Category: Curator- Job Hunter

 
 

Job Description Summary

Medicaid and/or State-Based Exchange experience highly recommended

Job Summary

Essential Duties and Responsibilities:
– Manage overall operations and performance of assigned contracts including P&L, quality and compliance with all terms and conditions along with preparing and analyzing regular performance reports.
– Manage all aspects of the customer relationship for assigned contracts ensuring effective and efficient communication along with addressing and resolving customer complaints.
– Provide leadership and direct supervision to assigned employees, including setting goals, monitoring work performance, coaching and evaluating results to ensure that objectives are met.
– Manage continual process improvement by monitoring, refining, and optimizing workflow and processes with the goal of continuously improving overall effectiveness (efficiency, productivity, and quality).
– Create an entrepreneurial work environment by involvement in developing and hiring superior talent and instilling a culture of accountability, measurability, and discipline without undue bureaucracy.
– Interpret policies, procedures, and goals of the company for subordinates.
– Participate in the development and monitoring of the operational budget related to assigned contracts.
– Work collaboratively and effectively with IT to ensure that product and service applications and technologies are optimized for contract compliance, productivity, and quality performance.
– Maintain primary responsibility for ensuring customer satisfaction, resolving compliance issues, and accountability for profit & loss with assigned contracts and lines of business.
– Act as the primary point of contact for state officials and other outside contacts for the assigned contract.
– Perform other duties, as necessary.

Minimum Requirements:
– Direct and control the activities of a broad functional area through several department managers within the company.
– Has overall control of planning, staffing, budgeting, managing expense priorities, and recommending and implementing changes to methods.
– Work on complex issues where analysis of situations or data requires an in-depth knowledge of the company.
– Participate in corporate development of methods, techniques and evaluation criteria for projects, programs, and people.
– Ensure budgets and schedules meet corporate requirements.
– Regularly interact with executives and/or major customers.
– Interactions frequently involve special skills, such as negotiating with customers or management or attempting to influence senior level leaders regarding matters of significance to the organization.
– Report to Senior Director or VP level.

MAXIMUS Introduction

Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.

EEO Statement

EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

Maximus compensation is based on various factors including but not limited to a candidate’s education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus’s total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation shall be commensurate with job duties and relevant work experience. An applicant’s salary history will not be used in determining compensation.

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CareFirst BlueCross BlueShieldWashington, DC Full-time

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• PURPOSE:The Quality of Care Nurse will effectively identify, prioritize and respond to high level grievances, complaints and complaint appeals from the member or member’s authorized representative for the Commercial or Medicare Advantage lines of business.
• The incumbent reviews and interprets the grievance or complaint, medical and dental records, narrative notes, in-patient/office policies and all documentation submitted or collected by the plan pertinent to the issue.
• The incumbent will also understand the merits of legal and accreditation actions.
• ESSENTIAL FUNCTIONS:Reviews all member grievances or complaints and complaint appeals concerning the quality of care provided by facilities or practitioners.
• Contacts members, providers, or other parties involved, as appropriate, verbally and in writing to obtain additional information regarding the complaint.
• Reviews medical and dental claims information and records, and member and provider correspondence to conduct patient care investigations and renders an investigative finding.
• Provides detailed written and/or verbal responses to members, providers, and authorized representatives upon completion of a thorough investigation.
• Responds to follow up questions or concerns with members, providers, and other parties involved in the investigation, as appropriate.
• Prepares training materials and serves as the professional resource for all quality of care complaints and quality of care appeal complaints.
• Conducts or participates in nursing research as appropriate.
• Completes medical research by defining and interpreting medical language, defining and interpreting medical procedures and medical/hospital office policies.
• Assists with the preparation of regulatory reports by detailing and summarizing the merits of legal or accreditation actions.
• QUALIFICATIONS:Education Level:Licenses/Certifications:RN – Registered Nurse – State Licensure And/or Compact State Licensure Practice in MD, DC, VA, WV.Experience: 5 years Clinical experience in direct health care or health insurance payor setting working with quality reporting, or analytics.
• Working knowledge of NCQA standards.
• Bachelor’s degree in Nursing.
• Behavioral Health Experience.
• Knowledge, Skills and Abilities (KSAs)Demonstrates excellent written and oral communication skills along with effective presentation skills.
• Able to provide verbal and written feedback for improvement.
• Must understand the appropriate mode of communication based on the subject matter.
• Computer proficiency and technical aptitude with the ability to utilize MS Office (Excel, Word and Outlook) and web based technology.
• Ability to exercise sound judgment in making critical decisions.
• Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
• Knowledge of patient rights and laws relative to those rights, such as HIPAAAbility to effectively communicate and provide positive customer service to every internal and external customerProficient in standard medical practices and insurance benefit structures with the ability to use them in varied siturationMust be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
• Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
• Department Department: DC Medicaid – Enrollment ServiceEqual Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.
• It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

 
 

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Found in: Whatjobs US Premium – 2 hours ago

Palm Beach Gardens, United States Amerihealth Caritas Health Plan Full time

Responsibilities:

Under the direction of the Regional President, Florida the Director, Compliance provides strategic direction and leadership for the development and implementation of compliance policy, process and control activities and provides oversight of all operating division compliance, privacy, and regulatory functions, in addition to possessing the following attributes:

* Demonstrates a solid understanding of operational processes and controls and monitors the execution of operational changes required by regulations and guidelines.

* Develops compliance methodologies to test established and newly executed operational processes and controls and monitor effectiveness.

* Proactively identify process gaps, weaknesses and deficiencies and/or business productivity/efficiency opportunities.

* Partners with local and corporate counterparts to develop protocols that support the review and assessment of objectives that ensure compliance with local plan and corporate policies and procedures.

* Develops and monitors metrics and ensures accurate reporting of regional/local compliance information and compliance and FWA issues reported via the compliance hotline.

* Ensure that local compliance related issues and risks are identified, aggregated and reported.

* Directs ad-hoc compliance assessments/research as requested by the local compliance associates.

* Aligns and monitors compliance training and education programs.

* Oversees compliance with the risk management program and regulatory reporting requirements.

The Compliance Lead may directly manage and support the development of highly skilled and knowledgeable associates. Must be able to operate independently with minimal management oversight and be able to manage competing priorities and deadlines that are subject to frequent change. Must possess and exercise excellent professional judgment in all interactions.

Education/Experience:

* Bachelors Degree or equivalent education and ten years of experience in managed health care including experience in the areas of compliance oversight.

* Advanced degree and/or JD preferred

* Certified in Health Care Compliance preferred.

* 5 to 10 years experience in a managed health care environment, including experience in the areas of compliance oversight.

Other Skills:

* Good working knowledge of AmeriHealth Caritas, its affiliates and the managed care industry.

* Demonstrated knowledge of compliance concepts and practices (strategies, control activities, information analysis and reporting and communication)

* Self-motivated with demonstrated project management skills.

* Strong oral and written communication skills.

* Strong facilitation, collaboration and teamwork skills with the ability to build cross-functional partnerships to drive results.

* Strong interpersonal skills.

* Innovative and creative. Able to embrace change and think outside the box.

* Strong problem solving and critical thinking skills.

* Strong analytical and research skills, able to synthesize information to provide practical solutions to accomplish meaningful results.

* Strong organizational skills, with the ability to apply good judgment and resolve ambiguities.

* Acts independently and requires minimal supervision.
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Job Details
Description:

Medicaid Project Management Specialist – Program Coordinator

University of Illinois Systems

Office of Medicaid Innovation – Remote

The Office of Medicaid (OMI) seeks a Medicaid Project Management Specialist to assist the Office of Medicaid Innovation (OMI) with day-to-day management of projects between the University of Illinois System and the Illinois Department of Healthcare and Family Services (HFS). The Healthcare Project Management Specialist will develop their knowledge and experience with project management to support multiple ongoing Project Orders to ensure that the goals and deliverables of the interagency agreements are met.

The University of Illinois is an Equal Opportunity, Affirmative Action employer that recruits and hires qualified candidates without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability or veteran status. For more information, visit

Major Duties and Responsibilities:

Project Management:

Under the supervision of the Associate Director of Project Management, the Project Specialist will:

Provide program knowledge and expertise of procedures, technical specifications, related to Medicaid Project Order activities
Assist in the development and administration of Medicaid programs, and special projects.
Support various aspects of project management, including creating project documents/artifacts, project schedules, leading meetings, managing, and documenting risk register, backlogs, etc.
Support the management of resources, determination, and supervision of staff functions; assists in the recruitment, training, and management of work related to Medicaid Project Orders.
Share and support OMI operating policies and processes.
Participate in departmental objectives and long-range planning.
Assist in the development of management reports, analyses, data aggregation related to unit projects.
Act as a point of contact with University of Illinois departments and HFS

Other duties as assigned

Position Requirements and Qualifications:

Required:

Bachelor’s degree.
One year of experience in project management, Medicaid policy, healthcare, and/or general operations.
Please note, a Master’s Degree in an area consistent with the duties of the position may be substituted for one (1) year of work experience.

Preferred:

Bachelor’s degree in Business, Social Services, Human Resources, Healthcare, or related field.

Knowledge, Skills, and Abilities:

Knowledge of business and management principles involved in strategic planning, resource allocation, and coordination of people and resources
Skill in analyzing information and evaluating results to choose the best solution and solve problems.
Skill in scheduling meetings, program activities, and the work of others.
Skill in oral and written communication
Ability to adjust actions in relation to others’ actions.
Ability to develop goals and plans to prioritize, organize, and accomplish work.
Ability to work independently and exercise judgment to be able to analyze and investigate a variety of questions or problems
Ability to analyze and develop guidelines, procedures, and systems

Environmental Demands:

Travel is required, reliable transportation is needed.

SALARY AND APPOINTMENT INFORMATION

This is a full-time Civil Service Program Coordinator position appointed on a 12 month service basis. The expected start date is as soon as possible after July 5, 2022 Salary is commensurate with experience.

TO APPLY:

Applications must be received by July 5, 2022. Apply for this position by going to . If you have not applied before, you must create your candidate profile at . If you already have a profile, you will be redirected to that existing profile via email notification. To complete the application process:

Step 1) Submit the Staff Vacancy Application.

Step 2) Submit the Voluntary Self-Identification of Disability forms.

Step 3) Upload the following documents:

cover letter
resume (months and years of employment must be included)
names/contact information for three references
OPTIONAL: academic credentials (unofficial transcripts or copy of diploma may be acceptable) Academic credentials are verified at the time of hire.

In order to be considered as a transfer candidate, you must apply for this position by going to . Applications not submitted through this website will not be considered. For further information about this specific position, contact Cass Dockrill at . For questions about the application process, please contact .

University of Illinois faculty, staff and students are required to be fully vaccinated against COVID-19. If you are not able to receive the vaccine for medical or religious reasons, you may seek approval for an exemption in accordance with applicable University processes.

The University of Illinois conducts criminal background checks on all job candidates upon acceptance of a contingent offer. Convictions are not a bar to employment. Other pre-employment assessments may be required, depending on the classification of Civil Service employment.

As a qualifying federal contractor, the University of Illinois System uses E-Verify to verify employment eligibility.

The University of Illinois System requires candidates selected for hire to disclose any documented finding of sexual misconduct or sexual harassment and to authorize inquiries to current and former employers regarding findings of sexual misconduct or sexual harassment. For more information, visit Policy on Consideration of Sexual Misconduct in Prior Employment

The University of Illinois must also comply with applicable federal export control laws and regulations and, as such, reserves the right to employ restricted party screening procedures for applicants.

College Name or Administrative Unit:
System Office
Category:
2-Administrative
Title:
Medicaid Project Management Specialist – Program Coordinator (166789)
Open Date:
06/15/2022
Close Date:
07/05/2022
Organization Name:
Ofc Medicaid Innovation

 
 

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Medicaid Business Development Leader – Remote + Location : National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint + Job Family : BUS >

Strategy, Planning & Execution + Type : Full time + Date Posted : Jun 28, 2022 + Req # : PS74116 Description Build the Possibilities.

Make an extraordinary impact. Responsible for positioning and capture execution of Medicaid health plan procurement and reprocurement opportunities, managing the strategy and preparations for upcoming Medicaid RFP’s;

partners with Plan Presidents to lead the cross functional team of health plan leaders and business development to identify gaps, mitigate risks, and develop solutions and strategy in months prior to an RFP.

Location : Remote any US location How you will make an impact : + Monitor and evaluate white space opportunities to make go / no-go recommendations to executive leadership.

• Develop and execute plans for the pursuit and capture of all Medicaid managed care procurement opportunities, including Alliance partnership opportunities.
• Leads the cross functional team of Growth Partners, Health Plan leaders, and Alliance partners (as applicable) to develop winning strategies and identify and mitigate risks and opportunities.
• Participates in bid decisions and develops recommendations for gate reviews. Collaborates with Health Plan Presidents and Health Plan leaders to understand current and emerging customer needs and requirements.
• Obtains market intelligence and competitive data to develop market strategy. + Participates in all levels of proposal development and draft review, providing active feedback and recommendations for improvement.
• Provides mentorship and coaching to other members of the broader Business Development team. Qualifications – External Minimum Requirements : + Requires a BA / BS degree in a related field.
• Minimum 10 years of experience in strategic planning and business development in Medicaid programs; to include leadership / management experience in health care management, marketing products, and managing significant business results;

or any combination of education and experience, which would provide an equivalent background. + Up to 30% travel may be required.

Preferred Skills, Capabilities and Experiences : + MBA, MPH, or MPP. + Proven successful past performance leading capture and proposal activities for significant opportunities ($1B and more).

• Previous P&L and / or business development experience and project management experience in Medicaid managed care setting.
• Experience in a capture function or executive leadership function for a managed care based product for state Medicaid agencies.
• State Medicaid agency experience or federal agency experience with CMS. Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health.

Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health.

Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler.

Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change.

Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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 Worlds 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.ElevanceHealthinc.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.

EEO is the LawEqual Opportunity Employer / Disability / Veteran Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

EEO Policy Statement + EEO is the Law Postero + EEO Poster Supplement-English Version + Pay Transparency + Privacy Notice for California Residents Elevance Health, Inc.

is an E-verify Employer Need Assistance?Email us (elevancehealth icareerhelp.com) or call 1-877-204-7664

 
 

 
 

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Summary

• Our client requires the services of a trainer/content developer to support training implementation of NC FAST Medicaid Transformation Project modules.
• Important Note: Statewide travel up to 25% of the time is required in the performance of the work for this position. Travel may include some evenings and weekend days.
• NOTE: COVID-19 restrictions prohibit travel at this time; however, when restrictions are lifted, this role may be expected to travel as needed to meet the requirements of this position.

Job Description

• The NC Department of Health and Human Services seeks contract resources to assist with the training and implementation of NC Families Accessing Services through Technology (NC FAST).
• The primary purpose of NC FAST Training Developer is to analyze the NC FAST system functionality to develop classroom facilitator-led learning solutions and eLearning courses to support NC FAST implementation.
• This position will work closely with the Training Lead, Training Scripts Writer, Applications Lead and subject matter experts to understand requirements to design training and develop course materials, to develop and maintain Adobe FrameMaker templates and scripts, and to revise training materials for instructional training of adult learners.
• Using this base, this resource will also be responsible for providing effective and creative classroom and virtual facilitation of training for all levels of employees who oversee and administer social services programs that are managed through the NC FAST system.

Skills Required

• Experience in curriculum design and developing training materials for adult learners Required 3 Years
• Understands the social services programs that drive the efforts of the county, regional, and state staff who administer those programs. Required 3 Years
• Research and evaluate the NC FAST case management software in order to translate the software functionality into effective learning materials. Highly desired 3 Years
• Ability to assist with scheduling, preparing for and participating in quality assurance checks on training materials that have been developed. Required 3 Years
• Experience working with training developers, program subject matter experts, technical support and others to assure training materials are effective. Required 3 Years
• Experience in business analysis, MS Office Suite (e.g., MS Word, MS Excel, MS PowerPoint) Required 3 Years
• Experience in Learning Management System (LMS) technology such as Moodle, XML, HTML Required
• 3 Years
• Experience in designing and delivering computer-based training instructional design, with learning program design systems. Required 3 Years
• Experience in software that may include Adobe FrameMaker, Adobe Captivate, Photoshop, Adobe Breeze, Dreamweaver, Visio or other training applications. Required 3 Years
• Experience developing dynamic instructional training materials using interactions and simulations to create interactive, engaging course content. Required 3 Years
• Experience developing interactive media presentations that enhance the online educational experience Required 3 Years
• Experience leading training sessions in a variety of formats that may include in person, virtual and/or webinar. Required 3 Years
• Ability to assist with basic application software and hardware support Highly desired
• Must have strong understanding of internet concepts and web technology Highly desired
• Ability to clearly communicate in oral and written form, and deal effectively with diverse groups to accomplish the objectives. Highly desired
• Experience evaluating student progress and making recommendations for continued training participation curriculum Required 3 Years
• Experience providing feedback on learning providing feedback on learning curriculum and methodology to assure program relevance and user comprehension. Required 3 Years
• Experience with processes to prepare for and conduct classroom training including facility management, course scheduling and student registration. Required 3 Years
• Knowledge of and experience with NC FAST and the Medicaid Program in NC Highly desired 2 Years

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The Virginia Hospital & Healthcare Association is seeking candidates for a Director of Medicaid Financial Policy at our headquarters in Glen Allen, Virginia. Ideal candidates will possess a working knowledge of Medicaid policy and reimbursement procedures and an understanding of hospital finance, as well as the ability to perform in-depth review and analysis of changes in Medicaid reimbursement policy and the impact on VHHA members. The position involves interpretation of enacted or proposed legislation related to Medicaid and the provider assessments associated with Medicaid expansion. Strong analytical skills, skills in performing financial modeling and strong communication skills required. Must have advanced Excel skills. Must have excellent relationship management abilities.

 
 

This is a full-time position which requires occasional travel within the Richmond metropolitan area and the Commonwealth of Virginia. A bachelor’s degree in Accounting, Finance or Business Administration and practical work experience (minimum of 5 years) in a relevant field is required. Compensation will be commensurate with work experience. VHHA offers a competitive benefits package and incentive plan opportunity.

 
 

VHHA is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, sex, national origin, age, disability, marital status, military service or veteran status, sexual orientation, gender identity, genetic information, pregnancy, childbirth, or related medical conditions, including lactation, political affiliation, or other basis prohibited by federal or state law relating to discrimination in employment.

 
 

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Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
Performs technical work in obtaining Medicaid/Social Security (SSI) insurance coverage for indigent patients to expedite reimbursement for medical services. Positions take the patient through the entire Medicaid application process from application to award or denial. Positions have authority to represent the Health Care System at each of the four levels of appeals when applications are denied.

Responsibilities:
1. Obtains detailed personal, financial and asset information to determine if patient qualifies for one of ten Medicaid/SSI programs. Completes or assists the patient with completion of Medicaid application. Explains the programs and advises patients of methods to become eligible by rearranging finances and assets. Follows through with applicants to obtain accurate and complete information within strict timeframes. Positions must have substantive knowledge of various rules and regulations governing the ten Medicaid programs. Interprets and applies frequent changes in program regulations to expedite applications.
2. Reviews denials from Medicaid/SSI and researches denial information with patients. Advocates for patient coverage with local and state Medicaid offices to obtain reversal of initial denial. Abstracts information, prepares appeals and represents UNC Health Care System in appeal hearings at local, state (Division of Medical Assistance), Office of Administrative Hearings, and state court to present supportive evidence for patient’s denial reversal.

Other Information

Education Requirements:
● Associate’s degree in an appropriate discipline (or equivalent combination of education, training and experience).
Licensure/Certification Requirements:
● No licensure or certification required.
Professional Experience Requirements:
● If an Associate’s degree: Two (2) years of experience in a social services or healthcare organization.
● If a High School diploma or GED: Four (4) years of experience in a social services or healthcare organization.
Knowledge/Skills/and Abilities Requirements:
● Analytical, Customer Service, Direct Patient/Family Interaction/ Hospital/Healthcare Experience, Interpersonal, Report Preparation, Strong Written and Verbal Communication skills.
 

 
 

Job Details

Legal Employer: STATE

Entity: Shared Services
 

Organization Unit: Medicaid Eligibility 

Work Type: Full Time
 

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

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Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
Performs technical work in obtaining Medicaid/Social Security (SSI) insurance coverage for indigent patients to expedite reimbursement for medical services. Positions take the patient through the entire Medicaid application process from application to award or denial. Positions have authority to represent the Health Care System at each of the four levels of appeals when applications are denied.

Responsibilities:
1. Obtains detailed personal, financial and asset information to determine if patient qualifies for one of ten Medicaid/SSI programs. Completes or assists the patient with completion of Medicaid application. Explains the programs and advises patients of methods to become eligible by rearranging finances and assets. Follows through with applicants to obtain accurate and complete information within strict timeframes. Positions must have substantive knowledge of various rules and regulations governing the ten Medicaid programs. Interprets and applies frequent changes in program regulations to expedite applications.
2. Reviews denials from Medicaid/SSI and researches denial information with patients. Advocates for patient coverage with local and state Medicaid offices to obtain reversal of initial denial. Abstracts information, prepares appeals and represents UNC Health Care System in appeal hearings at local, state (Division of Medical Assistance), Office of Administrative Hearings, and state court to present supportive evidence for patient’s denial reversal.

Other Information

Education Requirements:
● Associate’s degree in an appropriate discipline (or equivalent combination of education, training and experience).
Licensure/Certification Requirements:
● No licensure or certification required.
Professional Experience Requirements:
● If an Associate’s degree: Two (2) years of experience in a social services or healthcare organization.
● If a High School diploma or GED: Four (4) years of experience in a social services or healthcare organization.
Knowledge/Skills/and Abilities Requirements:
● Analytical, Customer Service, Direct Patient/Family Interaction/ Hospital/Healthcare Experience, Interpersonal, Report Preparation, Strong Written and Verbal Communication skills.
 

 
 

Job Details

Legal Employer: STATE

Entity: Shared Services
 

Organization Unit: Medicaid Eligibility 

Work Type: Full Time
 

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

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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)

This position provides leadership for the Community and State Health Plans Medicaid products in their assigned market to support continued growth and innovation. The position is a member of the health plan senior leadership team and will work collaboratively with the CEO, COO and CFO to ensure overall strategies are aligned with the market level business objectives. This position will oversee the Medicaid community agenda and field-based outreach teams to develop market leading provider and community engagement to forge strong external relationships. This position is responsible for forecasting and has accountability in achieving growth (Acquisition and retention) targets. This is an external and internal facing role.

If you are located in Philadelphia, Pennsylvania, you will have the flexibility to telecommute as you take on some tough challenges.

Primary Responsibilities:

 

• Develop and execute and continually update overall strategies for Medicaid product offering to maximize product growth, member retention, innovation and member and provider experience
• Drive smart Growth in membership and market share in designated market by developing solid relationships across segments and departments (Network, marketing, clinical, quality, finance)
• Lead, develop and uphold accountability of Medicaid products forecasting models with complete understanding of Auto assignment algorithms, eligibility requirements, self-select, and involuntary vs voluntary term ratios
• Manage local Medicaid field-based outreach teams and work directly with M&R regional sales leaders to leverage DSNP Outreach strategies and teams across segments
• Must be able to flex strategies to address local market nuances and unique requirements to assure that we are keeping healthcare “local” while maintaining a strong presence in the market
• Partner with local and functional teams to assure appropriate health plan benefit design and value-added services
• Formulate impactful relationships that drive engagement with community-based organizations and faith-based organizations
• Develop and implement provider engagement strategies (including Field-based approaches and face to face visits Providers) in partnership with Network partners that specifically focuses on membership growth and retention and making UHC the insurer of choice for UHC
• Lead and provide oversight for the Field community outreach team that orchestrates member events, potential consumer events, and community-based goodwill and general awareness that make UHC the insurer of choice
• Manage and uphold accountability for marketing, sponsorship and outreach budgets
• Represent the Health Plan at State meetings, community events, and media relations; Assist in developing new county expansions for existing Medicaid; Assist in implementing future product opportunities
• Ensure compliance to health plan State contract for MCO functions entailing Marketing, Communications, Engagement with Community Based Providers and Provider Network and outreach activities.
• Lead and develop top field talent in designated markets, while creating bench strength and opportunities for professional growth within the team
• Develop social determinants program for designated health plans

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
• 5+ years of people management experience
• 5+ years of experience in MLTSS
• Experience building analytical skills including experience generating ROI, business case forecasting and growth opportunities
• Managed care experience
• Proven track record developing and deploying market strategies
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifcations:

 

• Master’s degree (MPA / MBA)
• Active health license
• Familiar with possible Medicaid referral sources (i.e. CBOs, providers, etc.)
• Bi-lingual

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

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)

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.

 
 

Clipped from: https://www.themuse.com/jobs/unitedhealthgroup/medicaid-growth-leader-philadelphia-pennsylvania?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic