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About the company

 
 

United Training

1,155 followers

Information Technology & Services 51-200 employees 143 on LinkedIn

United Training was founded by a team of industry veterans who believe it is critical to be agile and develop innovative solutions to train professionals for the skills of the future. Our training and learning solutions are designed to help individuals and organizations do what they do best- only better.

 
 

Clipped from: https://www.linkedin.com/jobs/view/healthcare-proposal-writer-w-medicaid-expertise-at-united-training-2724671058/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Anthem Career Site

 
 

 Sevierville, TN Full Time

Job Posting for Nurse Case Manager l – OB (Medicaid) at Anthem Career Site

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.  It’s the foundation upon which we’re creating greater access to 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. 

 
 

Nurse Case Manager l – OB (Medicaid) PS58871

 
 

Location: Knoxville, Tennessee area. This is a work@home position that requires member-facing visits within the Knoxville area. You must reside in the Knoxville area.

 
 

Work Hours: 8am – 4:30pm, Monday – Friday. No holidays or weekends.

 
 

The Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning. Primary duties may include but are not limited to:

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extracontractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.

 
 

Qualifications

Minimum Requirements:

 
 

The health and safety of our associates, members and communities is a top priority for Anthem.  This priority has become increasingly important as we continue to face the challenges of the COVID-19 pandemic.  Anthem believes vaccination is the best way to reduce the spread of COVID-19 and protect our members, our communities, our families and ourselves. To minimize the risk of transmission of the COVID-19 virus and maintain a safe and healthy workplace, vaccination is required for this role. (At Anthem, fully vaccinated means it has been at least two weeks since you have received the second dose of a two-dose vaccine such as Moderna or Pfizer, or the single dose of a single dose vaccine, such as Johnson & Johnson).

 
 

If you do not meet the requirements for this position, we encourage you to review other positions that currently allow virtual work.  If you have a medical or sincerely held religious reason for not being vaccinated, consistent with applicable law, Anthem will consider requests for reasonable accommodation on this basis.  Should you have any questions regarding the requirement after applying, email TalentAcquisition_VaccinationSupport@anthem.com.

 
 

 
 

• BA/BS in a health-related field; 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in the state of Tennessee required.

 
 

Preferred Qualifications:

• OB or Labor & Delivery experience highly preferred.
• Substance abuse experience preferred.
• Certification as a Case Manager is preferred.
• MS Word and MS Excel proficient.

 
 

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.

 
 

Clipped from: https://www.salary.com/job/anthem-career-site/nurse-case-manager-l-ob-medicaid/c52a5b49-ed88-48d9-95da-d09e350c00fd?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job details

Role: Project ManagerLocation: Dayton, OH / RemoteDuration: 12 MonthsJob description: Strong experience in Medicaid/ Medicare implementation experience is mustClinical skills:

• Claims processing
• Utilization Management
• Prior Authorizations
• From a PM perspective, scheduling is the most important aspect.

Contract length: 12 monthsJob Type: ContractSchedule:

• Monday to Friday

Experience:

• Project management: 10 years (Preferred)
• Medicare / Medicaid: 3 years (Preferred)

Work Remotely:

• Yes

Apply on company website

 
 

Clipped from: https://jobs.laimoon.com/jobs/externalview/28113034?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Summary


CNSI is seeking an experienced Principal Business Solution Architect with specific knowledge around Claims Pricing and Edits. This person will provide end-to-end solution architecture for the new onboarding programs during fit-gap and solutioning phases. This role is a member of the Operations Team and reports directly to the Vice President of Design CoE. Working remotely within the United States is acceptable for this position.


Job Responsibilities

• Provide domain expertise in business solution architecture field, emerging trends, and industry practice.
• Act as the requirements subject matter expert and support requirements change management.
• Propose end-to-end functional and technical solutions for complex business requirements.
• Create conceptual design and write technical specifications for business requirements.
• Frequently apply in-depth Business Architecture knowledge to review and analyze systems problems and identify solutions.
• Develop uses cases, workflow diagrams, and conduct gap analysis to create and modify requirements documents and design specifications.
• Research and evaluate industry trends and technologies for solving complex technical problems.
  
  

Experience/Preferred Skills Required

• Master’s Degree or Bachelor’s Degree with a minimum of 15 years of business solution or analysis or related experience.
• 5+ years of technical leadership experience at large complex organizations, including leading centralized or matrixed teams.
• 8+ years of Lead Business Solution and/or Analyst experience on large complex projects.
• Medicaid / Medicare (healthcare) background and a high-level of technical and database knowledge.
• Experience facilitating and running JAD requirements design sessions, etc.
• Computer Science Engineering Business Administration or a closely related field, is preferred.
• Experience with Systems Development Life Cycle (SDLC)Experience in healthcare industry, is preferred.
• Core Claims and/or Provider Management and Enrollment System experience, is preferred.
• Excellent requirements elicitation and validation skills, is preferred.
• Management & Leadership skills with a high-level of technical and database knowledge, is preferred.
  
  

About Us

At CNSI, we strive to be the market leader and most trusted partner for innovative and transformative technology-enabled solutions that improve health outcomes and reduce costs. We’re passionate about helping our clients improve the health and well-being of individuals and families. We succeed when our clients succeed.

Innovation and commitment to our mission are core to our DNA. And through our shared values, we foster an environment of inclusion, empowerment, accountability, and fun! You will be offered a competitive compensation and benefits package.

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.

 
 

Clipped from: https://www.linkedin.com/jobs/view/business-architect-core-claims-%E2%80%93-medicaid-medicare-remote-at-cnsi-2722936933/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic
 

Clipped from: https://www.glassdoor.com/job-listing/sme-fraud-analyst-medicaid-fraud-hhs-technology-group-JV_KO0,32_KE33,53.htm?jl=1007301179535&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic&__cf_chl_jschl_tk__=pmd_2uI1uUJwFKyZYNbenzpkaR7C2Xqa8TPzx3HS2JeGJkc-1631709154-0-gqNtZGzNAvujcnBszQs9

 
 

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
• Increase program transparency and accountability
  
  

OhioRISE – Ohio Resilience through Integrated Systems and Excellence


As part of Ohio Medicaid’s next generation of its managed care program, Ohio is implementing OhioRISE, a specialized managed care program for youth with complex behavioral health and multi-system needs.


The OhioRISE managed care organization (MCO) will partner with the state, providers, and community organizations to expand access to in-home and community-based services. The MCO will contract with regional care management entities to ensure OhioRISE members and families have the resources they need to navigate their interactions with multiple systems such as juvenile justice and corrections, child protection, developmental disabilities, mental health and addiction, education, and others.


New And/or Enhanced Services Available Through OhioRISE Include

• Intensive Care Coordination
• Intensive Home-Based Treatment – enhanced
• Psychiatric Residential Treatment Facility
• Mobile Response and Stabilization Service
• Behavioral Health Respite – enhanced
  
  

Job Overview


Office: Strategic Initiatives


Classification: Deputy Director 5 (PN 20098838)


As ODM’s OhioRISE Deputy Director, Your Responsibilities Will Include


ODM is seeking a senior healthcare leader to oversee the administrative, programmatic, operational, and clinical development and implementation of the OhioRISE program.

• Providing administrative direction and oversight for the OhioRISE program, including direction and oversight of ODM’s relationship with the OhioRISE managed care plan
• Directing and managing operations of the OhioRISE program within ODM and in partnership with the OhioRISE plan
• Assuring the OhioRISE program’s full integration and coordination with the other components of ODM’s Next Generation of Managed Care
• Holding the OhioRISE program and the OhioRISE managed care plan accountable to the vision and goals set by the OhioRISE cross-agency governance structure
• Overseeing policy and programmatic development and implementation, as well as clinical operations and oversight for OhioRISE
• Engaging multiple state and local systems and other external stakeholders in developing regulatory structures and operational strategies to ensure successful implementation of the OhioRISE program
• Identifying and developing innovative strategies to improve outcomes for children, youth, and young adults served under the OhioRISE program
• Participating in leadership of ODM’s quality improvement framework, quality improvement planning, and quality improvement oversight activities
  
  

The ideal candidate should have strong operational leadership experience and a proven ability to champion the agency’s mission and vision across a variety of audiences and situations.

• Graduate degree from an accredited university or college in business, management or public administration, public health, health administration, social or behavioral science or related field
• Minimum of 5 years of experience in planning and administering a large health services program or health services project management
• Change agent with strong credibility and influencing skills and the proven ability to build relationships and influence stakeholders
• Ability to interface effectively with all levels of the organization as well as leaders working in other sister agencies of state government and other organizations outside of ODM
• Outstanding team leadership and multi-functional/cross-functional team management skills; able to drive a positive employee relations culture
• Strong interpersonal and organizational skills, with a highly collaborative working style and a commitment to diversity and inclusion
• Strategic development and successful execution of large, highly visible, and complex projects involving multiple stakeholders within aggressive time constraints
• Solutions-oriented approach to implement priority initiatives and meet project demands
• Ability to communicate effectively with people at all levels and backgrounds
• Strong presentation skills, written communication skills and experience with a variety of computer software applications and data processing systems
  
  

Primary Location


United States of America-OHIO-Franklin County-Columbus


Work Locations


Lazarus 5


Organization


Ohio Department of Medicaid


Classified Indicator


Unclassified


Bargaining Unit / Exempt


Exempt


Schedule


Full-time


Work Hours


8:00AM – 5:00PM


Compensation


Negotiable


Unposting Date


Ongoing


Job Function


Health Administration


Job Level


Individual Contributor


Agency Contact Information


HumanResources@medicaid.ohio.gov

 
 

Clipped from: https://www.linkedin.com/jobs/view/ohiorise-deputy-director-deputy-director-5-at-ohio-department-of-medicaid-2664480943/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Location: Company:

 
 

Centene is transforming technology and creating a digital evolution that will empower us to better serve our over 25 million members. Our scope covers all forms of healthcare, including Medicaid, Medicare, Marketplace, Commercial, and even specialty coverage.
Job Locations: Tampa, FL; Atlanta, GA
As a Senior Actuarial Analyst , your talents and skills will be challenged, recognized and rewarded. We are a pay-for-performance environment that promotes employees based on talent and contribution. In order to maintain our tremendous growth in this space, our over 400 member Actuary team is growing . Located across the country, this team uses:
– Technical skills to build leading edge models, predict outcomes and assess future impacts
– Business skills to develop strategy with senior leadership
– Personal skills to interact with state, federal and private employer customers
– Management skills to organize cross department projects
In this Senior Actuarial Analyst role, you will:
– Assist in financial analysis, pricing and risk assessment to estimate outcomes.
– Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes
– Assist with developing probability tables based on analysis of statistical data and other pertinent information
– Analyze and evaluate required premium rates
– Assess cash reserves and liabilities enable payment of future benefits
– Develop and run data reports
– Assist with determining the equitable basis for distributing money for insurance benefits
– Participate in merger and acquisition analysis
Education/Experience:
– Bachelor’s degree in related field or equivalent experience.
– Combination of years of experience and number of actuarial exams passed equals or exceeds 5 (Rule of 5). For example, 2 years of actuarial experience and 3 passed actuarial exams.
License/Certification:
Combination of years of experience and number of actuarial exams passed equals or exceeds 5 (Rule of 5). For example, 2 years of actuarial experience and 3 passed actuarial exams.
Job Locations: Atlanta, FA; Tampa, FL
Areas of focus within our Actuarial Department includes: Medicare / Medicaid; Marketplace / Commercial; Risk Adjustment; Reserving; Analytics; Value-Based Contracting, Cost Reporting, and Health Policy
About Us:
Centene Corporation, a FORTUNE 25 company, is the leading multi-national healthcare enterprise committed to helping people live healthier lives. We are revolutionizing the world of healthcare through digital transformation. Our world class teams use collective innovation to turn visions into action and challenge what is possible.
We are an industry leader with a local focus and a global vison:
– Listed on FORTUNE magazine’s World’s Most Admired Companies List for 2nd consecutive year.
– Ranked No.2 on the FORTUNE 500 Measure Up Initiative, a new benchmark to identify companies building inclusive and fair workplaces.
– National footprint in all 50 states, serving 1 in 15 individuals in the U.S.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
TITLE: Sr. Actuarial Analyst – Medicaid
LOCATION: Tampa, Florida
REQNUMBER: 1245935
COMPANY: Finance & Actuarial
POSITION TYPE: Both

 
 

 
 

Clipped from: https://www.adzuna.com/details/2457216443?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

State Health Technology Analytics

Are you a Medicaid Management Information System (MMIS) subject matter expert with technical/functional Medicaid Data Analytics experience? Do you want to help us transform the Medicaid market as it embraces modularization and we help our clients create a new future for Medicaid technology?

Work you’ll do

Provide expertise on Medicaid and Healthcare Analytics

Analyze, support and develop data warehouse objects, data quality processes, design and develop fact and dimension tables, logical and physical database design, data modeling, reporting objects and ETL processes.

Perform Data analysis and profiling

Interpret the rules for data integration and conversion

Drive client conversations around technical and functional design and specifications.

Work in Cloud based environment (AWS or Azure )

Implement technology-enabled business solutions for clients as part of a high-talent team.

The team

Our Health Technology team implements repeatable solutions to solve our government clients’ most critical health technology related issues. We advise on, design, implement and deploy solutions focused on government health agencies at the heart of the business’s issues including claims management, electronic health records, health information exchanges, health analytics and health case management.

Our clients seek a fresh perspective on how to leverage reusable, interoperable and flexible solutions that will enable them to reduce costs, improve health outcomes and respond to public health crises. Professionals will use their deep health, government and technology consulting experience to strategically help solve our client’s technology challenges.

Qualifications

Required:

2+ years of experience working within a Health Tech data analytics environment

Bachelor’s degree

MMIS , Medicare, Medicaid experience

Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future

Desired:

Experience with one of more of the following: SQL/PLSQL, ETL, Cognos, R, Python, Tableau, QlikView, Power BI, Business Objects

Experience working in Cloud based environment (AWS or Azure)

Healthcare Data Analytics

Oral and written communication skills, including presentation skills (MS Visio, MS PowerPoint

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.
 

 
 

Clipped from: https://www.mendeley.com/careers/job/state-health-technology-data-analytics-3680483?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Company: Gainwell Technologies LLC

Job Summary:

Manages client relationships and acts as a trusted advisor, thought leader and general manager to grow the business through sales Develops a client-centered agenda (plan), improves the financial quality of the account [s] (grow), harnesses innovations to meet contractual commitments (deliver) and provides the leadership that aligns teams and holds members accountable for results (lead).  Provides pan-company leadership working across company and with the customer as one unified company account team.  Use of this job family is restricted:  must own an account, sub-region/region P & L.

 
 

Responsibilities:

• Unique mastery and recognized authority on relevant subject matter knowledge including technologies, theories, or techniques
• Develops strategy and set functional policy and direction.
• Acts as a functional manager within area of expertise but does not manage other employees as a primary job function.
• Leads large, cross-division functional teams or projects that affect the organizations long-term goals and objectives.
• Contributes to the development of innovative principles and ideas
• Successfully operates in the most complex disciplines, in which the company must operate to be successful.  Provides highly innovated solutions
• Routinely exercises independent judgment in developing methods, techniques and criteria for achieving objectives. 
• Delivers Account  Business Plan (ABP), Account Financial Plan (AFP), and Account Operating Plan (AOP)
• Leads, coordinates, and manages the long-term, consultative, client relationship to become the client’s trusted advisor
• Establishes and manages, a program to achieve client service excellence
• Meets or exceeds financial commitments
• Delivers on company’s contractual commitments, technical or process innovations
  Enforces a change management mechanism for requests   outside the agreed scope
• Ensures a strong governance framework and meeting cadence within company and between company and the customers
• Leads all employees who provide services to the client, either directly or indirectly

Education and Experience:

• Bachelor’s Degree or equivalent, MBA or equivalent preferred
• 10-12 years’ experience in account leadership roles such as sales, delivery or business management
• At least five (5) years previous account management experience in managing State Medicaid Management Services
• Previous experience with a Medicaid Management System or with major operations-related components of an Medicaid Management System or other large healthcare systems and an ongoing relationship management with a large client.
• Experience working in a matrixed  environment
• Experience in IT industry required  and vertical industry preferred
• P & L, sales and risk management skills required

Knowledge and Skills:

• General Management Skills
• Consultative sales skills
• Financial Acumen
• Knowledge of IT Industry, including trends and competitors
• In depth knowledge of vertical industry
• Change Management skills
• Strong communication skills

 
 

Clipped from: https://jobs.gainwelltechnologies.com/job/Any-city-Account-General-Manager-State-Medicaid-Management-Services-NV-99999/789611700/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic