Category: Curator- Job Hunter

 
 

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

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. They 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

OhioRISE – Ohio Resilience through Integrated Systems and Excellence

As part of Ohio Medicaid’s next generation of its managed care program, Ohio is implementing OhioRISE, a specialized managed care program for youth with complex behavioral health and multi-system needs.

The OhioRISE managed care organization (MCO) will partner with the state, providers, and community organizations to expand access to in-home and community-based services. The MCO will contract with regional care management entities to ensure OhioRISE members and families have the resources they need to navigate their interactions with multiple systems such as juvenile justice and corrections, child protection, developmental disabilities, mental health and addiction, education, and others.

New and/or enhanced services available through OhioRISE include:

• Intensive Care Coordination
• Intensive Home-Based Treatment – enhanced
• Psychiatric Residential Treatment Facility
• Mobile Response and Stabilization Service
• Behavioral Health Respite – enhanced

Job Overview

Office: Strategic Initiatives

Classification: Deputy Director 5 (PN 20098838)

ODM is seeking a senior healthcare leader to oversee the administrative, programmatic, operational, and clinical development and implementation of the OhioRISE program. As ODM’s OhioRISE Deputy Director, your responsibilities will include:

• Providing administrative direction and oversight for the OhioRISE program, including direction and oversight of ODM’s relationship with the OhioRISE managed care plan
• Directing and managing operations of the OhioRISE program within ODM and in partnership with the OhioRISE plan
• Assuring the OhioRISE program’s full integration and coordination with the other components of ODM’s Next Generation of Managed Care
• Holding the OhioRISE program and the OhioRISE managed care plan accountable to the vision and goals set by the OhioRISE cross-agency governance structure
• Overseeing policy and programmatic development and implementation, as well as clinical operations and oversight for OhioRISE
• Engaging multiple state and local systems and other external stakeholders in developing regulatory structures and operational strategies to ensure successful implementation of the OhioRISE program
• Identifying and developing innovative strategies to improve outcomes for children, youth, and young adults served under the OhioRISE program
• Participating in leadership of ODM’s quality improvement framework, quality improvement planning, and quality improvement oversight activities

The ideal candidate should have strong operational leadership experience and a proven ability to champion the agency’s mission and vision across a variety of audiences and situations.

• Graduate degree from an accredited university or college in business, management or public administration, public health, health administration, social or behavioral science or related field
• Minimum of 5 years of experience in planning and administering a large health services program or health services project management
• Change agent with strong credibility and influencing skills and the proven ability to build relationships and influence stakeholders
• Ability to interface effectively with all levels of the organization as well as leaders working in other sister agencies of state government and other organizations outside of ODM
• Outstanding team leadership and multi-functional/cross-functional team management skills; able to drive a positive employee relations culture
• Strong interpersonal and organizational skills, with a highly collaborative working style and a commitment to diversity and inclusion
• Strategic development and successful execution of large, highly visible, and complex projects involving multiple stakeholders within aggressive time constraints
• Solutions-oriented approach to implement priority initiatives and meet project demands
• Ability to communicate effectively with people at all levels and backgrounds
• Strong presentation skills, written communication skills and experience with a variety of computer software applications and data processing systems

 
 

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Associate Actuary Medicaid

Updated today

Centene Corporation

North Hills, CA 91393

Full-time, Part-time

Refer friends, get paid!

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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)

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Job Description

Medicare/Medicaid Experience required

Read more of the job description

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Qualifications

Medicare/Medicaid Experience required

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.

 
 

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Clipped from: https://careers.humana.com/job/13080770/behavioral-health-medical-director-ohio-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Found in: Appcast US Premium Appcast US Premium

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

10 hours ago

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Description:

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 care companies and a Fortune Top 50 Company.


Location: This is a Work-At-Home position. However, the selected candidate must live within commutable distance from an Anthem office.


The Proposal Writer Sr. is responsible for writing strategic, highly customized, complex proposal responses to win and retain existing business. Primary duties may include, but are not limited to:


* Develops written solutions incorporating complex, custom win strategies based on local market needs, leveraging best practices, brand standards, innovative ideas, and reviewer insights. Identifies and creates standard content for the proposal database and edits content as needed.
* Aligns multiple written communication efforts with the overall Anthem messaging and goals.
* Partners with Subject Matter Experts (SMEs) to transfer knowledge, develop new solutions, obtain direction and create alternative solutions.
* Researches, recommends and develops creative approaches and solutions to content.
* Serves as a key communications resource for business leaders and collaborates across various areas to support enterprise-wide selling initiatives.


Qualifications


Requires a BA/BS degree; 5 years of health care specific proposal writing experience; or any combination of education and experience, which would provide an equivalent background. Experience working in a heavily matrixed environment and proven relationship-building skills required. Expert level experience in managing large-scale proposals or communication initiatives including writing and reviewing healthcare bids for healthcare companies in a deadline-driven environment required.


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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Description

The Process Improvement Representative 2 analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

The Process Improvement Representative 2 researches best business practices within and outside the organization to establish benchmark data. Collects and analyzes process data to initiate, develop and recommend business practices and procedures that focus on enhanced safety, increased productivity and reduced cost. Determines how new information technologies can support re-engineering business processes. May specialize in one or more of the

 
 

Clipped from: https://careers.humana.com/job/12987250/process-improvement-representative-2-remote-medicaid-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Description

JOB BRIEF Experienced Provider Relations Executive needed at a Premier Medicaid Health Plan. Your career starts now. Were looking for the next generation of health care leaders. At AmeriHealth Caritas, were 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, wed 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 [ RESPONSIBILITIES: The primary purpose of the job is to be responsible for all hospital, physician and physician extender network development and management. This position is also responsible for implementing strategies to improve provider satisfaction. This position will interact with Hospital and Physician Practice Chief Executive Officers, Chief Financial Officers, Directors of Managed Care and other high level executives. Ensures department achieves annual goals and objectives. * Responsible for strategic planning of hospital and physician network development and management. * Ensures compliance with pricing guidelines established by AHC and Plan. * Complies with established contract implementation process(s) for all contracts. * Ensures department staff remains current in all aspects of Federal and State rules, regulations, policies and procedures and creates or modifies departmental policies to reflect changes. * Ensures provider contracting is consistent with claim payment methodologies. * 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. * Maintains familiarity with State Medicaid fee schedules and analyzes comparable Plan pricing guidelines. * Ensures provider contracting policies are adhered to as related to standard contract language. * Ensures that non-standard contract elements are communicated to appropriate departments and obtains AHC and Plan approval prior to submission to provider. * Responsible for compliance with 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. * Augments and modifies the existing provider network to accommodate new products or clients as necessary. * Ensures provider communication and education meets AHC and Plan needs and functions as the liaison with the designated provider community. * 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. * Systematically keeps staff informed of policy and procedural changes affecting program and administrative operations. * Resolves individual provider complaints in a timely manner to ensure minimal disruption of the Plans network. * Ensures capitation, provider rosters, and RHC/FQHC reports are monitored and strategies are developed and plans are implemented to address outliers. * Drives Company-wide and Plan quality initiatives such as HEDIS, CAHPS and NCQA/URAC. * Ensures the achievement of financial, quality, and clinical objectives through accomplishment of provider initiatives. * 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. * Coordinates departments efforts with those of other departments. * Reviews reports on annual provider satisfaction surveys; ensures the development of plans to improve identified areas of concern; works with other departments to develop quality assurance initiatives based on survey results. * Develops and ensures compliance of department budget. * Participates in Plan and physician committees as appropriate. * Performs other related duties and projects as assigned. * Adheres to AHC policies and procedures. EDUCATION/ EXPERIENCE: * Bachelors degree in Business or health related disciplines such as Healthcare Administration or Healthcare management, or anequivalent business experience and education required. Masters Degree preferred * A valid Drivers License and current Auto Insurance required. * A minimum of 3 years Managed Care Provider Contracting and Reimbursement experience to include in depth knowledge of reimbursement methodologies and contracting terms; * Minimum 810 years of progressive business management and negotiation experience. * Minimum 5 years management experience, managing teams and project management. * Minimum 1-2 years Medicaid experience preferred. Back [ Share * * * * * Apply Now [

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Found in: Lensa

Description:

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. At Anthem, we are focusing on building a brighter future where health care is affordable, accessible, personalized, and uncomplicated.


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 care companies and a Fortune Top 50 Company.


We are hard at work reimagining our marketing organization to focus on bringing Anthem’s brand promise to life across all aspects of the consumer experience. We are eliminating traditional marketing silos so all Anthem talent is working together to improve the health and wellness of our members. If you have a passion for a career that impacts individual lives, we want to speak with you about joining our marketing team.


We are looking for a passionate creative leader to join Anthem’s Medicare and Medicaid group. In partnership with design, this leader will be responsible for a team of writers in the development of a broad portfolio of creative, from more detailed health-related pieces to conceptual campaigns. They will lead writers, helping them develop and hone their craft while keeping a high bar for high-performing creative. We are looking for someone who loves language and knows how to simplify complicated topics to speak about them in a way that people will pay attention. They must have a passion for understanding consumers, what they care about, and how they engage with us. From the first moment people consider a Medicare or Medicaid product, through every experience with our brand, we want to be able to create better connections, build their confidence, and help them achieve better health.


Primary duties:


* Lead editorial team to raise the creative bar and achieve business goals.
* Direct marketing communications vision to support local, regional and corporate strategic objectives
* Facilitate a collaborative environment that delivers thoughtful, well-executed, and effective creative.
* Deliver omnichannel creative solutions that are on-time, on-budget, and on-strategy.
* Collaborate on production and fulfillment of materials.
* Hire, train, coach, counsel, and evaluate the performance of direct reports.


Qualifications


* Requires a BA/BS; 7 years of experience in design/creative, solution design, user experience and development process of web properties, mobile assets and digital tools; or any combination of education and experience, which would provide an equivalent background.


Preferred Skills:


* Demonstrated ability in strategic leadership, creative leadership, operational/organizational leadership, while working across the matrix and effectively leading a team.
* Experience leading creative groups/teams in both agency side and client side preferred.
* Experience in a highly regulated industry (e.g., insurance, financial services, pharma, etc.) preferred.
* Medicare and/or Medicaid experience a plus.
* Excellent analytical, negotiation, and presentation abilities.
* Excellent managerial and change-management leadership skills.
* A Mass Communications degree is preferred
* Master’s Degree in Fine Arts, Business or Health Care Administration a plus.


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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Found in: Lensa

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

 
 

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