to work cooperatively as a team member with varying levels of staff throughout the organization. Must ensure compliance with confidential data and adherence to corporate compliance policy
• Strong planning, problem solving, analytic and change management skills. Ability to prioritize and manage competing issues and to effectively lead in a matrix environment.
• Strong presentation skills as well as highly-developed verbal and written communication skills.
• Excellent quantitative skills and attention to detail; strong analytic background preferred
• Excellent leadership ability to guide and inspire others, encourage high standards, and exemplify those standards. Requires strong skills at developing teamwork involving a multidisciplinary approach with staff and numerous departments throughout the company
• Requires a high degree of initiative, proactivity, and excellent judgment and decision-making ability. Ability to handle politically-sensitive situations and interact with a wide range of professionals. Requires the ability to work effectively in an extremely complex and often politically-charged environment, working with numerous interdepartmental contacts to problem solve and resolve complex provider issues
• Strong oral and written communication skills, working effectively with internal/external stakeholders including regulatory agencies.
• Requires excellent analytical skills necessary to formulate operational methodologies and analyze data. Must be adaptable to change and work in ambiguous situations while maintaining demeanor and performance under stress. Must possess the ability to critically assess new programs and policies and their impact on quality of operations. Requires a strong presence that will engender confidence among internal and external constituents.

What we build together changes our customer’s health for the better. We are looking for talented and innovative people to join our team. Come join us!

Clipped from: https://www.glassdoor.com/job-listing/manager-pharmacy-operations-commercial-medicaid-tufts-health-plan-JV_IC1154705_KO0,47_KE48,65.htm?jl=4168892051&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic&__cf_chl_jschl_tk__=pmd_51PaHkM7JBABYmKlt0dH3lb6KObgVBMpEVK2Av4BlCw-1632315718-0-gqNtZGzNAxCjcnBszQtR

 
 

 
 

 
 

Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world-class doctor close to where they live.

The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.

Position Purpose: Under the direction of the National Senior Director for Government Quality Programs, the Manager, Medicaid ACO Performance Programs oversees all aspects of performance initiatives, vendor management, and project planning for the Medicaid ACO. This role will lead key business initiatives aimed at ensuring operational efficiencies, meeting budgeted and contractual performance targets, and coordinating between cross functional business partners (e.g., Care Management, Pharmacy and Medicaid business unit) to drive quality performance outcomes for the Medicaid ACO. The role will assume a variety of tasks including, but not limited to, developing, and executing project and implementation plans, reporting on progress towards key business objectives, continuous QI/PI research and reporting, and vendor management.

• Develops and maintains Performance Programs strategic plan for the Medicaid ACO, ensuring that strategies are made with consideration of quality improvement, utilization management, care retention, and are developed using internal performance data, industry standards, and published literature
• Responsible for planning, coordinating, implementing, and overseeing strategies and tactics to support Performance Operations team with the goal of improving quality and financial performance. Provides project management support to QM, which may include creating and monitoring tracking mechanisms and monitoring improvement initiatives
• Oversees implementation and management of Performance Operations vendors and associated contracts for the Medicaid ACO. Ensures compliance of vendor obligations and optimizes use of vendor services and capabilities by Performance Operations team members
• Develops and maintains Performance Programs dashboard to identify opportunities for improvement, growth, and continued success, using competitive intelligence and industry research as applicable. Using data, evidence-based techniques, and business (contractual) priorities, identify top opportunities to improve performance measure rates and communicate these in a clear and timely fashion to leadership
• Creates plans, systems, and methods to support integration of new opportunities into the department’s workflow
• Oversees Medicaid ACO quality measurement, reporting and audits, including HEDIS, CAHPS, and custom state measures. Through data and analysis, evaluates impact of performance programs, and uses results to identify improvement and enhancement opportunities
• Project manages all aspects of collection of hybrid performance measure data and submission of this data to regulatory bodies in an accurate, complete, and timely fashion. Identify and implement opportunities to collect this data year round
• Manages quality improvement audit cycle, including project plans, training curriculum, and quality control of auditor’s work

Education / Experience / Other Requirements

Education:

• Bachelor’s degree required
• Master’s Degree preferred

Years of Experience:

• Four (4) + years of experience in health care quality focused roles that included medical record audits and/or performance metric i.e., HEDIS, Stars, or similar
• Significant experience in quality measurement, HEDIS, interpretation of claims data, medical record review

Specialized Knowledge:

• Strong computer skills, i.e., using various software, including intermediate Excel skills (sort, filter, reformat data, etc.)
• Strong analytic skills/ability to translate complicated data into useable information, including analysis of practice variation
• Successful experience managing complex projects beginning to end with accountability for outcomes, demonstrated organizational and project management skills to manage complex projects through effective planning, tracking, and resource allocation to meet business objectives and timelines
• Strong leadership and management skills; self-directed Ability to generate creative solutions

Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.

 
 

Clipped from: https://jobs.steward.org/manager-medicaid-aco-performance-programs/job/17537750?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Department of Health And Human Services

Office of Program Operations and Local Engagement (OPOLE)

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Program Operations and Local Engagement (OPOLE), Division of Innovation & Operations.


As a Health Insurance Specialist-Program Oversight, GS-0107-12, you will be responsible for evaluating compliance, oversight requirements, and procedures related to the monitoring and oversight of external stakeholders who provide health care services or contract with CMS.

Learn more about this agency

Responsibilities

• Develop, implement, and maintain a comprehensive program oversight strategy and processes, as well as maintain operational requirements, including standard operating procedures and processes for overseeing entities that provide health care services.
• Gather and analyze information, conduct various reviews and studies to access ongoing operations, program vulnerabilities, and initiate/recommend improvements or appropriate action.
• Develop, evaluate, and refine regulations, manuals, program guidelines, program memoranda, policy letters and instructions to disseminate and effectively communicate policy to Agency internal and external stakeholders.
• Attend meetings and conferences with CMS staff and serve as a source of background data on the basis of research performed in preparation for the meetings and conferences.

Travel Required

25% or less – You may be expected to travel up to 25% for this position.

Supervisory status

No

Promotion Potential

12

• 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.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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-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) Utilizing oversight processes or procedures in evaluating the performance of health care providers or entities; 2) Monitoring entities for compliance with program regulations or policies; and 3) Conducting reviews or special studies that identify trends or problem areas making recommendations that modify existing policies or procedures.


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.


Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11236175

Education

Additional information

Bargaining Unit Position: Yes

Tour of Duty: Flexible

Recruitment/Relocation Incentive: Not Authorized

Financial Disclosure: Not Required


CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. 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.


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.

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How You Will Be Evaluated

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

If you meet the minimum qualifications and education requirements for this position, your application and responses to the online occupational questionnaire will be evaluated under Category Rating and Selection procedures for placement in one of the following categories:

• Best Qualified – for those who are superior in the evaluation criteria
• Well Qualified – for those who excel in the evaluation criteria
• Qualified – for those who only meet the minimum qualification requirements

The Category Rating Process does not add veterans’ preference points or apply the “rule of three” but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans’ preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher).


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):

• Oral Communication
• Oversight
• Policy Analysis
• Written Communication

This is a competitive vacancy announcement advertised under Delegated Examining Authority. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would therefore be given new appointments to the civil service; however, benefits, time served and all other Federal entitlements would remain the same.


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.

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Background checks and security clearance

Security clearance

Not Required

Drug test required

No

Position sensitivity and risk

Non-sensitive (NS)/Low Risk

Trust determination process

Credentialing, Suitability/Fitness

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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.

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.

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Benefits

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.

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How to Apply

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 10/05/2021 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 Aquia.Davis@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.

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Agency contact information

Aquia Davis

Email

Aquia.Davis@cms.hhs.gov

Address

Office of Program Operations and Local Engagement
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,10/05/2021, 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.

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• Fair & Transparent

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

Equal Employment Opportunity Policy

The United States Government does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

• Equal Employment Opportunity (EEO) for federal employees & job applicants

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Reasonable Accommodation Policy

Federal agencies must provide reasonable accommodation to applicants with disabilities where appropriate. Applicants requiring reasonable accommodation for any part of the application process should follow the instructions in the job opportunity announcement. For any part of the remaining hiring process, applicants should contact the hiring agency directly. Determinations on requests for reasonable accommodation will be made on a case-by-case basis.

A reasonable accommodation is any change to a job, the work environment, or the way things are usually done that enables an individual with a disability to apply for a job, perform job duties or receive equal access to job benefits.

Under the Rehabilitation Act of 1973, federal agencies must provide reasonable accommodations when:

• An applicant with a disability needs an accommodation to have an equal opportunity to apply for a job.
• An employee with a disability needs an accommodation to perform the essential job duties or to gain access to the workplace.
• An employee with a disability needs an accommodation to receive equal access to benefits, such as details, training, and office-sponsored events.

You can request a reasonable accommodation at any time during the application or hiring process or while on the job. Requests are considered on a case-by-case basis.

Learn more about disability employment and reasonable accommodations or how to contact an agency.

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Legal and regulatory guidance

• Financial suitability
  
• Social security number request
• Privacy Act
• Signature and false statements
• Selective Service
• New employee probationary period

 
 

Clipped from: https://www.usajobs.gov/GetJob/ViewDetails/614852200?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

As a Sr. Regulatory Compliance Analyst, responsible for monitoring regulatory requirements affecting CareCentrix government program operations, analyzing and documenting those requirements, communicating and educating affected business areas about those requirements, developing training programs to ensure an understanding of those requirements, and working with affected business areas to modify operations and policies and procedures to ensure compliance.

 

In this role you will:

• Monitor federal and state laws impacting CareCentrix’s government program operations, analyze the information, and prepare and circulate written communications to affected business areas regarding such laws.
  
  
   
• Provide support, guidance and direction in the development of policies, procedures, and other operational changes necessary to comply with legal requirements and support the operational areas in the implementation of such policies, procedures, and other changes as required.
  
  
   
• Create and implement compliance tracking, trending, and reporting tools.
• Perform internal audits as needed and identify opportunities for improvement.
• Develop and deliver training programs to ensure a clear understanding of compliance requirements.
• Assist Director of Regulatory Compliance and Chief Compliance Officer as needed.
• Adhere to and participate in the Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.

Why you are going to love this role:


 

• You enjoy working with teams by building trust, fostering positive relationships and partnering with a diverse group of people.
• You like to move fast. You enjoy working through ambiguity and a changing market environment.
• You have the ability to function in a fast paced environment with high volume work output.

 
 

You should reach out if:


 

• You have a Bachelor’s Degree with a minimum of 5 years’ experience in a managed care setting.
• You have thorough understanding of federal and state laws impacting health insurers and their delegated entities, including but not limited to, laws impacting utilization management, claims, and credentialing for governmental health plans (Medicare, Medicaid).
• You are proficient in MS Office including PowerPoint, SharePoint, and Excel.
• You have excellent legal research skills.

What we offer:


 

• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
• Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more.
• Advancement opportunities, professional skills training, and tuition Reimbursement
• Great culture with a sense of community.

CareCentrix maintains a drug-free workplace.

Clipped from: https://www.linkedin.com/jobs/view/sr-regulatory-compliance-analyst-medicaid-medicare-at-carecentrix-2728254938/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic