Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

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

Title: Staff VP Encounters

Location: Virginia Beach, VA or within commutable distance to a local office

Travel: 25%

Responsible for the strategic, design and management of the Encounters e2e program and team that supports the day to day Encounter intake, analysis and submissions to federal and state partners, as well as the implementation of company-wide initiatives

Primary duties may include, but are not limited to:

• Oversees Encounters performance metrics ensuring timeliness, accuracy and completeness are met with state and federal partners for all lines of business
• Oversees Encounters submissions, rejection management & resolution for all lines of business including internal strategic partnerships supporting the production of encounters as well as providing overall organizational leadership aimed at managing overall healthcare costs
• Ongoing monitoring and management resolution for any potential penalties related to performance measurements of encounters submissions
• Engages with internal business partners and IT to analyze the root cause, identify potential risks, find ways to improve upon performance and lead the needed changes
• Develops and leads strategic innovative initiatives to deliver more value for state and federal partners. Consults and calibrates with senior leaders as well as vendors and outside organizations, being the face of Encounters for the Anthem enterprise
• Identifies, develops, hires, trains, coaches, counsels, and evaluates performance of direct reports

Qualifications

• Requires a BA/BS in business or related field; 15+ years of experience in Healthcare or Operations industry;
• Advanced strategic planning, organizational, managerial, and leadership skills; excellent verbal and written communication skills, experience drafting proposal, obtaining consensus for approving and implementing future state processes and systems need to support strategic direction or any combination of education and experience, which would provide an equivalent background.
• 5+ Medicare and Government Medicare, Medicaid
• 5+ Claims payment processing
• 5+ Financial management
• 5+ Regulatory and/or government experience

Preferred requirements:

• MA/MBA
• Vendor Management experience
• Claims and Encounters within Health Insurance
• Six Sigma, Agile Methodology and Design Thinking

  
  Clipped from: https://anthemcareers.ttcportals.com/jobs/6579403-staff-vp-encounters-gbd-medicare-and-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Anthem Nashville, TN

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.  It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.   This is an exceptional opportunity to do innovative work that means more to you and those we serve.    Nurse – Utilization Review / Home Health (Medicaid) PS54174   Note about Location and Work Hours: This position requires day travel (in the future) throughout your assigned territory in Middle Tennessee. Mileage will be reimbursed. Currently requires virtual meetings during the hours of 8am and 5pm, Monday – Friday, Central Time.   Location: This position will allow you to work from your home office. In the future, you will visit members and providers in the field up to 30% of the time, day travel. You must reside in middle Tennessee.   The Nurse Medical Management l (Home Health) is responsible for collaborating with healthcare providers primarily and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and  managed care products, and steering members to appropriate providers, programs or community resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment. Primary duties may include, but are not limited to:

• Conducts pre-certification, continued stay review, care coordination, or discharge planning assessments for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
• Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
• Collaborates with providers to assess members’ needs for early identification of and proactive planning for discharge planning.
• Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.
• Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

nthem positions.

Qualifications

Requires:

• Current active unrestricted RN license to practice as a health professional in the State of Tennessee and 2 years acute care clinical experience.
• Minimum 1 – 2 years home health care or private duty nursing clinical experience.
• Internet Access – Home office.
• Proficient use of computers required.

  Preferred:

• Utilization management/review experience within managed care or provider care strongly preferred.
• Case Management, Discharge Planning, and Managed Care experience a plus.
• Ability to assess member needs for outpatient services and support by gathering documentation and interpreting for medical necessity.
• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

 
 

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.

 
 

Clipped from: https://www.ziprecruiter.com/c/Anthem/Job/Nurse-Utilization-Review-Home-Health-(Medicaid)/-in-Nashville,TN?jid=4a419e0072a0d6a9&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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 AE II is responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers. Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations. 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. Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the Plan’s territory in keeping w/ State and Federal contact mandates for all products. Identifies, contacts and actively solicits qualified providers to participate in Plan at new and existing service areas and products, assuring financial integrity of the Plan is maintained and contract management requirements are adhered to, including language, terms and reimbursement requirements. 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.


Education/ Experience

• Bachelor’s Degree.
• 1 to 3 years previous Account Executive experinces in the manage care space.
• Required Medicaid experience along with 3 to 5 years experience in a Provider Services position working with providers
• 5 ot 10 years experience in the managed care/health insurance industry with demonstrated strengths in:

 
 

• Plan policies and procedures related to provider contracting, provider credentialing, provider billing and payment, provider incentive programs.
• State and Federal regulatory requirements related to providers, claim adjudication systems, provider file database requirements and relevant software applications.
• Substantive Account Executive experience with high impact, high dollar, extremely visible and critical provider groups.
• 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.
   

Note: Presently all of our AmeriHealth Caritas Family of Companies associates are working remotely due to the Pandemic. This role/department will be transitioning to the District of Columbia site when it is safe to return to the office.

 

Clipped from: https://www.linkedin.com/jobs/view/provider-network-account-executive-ii-medicaid-at-amerihealth-caritas-2604213790/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

Responsibilities:

Responsible for managing the day-to-day activities of the Network Management department and staff. Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication. This position is also responsible for all provider network recruiting and contracting management activities. Ensures that the department and staff remain current in all aspects of Federal and State rules, regulations, policies and procedures and creates or modifies departmental policies to reflect changes. Ensures department achieves annual goals and objectives.

Contracting

• Responsible for hospital and physician network development and management.
• Develops and recommends policy changes related to provider recruitment and contracting.
• Recruits and negotiates contracts with specific providers within operational and potential new counties to meet company requirements.
• Oversees training and communication for network providers and acts as a liaison with the provider community.
• Ensures compliance with pricing guidelines established by AMC and Plan.
• Ensures provider contracting is consistent with claim payment methodologies.
• Maintains familiarity with State Medicaid fee schedules and analyzes comparable Plan pricing guidelines.
• Resolves difficult complex contract issues to ensure that provider contracts are in compliance with state, federal, national accrediting agencies and Plan contracting guidelines.
• Ensures that non-standard contract elements are communicated to appropriate departments and obtains AMFC and Plan approval prior to submission to provider.
• Responsible for the accuracy and timely management of all provider contracts.
• Responsible for implementation of electronic strategies for provider network to include increasing electronic claims submission and implementation of improved processes that result in increased auto-adjudication of claims.

Recruitment

• Responsible for compliance with State and accrediting agencies’ network adequacy standards.
• Ensures the provider network meets the health care needs of Plan members.
• Establishes a recruitment plan, conducts recruiting activities and oversees the recruitment efforts of staff.
• Establishes a priority list of new geographic locations and types of providers to be added to the Plan network in concert with Plan departments.
• Works with Plan departments to retain network providers at risk for termination.
• Augments and modifies the existing provider network to accommodate new products or clients as necessary.

General Administrative Activities

• Responsible for departmental staffing decisions and provides supervision to assigned staff, writes and performs annual reviews and monitors performance issues as they arise.
• Leads team in a manner conducive to ongoing growth and expanded knowledge of associates.
• Coach team members in the use of data and appropriate analytical tools that support improved quality.
• Support team members in the identification and creative problem resolution for improved processes and expanded use of technology.
• Support collaborative team efforts that produce effective working relationships and trust.
• Systematically keeps staff informed of policy and procedural changes affecting program and administrative operations.
• Regularly suggests innovative means of structuring operations in a fashion that helps alleviate backlogs and ensures the optimal utilization of resources.
• Resolves individual provider complaints in a timely manner to ensure minimal disruption of the Plan’s network.
• Analyzes and monitors provider claim compliance with Plan policies and procedures and recommends solutions when problems occur.
• Responsible for facilitating the department on system upgrades, regulatory directives (i.e., Medicaid Bulletins, etc.) and assigned corporate initiatives.
• Monitors capitation, provider rosters, and RHC/FQHC reports and develops and implements strategies to address outliers.
• Conducts and prepares reports on annual provider satisfaction surveys; develops plans to improve identified areas of concern; works with other departments to develop quality assurance initiatives based on survey results.
• Supports the Quality Management Department and Company-wide Quality Initiatives such as HEDIS, CAHPS and NCQA/URAC:
• Reviews Quality indicators and makes recommendations for improvement
• Compiles documentation regarding quality Reports and provider utilization platforms.
• Will partner with medical management team to identify and measure methods to improve process and workflows
• Participates in Plan and physician committees as appropriate.

Education/Experience:

• Bachelor’s degree in business or health related discipline such as Healthcare Administration or Healthcare Management or equivalent business experience required.
• Master’s Degree preferred.
• 1- 3 years Medicaid experience preferred.
• 5 years provider contracting/reimbursement experience in healthcare setting.
• 3 years of effective and successful upervisory/management/leadership experience, preferably in a managed care setting.
• Valid driver’s license and current auto insurance required.

16 hours ago

 
 

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Position Purpose:

 
 

• Conduct analysis, pricing and risk assessment to estimate financial outcomes.
• Manage health plan specific actuarial needs and produce actuarial reports to aid in developing corporate strategy.
• Comfort with working on large data sets, including ability to write and debug code necessary to manage analytical processes; Strong proficiency in Excel, and programming experience in SAS and/or SQL
• Serve as the main point of contact for all actuarial related activities for an assigned health plan
• Manage at least 1 health plan – Medicaid
• Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes
• Developing probability tables based on analysis of statistical data and other pertinent information
• Research and analyze the impact from legislative changes
• Analyze and evaluate required premium rates
• Assess cash reserves and liabilities enable payment of future benefits
• Analyze various data reports, identify trends and gaps and recommend action
• Determine the equitable basis for distributing money for insurance benefits
• Create and update actuarial reports
• Participate in merger and acquisition analysis

Education/Experience:

• Bachelor’s degree in related field or equivalent experience.
• 2+ years of actuarial experience.

 
 

License/Certification:

• Associate of the Society of Actuaries (ASA) (or equivalent international certification)

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.

Clipped from: https://jobs.centene.com/us/en/job/REA1221748/Associate-Actuary-Medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Overview:

Berry Dunn is seeking a Sr. Consultant who will be responsible for the management, reporting, and achievement of project objectives, schedule, quality, resources, and budget for the design, development, and implementation of multiple Medicaid and/or Children’s Insurance Program (CHIP) business initiatives and activities that state health and human services clients may undertake. The Sr. Consultant will work with the client, team, vendor(s), and federal stakeholders to achieve project objectives.

In addition, the Health and Human Services Project Manager may support testing requirements, and operational readiness testing efforts in support of different health and human services project. This position is planned to sit remotely or in Portland, Maine .

You will report to the Principal in the Medicaid Practice Group.

Travel Expectations:
Although Berry

Dunn consultants are currently not travelling due to the COVID-19 pandemic, future travel to client sites can range from 50-75%.

Responsibilities:

You will :

Support the delivery of services to clients on time, within scope, and within budget, including assigning and managing staff and creating work product

Deliver frequent, clear, and consistent communication to the client, team members, vendor, and direct reports

Develop, review, distribute, and present project status reports

Lead the documentation of project action items, issues, risks, and decisions

Oversee deliverable review facilitation, tracking, and maintenance

Lead staff/team meetings and trainings

Perform and delegate administrative tasks efficiently and effectively, asking questions when instructions are unclear

Provide oversight, facilitation, and assistance across each of the project’s testing related phases (i.e., developing testing, system integration testing, user acceptance testing, operational readiness testing, pilot testing, regression testing, etc.)

Estimate and maintain resource projections for responsible tasks; assist in the facilitation of stakeholder involvement in project testing efforts; and assist in the development, review, distribution, and presentation of project status reports

Qualifications:

You have :

At least 5 to 7 years of public sector experience

At least three years of experience working with state Medicaid agencies

Experience with transformation of business rules into system configurations; business and technical aspects of healthcare information systems; and knowledge of the business areas of the Medicaid Information Technology Architecture (MITA) framework preferred

Experience with assisting and/or leading testing efforts for a health and human services technology solution implementation

In-depth understanding of the testing lifecycle, knowledgeable in test execution and defect management (defect identification, documentation, management, and reporting)

Developed, edited, and presented summaries, reports, and presentations of complex information and data for project and client teams

Estimated and maintained resource projections for responsible tasks

Managed a project team

Strong communication skills and attention to detail

Bachelor’s Degree (BA/BS)

Knowledgeabl in quality assurance/control procedures and demonstrated proactive problem management skills

Demonstrated ability to excel in a team setting

Strong experience with Microsoft desktop applications

Prior consulting experience in a national or regional consulting firm, experience working in/with the public sector or relevant independent consulting experience.

Our

Benefits:

We value our employees and offer a variety of attractive benefits, in addition to being part of a high-powered, effective team! Here are just a few of our attractive benefits:

Health, Dental, Rx and Vision Insurance

Health Savings Account (HSA);
Employer contribution

Responsible Paid-Time-Off policy, including Paid Family Leave

401(K) profit sharing plan with employer match after one year

Life and AD&

D Insurance

Long-term Disability Insurance

Long-term Care Insurance

Tuition Reimbursement, Continuing Professional

Education , and CPA Exam

Wellness Programs

Mentor Programs

About Berry

Dunn:

Berry

Dunn is a CPA and Management Consulting firm with over 500 employees throughout the country that provide a full range of services including Management and IT Consulting, Health Analytics/Actuarial Consulting, Audit, Accounting, and Tax. We are headquartered in Portland, Maine, with offices in Arizona, Connecticut, New Hampshire, and West Virginia. Berry

Dunn has maintained steady growth over its 40+ year history, and the firm is regularly named to national “Top 100” lists, including recent recognition for being a “fastest-growing” firm. We partner with clients across the United States and Canada, and we attribute our growth to attracting, developing, and retaining outstanding employees who help our clients create, grow, and protect value.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.

Clipped from: https://www.learn4good.com/jobs/portland/maine/info_technology/389394607/e/

 
 

Description


 

SHIFT: Day Job


SCHEDULE: Full-time
 


 

<span style=”font-family:”Times New Roman”,serif”>Responsible for financial leadership, decision support, and strategic consultation to the Ohio<span style=”font-family:”Times New Roman”,serif”> Medicaid Health Plan leadership team. Directs health plan financial analysis, cost of care analytics, trend analysis, financial reporting, financial operations, and cost and budget management and allocation in a Health Plan with an assigned product or portfolio, which may include specialty products and/or provider contracting arrangements that carry financial risk to the plan P&L, serves as legislative consultant with state partners on financial/reimbursement policy and payment mechanisms.


 

<span style=”font-family:”Times New Roman”,serif”>Primary duties may include, but are not limited to:


 

• <span style=”font-family:”Times New Roman”,serif”>Directs market leadership for P&L and SG&A budget; operates as a financial liaison to state partners; leads rates management and negotiation including reserve development and analytics; and leads the Medical Cost and RX Trend identification and mitigation process with key business partners including network and clinical teams.
• <span style=”font-family:”Times New Roman”,serif”>Maintains trends that are appropriate given premium reimbursement.
• <span style=”font-family:”Times New Roman”,serif”>Reviews, analyzes, reports, and presents financial results. Provides decision support for business unit President and senior management teams’ operational and business goals.
• <span style=”font-family:”Times New Roman”,serif”>Achieves Medical Cost and MLR targets set in plans and forecasts; may ensure that provider network contracting efforts obtain the best possible financial arrangements; may own the setting of and achievement of Cost of Care targets; and achieves operating gain targets set in budgets and forecasts.
• <span style=”font-family:”Times New Roman”,serif”>Directs Health Plan preparation of annual operating/capital budget and forecasts to provide senior leadership with tools necessary to maximize investment of resources.
• <span style=”font-family:”Times New Roman”,serif”>Directs interface with regulatory and audit personnel and technical consultants as required to ensure fiscal accountability.
• <span style=”font-family:”Times New Roman”,serif”>Supporting the pricing actuaries on premium rate actions.
• <span style=”font-family:”Times New Roman”,serif”>Representing the health plan at key state and provider meetings; oversees the processing and delivery of several major provider pass thru payments; and is a key member of the Ohio leadership team.
• <span style=”font-family:”Times New Roman”,serif”>Helping to support the plan president on setting and achieving health plan goals.

Qualifications


 

<span style=”font-family:”Times New Roman”,serif”>Requires a BS/BA in Finance, Business Administration, Economics  or Accounting; 8-10 years of progressive financial experience accounting, financial reporting, business analysis, budgeting, forecasting, and strategic and tactical planning within a health insurance/managed care environment; experience with complex business environments including multiple entity and highly regulated situations; or any combination of education and experience, which would provide an equivalent background.; MBA preferred. Significant experience working with shared savings arrangements is strongly preferred. Medicaid managed care experience preferred.

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

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

 

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AHCCCS

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs, and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona.

Grants Coordinator

AHCCCS

Posting Details:

Salary: $57,000-$60,000 
 

Grade: 21

Job Summary:

The Division of the Grants Administration (DGA) is looking for a highly motivated individual to join our team as a Grants Coordinator. This position will serve as a subject matter expert for integrated services for individuals determined to have a Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED), First Episode Psychosis (FEP), and on questions related to service delivery and oversight throughout Arizona. It is important that this position be able to determine appropriateness and effectiveness of state and federally funded mental health and integrated care services. The Division of Grants Management (DGA) is responsible for the application, oversight, monitoring, and implementation of contracts deriving from state and federal funding with an emphasis on the Mental Health Block Grant (MHBG). Under limited supervision, this position will evaluate the design, delivery, implementation, and effectiveness of the mental health services statewide. The position is grant funded and may be eliminated based on the availability of funding.

Job Duties:

* Oversee Mental Health Block Grant (MHBG) contracts and activities. Maintain close contact with Contractor’s staff regarding MHBG, Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED), and First Episode Psychosis (FEP) activities. Monitors contractor performance through the annual operational review, annual reports, site visits, and recurring coordination meetings. Provides training and technical assistance to contractors as needed.

* Serve as a Subject Matter Expert (SME) for integrated services for individuals determined to have a Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED), and First Episode Psychosis (FEP), for the Division of Grants Administration (DGA), which will include but is not limited to providing trainings to AHCCCS staff, contractors, and stakeholders as appropriate.

* Assist with and facilitate AHCCCS projects. Projects to include but are not limited to: submitting and assisting in the development of grant applications, navigating and managing data submissions to grant systems such as WebBGas and eRA Commons, federal deliverable development and submission, Contractor Expenditure Report (CER) reviews, and technical assistance provision.

* Prepare documents including protocols, policies and procedures, and contracts (as needed) for the development of requirements as they relate to the oversight of sub-grantees and contractors, outcome and progress reports written, communication, and presentations which include statistics and financial data pertaining to MHBG programs.

* Represents AHCCCS at national, state, and internal meetings and committees for the purpose of integrated behavioral health care.

* Works with community and state stakeholders and the federal government to develop, modify, adapt policies, and improve the efficacy of services in Arizona

* Project Management including grant work plans, timelines, and deliverables.

 

Knowledge, Skills & Abilities (KSAs):

* Experience providing mental health services, as well as knowledge of Arizona’s behavioral health program delivery system (mental health, substance use and integrated care).

* Knowledge of and/or experience in implementing evidence-based practices and research in Serious Mental Illness (SMI), Serious Emotional Disturbance (SED), and First Episode Psychosis (FEP) populations.

* Oversight and monitoring contractual requirements

* Computer skills including use of Microsoft Office (or comparable software program)

* Strong negotiation and problem resolution skills

* Effectively communicate orally and in writing

* Plan and implement complex initiatives, tasks and events

 

Selective Preference(s):

* Minimum Bachelor’s degree in the behavioral health field, or related field

* Two years of experience working in direct behavioral health services

* Master’s degree in behavioral health or related field preferred

* Multi-lingual preferred

 

Pre-Employment Requirements:

Valid Arizona Drivers License

Benefits:

At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

 
 

Clipped from: https://jobs.azahcccs.gov/grants-coordinator/job/16817603?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

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 and
• Increase program transparency and accountability.

 
 

Unless required by legislation or union contract, starting salary will be set at step 1 of the pay range.


Office: Legal Counsel


Bureau: Program Integrity


Working Title: Medicaid Health Systems Specialist (PN:20043125)


Job Overview


The Ohio Department of Medicaid (ODM) is seeking a healthcare professional to be a part of our Data Support team for
the Surveillance and Utilization Review Section (SURS). SURS is part of the Bureau of Program Integrity which focuses
on fraud, waste, and abuse related activities and supports quality of care. As a Medicaid Data Support Specialist, your


Responsibilities Will Include

• Compiling complex, data reports and/or summaries for internal and external entities related to reviewing Medicaid Providers for compliance using a variety of technological systems and applications
• May assist IT staff as an SME in the development and/or testing of technology systems (e.g. Enterprise Data Warehouse (EDW)) and analytical systems for decision support
• Establishing standards for data consistency, reporting and analytic support
• Handling confidential records and information
• Coordinating with department staff and systems

 
 

The preferred candidate will have experience compiling and analyzing complex data reports.


Completion of undergraduate core program in business administration, social or behavioral science, health or statistics; additional 24 months experience specific to subject area of which 12 months experience in use of spreadsheet and database software.


 

• Or 24 months experience as Medicaid Health Systems Analyst, (65291).
• Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required.
  
  
   

Note: education & experience to be commensurate with approved position description on file.


Primary Location


United States of America-OHIO-Franklin County-Columbus


Work Locations


Lazarus 4


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


$29.16/per hour


Unposting Date


Jul 7, 2021, 10:59:00 PM


Job Function


Health Administration


Job Level


Individual Contributor


Agency Contact Information


HumanResources@medicaid.ohio.gov

Clipped from: https://www.linkedin.com/jobs/view/medicaid-data-support-specialist-medicaid-health-systems-specialist-at-ohio-department-of-medicaid-2605801671/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Description:

Description

The Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Provider Contracting Professional 2 communicates contract terms, payment structures, and reimbursement rates to providers within the Behavioral Health/Medicaid space. You will develop and grow positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications

* Bachelor’s degree
* 2 – 5 years of experience in negotiating managed care contracts with physician, hospital and/or other provider contracts.
* 1+ years experience with Medicaid contracting
* Experience in provider engagement and education
* Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.
* Excellent written and verbal communication skills
* Ability to manage multiple priorities in a fast-paced environment
* Proficiency in MS Office applications
* Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

* Master’s Degree
* Experience with Value Based Contracting
* Experience working with Behavioral Health Medicaid contracts

Additional Information

This position will be remote/work at home, to be based anywhere in the United States

Scheduled Weekly Hours

40

Clipped from: https://us.trabajo.org/job-640-20210623-c3d353580c92ec0cd8120bd7b1c0ce02?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic