Job Description
The goal of the Care Manager, Social Worker is to advocate for and assist the patient in the achievement of optimal health, access to care, and appropriately utilizing resources. The Care Manager Social Worker utilizes the following processes to meet the patient’s individual healthcare needs: assessment, planning, implementation, coordination, monitoring and evaluation of the plan of care. The management of resources and the coordination of the continuum of care will be performed in a manner consistent with the mission vision and core values of St.
Joseph Health. Required qualifications:
Master’s Degree in Social Work, Psychology, Counseling, Or Master’s Degree with five (5) years relevant social work experience. Driving may be necessary as part of this role. Caregivers are required to comply with all state laws and requirements for driving. Caregivers will be expected to provide proof of driver license and auto insurance upon request. See policy for additional information. 6 months Clinical experience in an HMO, medical group, affiliated model, hospital or medical office/clinic setting.
3 years Utilization management and/or case management highly desirable Preferred qualifications:
Certification in Case Management (CCM, ACM) Psychiatric chemical dependency treatment. Managed care experience. Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About UsAt Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected.
Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Check out our benefits page for more information about our Benefits and Rewards.
About the Team Providence Physician Enterprise (PE) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care. Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers. PE is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon;
Swedish Medical Group in Washington’s greater Puget Sound area, Pacific Medical Centers in western Washington;
Kadlec in southeast Washington;
Providence’s St. John’s Medical Foundation in Southern California;
Providence Medical Institute in Southern California;
Providence Facey Medical Foundation in Southern California;
Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico.
We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.
We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status.
We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.
We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration,…
Category: Curator- Job Hunter
Provider Network Account Executive II [Medicaid Expert] | AmeriHealth Caritas
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at
The Provider Services AE II is responsible for building, nurturing and maintaining positive working relationships between Plan and its key contracted providers. Assigned provider accounts may include single or multiple practices in single or multiple locations, health systems, integrated delivery systems or other provider organizations. Provider Services AE II maintains in depth understanding of Plan’s contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues. Ensure that network provider perspectives and feedback are included in evaluations of improvement initiative successes; Collaborate with other ODM-contracted managed care entities to simplify provider requirements and remove administrative barriers; and Develop and implement the MCO’s provider claim dispute resolution process Collaborates with Provider Network Operations to resolve Provider concerns timely. Maintains complete understanding of Plan reports and metrics and uses them to evaluate the performance of assigned providers/practices/facilities, determining, communicating and implementing plans for providers to improve performance and measuring ongoing performance. Uses data to develop and implement methods to improve relationship. Assists in corrective actions required up to and including termination, following Plan policies and procedures. Supports the Quality Management department with the credentialing and re-credentialing processes, investigation of member complains and any potential quality issues. Maintains a functional working knowledge of Facets, including the provider database and routinely relays information about additions, deletions or corrections to the Provider Maintenance Department. Maintains and delivers accurate, timely activity and metric reports as required. Identifies and maintains strong partnerships with appropriate internal resources and stakeholders.
An AE II’s Accounts/assignments Include
- Those that are most complex, a higher number of multiple practice locations and multi-specialty practices and multiple providers and/or a large health system.
- Those that impact a total member population of a minimum of 5,000 or more. The appropriate minimum number of member population impact for the Provider Services AE II level is determined by each Plan according to their business environments.
Will develop/implement/manage programs and projects that support/impact high dollar and high member provider groups.
The Provider Services AE II is responsible for participating or independently developing and implementing Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor and support new AE’s. The AE II will assist AE I’s in resolving/managing issues with Providers.
Education/ Experience
- Bachelor’s Degree.
- 3 to 5 years experience in a Provider Services position working with providers.
- 5 to 10 years experience in the managed care/health insurance industry with demonstrated strengths in: knowledge of Plan policies and procedures related to provider complaint resolution, provider credentialing, provider billing and payment, provider incentive programs and other key State and Federal regulatory requirements related to providers, claim adjudication systems, provider file database requirements and relevant software applications; working independently and managing complex projects and programs both as an independent owner and team leader, training and mentoring skills, interacting at an executive level internally and externally.
- Substantive Account Executive experience with high impact, high dollar, extremely visible and critical provider groups.
- Medicaid experience required.
- Hybrid role requiring 2 days in office and also must reside in Washington DC, Maryland or Virginia.
Case Manager – Medicaid Waiver
Job details
Salary
$40,000 – $50,000 a year
Job Type
Full-time
Qualifications
- Bachelor’s (Required)
Benefits
Pulled from the full job description
Dental insurance
Employee assistance program
Employee discount
Flexible schedule
Flexible spending account
Health insurance
Case Manager- Medicaid Waiver
Status: Salary Exempt- Administrative
SOC Code: 21-1093
Department: Medicaid Waiver
Reports to: Medicaid Waiver Program Supervisor
Analysis Completed: July 2016
Description:
The Medicaid Waiver Case Manager assists individuals in gaining access to appropriate, needed, and desired waiver and other State Plan services, as well as needed medical, social, educational, and other appropriate services. The position serves to provide necessary coordination with direct service providers (DSP) of non-medical, non-waiver services when the services provided by these entities are needed to enable the client to function at the highest attainable level or to benefit from programs for which clients might be eligible. The Case Manager reports to the
Medicaid Waiver Supervisor.
Tasks & Responsibilities:
General Duties:
- Prepares personal work plan to meet departmental objectives and expectations; schedules office and field activities to include data collection, research, and meetings.
- Assists Program Supervisor as needed.
- Communicates with client, caregivers, service providers, and physicians on a regular basis.
- Completes and submits required paperwork in a timely manner. Must meet deadlines.
- Responsible for maintaining orderly, confidential files.
- Conducts verification of monthly service billing and eligibility.
- Attends and participates in monthly staff meetings.
- Communicates with Assistant Supervisor and Program Supervisor on a regular basis to ensure caseload work is being met.
- Prepares and submits daily activity log.
Case Management Duties:
- Maintains a caseload of 35-40 clients each month.
- Executes ongoing monitoring of the provision of waiver and non-waiver services including the individual’s Plan of Care.
- Conducts intake and screening of clients.
- Authorizes initial waiver services and determines continued eligibility.
- Determines level of care.
- Determines choice of institution or community care.
- Develops plan of care based on individual needs.
- Coordinates, monitors, changes, re-determines, level of services.
- Authorizes termination of services or case transfer/termination.
- Makes monthly visit to client to ensure level of care is being upheld. Responsible for other required home visits when needed.
- Responsible for in depth record keeping including documenting monthly visits and keeping daily logs.
- Maintains regular contact with clients and advocates for their rights within scope of services.
- Facilitates crisis intervention.
- Provides guidance and support for clients, client’s families, and staff.
Competencies:
- Active listening skills.
- Ability to communicate in a collaborative, effective manner with others and to maintain good working relationships.
- Ability to comprehend basic medical terminology.
- Possess knowledge of Medicaid Waiver programs and service providers.
- Flexibility. Workload may include working before or after normal business hours.
- Communication Proficiency. Both written and oral.
- Personal Effectiveness/Credibility.
- Strong interpersonal skills.
- Project Management.
- Critical thinking and deductive reasoning skills.
- Ability to maintain high degree of confidentiality.
- Microcomputer skills to preform word processing and spreadsheet analysis, use databases and software, use e-mail, and access the internet.
- Experience with Microsoft Office programs (Word, PowerPoint, and Excel).
- Ability to interpret and communicate complex rules and regulations.
- Excellent organization skills.
- Ability to work towards objectives with little supervision.
- Strong time management skills. Ability to meet deadlines.
- Problem solving skills.
- Attention to detail.
Experience:
Bachelor’s Degree from an accredited college or university in human services related field (preferably in social work). At least 2 years of professional experience in the human services field preferred. Knowledge of Medicaid programs and experience working with elderly and disabled people preferred.
-OR-
Master’s Degree in Social Work.
Licensed Clinical Social Worker (LCSW) preferred.
Managerial/ Supervisory Requirements:
None.
Physical Requirements:
May spend long hours sitting and using office equipment and computers. Some lifting of supplies and materials. Work in the field is required. Ability to operate vehicle.
Must pass background and sex offender check.
*The above statements are intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. RPCGB leadership reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
Job Type: Full-time
Pay: $40,000.00 – $50,000.00 per year
Benefits:
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Professional development assistance
- Retirement plan
- Tuition reimbursement
- Vision insurance
Schedule:
- Day shift
- Monday to Friday
Ability to commute/relocate:
- Birmingham, AL 35203: Reliably commute or planning to relocate before starting work (Required)
Education:
- Bachelor’s (Required)
Work Location: Hybrid remote in Birmingham, AL 35203
Compliance_Regulatory Analyst in United States | Compliance and Legal at AmeriHealth Caritas
Responsibilities:
The primary purpose of the job is to:;
- Assist with the implementation of the Compliance program for AH Louisiana.
- Assist with the HIPAA desk audits.
- Assist with compliance monitoring and auditing activities to ensure contract compliance.
- Assist with training staff on Compliance and HIPAA.
- Generate compliance and privacy activity reporting.
- Assist with State complaints and maintain a log for all complaints.
- Maintain all AH Louisiana policies and subcontractor policies that reflect AH Louisiana.
- Distribute State e-mails to appropriate staff.
- Review Medicaid policies and contract changes to determine impact to the plan.
- Maintain contract compliance log of Medicaid policy and contract changes and distribute to appropriate staff.
- Assist with member materials and marketing approvals.
- Assist with State Compliance Audits.
- Act as the administrator for all State applications.;
Education/ Experience:
- Bachelor’s Degree or equivalent educaiotn and experience required.
- Familiarity with Government Programs and contracts required.
- ;2 or;more;years experience;in healthcare/ insurance, preferably in managed care.;;;;
- Experience with Microsoft Office Suite.; ;;;;;;;;;;;;;;;
Director of Federal Medicaid Practice – Mathematica Policy Research
Position Description:
Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding using data science and analytics. Our work yields actionable information to guide decisions in wide-ranging policy areas, from health, education, early childhood, and family support to nutrition, employment, disability, and international development. Mathematica offers our employees competitive salaries, and a comprehensive benefits package, as well as the advantages of being 100 percent employee owned. As an employee stock owner, you will experience financial benefits of ESOP holdings that have increased in tandem with the company’s growth and financial strength. You will also be part of an independent, employee-owned firm that is able to define and further our mission, enhance our quality and accountability, and steadily grow our financial strength.Read more about our benefits here: https://www.mathematica.org/career-opportunities/benefits-at-a-glance.
We are currently seeking a Director of Federal Medicaid Practice to lead the management group within the Learning & Technical Assistance Community. The Director will exercise leadership through a group of supervisors and manages to performance targets for a portfolio of Medicaid program design and operations projects.
Responsibilities:
Work with the Vice President to manage the performance of the Learning & TA Community within the Federal Medicaid Practice by tracking revenue, backlog, billability, open project-staffing requests, and other metrics
Proactively engage unit and project leadership to anticipate and address project and proposal staffing needs
Work with the Vice President and Health Unit leadership to support strategic planning and execution
Serve as a senior resource for supervisors and project directors with staff challenges
Actively work to build and maintain the morale of the staff
Oversee recruitment activity by engaging area directors and the Vice President in staff pipeline assessments and target-setting, and by directing recruitment teams in their hiring efforts
Partner with HR and the Vice President to plan staff development and training activities to ensure the Learning & TA Community is adequately prepared to respond to new opportunities
Partner with HR to support the development of policies and processes for staff assessment and advancement, including the ongoing build-out of the CCF career pathways relevant to staff working in the Learning & TA Community
Maintain relationships with staff in the client space and advise others on client needs, preferences, and priorities
Work with the Vice President and other Federal Medicaid management to support the consistent communication of management policies, priorities, and updates to supervisors and staff
Where needed, work with Federal Medicaid management other Health Unit management to support staff management and the execution of initiatives across communities, departments, and divisions within the Health Unit
Actively support the advancement of organizational diversity, equity and inclusion efforts, and apply a diversity, equity and inclusion lens across job responsibilities
Maintain project participation (50% of the role) on federal Medicaid TA projects
Position Requirements:
A master’s or doctorate degree in public policy, public health, economics, health services research, business administration, management, or other relevant discipline, or commensurate professional experience that may substitute for educational requirements
10 or more years of professional experience relevant to Medicaid policy and health care contracting
5 or more years managing or directing the work of a group of staff (for example, leading strategic initiatives or process improvement activities, reconciling staffing, managing recruitment targets, managing staff development, and directing projects.)
Experience leading and understanding the roles of staff with a wide range of skills relevant to Medicaid technical assistance work, including policy option development, qualitative and quantitative research, data management, data validation, statistical analysis, measurement, stakeholder facilitation, program design and monitoring, feedback reporting, and project management
Ability to gain trust and support from groups of senior staff using both formal and informal leadership structures
To apply, please submit your resume and a cover letter. Applications will be accepted through Monday, February 13, 2023.
This position offers an anticipated base salary range of $120,000 – $185,000 annually.
Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on the project. If you are assigned to such a project, you will be required to obtain the requisite security clearance.
Available locations: Washington, DC; Princeton, NJ; Cambridge, MA; Woodlawn, MD; Chicago, IL; Ann Arbor, MI; Oakland, CA; Seattle, WA; Remote
To apply, please provide a cover letter, resume, and writing sample.
In accordance with Executive Order 14042 and its implementing guidelines, all Mathematica employees must provide documentation that they have been fully vaccinated or obtain an accommodation through Human Resources by providing documentation from a licensed health care provider that they are unable to be vaccinated against COVID-19 because of a disability (which would include medical conditions) or provide an attestation that they are entitled to an accommodation because of a sincerely held religious belief, practice, or observance.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
Medicaid Specialist – Community Care Services Program Job in Norcross, GA
PruittHealth is a COVID-19 vaccine-mandated employer.
JOB PURPOSE:
Assists the Elderly and Disabled Waiver Program (EDWP) clients who do not
have active Medicaid eligibility [Potential Medicaid Assistance Only (PMAO) or Medicaid Assistance Only (MAO)], with the Medicaid Application process and follows up with the Division of Family and Children Services (DFCS) to ensure the clients’ eligibility process is complete.
KEY RESPONSIBILITIES:
1. Assists with EDWP Intake. Monitors PMAO and MAO referrals and census data.
2. Coordinates with Home First Case Management agencies in determining EDWP clients’ MAO or PMAO eligibility or continued eligibility status
3. Assists EDWP clients with the Medicaid Application process and renewals
4. Collects copies of financial documents from EDWP clients and submits to DFCS
5. Completes and uploads necessary provider forms to Georgia Gateway
6. Follow-up with DFCS routinely using the Medicaid Provider Status Request spreadsheet
7. Document follow-up with EDWP clients and DFCS via the DCH/DDS electronic data system
8. Verify Medicaid eligibility or continued eligibility via the Georgia Medicaid Management
Information Systems (MMIS)
9. Maintains Medicaid documentation in accordance with EDWP operating procedures and policies as well as auditing entities for Medicaid.
KNOWLEDGE, SKILLS, ABILITIES:
- Knowledge of Georgia Medicaid
- Proficient in using Microsoft Office (Outlook, Word, Excel)
- Excellent verbal communication skills, and basic typing ability
Job Requirements:
MINIMUM EDUCATION REQUIRED:
Bachelor’s degree in a related field from an accredited college or university OR Associate’s degree from an accredited college or university AND One year of related experience OR High school diploma or GED AND Three years of related experience
MINIMUM EXPERIENCE REQUIRED:
One (1) year experience in Medicaid billing, collections, or recovery OR One (1) year experience in the Division of Family and Children Services (DFCS) MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW: N/A
ADDITIONAL QUALIFICATIONS: (Preferred qualifications)
- B.S. degree in Social Work or in a related field
- Prior experience in the Division of Family and Children Services (DFCS) in the Aged, Blind, and Disabled (ABD) unit
- Two (2) years’ experience in Medicaid billing, collections, or recovery
- Demonstrated knowledge of electronic data systems
Proof of COVID-19 vaccination or approved exemption is required by date of hire
Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.
We are eager to connect with you! Apply Now to get started at PruittHealth!
Finance Director – Medicaid Job in Atlanta, GA – Elevance Health
Finance Director – Medicaid
Elevance Health Atlanta, GA (On Site) Full-Time
Description
The Finance Director is responsible for supporting budgeting, forecasting, long-term planning, business strategic analysis of the team, month-end reporting, and corporate deliverables for Medicaid. Provides financial leadership, decision support and strategic direction to support the senior management team’s achievement of the business plan.
Primary duties may include, but are not limited to:
* Provides decision support/analysis and financial leadership to business unit President and senior management team.
* Conducts analysis and reporting to understand trends, variances and identify opportunities for margin and operational improvement.
* Leads the preparation of budget and forecasts that represent the best projection of future performance.
* Works with management to determine assumptions and identify new initiatives for the business unit.
* Ensures alignment of budget/forecast to business plan.
Minimum Requirements:
* Requires a BA/BS in accounting or finance and a minimum of 5 years of progressively more responsible experience in a high-level financial analysis position for a publicly held company; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, and Experience:
* MBA, CPA, CFM, or CMA preferred.
* Experience supporting senior management and prior leadership experience preferred.
* Experience in Medicaid
* Hight proficiency in MS Office (Excel, PowerPoint, and Word)
* Strong analytical skills
* Strong communication skills (verbal and written)
* Knowledge of accounting principals
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 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 [ Email address blocked ] – Click here to apply to Finance Director – Medicaid for assistance.
Recommended Skills
- Accounting
- Analytical
- Communication
- Finance
- Financial Analysis
- Forecasting
SonicJobs – Public Sector Consulting Actuary Medicaid
By applying, a Career Builder account will be created for you. Career Builder’s Terms & Conditions and Privacy Policy will apply.
Ideal candidate will have experience working with governments in a healthcare setting. Medicaid Experience Needed!
This Jobot Job is hosted by: William Zaranka
Are you a fit? Easy Apply now by clicking the “Apply Now” button and sending us your resume.
Salary: $80,000 – $140,000 per year
A bit about us:
Join a nationally recognized as an industry leader in the areas of healthcare data analysis, program evaluation, and quality improvement. We are in search of talented individuals who are interested in a leadership position as a Consulting Actuary in our Data Science & Advanced Analytics (DSAA) division. Together we can spread positive change to make healthcare better.
Why join us?
A comfortable work-life balance, including half-day Fridays and flexible work schedules.
Three weeks of paid time off and 15 company-paid holidays where staff leave two hours early prior to each holiday to get a jump start on holiday festivities.
They offer a competitive benefit package that includes medical, dental, vision, tuition reimbursement, 401(k) and an employee stock ownership plan.
Job Details
- Bachelors degree in actuarial or actuarial related science.
- Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA) designation.
- At least 5 years experience working in a healthcare setting (i.e., managed care plan, actuarial firm).
- Development and certification of Medicaid managed care rates for Medicaid populations.
- Understanding of Medicaid waivers and budget neutrality requirements [e.g., 1115, 1915(b/c) waivers].
- Use and applications of various risk adjustment mechanisms and tools.
- Serve as a senior leader within HSAGs DSAA division.
- Act in a liaison capacity between HSAG and outside agencies and organizations.
- Oversee communication with project partners, subcontractors, and other entities.
- Assign and oversee actuarial activities.
Interested in hearing more? Easy Apply now by clicking the “Apply Now” button.
Medicaid Waiver Case Manager – Anderson, IN
Benefits
Pulled from the full job description
Dental insurance
Flexible schedule
Flexible spending account
Health insurance
Health savings account
Life insurance
Job Summary
Inspire Case Management has the privilege of currently serving all 92 counties across central Indiana. Inspire Case Management is always looking for qualified individuals who have a passion for working with individuals with Intellectual Disabilities.
Please visit our website at https://www.inspirecm.com/ for more information regarding what we do and to complete our application process.
Responsibilities and Duties
Case Managers assist participants in gaining access to needed waiver and other Medicaid State Plan services, as well as needed medical, social, educational and other services, regardless of the funding source for the services to which access is gained.
Additional Responsibilities and Duties:
- Developing, updating, and reviewing the PCISP using the person-centered planning process.
- Convening team meetings at least every 90 calendar days and as needed to discuss the PCISP and any other issues needing consideration in relation to the participant.
- Completion of a DDRS-approved risk assessment tool during service plan development, initially, annually, and when there is a change in the participant’s status.
- Monitoring of service delivery and utilization (via telephone calls, home visits, and team meetings) to ensure that services are being delivered in accordance with the PCISP.
- Completing and processing the annual level of care determination.
- Compiling case notes for each encounter with the participant.
- Conducting face-to-face contacts with the individual (and family members, as appropriate) at least once every 90 calendar days in the home of the waiver participant and as needed to ensure health and welfare and to address any reported problems or concerns.
- Completing and processing the 90-Day Checklist
- Developing initial, annual, and update Cost Comparison Budgets using the State-approved process.
- Disseminating information including all Notices of Action and forms to the participant and the Individual Support Team (IST) within five business days of the IST meeting.
- Completing, submitting, and following up on incident reports in a timely fashion using the State approved process, including notifying the family/guardian of the incident outcome, all of which must be verifiable by documented supervisory oversight and monitoring of the Case Management agency.
- Monitoring participants’ health and welfare.
- Monitoring participants’ satisfaction and service outcomes.
- Monitoring claims reimbursed through the approved Medicaid Management Information System (MMIS) and pertaining to waiver-funded services.
- Maintaining files in accordance with State standards.
- .Cultivating and strengthening informal and natural supports for each participant.
- Identifying resources and negotiating the best solutions to meet identified needs.
Please visit our website at https://www.inspirecm.com/ for more information regarding what we do and to complete our application process.
Qualifications and Skills
Inspire Case Management requires at least 1 year of field experience working with individuals with Intellectual Disabilities and at least a bachelor’s degree from an accredited college or university in a related field. Inspire Case Managers must reside in Indiana and be able to travel locally. Please visit our website at https://www.inspirecm.com/ for more information regarding what we do and to complete our application process.
Benefits
Although Inspire’s headquarters is based out of the Indy area, we have the privilege of serving all 92 counties across central Indiana (with the hopes of expanding that as the need arises). Case Managers are hired geographically based off the need in particular areas. Case Managers work out of their home offices and travel locally. Flexible hours. Please visit our website at https://www.inspirecm.com/ for more information regarding what we do and to complete our online application process.
Job Type: Full-time
Salary: $30,000.00 – $51,000.00 per year
Benefits:
- Dental insurance
- Health savings account
- Life insurance
- Vision insurance
Schedule:
- 4 hour shift
- 8 hour shift
- Monday to Friday
Job Types: Full-time, Part-time
Pay: $30,000.00 – $51,000.00 per year
Benefits:
- Dental insurance
- Flexible schedule
- Flexible spending account
- Health savings account
- Life insurance
- Vision insurance
Schedule:
- Self-determined schedule
Work Location: On the road
Clinical Authorization Review Nurse (Medicaid Health Systems Specialist – RN) | Ohio Department of Medicaid
THIS POSITION MAY BE TELEWORK ELIGIBLE ON A HYBRID BASIS.
About Us
The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. ODM is implementing the next generation of Ohio Medicaid to fulfill its bold, new vision for Ohio’s Medicaid program – focusing on the individual rather than the business of managed care.
The goals of the next generation of Ohio Medicaid are:
- 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
What You Will Do At ODM
Working Title: Clinical Authorization Review Nurse
Classification: Medicaid Health Systems Specialist RN (PN 20046588, 20037628)
Office: Health Innovation & Quality
Bureau: Clinical Operations
Pay rate: $30.93/per hour
Job Overview
As the Clinical Authorization Review Nurse in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include:
- Monitoring and evaluating contractors, projects, programs or service delivery
- Participation in prior authorization and service authorization oversight and utilization activities
- Reviewing both physical and behavioral health clinical records and files, other medical and administrative data, and patient summary/profile reports to determine if providers or care delivery meets or equals the established care standards/clinical practice guidelines set forth in Medicaid programs, professional standards, and/or evidence-based best practices, and recommending health and safety process improvements
- Reviewing and approving claims for payment
- Working collaboratively with internal and external stakeholders across a variety of departments, levels, state agencies, and MCPs to improve health services for the individuals served by ODM
- Using your nursing expertise to evaluate authorization decisions for individuals served in both Managed Care, Fee for Service and Waiver populations
Must possess a current & valid license as registered nurse (RN) as issued by Ohio Board of Nursing, pursuant to Sections 4723.03 & 4723.09 of Ohio revised code.
Current & valid license to practice professional Nursing as a Registered Nurse (i. e., RN) in Ohio as issued by the Board of Nursing pursuant to Sections 4723.03 to 4723.09, inclusive of Ohio Revised Code; additional 24 months of experience in Nursing.
Training & Development Required to Remain in Classification After Employment: Biennial renewal of license in practice as Registered Nurse per Section 4723.24 of Ohio Revised Code.
Primary Location
United States of America-OHIO-Franklin County-Columbus
Work Locations
Lazarus 5
Organization
Ohio Department of Medicaid
Classified Indicator
Classified
Bargaining Unit / Exempt
Bargaining Unit
Schedule
Full-time
Work Hours
8:00 a.m. – 5:00 p.m.
Compensation
$30.93/per hour
Unposting Date
Feb 5, 2023, 10:59:00 PM
Job Function
Nursing
Agency Contact Name
ODM Human Resources
Agency Contact Information
HumanResources@medicaid.ohio.gov