Category: MM Curator
OhioRISE Deputy Director (Deputy Director 5) | Ohio Department of Medicaid
The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. In 2020, ODM introduced a new vision for Ohio’s Medicaid program — one that strengthens Ohio’s future and ensures everyone has the chance to live life to its full potential.
Today, more than 90 percent of Ohio Medicaid members are supported by managed care organizations. During the year ahead, ODM will begin implementing a new vision for care; focusing on the individual, a strong partnership among MCOs and the department, and supporting specialization in addressing critical needs.
A program that puts the individual first
They Are
Adopting Governor DeWine’s philosophy of service to Ohioans, ODM embarked on an aggressive effort to redesign its managed care program. The goal is to provide more personal, holistic care and supports for millions of Ohioans served by Medicaid. Listening to feedback from more than 1,100 individuals and organizations we identified five procurement goals that would put the individual front and center of Medicaid’s program and policy decisions.
- Emphasize a personalized care experience
- Improve care for children and adults with complex behavioral health needs
- Improve wellness and health outcomes
- Support providers in better patient care
- 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
Sr. Actuarial Analyst – Medicaid
Location: Company:
|
Tampa, FL |
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 Data Analytics – Atlanta
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.
Account General Manager – State Medicaid Management Services
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
Medicaid Business Data Analyst – Telecommute – Atlanta, United States
Found in: beBee S2 US
Description:
UnitedHealthcare is a company that’s on the rise. We’re expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn’t about another gadget, it’s about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life’s best work.(sm)
In this role you will supporting the Michigan Health Plan executive team as relates to operation data analysis. You will be mining, analyzing claims and HEDIS data. Your take your experience to develop usable reports to help the leadership make informed decisions.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Analyze and interpret data to identify trends, patterns and opportunities for the business and clients
- Communicate analysis and interpretation to appropriate audiences
- Produce, publish, and distribute scheduled and ad-hoc client and operational reports relating to the development and performance of products, processes, and technologies
The question is how effective can you be in interpreting and analyzing large amounts of information from multiple sources and use it to tell a meaningful story? The challenge will be to manage outcomes of various studies that include analyzing, reviewing, forecasting, trending and then presenting information for operational and business planning, all while adapting to change quickly.
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications
- Bachelor’s degree in Business, Finance, Health Administration or related field or equivalent experience
- 3+ years of experience in business/finance including analysis experience with a solid understanding of data storage structures
- 3+ years of experience working with Medicare or Medicaid data fields
- 3+ years of working experience with Medicare or Medicaid Claims data
- 3+ years of experience in analysis of business process and workflow and providing an evaluation, benchmark and/or process improvement recommendations
- 3+ years of experience with PC-based software programs and automated database management systems (Excel, Access, PowerPoint)
- 2+ years of experience using SAS and/or SQL for data queries and data analytics
- 1+ years of experience with project methodology (requirements, design, development, test, and implementation)
Preferred Qualifications
- Michigan Medicaid experience
- Prior experience working with HEDIS data
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That’s why you’ll find some of the most amazingly talented people in health care here. We serve the health care needs of low- income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life’s best work.(sm)
Colorado Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Medicaid, HEDIS, Data Analysis, Michigan, Medicare, SAS/SQL, Claims data, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote
calendar_today 7 hours ago
Sr. Actuarial Analyst – Medicaid at WellCare Health Plans in Atlanta, Georgia
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.
Job Field: Actuarial Services
By submitting your interest in this job, you agree to receive text notifications with additional steps to complete your job application. You will receive up to 6 messages from the number “63879”. Message & data rates may apply. Please refer to our privacy policy for more information.
Nurse | Centers for Medicare & Medicaid Services
As a Nurse, you will be focusing in the areas of clinical quality improvement programs; utilization management and clinical standards impacting health service delivery.
What you’ll do:
- Provide recommendations about clinical aspects of nursing practice and programs that pertain to national-level programs affecting a variety of health care settings and clinicians.
- Provide clinical nursing perspective in the assessment of policies, projects, and data related to the measurement of quality, legislative and administrative proposals, and make recommendations to agency managers.
- Prepare issue papers, briefing materials, manuals, presentations, reports and correspondence for an assigned health policy area.
Experience we’re looking for:
(1) Assisting with researching policies regarding clinical aspects of program operations.
(2) Interacting with internal and external stakeholders to provide clinical nursing advice or guidance.
– OR –
Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing 3 full years of progressively higher level graduate education leading to such a degree or Ph.D. or equivalent doctoral degree or LL.M., if related to the position being filled.
– OR –
Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at grades GS-11. Therefore, only education in excess of a master’s or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree, may be used to combine education and experience.
To see full list of eligibility criteria, see job posting on USAJOBs.
US Centers for Medicare & Medicaid Services Financial Management Analyst
Financial Management Analyst
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicaid and CHIP Services, Financial Management Group (FMG), Division of Financial Operations East-Branch A.
As a Financial Management Analyst, GS-0501-12, you will perform a variety of financial management duties and must have
knowledge of financial principles and procedures in carrying out assignments.
25% or less – You may be expected to travel up to 25% for this position.
- Job family (Series)
0501 Financial Administration And Program
- Requirements
Requirements
Conditions of Employment
- You must be a U.S. Citizen or National to apply for this position.
- You will be subject to a background and suitability investigation.
- Time-in-Grade restrictions apply.
Qualifications
ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.
Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.
In order to qualify for the GS-12, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-11 grade level in the Federal government, obtained in either the private or public sector, to include:
1) Developing and reviewing budgets reports or expenditures to ensure compliance; AND 2) Gathering and/or analyzing information pertaining to financial operations; AND 3) Compiling financial data answering specific requests for information; AND 4) Identifying issues in budget or financial proposals and recommending solutions.
Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.
Time-in-Grade: To be eligible, current or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.
Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11230240
Education
This job does not have an education qualification requirement.
Additional information
Bargaining Unit Position: Yes
Tour of Duty: Flexible
Recruitment/Relocation Incentive: Not Authorized
Financial Disclosure: Not Required
Full-Time Telework Program for CMS Employees: CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page.
Additional Forms REQUIRED Prior to Appointment:
- Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
- Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
- Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.
The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.
If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.
How You Will Be Evaluated
You will be evaluated for this job based on how well you meet the qualifications above.
Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with any interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.
Once the announcement has closed, your online application, resume, transcripts and CMS required documents will be used to determine if you meet eligibility and qualification requirements listed on this announcement. If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration. Please follow all instructions carefully. Errors or omissions may affect your rating.
Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):
- Analysis
- Financial Management
- Oral Communication
- Writing
Background checks and security clearance
Security clearance
Not Required
Drug test required
No
Position sensitivity and risk
Non-sensitive (NS)/Low Risk
Trust determination process
Credentialing, Suitability/Fitness
- Required Documents
Required Documents
The following documents are REQUIRED:
1. Resume
showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/
2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.
PLEASE NOTE: A complete application package includes the online application, resume, transcripts and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume, transcripts and CMS required documents, will result in you not being considered for employment.
- Benefits
Benefits
A career with the U.S. Government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
Review our benefits
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time, or intermittent. Contact the hiring agency for more information on the specific benefits offered.
Medicaid Program Specialist – DHW at State of Idaho
Description
How would you like to make a difference in the health of the children of Idaho and have an impact on your community? The Idaho Department of Health and Welfare, Division of Medicaid has an opening for the clinical position of a Program Specialist – DHW in the Clinical & Quality Management Program.
This position is located in beautiful Idaho and will be open statewide. This is a telecommuting position and will be part of the Children’s Medicaid team. This individual will work closely with the families and treatment providers of children with serious emotional disturbance to safely transition these children between inpatient and outpatient levels of care. We are seeking applicants with backgrounds in counseling or social work, critical thinking skills, developed interpersonal skills, excellent written and verbal communication skills, and the ability to work tactfully and professionally as a team player.
We offer a competitive benefits package which includes excellent medical, dental and vision insurance; generous vacation and sick leave accrual beginning as soon as you start; eleven (11) paid holidays a year; participation in one of the Nation’s best state retirement systems; multiple savings plans and optional 401K; life insurance; wellness programs; ongoing training opportunities; optional flex scheduling; telecommuting; and more.
Example of Duties
- Complex case management coordination working directly with members and families who require intensive and complex services
- Directly manage logistical operations for successful Children’s Medicaid residential placements, to include in-state and out-of-state placements
- Work closely with treatment teams at psychiatric residential treatment facilities across the country, from admission to discharge, to ensure appropriate care is sustained through each stay
- Work directly with quality improvement organization (QIO) to ensure appropriate access to and ongoing care for children who are admitting, residing or discharging from psychiatric residential treatment
- Partner with other State agencies and community providers to transition members between inpatient and outpatient levels of care
- Problem-solve access to care issues, especially for children residing in more rural and frontier communities across the state
- Participate in a Quick Reaction Team (QRT) to support youth discharging from a variety of out-of-home placements
- Provide exemplary customer services advocating for the members’ needs
- Possess the ability to distill complex multi-disciplinary issues and situations into readily understandable with recommendations for resolution and improvements
- Lead, participate, and coordinate treatment team meeting calls for denials which includes parent/guardian, clinicians, behavioral health care coordinator, caseworker, probation officer and others as necessary
- Work as part of an engaging team to manage the care of some of Medicaid’s most vulnerable children, ensuring medical necessity and transitions of care
- Collates and reports on care access for members assigned in caseload
Minimum Qualifications
You must possess all the minimum qualifications listed below to pass the exam for this position. Click on the Questions tab associated with this announcement for the details regarding minimum qualification requirements. The Supplemental Questions on the application are the exam questions. If it is a written answer, please make sure you answer each question with enough detail to determine how you meet the requirements. Do not put see resume as your answer to written questions. Answer each written question thoroughly. Failure to do this may result in not passing the exam and disqualify you from being considered for this position.
- Experience developing, recommending, and evaluating operating procedures and recommending changes.
- Experience developing technical written materials such as policies, technical manuals or rules/regulations.
- Experience providing technical program assistance to internal and external stakeholders.
Supplemental Information
Additional Qualifications: Are not required, however, having the minimum qualifications and the education and/or experience below will increase your score.
- Current licensure as a behavioral health professional in the State of Idaho (e.g., LPC, LCSW, LMSW, LCPC, LMFT).
- Bachelor or master’s degree in social work, psychology, marriage and family counseling/therapy, psychosocial rehabilitation counseling, psychiatric nursing, or closely related field of study.
- Experience with children’s mental health and good knowledge of behavioral health treatment approaches and stages of development. Gained by providing two years of social/treatment services in an institutional, clinical, correctional, or community-based setting.
- Experience working with individuals with developmental disabilities. Gained by two years providing social/treatment services in institutional, clinical, or community-based setting.
DEDICATED TO STRENGTHENING THE HEALTH, SAFETY, AND INDEPENDENCE OF IDAHOANS
People Making A Difference!
VISIT US ONLINE
Learn About a Career with DHW
https://healthandwelfare.idaho.gov/about-dhw/dhw-careers
For all Idaho state government jobs:
https://dhr.idaho.gov
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***PLEASE NOTE: application assistance is not available after the business hours listed below, on the weekends, or on holidays and you must apply before 11:59 pm on the closing date. When applying, use CHROME as your browser to avoid complications.
If you have questions, please contact us at:
TROUBLE APPLYING: 1-855-524-5627
(Monday through Friday, 6am – 5pm, Pacific Time)
EMAIL:
dhwjobs@dhw.idaho.gov
(answered Monday through Friday during business hours MST)
Email is the quickest way to get an answer to your questions.
PHONE:
(208) 334-0681
(answered Monday through Friday during business hours MST)
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