Author: MM_ADMIN

About The Community Health Worker Position


Babylon Health is recruiting for multiple full-time Community Health Worker positions that will join our population health team and have the opportunity to support our Medicaid patients.


This position is currently remote but as public health guidelines evolve, there will be a requirement to travel from time to time.


Start Date


We are looking to onboard and train our population health team at the end of June/July 1st.


The Opportunity

• Our Community Health Workers will join a multidisciplinary team of physicians, nurses and social workers to provide comprehensive care to our Medicaid patients.
• You’ll have the opportunity to work with underserved populations and be an advocate for those who need support and resources. We provide care in a variety of ways – you’ll connect with our patients in-person (once public health guidelines change), on the phone, embedded (on site) in the physician office or hospital or in the home as needed.
• You’ll have the opportunity to work closely with our integrated care team to improve patient access to community and government service agencies.
• Be a part of our mission to put an affordable and accessible health service in the hands of every person on earth.
  
  

What We’re Looking For

• Experience working with Medicaid/Medicare/Vulnerable Populations
• Experience as a Community Healthcare Worker or similar position – being an advocate for patients and underserved communities
• The ability to navigate multiple computer systems and software (we use G-Suite, Slack and an EHR)
  
  

What We Offer

• Competitive base salary. The compensation range for this role will be shared during the early interview stages.
• 4 weeks’ paid vacation
• 401k’ with employer matching contribution
• Benefits include bonus, medical insurance, vision, and dental coverage
• Incredible growth opportunities with a global health tech startup with a meaningful mission
  
  

Clipped from: https://www.linkedin.com/jobs/view/community-health-worker-medicaid-at-babylon-health-2549994441/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description

The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members’ needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member’s physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care.

• Ensures patient is progressing towards desired

Clipped from: https://careers.humana.com/job/13299651/care-manager-telephonic-nurse-2-medicaid-rn-bilingual-english-spanish-orlando-fl-orlando-fl/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Clipped from: https://www.governmentjobs.com/jobs/3141655-0/medicaid-program-

Job Details

MEDICAID PROGRAM MONITOR (WAE)

This listing closes on 7/20/2021 at 11:59 PM Central Time (US & Canada).

Salary $23.33 – $45.91 Hourly $4,044.00 – $7,958.00 Monthly

$4,044.00 – $7,958.00 Monthly

Location Baton Rouge, LA

Baton Rouge, LA

Job Type

Classified

Department

LDH-Medical Vendor Administration

Job Number

MVA/CSH/2260

Closing date and time

7/20/2021 at 11:59 PM Central Time (US & Canada)

• Description
• Benefits

This position is located within the Louisiana Department of Health / Medical Vendor Administration / Eligibility Program Operations / East Baton Rouge Parish

Job Number: MVA/CSH/2260
Cost Center: 3052050401
Position Number(s): 50479955
 

This vacancy is being announced as a classified position and will be filled as a part-time WAE appointment.  

**Please note** Part-time WAE appointments are temporary and may last up to a year. Employee’s can only work a total of 1,245 hours within a year.
 

To apply for this vacancy, click on the “Apply” link above and complete an electronic application which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process by selecting the ‘Applications’ link after logging into their account.  Below are the most common status messages and their meanings.

*Resumes will not be accepted in lieu of job experience on the application. Failure to complete an application may result in your application being disqualified.*

You must describe your actual duties as you will not be qualified based on job title alone. 

A resume upload will NOT populate your information into your application.
Work experience left off your electronic application or only included in an attached resume is not eligible to receive credit
 

To apply for this vacancy, click on the “Apply” link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page.
 

For further information about this vacancy contact:
Casey Hickman
Casey.Hickman@la.gov
LDH/HUMAN RESOURCES
P.O. BOX 4818
BATON ROUGE, LA 70821
225 342-6477
 
This organization participates in E-verify, and for more information on E-verify, please contact DHS at 1-888-464-4218. 

Qualifications

MINIMUM QUALIFICATIONS:

A baccalaureate degree plus three years of professional level experience in administrative services, economics, public health, public relations, statistical analysis, social services, or health services.

SUBSTITUTIONS:
Six years of full-time work experience in any field may be substituted for the required baccalaureate degree.

Candidates without a baccalaureate degree may combine work experience and college credit to substitute for the baccalaureate degree as follows:

A maximum of 120 semester hours may be combined with experience to substitute for the baccalaureate degree.

30 to 59 semester hours credit will substitute for one year of experience towards the baccalaureate degree.
60 to 89 semester hours credit will substitute for two years of experience towards the baccalaureate degree.
90 to 119 semester hours credit will substitute for three years of experience towards the baccalaureate degree.
120 or more semester hours credit will substitute for four years of experience towards the baccalaureate degree.

College credit earned without obtaining a baccalaureate degree may be substituted for a maximum of four years full-time work experience towards the baccalaureate degree. Candidates with 120 or more semester hours of credit, but without a degree, must also have at least two years of full-time work experience tosubstitute for the baccalaureate degree.

Graduate training with eighteen semester hours in one or any combination of the following fields will substitute for a maximum of one year of the required experience on the basis of thirty semester hours for one year of experience: public health; counseling; social work; psychology; rehabilitation services; economics; statistics; experimental/applied statistics; business, public, or health administration.

A master’s degree in the above fields will substitute for one year of the required experience.

A Juris Doctorate will substitute for one year of the required experience.

Graduate training with less than a Ph.D. will substitute for a maximum of one year of experience.

A Ph.D. in the above fields will substitute for two years of the required experience.

Advanced degrees will substitute for a maximum of two years of the required experience.

NOTE:
Any college hours or degree must be from a school accredited by one of the following regional accrediting bodies: the Middle States Commission on Higher Education; the New England Association of Schools and Colleges; the Higher Learning Commission; the Northwest Commission on Colleges and Universities; the Southern Association of Colleges and Schools; and the Western Association of Schools and Colleges.

Job Concepts

Function of Work:
To perform advanced research, analyses, and/or policy management activities for Medicaid programs.

Level of Work:
Advanced.

Supervision Received:
Broad from a Medicaid Program Supervisor or above.

Supervision Exercised:
None.

Location of Work:
Department of Health and Hospitals, Medical Vendor Administration.

Job Distinctions:
Differs from Medicaid Program Specialist 2 by the presence of advanced research, analysis and policy management responsibility.

Differs from Medicaid Program Supervisor by the absence of supervisory responsibility.

Examples of Work

Conducts audits of eligibility enrollment applications; prepares reports on results of each audit.

Prepares, interprets and clarifies eligibility policies and procedures.

Revises rules, regulations, and procedures to meet changes in law or policy.

Compiles data and proposes budgets for subprogram studies and proposed legislation; determines programmatic impact and composes response for
fiscal statements and fiscal notes.

Reviews current and proposed state and federal regulations and/or revisions to those regulations for hospitals and home health providers.

Evaluates new and/or revised regulations to determine the impact to the state Medicaid program.

Reviews audits performed by the contracted auditor to determine compliance with federal and/or state policies and regulations, which affect allowable costs.

Coordinates compliance monitoring of Medicaid Application Centers statewide.

Receives, approves and schedules all requests for Application Center Representative training.

Advises and assists field staff in performing on-site monitoring reviews to ensure that the Application Centers adhere to federal, state and agency
rules and regulations.

Assist in negotiating contractual agreements between the Department of Health and Hospitals and the Application Centers.

Provides functional supervision over contract staff.

Monitors and evaluates training provided by contract staff.

Prepares the annual budget request utilizing the prescribed format and addendums issued by the Office of Planning and Budget. Prepares detailed analyses
and narratives supporting and/or justifying the request as submitted. Responds to requests for additional information and modifications to the budget during
the legislative approval process.

Trains staff of all Medical Vendor Administration sections in fiscal management, budget development and variance reporting.

Develops training module and provides essential guidance to managers regarding preparing accurate, pertinent and substantiated data.

Benefits

Louisiana State Government represents a wide variety of career options and offers an outstanding opportunity to “make a difference” through public service. With an array of career opportunities in every major metropolitan center and in many rural areas, state employment provides an outstanding option to begin or continue your career. As a state employee, you will earn competitive pay, choose from a variety of benefits and have access to a great professional development program.

Flexible Working Arrangements – The flexibility of our system allows agencies to implement flexible working arrangements through the use of alternative work schedules, telecommuting and other flexibilities. These arrangements vary between hiring agencies.

Professional Development – The Comprehensive Public Training Program (CPTP) is the state-funded training program for state employees. Through CPTP, agencies are offered management development and supervisory training, and general application classes on topics as diverse as writing skills and computer software usage.

Insurance Coverage – Employees can choose one of several health insurance programs ranging from an HMO to the State’s own Group Benefits Insurance program. The State of Louisiana pays a portion of the cost for group health and life insurance. Dental and vision coverage are also available. More information can be found at www.groupbenefits.org.

Deferred Compensation – As a supplemental retirement savings plan for employees, the State offers a Deferred Compensation Plan for tax deferred savings.

Holidays and Leave – State employees receive the following paid holidays each year: New Year’s Day, Martin Luther King, Jr. Day, Mardi Gras, Good Friday, Memorial Day, Independence Day, Labor Day, Veteran’s Day, Thanksgiving Day and Christmas Day. Additional holidays may be proclaimed by the Governor. State employees earn sick and annual leave which can be accumulated and saved for future use. Your accrual rate increases as your years of service increase.

Retirement – State of Louisiana employees are eligible to participate in various retirement systems (based on the type of appointment and agency for which an employee works).  These retirement systems provide retirement allowances and other benefits for state officers and employees and their beneficiaries. State retirement systems may include (but are not limited to): Louisiana State Employees Retirement System (www.lasersonline.org), Teacher’s Retirement System of Louisiana (www.trsl.org), Louisiana School Employees’ Retirement System (www.lsers.net), among others. LASERS has provided this video to give you more detailed information about their system.

Agency State of Louisiana Phone (866) 783-5462 Website http://agency.governmentjobs.com/louisiana/default.cfm

Address For agency contact information, please refer to
the supplemental information above.
Louisiana State Civil Service, Louisiana, 70802 monitor-wae?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Identifies opportunities for expansion into new product or geographic areas. Oversees the development and execution of market entry and expansion plans including, identification and retention of lobbyist, stakeholder and advocacy outreach, and partnership with key influencers and provider associations. Oversees and leads the development of business case for each potential RFP or new business opportunity. Gains internal consensus with business leads, Med Management, IT, finance and legal and any applicable government affairs. Leads ongoing market and competitive analyses to aid strategic decision making and development of key messaging /positioning in support of the business. Oversee Community Development and Advocacy Strategy in footprint to support growth efforts, and shape partnerships with key stakeholders and influencers in addition to gaining market intelligence. Coordinate with Aetna Enterprise initiatives to leverage activities for market pursuit.

Required Qualifications

• 10+years experience selling, claims administration, pharmaceutical services or healthcare management services to business sector customers.
• Position may require up to 75% travel throughout the United States.
• Proven group presentation skills.
• Significant business development transactional experience at a senior level, leading complex negotiations to a successful conclusion.
• Minimum of 10 years recent and related management experience required
• Ability to work independently.
• Strong verbal and written communication skills
• Demonstrated analytical and problem-solving skills.

Preferred Qualifications

• Medicaid experience

Education

• BA Degree required
• MA Degree preferred

Clipped from: https://www.linkedin.com/jobs/view/executive-director-medicaid-business-development-at-cvs-health-2636945057/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Details

Medicaid Specialist I

This listing closes on 12/17/2021 at 11:59 PM Central Time (US & Canada).

Salary

$27,346.56 Annually

Location 75 – WARREN COUNTY, MS

75 – WARREN COUNTY, MS

Job Type

Full-Time

Department

0665 – MEDICAID DIVISION

Job Number

3103-0665-2021-0706Wa

Closing date and time

12/17/2021 at 11:59 PM Central Time (US & Canada)

• Description
• Benefits
• Questions

Characteristics of Work

This is investigative work involving the interpretation of policy to determine Medicaid eligibility for families and children and aged, blind, and disabled individuals. The incumbent makes the initial and continuing determinations of eligibility for Medicaid recipients who live in private and institutional settings. Limited supervision is received from administrative supervisors who oversee a regional office or Central Enrollment Office.

Examples of Work

Examples of work performed in this classification include, but are not limited to, the following:

Assumes responsibility for a Medicaid eligibility determination caseload for a designated territory within a region. 

Investigates and verifies accuracy of information provided by recipients under the Medicaid programs to determine compliance with State and Federal laws, rules, and regulations.

Determines an applicant’s eligibility for institutional care based on State and Federal guidelines and verifies the accuracy of information listed on the applicants’ applications.

Maintains effective public relations with medical facilities and federal, state, county, and city agencies within assigned territory.

Verifies accuracy of information listed on applicants’ applications including income, bank accounts, and any other assets.

Makes determination of an applicant’s eligibility based upon established criteria.

Visits contact centers and medical facilities; assists other regional offices on an as-needed basis.

Performs related or similar duties as required or assigned.

Minimum Qualifications

These minimum qualifications have been agreed upon by Subject Matter Experts (SMEs) in this job class and are based upon a job analysis and the essential functions. However, if a candidate believes he/she is qualified for the job although he/she does not have the minimum qualifications set forth below, he/she may request special consideration through substitution of related education and experience, demonstrating the ability to perform the essential functions of the position. Any request to substitute related education or experience for minimum qualifications must be addressed to the Mississippi State Personnel Board in writing, identifying the related education and experience which demonstrates the candidate’s ability to perform all essential functions of the position.

EXPERIENCE/EDUCATIONAL REQUIREMENTS:

Education:
A Bachelor’s Degree from an accredited four-year college or university.

OR

Education:
An Associate’s Degree or completion of sixty (60) semester hours from an accredited college or university;

AND

Experience:
Two (2) years of experience related to the described duties.

Substitution Statement:
Above an Associate’s Degree or completion of sixty semester hours from an accredited college or university, related education and related experience may be substituted on an equal basis.

Essential Functions

Additional essential functions may be identified and included by the hiring agency. The essential functions include, but are not limited to, the following:

1. Maintains caseload for Medicaid eligibility.

2. Maintains good public relations and customer service.

3. Collects eligibility data information.

4. Visits Medicaid contact centers and/or long-term care facilities.Clipped from: https://www.governmentjobs.com/jobs/3142662-0/medicaid-specialist-i?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

• Humana • Portsmouth, NH 03801

Job #1666164804

•  
• Description

The Vendor Management Lead works as liaison between vendors and organization. The Vendor Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Clinical Vendor Management & Program Delivery Lead reviews and negotiates terms of vendor contracts and communicates with vendors regarding day-to-day matters. Builds and maintains positive relationship with vendors and monitors vendor performance. Researches invoice and contractual issues and resolves discrepancies. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Detailed Job Responsibilities include:

• Leads Clinical Operations in identifying and delivering Medicaid services and products to address strategic initiatives;
• Administers operational process delivery for National clinical vendor pilots and partnerships;
• Works closely with Medicaid’s Vendor Management contracting team to procure contracts and support relationships with vendors and partners;
• Identifies and documents operational policies, process and workflows with vendors; submits IT business requirements, and develops training content for clinical teams;
• Supports Director of Clinical Vendor Program Delivery in identifying best in class clinical partnerships, capabilities, and vended solutions to support industry-leading capabilities for Medicaid population;
• Works closely with Medicaid Business Development, National and Medicaid Market Operational leaders, and Vendor Contracting team to identify clinical products and solutions;
• Determines detailed business requirements, operational workflows, business area reporting, service level standards, and processes; works with vendors and internal partners to implement and support delivery of products and services;
• Collaborates with Population Health Strategy team, Analytics, and Quality teams to establish reporting requirements, measures of success, and test pilot assumptions;
• Leads operational clinical vendor implementations, provides oversight of effectiveness studies and recommends program changes needed to optimize health outcomes;
• Monitors and supports ongoing decision making around scaling clinical solutions across Medicaid markets.

Required Qualifications

• 3+ years of Clinical Product Management or Clinical Vendor Management experience
• 2+ years of Medicaid experience
• Demonstrated experience with implementation of large scale enterprise projects, pilot oversight, and/or development and leadership of collaborative partnerships with enterprise cross-functional teams and external partners.
• Implementation experience within a large metric-intensive operational unit
• Established experience with determination, analysis, and monitoring of vendor performance expectations; creating an accountability structure for vendors; and communicating vendor performance to key stakeholders
• Demonstrated experience and recommendations from peers as a customer-focused, team player, with collaborative approach to leading
• Proficient in Microsoft Office applications including Word, Excel and PowerPoint
• Strong verbal and written communication skills
• Strong facilitation and project management skills

Preferred Qualifications

• 3+ years of Clinical industry or Managed Care organization experience with progressive leadership experience
• Knowledge of and experience with state and federal Medicaid regulations or contracts
• Vendor management or project management experience that interfaces with quality and/or accreditation standards
• Master’s Degree
• Certification with Six Sigma and/or the Project or Product Management certification
• Clinical licensure (RN)

Additional Information

This position is open to working remote. (with the ability to work and support in the Eastern Time Zone)

Scheduled Weekly Hours

40

Clipped from: https://www.nexxt.com/jobs/medicaid-clinical-vendor-management-program-delivery-lead-portsmouth-nh-1666164804-job.html?utm_campaign=google_for_jobs&utm_source=google&utm_medium=organic&aff=2ED44C72-8FD2-4B5D-BC54-2F623E88BE26&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description:

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 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 an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortune Top 50 Company.

Our Governmental Relations Directors are responsible for developing and implementing strategies to advocate enterprise and large state specific legislative and regulatory positions in the most complex legislative and/or regulatory environments, directing and overseeing the resolution of most highly complex, varied and sensitive political issues within the region, and may have federal or multi-state responsibility. Also responsible for enterprise business development and retention which includes supporting new business growth within existing markets, as well as new market (or customer) opportunity development.   This high-performing individual contributor will be aligned to the State of Iowa’s Anthem Medicaid Business.

Primary duties may include, but are not limited to: Develops and implements strategies to advocate enterprise and state specific legislative and regulatory positions to support business goals and objectives, which may include: serving as the lead business owner for the rate setting process with state regulators; establishing and implementing proactive strategies to bring new products or extensions of current products to market; monitoring market databases and product review to analyze opportunities. Represents the enterprise and its specific businesses in advocacy efforts. Establishes and maintains strong relationships with legislators, regulators, other policymakers and their staff that will support membership growth. Develops strategies for utilizing PAC and/or corporate political contributions. Partners with SBUs and CEEs to inform and support business planning processes and proactively raise and address issues of concern. Makes internal and external written and oral presentations on behalf of the company. Develops coalitions and target grassroots capabilities. Manages budgets and issues of importance to the enterprise and contracted lobbying staff, and may act as a team lead. Serves as a leader in trade associations and other advocacy organizations to influence their positions, tactics, and strategies to support enterprise goals. Generally works with legislative sessions of 6 months or longer and/or in the most complex legislative and/or regulatory environments.

[Candidate must reside within or relocate to Des Moines, Iowa]

Qualifications

BA/BS in a related field; 10 years of legislative, regulatory, political, public affairs or industry experience; or any combination of education and experience, which would provide an equivalent background.

Highly preferred experience:

-In-depth knowledge of the Medicaid business, including products and regulatory issues, and knowledge of future trends in the delivery and financing of health care services in the public sector managed care environment.

-Experience within a Health Plan operating in Iowa

-Former legislative experience in the state of Iowa

-Former experience inside an Iowa state regulatory agency or administrative office

-Independent lobbyist experience, consulting with variety of clients

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/7090030-governmental-relations-director-iowa-medicaid?tm_job=PS54157&tm_event=view&tm_company=2522&bid=56

About the job

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


Job Summary


Job Description


Requirements


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!

Industry

• Insurance
• Hospital & Health Care

Employment Type

Full-time

Job Functions

• General Business
• Other

Clipped from: https://www.linkedin.com/jobs/view/director-ri-medicaid-product-strategy-at-tufts-health-plan-2624842107/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic