Category: Curator- Job Hunter

 
 

Description:

Job Summary:
Will be responsible for processing and validating State Medicaid Drug Rebate Program invoices for various government programs. Work with external vendor for invoice data entry and uploading. Prepare related rebates for payment. Coordinate approvals and payment processing with Accounts Payable. Troubleshoot, analyze and resolve state invoice discrepancies using external website or state data for utilization validation. Perform State Medicaid invoice account reconciliations. Work with State Medicaid Analysts to resolve utilization disputes between Amgen and State Medicaid Agencies at state government level. Analyze utilization trends. Provide data and analytics for internal reporting requirements. Help facilitate process improvements. Perform other administrative functions and other special projects as needed.

Basic Qualification:
Education and Experience:
1. Bachelors Degree highly preferred, Advanced degree a plus
2. Internal Amgen experience or experience in a pharmaceutical/biotech environment highly preferred.
3. 4+ years experience in related field (6 or more a plus); including Finance, Contracts or Project Management: demonstrated track record of increasing responsibility
4. General knowledge of Medicaid reimbursement policies, Government Medicaid Programs, invoices and claims processing is highly preferred.
5. Good analytical skills

Knowledge:
– Strong computer & M/S Office skills.
– Develops spreadsheet models for moderately complex financial analysis.
– Good verbal and written communication skills. May deliver formal presentations.
– Communicates effectively within and outside the department and with State Government Agencies.

Problem Solving:
– High attention to detail/reporting accuracy, while also able to focus on the overall problem / solution
– Translates high volumes of data into meaningful information to support key business decisions
– Identifies and implements process improvement opportunities

Autonomy:
– Completes projects timely and makes decisions with minimal direction and ability to assess prioritization and completion timeframes for multiple simultaneous assignments.
– Self motivates and owns project from inception to completion and completes work with given guidelines and procedures
– Thinks strategically (can see big picture) while delivering results at the appropriate level of detail
– Tolerance of ambiguous situations

Contribution:
– Strong presentation skills; can effectively articulate and influence meeting decisions with cross functional group attendees
– Team player, supports team members as needed
– Effectively represents team in a complex matrix organization with cross-functional groups within Contracts and Pricing Execution (CPE) and support functions

Strong project management skills and leads projects as required.

Provides analysis and recommendations to support decisions by team management

Perform other administrative functions and ad-hoc special projects as needed

Join UsIf you’re seeking a career where you can truly make a difference in the lives of others, a career where you can work at the absolute forefront of biotechnology with the top minds in the field, you’ll find it at Amgen.Amgen, a biotechnology pioneer, discovers, develops and delivers innovative human therapeutics. Our medicines have helped millions of patients in the fight against cancer, kidney disease, rheumatoid arthritis and other serious illnesses.As an organization dedicated to improving the quality of life for people around the world, Amgen fosters an inclusive environment of diverse, ethical, committed and highly accomplished people who respect each other but compete intensely to win. Together, we live the Amgen values as we continue advancing science to serve patients.Amgen is an Equal Opportunity employer and will consider all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

 

 
 

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Summary:

Perform a full range of tasks that support the Winchester Public Schools Medicaid program. Serve as the primary point of contact for all Medicaid program activities.

Responsibilities:

The successful candidate will be responsible for the following:

• Develop procedures pertaining to Medicaid documentation and reimbursement and ensures FERPA and HIPPA compliance;
• Develop procedures for identification of Medicaid-eligible students;
• Interface with staff to obtain parental consent forms;
• Interface with federal, state, local and private agencies to obtain information about eligible students;
• Monitor federal, state and licensing boards regulations pertaining to the Medicaid and Schools program
• Review applicable laws and regulations
• Prepare, maintains and reviews all student Medicaid files;
• Analyze documentation in case files for accuracy, follow-up and changes in status;
• Coordinate all billable services (i.e. nursing, personal care, psychological, speech, physical and occupational therapy services and transportation); Creates, maintains, and provides supporting documentation and provider qualifications; submit all billing
• Analyzes plans of care, addendums, discharge, note documentation and billing information;
• Act as Winchester Public Schools liaison with appropriate state agencies;
• Collaborates with the Department of Technology to manage the Medicaid database and security;
• Develop and maintains billing program for reimbursement of services;
• Reconcile accounts and responds to billing discrepancies;
• Train providers regarding compliance with Medicaid requirements and procedures;
• Prepare and reviews program-related correspondence;
• Create procedural protocols for the local implementation of Medicaid reimbursement program;
• Coordinate and monitor the Administrative Claiming Program (including quarterly time study);
• Stay abreast of changes and developments in the Medicaid reimbursement program and attend Medicaid meetings conducted by state, federal agencies and the National Alliance of Medicaid in Schools (NAME);
• Collaborate with Finance, Special Education and Health Services and Transportation departments to obtain information on Medicaid-related activities as needed for Cost-Based Reimbursement; Complete quarterly ACC reports, yearly school based services and transportation cost reports;
• Develop and maintain database to track children and their Medicaid eligibility
• Submit billing
• Perform related work as required and keep up with ever changing Federal Medicaid rules and regulations;

Qualifications:

Experience in providing support in the area of medicaid related issues.

Location:

Winchester Public Schools Central Administrative Offices

Salary:

Salary range is $16.17 – $34.69 per hour

Workday:

Part-time, 6 hours per day, Monday – Friday

Start Date:

Upon Hire

 
 

Clipped from: https://www.topschooljobs.org/job/1172383/medicaid-specialist-wps-2020-2021-/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Role Overview

The Medicare/Medicaid Eligibility Specialist works with health plan members to determine eligibility for Social Security disability benefits. The Medicare/Medicaid Eligibility Specialist advocates and assists low-income Medicare beneficiaries apply to and requalify for government assistance programs. The Medicare/Medicaid Eligibility Specialist builds trusting relationships with members provide critical application assistance.

Role Responsibilities

• Conducts telephonic outreach activities for members who need to apply or recertify and are potentially eligible for various Medicaid programs including the Medicare Savings Programs
• Collaborates with government offices to accurately complete the application and recertification process
• Secures documentation for Medicaid/MSP renewal applications if needed for members
• Attention to detail by adhering to state requirements and securing supporting documentation
• Meets daily, weekly, and monthly production goals. Must also meet quality standards by ensuring proper phone etiquette and adherence to scripts, state regulations, HIPAA compliance, meet ongoing corporate compliance standards, and make accurate and descriptive documentation
• Participates as required in operational development programs
• Research changes with any state and federal regulatory requirements to adhere to strict compliance of all aspects of Medicare programs and Medicaid Outreach Operations
• Demonstrates behaviors, actions, and attitudes that reflect our vision, mission and values
• Understand and agree to role-specific information security access and responsibilities
• Ensure safety and confidentiality of data and systems by adhering to the organizations information security policies
• Read, understand and agree to security policies and complete all annual security and compliance training
  
  

Role Requirements

• Medicare/Medicaid program experience, and experience with screening for Medicaid eligibility a strong plus
• Expertise and knowledge of Medicaid, Special Needs Programs (SNP), Low Income Subsidy (LIS) and the Medicare Savings Program (MSP)
• Strong working knowledge with Microsoft Office programs, and some experience with Excel.
• Excellent oral communication skills; ability to communicate with elderly individuals and governmental personnel
• 2-3 years related experience with direct consumer interaction
• Outstanding customer service and communication skills
• Strong organizational, analytical, critical thinking and customer service skills
• Ability to analyze and interpret governmental program criteria
• Ability to manage a fast-paced environment
• Must be able to navigate through multiple databases/monitors with a minimum typing speed of 45 wpm
• Telephone experience and ability to interact and decipher information via telephonic or correspondence inquires
• Strong subject matter expertise of Medicaid programs regulations and industry standards
• Case management experience or related experience / intermediate
• A compassionate and empathetic nature with a strong desire to help and make a difference
• Bachelor’s or Associate’s Degree a plus
  
  

Centauri Health Solutions is an equal opportunity employer.

Other Details

• Pay Type Hourly

 
 

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Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company, 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

This position may be remote within NC and will be responsible for overseeing a designated region of NC. Home office location: 11000 Weston Parkway, Cary, NC. Candidates must reside in the state of NC or neighboring states. Currently, this position is remote due to COVID. Once we resume all standard operations, travel time for this position will be as indicated under the Requirements section. 

The Provider Clinical Liaison supports primary care groups in Advanced Medical Home population health activities. This position serves a key role in Healthy Blue’s geographically organized provider support. The Clinical Liaison is responsible for managing quality and medical expense goal metrics for primary care groups by assisting in connecting high risk members and those having HEDIS gaps to their medical homes, to establish care plans that improve health outcomes. 

Primary duties include:

• Use Healthy Blue databases and tools, including risk adjustment tools to identify opportunities for improvement in quality and costs for members in assigned practices
• Develop an operational plan for each medical practice to deploy office personnel and coordinate with Healthy Blue resources to optimize performance on targeted quality measures and to improve clinical and cost outcomes for members identified to have high clinical risk
• Coordinate scheduling of high risk members and those having HEDIS gaps for appointments
• Communicate with medical office personnel about identified gaps in care that will be apparent to the practitioner at the patient encounter
• Meet with physicians and other clinical personnel to problem solve and develop engagement plans for high risk members
• Work with practitioners and office staff to improve documentation of diagnoses, including specific manifestations, facilitate access of members to Healthy Blue case management, population health, and behavioral health programs as indicated, and help coordinate services provided by practice and Healthy Blue personnel
• Serve as the subject matter expert for primary care practices on all Healthy Blue clinically focused program
• Conduct periodic meetings with each practice to track progress towards implementing the project plan and attaining goals established in the engagement contract
• Support the Healthy Blue Provider Collaboration Lead in organizing and implementing support to achieve targeted revenue, medical expense, and quality goals for the assigned region 
• Assures compliance to practice guideline, delegation and continuity and coordination of care standards 
• Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of results. 

Qualifications

Requires: 

• BA/BS in Nursing 
• Minimum 5 years of clinical experience 
• Demonstrated commitment to clinical quality improvement  
• Unrestricted RN license in the state of North Carolina
• This position requires field work, visiting providers, approximately 75% of the time.

 
 

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. 

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/6232865-provider-clinical-liaison-north-carolina-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

The GovernmentBusiness Division Finance Director is responsible for financialleadership, decision support, and strategic consultation to the leadership teamin the Health Plan. This role directs health plan trend analysis, cost ofcare, financial reporting and analysis, financial operations, cost and budgetmanagement and administrative allocations in the Ohio Medicaid Health Plan, andserves as a key liaison and subject matter expert with our state customer on medicaltrends, financial/reimbursement policy, payment mechanisms and financialimplications of program and benefit changes.Primaryduties may include, but are not limited to: Health plan P owner along with plan president and other functional leaders. Serves as key health plan leader providing financial and strategic insight to other health plan functional areas; operates as a liaison with state partners; leads reimbursement management and negotiation; owns the Medical Cost Trend, cost of care process for plan and mitigation initiatives; and reviews financial statements, reserve development and financial analytics. Partners with pricing actuaries to ensure that premium reimbursement is adequate to cover medical trends, administrative expenses and profit. Reviews, analyzes, and presents financial results to health plan and line of business leadership as well as the board of directors. Provides decision support for health plan leadership team for operational and business goals. Directs health ) Achieves Medical Cost, MLR and operational income targets set in forecasts; ensures that provider network contracting obtains optimal financial arrangements; co-develops the setting of Cost of Care (CoC) targets and is responsible for CoC execution. Directly interfaces with regulatory and audit personnel and technical consultants as required to ensure fiscal accountability. Requires a BS/BA in Finance, Business Administration, or Accounting; 8-10 years of progressive financial experience with strategic and tactical planning, medical trend or business analytics, budgeting/forecasting, and accounting or financial reporting within a health insurance or managed care environment; experience with complex business environments and highly regulated situations; or any combination of education and experience, which would provide an equivalent background. MBA preferred. AnEqualOpportunityEmployer/Disability/Veteran

 
 

20 hours ago

Mason, Ohio

Anthem Inc.

Full Time

 
 

Clipped from: https://us.melga.com/job/2021-06-16_cd0d412b40496125ff2dcc42f2c49c2b?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

RANKIN COUNTY, MS

This is investigative work involving the interpretation of policy to determine Medicaid eligibility for families and children and aged, blind, and disabled individuals. The incumbent makes the initial and continuing determinations of eligibility for Medicaid recipients who live in private and institutional settings. Limited supervision is received from administrative supervisors who oversee a regional office or Central Enrollment Office.

Job Type: Full-Time

Location: 61 – RANKIN COUNTY, Mississippi

Agency: 0665 – MEDICAID DIVISION

 
 

Clipped from: https://www.monster.com/job-openings/medicaid-specialist-i-ms–36208d88-3009-4144-8340-190c4f235462?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Description:

Description


The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Senior Provider Contracting Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.


Responsibilities


Assignment: Humana Behavioral Health


Location: SC


The Senior Provider Contracting Professional for SC Medicaid communicates contract terms, payment structures, and reimbursement rates to providers. Providing a comprehensive hospital network to consumers in the behavioral health arena and executing on Humana’s consumer-focused business strategy demands constant negotiation with a variety of provider constituencies and continual re-prioritization of corporate and consumer needs. 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. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. In this role you will:


* Negotiate hospital and ancillary contracts at market competitive pricing.
* Initiate and maintain productive long-term relationships with key hospital and group practice administrators and members.
* Communicate proactively with other departments in order to ensure effective and efficient business results.
* You will handle services and levels of care and pricing on the behavioral health network side
* Subject matter expert on their assigned region or states on all things behavioral health networks
* Manage large accounts and/or provider relations
* Associate management oversight of 3-5 direct reports
* C-suite interactions both internally and externally


Role Essentials


* 3-4 years of progressive network management experience including hospital contracting and network administration in a healthcare company or healthcare system
* Medicaid behavioral health contracting experience
* Medicaid provider relations experience (face to face provider visits required
* Experienced in negotiating managed care contracts with large physician groups, ancillary providers and hospital systems.
* 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
* Previous leadership experience and oversight of Associates
* Ability to have difficult conversations with individuals at all levels of the organization internally and externally
* Ability to manage regional accounts
* Ability to adapt well when utilizing multiple new systems
* Strong negotiation skills


Role Desirables


* Behavioral health contracting experience
* Bachelor’s Degree
* Experience with ACO/Risk Contracting
* Experience with Value Based Contracting


Additional Information


This position is “remote/work at home”, however, you must live within the state of South Carolina in order to be considered for this opportunity.


Humana is an organization with careers that change lives-including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.


Scheduled Weekly Hours


40

 
 

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Delta Dental Of California Alpharetta, GA

At Delta Dental, our strategy is only as strong as the people who execute it! We are hiring individuals that are not just right for today but also for our future. We have built a foundation of high-trust by treating all people with dignity, making and keeping commitments, and consistently striving to do the right thing. Our leaders optimistically share future possibilities to inspire and motivate others toward their full potential. We expect our employees to find ways to embrace positive change, be curious and challenge the status quo, and provide solutions to unmet problems. Joining Delta Dental means joining a culture focused on fostering development, building genuine connections, recognizing each other’s strengths and sharing in successes. 

 
 

This position is responsible and accountable for the effective project management to implement all new and existing business along with implementing process solutions of all levels of complexity into Delta Dentals’ systems and processes for the line of business. Responsibilities of the position include collaborating with the business lines, developing and executing project plans that embrace best practices, change management, quality management, effective communication plans, requirements management, and securing all necessary resources needed to achieve the project objectives.

 
 

How you will make an impact:

• Acts as key partner to the line of business: understands strategic goals, customer needs and business objectives; acts as liaison between the line of business and Sales Shared Services and cross-functional partners involved in implementation.
• Plans, documents and executes all phases of the project lifecycle, including scope management, requirements management, work breakdown schedule and timeline management, priority and dependency management, and the assignment of roles and responsibilities.
• Performs risk management to minimize project risks.
• Develops detailed work breakdown schedules, project estimates, and resource plans that support scope.
• Develops comprehensive project plans to be shared with clients as well as other staff members.
• Conducts and facilitates effective project meetings, including issue tracking, status reports, and executive communications.
• Ensures problems are effectively escalated and crisis management activated, as needed.
• Manages changes to the project scope and project schedule.
• Acts as an advocate for the business, by providing first class service through expert development of the project management discipline.
• Lends subject matter expertise and knowledge management to the project team and stakeholders and ensures customer satisfaction through quality and timely product delivery.
• Promotes change, process, and best practices to both the business and technical team members, providing training for the project management discipline.
• Leads the project team on development efforts and lends both functional and technical system-specific knowledge throughout the project lifecycle.
• Provides advice and guidance to less experienced staff and assists in resolving escalated complex issues/problems, as needed.
• May attend in person finalist presentations and represents implementation.
• May lead in person implementation kick off meetings with external clients and brokers.
• Leads implementation kick off meetings with cross-functional partners.
• Uses and continually develop leadership skills.
• Performs miscellaneous duties as assigned.

What we look for:

• A Bachelor’s degree preferred. Equivalent experience may be considered in lieu of degree.
• A minimum of 6 years related experience.
• 2+years of industry experience onboarding Medicaid and Medicare (CMS) with demonstrated experience leading onboarding projects.
• PMP Certification would be preferred but not required.
• Ability to understand customer needs.
• Detail orientation and problem-solving abilities.
• Strong Presentation Skills.
• Advanced analytical and problem-solving skills to evaluate business processes and recommend effective solutions.
• Advanced organizational/time management and project management skills and multi-tasking abilities.
• Advanced knowledge of project development life cycle, including the ability to coordinate and prioritize multiple complex projects and cost analysis.
• Knowledge of Delta Dental products, policies, claims, eligibility and underwriting guidelines.
• Ability to coordinate issues between internal and external clients and the development teams.
• Ability to identify non-standards and foster creative solutions.
• Expert knowledge of project development life cycles, including the ability to coordinate and prioritize multiple projects.
• Excellent client-facing and internal communication skills.
• Strong leadership skills to lead the project team.

Benefits and perks:

• 12 days starting vacation plus 12 holidays and your birthday off!
• Multiple medical insurance options: 100% paid or low cost premiums
• 100% paid dental insurance
• 100% paid vision insurance
• Employee Well-Being Program
• Culture of learning: substantial tuition reimbursement to improve your skills
• Career growth: we love promoting from within
• Strong commitment to work/life balance  
• Social responsibility and volunteer opportunities

Due to COVID-19, there is an even greater demand for flexibility and change. Due to the pandemic, the expectation around work location for certain roles may be remote until a future date, determined by Delta Dental Management. Should the position you seek be determined by Delta Dental Management as “remote,” the position may require you to have access to remote internet in order to meet the expectations outlined in the job duties.

 
 

Please note, Delta Dental will not sponsor applicants for work visas for this position.

 
 

#LI-LS1

 
 

At Delta Dental we:

Promote accountability, integrity and collaboration: Our employees are collaborative, self-aware, and ethical. It is our expectation to do the right thing and follow through on commitments.

Foster professional development: Our employees take ownership of developing themselves and others through coaching, mentoring and providing/being open to constructive feedback and identifying learning opportunities.

Value customers and cultivate positive experiences: Our employees take time to build rapport with customers, while anticipating and exceeding their needs to ensure positive outcomes.  

 
 

If you think this sounds like you, let’s chat. We would love to tell you more!

 
 

To see some of the smiling faces behind Delta Dental and to learn more about what our values and culture look like in action, connect with us on social media: @lifeatddins on Facebook and Instagram, @deltadentalins on Twitter, and Delta Dental Ins. on LinkedIn.

 
 

ABOUT Delta Dental

Delta Dental covers more Americans than any other dental benefits provider. Our vision is to motivate and empower every employee so we’re all inspired to take exceptional care of our customers, providers and each other. Our Enterprise Strategy focuses on pillars of Growth and Diversification, supported by the platforms of Culture and People, Process and Technology. Our employees take pride working for a purpose-driven organization and live our values of Trust, Service, Excellence and Innovation.

 
 

We are part of the Delta Dental Plans Association, a network of companies that provides dental coverage to 74 million people in the U.S. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with our affiliate companies, form one of the nation’s largest dental benefits delivery systems, covering 33 million enrollees. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country.

 
 

Delta Dental provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other classification protected by federal or state law. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

 
 

Proof of eligibility to work in the United States must be provided if selected for hire. 

 
 

Clipped from: https://www.ziprecruiter.com/c/Delta-Dental-Of-California/Job/Onboarding-Project-Manager-(Medicare-Medicaid)/-in-Alpharetta,GA?jid=9f1e49ec5282fc0c&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Job Description

Accenture Consulting: Your Unique Place in our Global Collective
Being part of Accenture Consulting means becoming an expert at making the New happen Now. To us, the New is all about the wise pivot that turns constant disruption to continuous reinvention. We are an innovation led-company that works at the heart of our clients’ organizations so that no matter how complex the business challenge, we face the future with confidence.
If you love solving challenges and not just studying them, then Accenture Consulting is the right place for you. Join us to develop your ideas into provocative points of view and transformative insights that help shape industries. You’ll work with an amazing and diverse mix of world-class experts with access to one of the most robust portfolios of capabilities and ecosystem relationships in the industry. Together, you’ll do so much more than consult.
Coming here means future-proofing your career and going as far as your ambition takes you. Becoming a tech-savvy, well-rounded, multi-disciplined and market-relevant advisor doesn’t happen by chance. We invest in training and development in a big way, so you can build your future along with ours, creating an impactful career unique to you. Ultimately, we believe we is greater than me and that diverse perspectives lead to the best solutions. Joining Accenture Consulting means you will learn, innovate and lead, and together we will improve the way the world works and lives.
People in our Client & Market career track drive profitable growth by developing market-relevant insights to increase market share or create new markets. They progress through required promotion into market-facing roles that have a direct impact on sales.
Management Consulting professionals design and implement process and change interventions that integrate strategy, technology and people to enable process improvements that create value for clients.
Job Description:
Medicare/Medicaid Operations Transformation Manager will be responsible for Design and implement business changes that drive industry specific, function and digital operating model transformation, focusing on task relating to people and process.
Responsibilities include:
– An ability to articulate and clearly communicate complex problems and solutions in a simple, logical and impactful manner.
– Experience eliciting high-level business requirements and creating detailed functional specs and other documentation, such as requirement traceability matrices, work-flow diagrams and use-cases.
– The ability to develop creative and breakthrough solutions.
– Strong interpersonal, team building, organizational and motivational skills.
– Experience working through organizational change, with a demonstrated track record of continuing responsibilities, creativity and innovation, including evidence of solution design.
– Well-developed analytical skills and the ability to provide clarity to complex issues, and synthesize large amounts of information.
– An ability to identify the root causes of issues by analyzing patterns and trends.
– An awareness of key methodologies, approaches and market trends in the industry.
– A desire to deliver to a high standard in a suitable timeframe.
– Self-motivating, adaptable, able to prioritize and able to inspire and motivate others.
– Manages large – medium sized teams and/or work efforts (if in an individual contributor role) at a client or within Accenture.
– Ability to travel up to 100% is required.
– Racking up those air miles will have to wait, as weekly non-essential travel to client sites Monday through Thursday is currently suspended. For now, all Accenture business travel, international and domestic, is currently restricted to client-essential sales/delivery activity only.
– Please note: The safety and well-being for our people continues to be the top priority, and our decisions around travel are informed by government COVID-19 response directives, recommendations from leading health authorities and guidance from a number of infectious disease experts.

Read more of the job description
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Qualifications

Basic Requirements:
– Bachelor’s Degree
– Minimum of 4 years of experience driving Management Consulting projects in the Medicaid/Medicare space
– Minimum of 5 years of experience with process re-engineering, operating model, design, operational performance assessment, operational strategy, capability assessment and roadmapping
– Minimum of 4 years of experience with either Medicare or Medicaid Health experience
– Minimum of 4 years experience on the Payer side of health
– Minimum of 5 years of Consulting experience that includes health industry medicareor medicaid operations
Preferred Skills:
– Proven ability to work independently as well as with a team.
– Good communication skills, both written and oral.

–

What We Believe

We have an unwavering commitment to diversity with the aim that every one of our people has a full sense of belonging within our organization. As a business imperative, every person at Accenture has the responsibility to create and sustain an inclusive environment.

Inclusion and diversity are fundamental to our culture and core values. Our rich diversity makes us more innovative and more creative, which helps us better serve our clients and our communities. Read more here

Equal Employment Opportunity Statement

Accenture is an Equal Opportunity Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion or sexual orientation.

All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.

Accenture is committed to providing veteran employment opportunities to our service men and women.

For details, view a copy of the Accenture Equal Opportunity and Affirmative Action Policy Statement .

Requesting An Accommodation

Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.

If you would like to be considered for employment opportunities with Accenture and have accommodation needs for a disability or religious observance, please call us toll free at 1 (877) 889-9009, send us an email or speak with your recruiter.

Other Employment Statements

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.

Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.

Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.

The Company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.

Locations
GA – Atlanta,IL – Chicago

 
 

Clipped from: https://www.snagajob.com/jobs/635403805?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

It’s a big step forward when you realize that you’ve earned the trust to lead a team. Now, let’s determine just how big that step can be. Take on this Network Contracting role with UnitedHealth Group and you’ll be part of a team that’s reshaping how provider networks evolve and how health care works better for millions. This position will guide the development and support of Provider Networks as well as unit cost management activities through financial and network pricing modeling, analysis, and reporting. As you do, you’ll discover the impact you want and the resources, backing and opportunities that you’d expect from a Fortune 5 leader.


If you are located in Arkansas, Tennessee, Alabama, Mississippi, or Louisiana, you will have the flexibility to telecommute* as you take on some tough challenges.


Primary Responsibilities

• Contracting for provider contracts for all lines of business such as commercial, Medicare, Medicaid, DSNP (M&R, E&I, C&S).

 
 

• Manage unit cost budgets, target setting, performance reporting and associated financial models
• Guide development of geographically competitive, broad access, stable networks that achieve objectives for unit cost performance and trend management
• Evaluate and negotiate physician contracts in compliance with company templates, reimbursement structure standards and other key process controls
• Ensure that network composition includes an appropriate distribution of provider specialties
• Provide explanations and information to others on difficult issues
• Coach, provide feedback and guide others

 
 

Get ready for some significant challenge. This is an intense, fast-paced environment that can be demanding. In addition there are some data challenges and unique problems that need to be solved related to gaps in the process.


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

• Undergraduate degree or equivalent experience
• 3+ years of experience in a network management-related role, such as contracting or provider services
• 2+ years of experience in fee schedule development and analysis to negotiate rates with providers
• 2+ years of experience in performing network adequacy analysis
• Strong negotiation skills and ability to provide conflict resolution
• Intermediate level of knowledge of claims processing systems and guidelines
• Must reside within a state of this specific career opportunity (AR, TN, AL, MS, LA)
• Willing and able to travel up to 25%

 
 

Preferred Qualifications

• CLM/Emptoris Contracting experience
• Experience with MSPS (market standard pricing schedule)
• Knowledge of Medicare Resource Based Relative Value System (RBRVS)
• Expertise within Commercial, Medicare, Medicaid and/or DSNP (M&R, E&I, C&S).

 
 

Careers with UnitedHealthcare. Let’s talk about opportunity. Start with a Fortune 5 organization that’s serving more than 85 million people already and building the industry’s singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they’re found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that’s second to none. This is no small opportunity. It’s where you can 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.


Job Keywords: Network Contract, Negotiator Manager, Telecommute, AR, TN, AL, MS, LA, Arkansas, Tennessee, Alabama, Mississippi, Louisiana, Healthcare, Contracting, Account Manager, Negotiation, Business Development, Manager, Consultant

 
 

Clipped from: https://www.linkedin.com/jobs/view/network-contract-manager-remote-within-multiple-locations-at-unitedhealthcare-2592192241/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic