Author: MM_ADMIN

Clipped from: https://www.linkedin.com/jobs/view/medicaid-product-strategist-work-from-home-express-scripts-at-express-scripts-3332381847/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description Of Position

 
 

• The Product Management Senior Advisor is responsible for working across Express Scripts Regulated Markets division and cross-functionally to define the overall Medicaid strategy for our current products and capabilities. This individual will closely coordinate with cross-enterprise teams to identify, propose, prioritize and execute projects that drive value to our stakeholders and meet the needs of our client and members. The ideal candidate will have a broad based knowledge of Regulated Markets/PBM, a strategic mindset, and the ability to influence and drive change.
  

 
 

Essential Functions

 
 

• Regularly monitor the competitive market landscape (i.e., market trends, competitor offerings, needs of key stakeholders, etc.). and in partnership with Regulated Markets stakeholders, ensure the team’s strategic direction is properly focused.
  
• Address the specific and unique needs of the various Medicaid markets, identify and introduce products and capability enhancements that drive continued profitable growth, client and customer savings, and better health outcomes.
  
• Collaborate with Regulated Markets and other key Product owners across Evernorth to align strategies to ensure competitive positioning, profitability and responsiveness to market needs.
  
• Effectively maximize key relationships to create synergies, alliances and opportunities.
  
• Partner with team to determine success metrics for products and follow-up with postmortem analysis of product misses, based on stakeholder feedback.
  
• Communicate project statuses, insights, and resulting business recommendations to senior leadership and matrix partners.
  

 
 

Knowledge/Skills And Abilities

 
 

• Bachelor’s or Master’s Degree in business, marketing, operations or related field, at least 5 years of relevant experience in Regulated Markets/Medicaid is strongly preferred.
  
• Experienced influencer and collaborator, working through others, building relationships and leading in a matrix organization.
  
• Strong learning skills and ability to adapt quickly to changing environment.
  
• Comfortable navigating and informing strategy against CMS regulation.
  
• Individual contributor, organized and process oriented.
  
• Exceptional organizational agility skills with a strong understanding of business processes, operations and financials to facilitate execution of initiatives.
  
• Excellent communication and presentation skills with experience communicating with internal and external individuals in various functional areas and at various levels of management.
  
• Proficient in Excel and PowerPoint
  

 
 

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

 
 

For this position, we anticipate offering an annual salary of 101,100 – 168,500 USD / yearly, depending on relevant factors, including experience and geographic location.

 
 

This role is also anticipated to be eligible to participate in an annual bonus plan.

 
 

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna.

 
 

About Cigna

 
 

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

 
 

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

 
 

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

 
 

Cigna has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Clipped from: https://www.dice.com/jobs/detail/df0afb3861348099f6eb3d1bbd3b79dc?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Overview

About Public Consulting Group

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, technology, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG employs approximately 2,000 professionals worldwide-all committed to delivering solutions that change lives for the better. The firm has extensive experience in all 50 states, Canada, and a growing practice in Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com.

Responsibilities

The Medicaid marketplace is changing, and PCG is at the forefront. We are looking for an experienced Medicaid Consultant to join our team and help lead our growth efforts. Deep Medicaid experience is critical, as well as experience working with the Centers for Medicare and Medicaid Services (CMS) and the new streamlined modular certification (SMC) and outcomes-based certification (OBC). Our ideal Medicaid Consultant will provide oversight and direction for scope, schedule, , quality, , communications, risk, and , stakeholder management activities, all while adding deep Medicaid and Medicaid Enterprise Systems (MES) experience and thought leadership

Specific Responsibilities:
• Demonstrated understanding and knowledge of Medicaid, CMS, SMC/OBC, and MES
• Conduct Medicaid System Assessments
• Help states plan for and execute SMC/OBC activities
• Help lead and provide expert level guidance on various projects
• Ensure planned results are achieved on time
• Work with clients, vendors, team members to establish and achieve project goals
• Address problems through risk management and contingency planning
• Plan, organize, execute, and monitor and control project activities
• Perform project assessments and report on project progress
• Facilitate meetings and present project information
• Identify, document, and/or escalate issues to appropriate levels

Qualifications

Required Skills/Experience:
• Bachelor’s degree or equivalent university degree
• 5+ years experience performing project oversight and assessments for a large enterprise grade information technology initiative
• 4+ years experience performing performance metrics measurements and reporting to management and executive level staff.
• Demonstrated experience working with SMC/OBC
• Demonstrated written and verbal communications skills
• Ability to influence internal and external stakeholders
• Ability to lead/manage others in a matrixed environment
• Proficiency in Microsoft applications (Outlook, Word, Excel, PowerPoint, Visio, Project) and project management tools

#LI-AH1

#D-PCG

#LI-remote

EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

Clipped from: https://careers.humana.com/job/16966113/director-medicaid-strategic-solutions-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Humana is at the nexus of the innovation taking place within healthcare. Broadly speaking, we are one of the most active participants in the sector. This is an exciting company headquartered in a city with an excellent quality of life!

Oliver
Director, Corporate Development and Venture Capital

 
 

I looked for the opportunity for growth and stability and I found it here.

Barry
Manager, Software Engineering Strategic HR Systems

 
 

Humana has really helped my sense of belonging because I feel part of the team.

Rosemary
Senior Consumer Experience Professional

 
 

The best part of this company is the commitment to associates, which naturally leads to commitment to members.

Abigail
Medical Director, Mid-South

 
 

Equal Opportunity Employer
It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact yourcareer@humana.com for assistance.

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Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working outside of their homes. Learn how we are doing our part

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Clipped from: https://careers.guidehouse.com/veterans/jobs/21307?lang=en-us&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Overview

 

Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit www.guidehouse.com.

Responsibilities

 

Work with the Medicaid agency staff in reviewing the process flow of completing the quarterly CMS Medicaid/CHIP expenditure reporting forms (CMS-64, CMS-21, CMS-37, CMS-21b) and provide recommendations to make the process more efficient. Provide quality reviews and make improvements to workpapers used to prepare expenditure reporting form submissions.  Conduct training for Medicaid agency staff to address questions raised and corrections needed to the Medicaid agencies processes.  Provide technical advisory for reviews of the expenditure reporting forms performed by CMS, OIG and state auditors.  Reconcile expenditure reporting forms to state accounting and claim records. 

 
 

 
 

Job Description/Responsibilities: (bullet format)

• Assess weakness and provide recommendations on reporting of expenditures, audit adjustments, recoveries, overpayments on the CMS-64, CMS-21, CMS-37, and CMS-21b.
  
• Support and audit each step in accumulating, confirming, adjusting, and allocating data as the CMS-64 and CMS-21 reports are completed.
  
• Develop reconciliation processes to map expenditures and revenue from the state accounting and claim systems to entries made into the Medicaid and Children’s Health Insurance Program Budget and Expenditure System (MBES).
  
• Review workbooks used to support the CMS-64 and CMS-21. Ensure workpapers prepared by Medicaid agency staff have been compared to entries made into MBES.  Ensure that any noted variances noted are resolved and that all entries are properly reported prior to certification of the CMS-64 and CMS-21.
  
• Prior to the end of the federal fiscal year, prepare the following reconciliations of CMS-64 and CMS-21:
  

 
 

• Reconcile Federal draws from the U.S. Treasury Payment Management System (PMS) to the Federal Share reported on the CMS-64 and CMS-21.
  
• Reconcile Non-Federal share to the total State General Revenue and other revenue sources maintained in a state agencies fund accounting system.
  
• Prepare work plans with tasks and target dates for developing protocols, procedures and supporting work templates for the federal reporting forms.
  
• Provide status updates to Medicaid agency staff on the progress made in completing work plan tasks.
  
• Develop and deliver technical training to Medicaid agency staff on CMS-64, CMS-21, CMS-37, and CMS-21B requirements and processes.
  
• Provide technical advisory on reviews and audits of the CMS-64, CMS-21, CMS-37, and CMS-21B performed by external reviewers.
  
• Support various program integrity and audit projects.
  

 
 

 
 

Qualifications

 

• BA/BS degree in Health Policy, Economics, Finance, Data Science or other Healthcare/Science/Finance related disciplines OR 10yrs. similar relevant experience, Master’s degree preferred
  
• 7+ years of experience working with Medicaid/Medicare or other health care claims data. 
  
• 5+ years of previous work experience in the health care industry or with a consulting firm to include the following:
  

 
 

• A complete understanding of the flow information through the forms reported on CMS-64, CMS-21, CMS-37, and CMS-21B reports.
  
• Knowledge of all code of federal regulations (CFR’s), state Medicaid manual references, state Medicaid director’s letters, departmental appeals board (DAB) decisions, Office of Management and Budget (OMB) circulars and title XIX/title XXI of the social security act citations applicable to Medicaid and CHIP expenditure federal reporting.
  
• Familiarity with Medicaid State Plan Amendments and Public Assistance Cost Allocation Plans.
  
• Understanding of basic Medicaid reimbursement methodologies including per diems, Diagnosis Related Group (DRG), Ambulatory Payment Classifications (APC’s), Resource-based relative value scale (RBRVS), Resource Utilization Groups (RUG) and Medicare cost reporting principles.
  
• Ability to work overtime
  

 
 

Preferred:

 
 

• 7+years of experience working on hospital-based financing for Medicaid payments (IGT, CPE, CMS-64, DSH assessments, etc.)
  
• 5+ years of experience working in a variety of State Medicaid Programs (Rate Setting, CMS 64 other payment initiatives)
  
• 5+ years of experience preparing deliverables for healthcare payment and pricing projects, payment incentive models, hospital payment adequacy analyses, federal compliance for Medicaid programs, and federal revenue enhancement programs
  
• 5+ years of experience using the CMS-2552-10, Medicare acuity, and Medicaid quality scores in assessing hospital performance and hospital reimbursement through Medicaid
  

 
 

• Knowledge and experience with the application of methods for risk adjustment, reserving, pricing, and forecasting for health insurance
  
• Ability to engage in relationship initiation and cultivation with state Medicaid leaders and/or hospital industry leaders.
  
• Proficient in Microsoft Office Suite 
  

Additional Requirements

 

• The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job esponsibilities as described.
  
• The salary range for this consultant role is $140,000 to $200,000 but may vary based on experience and location
  
• Applicants must be currently authorized to work in the United States for any employer.
  
• No sponsorship is available for this position.
  

 
 

Disclaimer

 

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

 
 

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

 
 

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

 
 

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

 
 

Rewards and Benefits

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

 
 

Benefits include:

• Medical, Rx, Dental & Vision Insurance
  
• Personal and Family Sick Time & Company Paid Holidays
  
• Position may be eligible for a discretionary variable incentive bonus
  
• Parental Leave and Adoption Assistance
  
• 401(k) Retirement Plan
  
• Basic Life & Supplemental Life
  
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
  
• Short-Term & Long-Term Disability
  
• Tuition Reimbursement, Personal Development & Learning Opportunities
  
• Skills Development & Certifications
  
• Employee Referral Program
  
• Corporate Sponsored Events & Community Outreach
  
• Emergency Back-Up Childcare Program
  

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Clipped from: https://www.learn4good.com/jobs/atlanta/georgia/management_and_managerial/1682279245/e/

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What job do you want?

Maximus seeks an implementation director with Medicaid experience overseeing the implementation and integration of government systems and operational projects. The ideal candidate has experience in transformation projects, replacing legacy systems with modular, integrated systems and a background in Medicaid or healthcare systems. However, other system transformation and integration experience will be considered.

Primary Responsibilities:

 

• Manage Maximus departments, in a matrix environment, to successfully implement new contracts
  
• Create and maintain project schedules
  
• Present status reports to internal and external clients
  
• Write and review project deliverables
  
• Lead requirements gathering and analysis sessions
  
• Manage all client contact throughout the implementation of a complex project, including systems and operations projects
  
• Track all implementation activities and artifacts. Lead and participate in requirement and process analysis sessions and interviews
  
• Create MS Project schedules to align with required timeline and scope
  
• Create and review project deliverables
  
• Maintain project forecasts and budgets
  
• Collaborate with various functional and technical teams (Maximus and external partners) to ensure timeline, complete, and accurate implementations
  
• Contribute to corporate repository of project standards
  
• Contribute to proposal writing
  
• Bachelor’s degree from an accredited college or university in Business, Management Information Systems, Computer Science, Public Administration, or a related field
  
• 7 years of relevant professional experience
  
• At least 7 years of project management experience which must include leadership of at least one complex project
  
• PMP certification required
  
• Must possess exceptional organizational, interpersonal, written and verbal communication skills
  
• Must be able to communicate effectively and professionally, verbally and in writing, to all segments of the population
  
• Experience in managing both staff and processes, deadline-oriented work, budgets and revenue and profitability
  
• Experience leading complex projects spanning multiple knowledge, technical, and functional disciplines
  
• Health or Human Services experience a plus
  
• Experience working as a team member and independently
  
• Strong computer skills, including intermediate to expert skill level of MS Office, MS Project, and Share Point
  
• Travel may be required to project sites during implementations
  
• Knowledge of Medicaid Management Information Systems (MMIS) or Medicaid Enterprise Systems (MES)
  
• Experience working on Medicaid modernization projects
  
• Manage the implementation of MMIS onents or modules
  
• Experience integrating complex system platforms across providers, members, and health plans
  

Recommended Skills
 

• Best Practices
  
• Business Process Improvement
  
• Health And Human Services
  
• Metrics
  
• Project Management
  

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Clipped from: https://www.ziprecruiter.com/c/Horizon-Blue-Cross-Blue-Shield-of-New-Jersey/Job/Mgr,-Medicare-&-Medicaid/-in-Pennington,NJ?jid=626ce7ea19076234&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:
The Manager, Medicare and Medicaid Risk Adjustment is responsible to act as the lead for multiple data projects and tasks working directly with the Director, Risk Adjustment Revenue. This position will be actively involved in managing the company’s Medicare and Medicaid risk adjustment revenue management and analysis. This position will work interdepartmentally as well as with outside vendors, such as, but not limited to, Inovalon, Cognizant, Cognisight, Apixio, Change Healthcare, Pharmacy Benefit Administrator (PBA), Membership Systems, etc., in matters related to the membership, revenue, risk adjustment accuracy, and data submission completeness & accuracy. Lead an analytics-focused team and manage a coordinated, cross-functional and integrated process across the organization with partners in Service, Informatics, HCM&T, and IT to implement the programs and streamline and leverage activities.

• Manage the existing Medicare risk adjustment programs, ensuring risk score accuracy capabilities, timely and accurate data submissions, financial impact and related functions. Responsible for managing the Medicare Risk Adjustment Processing System (RAPS) and Encounter Data Processing (EDPS) Submission process and reconciliation of submissions against claims data. Coordinate the work of government audit on risk adjustment data (RADV Audit). Assist in implementation and management of Risk Adjustment related vendor activities.
  
• Oversee DSNP vendor relationships, establishing clear performance goals and expectations. Coordinate the operations for vendors in developing data extracts for accurate and timely RAPS/EDPS submissions as it relates to chart review and in-home assessments. Track vendor progress in meeting deadlines, reporting accurate and complete data.
  
• Establish appropriate receivable balances and the application of monthly payment remittances from the Centers for Medicare and Medicaid Services (CMS) and New Jersey State Department of Human Services Division of Medical Assistance and Health Services (DMAHS).
  
• Manages the DSNP NJ State/CMS reconciliation of preparation and distribution of monthly premium and enrollment derived from the Monthly Membership Report (MRR) and Remittance Advice (RA) respectively.
  
• Prepare and analyze financial data and reports and for maintenance and reconciliation of receivable balances and accounts. Implement and monitor basic control processes, communications improvements, and analysis.
  
• Oversee Medicaid Pharmacy Benefit Administrator (PBA) ensuring timely and accurate Encounters submissions & reconciliation aligning with the TR65 certification. Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and plan’s objectives.
  
• Manage data assurance and reconciliation of Medicare Prescription Drug Event (PDE) data interdepartmentally.
  
• Responsible for duties including training, development, communication and implementation of office audit standards, policies and procedures, reviewing monitoring, establishing tasks, setting goals and evaluating of employee work performance, reviewing operational programs, establishing work priorities, and researching technical and procedural issues related, but not limited to the actions that could potentially affect the member premium. Work in partnership with customers, vendors, and other key stakeholders to deliver the service and products required. Create/revise policies and procedures in accordance with the State and federal requirements and maintain compliance.
  
• Manage, develop and train four – six staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.
  

Education/Experience:
 

• Bachelor degree preferred from an accredited college or equivalent work experience
  
• Requires a minimum of five to eight years of experience in Accounting, Revenue and/or Healthcare Accounts Receivable Management, preferably for a payer organization
  
• Requires premium and/or healthcare receivable management experience (claims processing experience is preferred).
  
• Requires experience processing and analyzing large data files including directing the development of queries and reports to support the management of accounts receivable balances.
  
• Experience in the Medicare and/or Medicaid Managed Care industry is preferred.
  

Knowledge:
 

• Requires working knowledge of personal computers and supporting windows based environment including MS Access, Excel, and Word.-Requires knowledge of claims processing.
  
• Prefers knowledge of industry standard claims coding.
  
• Requires knowledge of provider contracting.
  
• Prefers knowledge of claim system configurations.
  
• Prefers project management skills.
  
• Knowledge of CMS Risk Adjustment Process (RAPS), State and Federal Encounters-Reporting, Part D, Premium Billing, Membership Reconciliation, CMS and State of NJ Revenue Cycle desired.
  

Skills and Abilities:
 

• Requires analytical and problem solving skills.
  
• Requires strong oral and written communication skills.
  
• Requires the ability to adapt to change and meet deliverables in a fast paced, dynamic environment.
  
• Requires the ability to research and resolve problems through interaction with companywide personnel.
  
• Requires the ability to organize and prioritize work assignments.
  
• Requires effective verbal and written communication skills and demonstrate the ability to work well within team.-Requires the ability to work independently and coordinate projects.
  

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

Clipped from: https://careers.novonordisk.com/job/Plainsboro-Senior-Associate-Government-Contracts-Medicaid-NJ/855776001/?feedId=300501&utm_source=HireLifeScience&utm_campaign=NovoNordisk_HLS

About the Department                                                                                                                                                 

At Novo Nordisk, our Strategy, Finance, and Operations team works to provide strategic direction to the company, ensuring that everything we do is viable and built to last. Overseeing and safeguarding Novo Nordisk’s short and long-term planning, the Strategy, Finance and Operations team works closely with the business across the organization to develop strategies and business plans, monitor industry trends, and provide operating recommendations. We regulate accounting, uphold workplace safety, manage our supply chain and sampling, support technology, provide commercial insights & analytics, maintain our facilities and assure the integrity and completeness of all business transactions. At Novo Nordisk, you will have the opportunity to build a life-changing career in a global business environment. We encourage our employees to make the most of their talent. And we reward hard work and dedication with the opportunity for continuous learning and personal development. Are you ready to realize your potential?

 
 

The Position

Responsible for processing and reconciling the Medicaid rebate claims utilizing the Model N Medicaid System. Regularly coordinates with State Medicaid agencies, contract administrators and assists with analyses on resolutions. Ensures Novo Nordisk Inc (NNI) compliance with the Medicaid Drug Rebate Program (MDRP).

 
 

Relationships

Reports to an Associate Director manager in Government Contracts – Medicaid. Internal relationships include Government Contracts, Pricing, Pricing, Contract Operations & Reimbursement and general finance. External relationships include Centers for Medicaid and Medicare Services (CMS), State Medicaid agencies and Pharmacy Benefit Administrators.

 
 

Essential Functions

• Data Analysis and Medicaid Reporting
  

 
 

• Attends Financial Planning &Analysis (FP&A) forecasting meetings and provides guidance to FP&A Department on potential future Medicaid events that could impact rebate forecasting
  
• Analyzes and ensures accuracy of state rebate formatted data for each level of processing
  
• Assists management in Government Compliance regarding pricing and reporting issues as required
  
• Prepares and provides standard Medicaid rebate reports to field and home office management. These reports include state utilization trending, claim receipt status, reconciliation of state invoice and ad-hoc reporting
  
• Prepares Medicaid data analyses to explain variances between rebate periods
  
• Reviews and analyzes contract terms and conditions; ensures data in the Model N Medicaid system reflects the current contract terms for accurate processing
  
• Medicaid Rebates
  

 
 

• Acts as company liaison, negotiating with state Medicaid agencies and Pharmacy Benefit Administrators regarding dispute resolution with a third party Consultant
  
• Assists internal & external customers with inquiries relating to Medicaid payments, dispute and contracts
  
• Builds and maintains relationships with internal stakeholders to build an understanding of business objectives
  
• Coordinates Medicaid claim data entry with third party vendor
  
• Coordinates Medicaid disputes with third party dispute vendor and provides periodic reporting to Senior Management.
  
• Develops and distributes quarterly analysis of Medicaid Rebate Liability
  
• Ensures compliance with all state mandated due dates by avoiding interest penalties at all times
  
• Ensures that all dispute inquires and claim level details received from the States are submitted to dispute resolution consultant in a timely manner
  
• Maintains knowledge in operation of Model N Medicaid Rebate Processing system
  
• Prepares/reviews quarterly Federal Medicaid, ADAP, SPAP (State Programs), and Supplemental Invoices; prepares/reviews prior quarter adjustments as necessary
  
• Responsible for the timely and accurate payments of all Federal and State Medicaid Rebate claims
  
• Reviews state utilization data for reasonableness and quantifies and accounts for Medicaid dispute exposure
  
• Serves as point of contact for all State Medicaid customers regarding rebate payment inquiries
  
• Stays up-to-date and applies knowledge of the Medicaid Rebate legislation to all Federal and individual State programs
  

 
 

• Systems Maintenance/Contract Administration
  

 
 

• Assists internal and external customers with inquiries relating to Medicaid payments, dispute resolution and contract inquiries
  
• Coordinates the implementation of Medicaid system enhancements and testing
  
• Coordinates with Accounts Payable and IT regarding SAP interface check requests and wire transfers
  
• Formats incoming claims data from Medicaid contract customers; ensures rebate claims data is in proper format
  
• Maintains up-to-date knowledge of Model N Medicaid system and coordinates with IT and Model N tech support as necessary
  
• Processes, reviews and validates all Medicaid rebate claims, ensuring all payments are made within the required timeframes, as stated in the contractual agreements
  
• Utilizes DNA Software for State Preferred Drug Lists and dispute analysis
  

 
 

Qualifications

• A Bachelor’s degree required; relevant experience may be substituted for degree when appropriate
  
• 3 years relevant experience preferred with at least 1 year required
  
• Ability to interact with various departments and levels internally and externally
  
• Ability to work independently
  
• Advanced PC skills required
  
• Experience with Government Pricing Medicaid rebate system preferred (Model N)
  
• Intermediate skills in Access and Showcase Query preferred
  
• Intermediate skills in Microsoft Excel required
  
• Knowledge of Medicaid Drug Rebate Program desirable
  
• Strong analytical, quantitative, and qualitative analysis skills required
  
• Strong attention to detail required
  
• Strong organization and prioritization skills required
  

 
 

We commit to an inclusive recruitment process and equality of opportunity for all our job applicants.

 
 

At Novo Nordisk we recognize that it is no longer good enough to aspire to be the best company in the world. We need to aspire to be the best company for the world and we know that this is only possible with talented employees with diverse perspectives, backgrounds and cultures. We are therefore committed to creating an inclusive culture that celebrates the diversity of our employees, the patients we serve and communities we operate in. Together, we’re life changing.

 
 

Novo Nordisk is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, gender identity, sexual orientation, national origin, disability, protected veteran status or any other characteristic protected by local, state or federal laws, rules or regulations.

 
 

Novo Nordisk requires all new hires to be fully vaccinated against COVID-19 prior to the first date of employment. As required by applicable law, Novo Nordisk will consider requests for reasonable accommodation.

 
 

If you are interested in applying to Novo Nordisk and need special assistance or an accommodation to apply, please call us at 1-855-411-5290. This contact is for accommodation requests only and cannot be used to inquire about the status of applications.

Clipped from: https://hirelifescience.com/career/117892/Senior-Associate-Government-Contracts-Medicaid-New-Jersey-Nj-Plainsboro

About the Department

At Novo Nordisk, our Strategy, Finance, and Operations team works to provide strategic direction to the company, ensuring that everything we do is viable and built to last. Overseeing and safeguarding Novo Nordisk’s short and long-term planning, the Strategy, Finance and Operations team works closely with the business across the organization to develop strategies and business plans, monitor industry trends, and provide operating recommendations. We regulate accounting, uphold workplace safety, manage our supply chain and sampling, support technology, provide commercial insights & analytics, maintain our facilities and assure the integrity and completeness of all business transactions. At Novo Nordisk, you will have the opportunity to build a life-changing career in a global business environment. We encourage our employees to make the most of their talent. And we reward hard work and dedication with the opportunity for continuous learning and personal development. Are you ready to realize your potential?

The Position


Responsible for processing and reconciling the Medicaid rebate claims utilizing the Model N Medicaid System. Regularly coordinates with State Medicaid agencies, contract administrators and assists with analyses on resolutions. Ensures Novo Nordisk Inc (NNI) compliance with the Medicaid Drug Rebate Program (MDRP).

Relationships

Reports to an Associate Director manager in Government Contracts – Medicaid. Internal relationships include Government Contracts, Pricing, Pricing, Contract Operations & Reimbursement and general finance. External relationships include Centers for Medicaid and Medicare Services (CMS), State Medicaid agencies and Pharmacy Benefit Administrators.

Essential Functions
 

• Data Analysis and Medicaid Reporting
  

 
 

• Attends Financial Planning &Analysis (FP&A) forecasting meetings and provides guidance to FP&A Department on potential future Medicaid events that could impact rebate forecasting
  
• Analyzes and ensures accuracy of state rebate formatted data for each level of processing
  
• Assists management in Government Compliance regarding pricing and reporting issues as required
  
• Prepares and provides standard Medicaid rebate reports to field and home office management. These reports include state utilization trending, claim receipt status, reconciliation of state invoice and ad-hoc reporting
  
• Prepares Medicaid data analyses to explain variances between rebate periods
  
• Reviews and analyzes contract terms and conditions; ensures data in the Model N Medicaid system reflects the current contract terms for accurate processing
  
• Medicaid Rebates
  

 
 

• Acts as company liaison, negotiating with state Medicaid agencies and Pharmacy Benefit Administrators regarding dispute resolution with a third party Consultant
  
• Assists internal & external customers with inquiries relating to Medicaid payments, dispute and contracts
  
• Builds and maintains relationships with internal stakeholders to build an understanding of business objectives
  
• Coordinates Medicaid claim data entry with third party vendor
  
• Coordinates Medicaid disputes with third party dispute vendor and provides periodic reporting to Senior Management.
  
• Develops and distributes quarterly analysis of Medicaid Rebate Liability
  
• Ensures compliance with all state mandated due dates by avoiding interest penalties at all times
  
• Ensures that all dispute inquires and claim level details received from the States are submitted to dispute resolution consultant in a timely manner
  
• Maintains knowledge in operation of Model N Medicaid Rebate Processing system
  
• Prepares/reviews quarterly Federal Medicaid, ADAP, SPAP (State Programs), and Supplemental Invoices; prepares/reviews prior quarter adjustments as necessary
  
• Responsible for the timely and accurate payments of all Federal and State Medicaid Rebate claims
  
• Reviews state utilization data for reasonableness and quantifies and accounts for Medicaid dispute exposure
  
• Serves as point of contact for all State Medicaid customers regarding rebate payment inquiries
  
• Stays up-to-date and applies knowledge of the Medicaid Rebate legislation to all Federal and individual State programs
  

 
 

• Systems Maintenance/Contract Administration
  

 
 

• Assists internal and external customers with inquiries relating to Medicaid payments, dispute resolution and contract inquiries
  
• Coordinates the implementation of Medicaid system enhancements and testing
  
• Coordinates with Accounts Payable and IT regarding SAP interface check requests and wire transfers
  
• Formats incoming claims data from Medicaid contract customers; ensures rebate claims data is in proper format
  
• Maintains up-to-date knowledge of Model N Medicaid system and coordinates with IT and Model N tech support as necessary
  
• Processes, reviews and validates all Medicaid rebate claims, ensuring all payments are made within the required timeframes, as stated in the contractual agreements
  
• Utilizes DNA Software for State Preferred Drug Lists and dispute analysis
  

Qualifications

 

• A Bachelor’s degree required; relevant experience may be substituted for degree when appropriate
  
• 3 years relevant experience preferred with at least 1 year required
  
• Ability to interact with various departments and levels internally and externally
  
• Ability to work independently
  
• Advanced PC skills required
  
• Experience with Government Pricing Medicaid rebate system preferred (Model N)
  
• Intermediate skills in Access and Showcase Query preferred
  
• Intermediate skills in Microsoft Excel required
  
• Knowledge of Medicaid Drug Rebate Program desirable
  
• Strong analytical, quantitative, and qualitative analysis skills required
  
• Strong attention to detail required
  
• Strong organization and prioritization skills required
  

We commit to an inclusive recruitment process and equality of opportunity for all our job applicants.

At Novo Nordisk we recognize that it is no longer good enough to aspire to be the best company in the world. We need to aspire to be the best company for the world and we know that this is only possible with talented employees with diverse perspectives, backgrounds and cultures. We are therefore committed to creating an inclusive culture that celebrates the diversity of our employees, the patients we serve and communities we operate in. Together, we’re life changing.

Novo Nordisk is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, gender identity, sexual orientation, national origin, disability, protected veteran status or any other characteristic protected by local, state or federal laws, rules or regulations.

Novo Nordisk requires all new hires to be fully vaccinated against COVID-19 prior to the first date of employment. As required by applicable law, Novo Nordisk will consider requests for reasonable accommodation.

If you are interested in applying to Novo Nordisk and need special assistance or an accommodation to apply, please call us at 1-855-411-5290. This contact is for accommodation requests only and cannot be used to inquire about the status of applications.

Clipped from: https://www.themuse.com/jobs/cvshealth/lead-director-network-provider-relations-michiganmedicaidremote-41027a?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description
The Michigan Medicaid Network State Director manages and oversees compliance with our Network responsibilities as provided within the State Medicaid contractual requirements as outlined below:

• This Position will manage separate functions for external provider engagement representatives and internal provider relations representatives to ensure successful Provider Relationships, Network Performance including Clinical and Affordability Targeted Improvements as identified.
• The State Network Director will manage and deploy the Medicaid National Provider Engagement Program through the Local Market Network Engagement Provider Representatives within their respective Leadership
• The State Network Director will manage and direct the internal / external Network Provider Relations staff to ensure “best in class” Provider Relationships
• The State Network Director will assist in the recruitment of new providers as needed and maintain compliance with all network access requirements.
• Develops and implements training programs and educational materials for providers as well as for internal staff and aligns Network functions with Operations and Claims as needed.
• Assist and develop Network Action Plans to ensure Network Compliance with any and/all State Network Compliance requirements

Role/responsibilities
• Manages Local Provider Engagement Team to Deploy National Engagement Model
• Manages Local Provider Relations staff to ensure Market Leading Provider Satisfaction
• Provides direction to operations teams regarding policy and procedures related to claims/providers.
• Facilitates Provider Advisory Group and JOC meetings to work with management to implement changes via coordination with Quality Management to develop appropriate provider Clinical measure improvements and implement those measures in the provider community.
• Oversees the monitoring of executed provider contracts to ensure Network Access meets State requirements.
• Coordinate’s provider information with Member Services and other internal departments as requested.
• Provides service to providers by resolving problems and advising providers of new protocols, policies, and procedures.
• Develops training materials for staff and provider network; oversees staff responsible for initial and ongoing provider in-services and provider education; develops and implements provider satisfaction surveys.
• Participates in Grievance and Appeals meetings, tracks and trends provider grievances, monitors staff for timely compliance;
• Compiles data and staff metrics in order to complete regulatory deliverables; participates in all internal compliance audits and Regulatory reviews.
• Researches, reviews, and prepares response for all governmental, regulatory and quality assurance provider complaints ; timely and continuous reconciliation of provider records; oversees Provider Access and Availability by reviewing Appointment Availability Audits conducted by staff.
• Provides support and maintenance assistance for websites, portals, directories, manuals, and dashboards; plans, coordinates, and conducts provider forums and monthly webinars; develops communications including newsletters, notifications and Fax Blasts.
• Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with Member Services and other internal departments.
• Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions. Monitors staff performance, including weekly staff metrics; coaches and mentors’ staff on performance issues or concerns.
• Promotes and educates providers on cultural competency

Pay Range
The typical pay range for this role is:
Minimum: 100,000
Maximum: 221,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
• Minimum of 5 to 7 years recent Managed Care Network experience in Provider Relations & Employee Supervision with 3-5 Years Medicaid Network
• Excellent interpersonal skills and the ability to work with others at all levels
• Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards
• Excellent analytical and problem-solving skills
• Strong communication, negotiation, and presentation skills
• Knowledge of Michigan Medicaid.

Preferred Qualifications
Master’s degree preferred.

Candidates to reside in applicable State or surrounding State.

Education
• Bachelor’s degree in a closely-related field or an equivalent combination of formal education and recent, related experience.

Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand – with heart at its center – our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Clipped from: https://simplify.jobs/p/78327025-86c0-42a4-a354-13c73bb5bd9b/Community-Health-Care-Case-Worker?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Outreach Specialist

Posted on 11/1/2022

Locations

Toledo, OH, USA

Experience Level

Entry

Junior

Mid

Senior

Expert

Desired Skills

Customer Service

Requirements

• Requires HS Diploma and a minimum of 1 year of customer service experience, or any combination of education and experience that would provide an equivalent background
  
• For Medicaid business units, a Community Health Worker Certification is required
  

Responsibilities

• Responds to telephone, written, and in-person inquiries and initiates steps to assist regarding issues relating to content or interpretation of benefits, policies and procedures
  
• Provides timely and accurate resolution of inquiries and issues regarding benefits, services and policies
  
• Supports and promotes State Sponsored Programs through participation in community events
  
• Represents State Sponsored Programs in community collaborations
  
• Supports member access to care through home visits, processing of reports, and distribution of collateral materials
  
• Performs new member orientations
  
• Provides superior quality outcomes by taking ownership of issues to ensure timely resolution or follow-up
  
• Provides superior, professional, and courteous service to customers. Comprehends the various cultural and linguistic needs of the Medicaid and SCHIP population, knowledge of the various health and social services available in the assigned region with a special emphasis on services offered by community based organizations, ability to work professionally with the company’s associates, community-based organizations, providers and plan members
  

Desired Qualifications

• Understanding of the basic principles of managed care and the concepts of publicly financed health insurance such as Medicaid and SCHIP programs is preferred
  

Position Title:

Community Health Care Case Worker (Outreach Specialist)

Job Description:

Responsible for serving as the initial and main point of Field contact between the Company and current and potential members.

Primary duties may include, but are not limited to:

• Responds to telephone, written, and in-person inquiries and initiates steps to assist regarding issues relating to content or interpretation of benefits, policies and procedures.
  
• Provides timely and accurate resolution of inquiries and issues regarding benefits, services and policies.
  
• Supports and promotes State Sponsored Programs through participation in community events.
  
• Represents State Sponsored Programs in community collaborations.
  
• Supports member access to care through home visits, processing of reports, and distribution of collateral materials.
  
• Performs new member orientations.
  
• Provides superior quality outcomes by taking ownership of issues to ensure timely resolution or follow-up.
  
• Provides superior, professional, and courteous service to customers. Comprehends the various cultural and linguistic needs of the Medicaid and SCHIP population, knowledge of the various health and social services available in the assigned region with a special emphasis on services offered by community based organizations, ability to work professionally with the company’s associates, community-based organizations, providers and plan members.
  

Minimum Requirements: 

•  Requires HS Diploma and a minimum of 1 year of customer service experience, or any combination of education and experience that would provide an equivalent background.
  
• For Medicaid business units, a Community Health Worker Certification is required.
  

Preferred Skills, Capabilities and Experiences: 

•  Understanding of the basic principles of managed care and the concepts of publicly financed health insurance such as Medicaid and SCHIP programs is preferred.  
  

Job Level:

Non-Management Non-Exempt

Workshift:

Job Family:

CUS > Care Reps

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short- and long-term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contactability@icareerhelp.comfor assistance.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short- and long-term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at
careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.