Description:

Medicaid ACO Clinical Coordinator (RN or MSW/LICSW) – MGB Community Physicians

– (3157940)

General Summary:

The Medicaid ACO Clinical Coordinator is responsible for the clinical oversight of the Long Term Support Services (LTSS) and Medicaid ACO Community Programs. The Clinical Coordinator will support the development, implementation, monitoring and evaluation of these Medicaid ACO programs while also assisting with the LTSS clinical work. The Clinical Coordinator will also be responsible for the clinical support and oversight of the Community Resource Specialists (CRS).

Personnel and Management Responsibilities:

• Interviews, manages and evaluates Community Resource Specialists if applicable in collaboration with the MGB CP Program Manager.

 
 

• Develops, implements, monitors, and evaluates orientation sessions including scheduling, competencies, and preceptor assignments/training in collaboration with the Program Manager.

 
 

• Promotes the development of the team, including team meetings, professional collaboratives and participation at PHM & QPE meetings.

Organizational Responsibilities:

• Demonstrates a positive attitude in dealing with co-workers and other health care providers and in addressing problems and/or crisis situations.

 
 

• Requires the ability to work independently as well as function effectively within a team based model of care.

 
 

• Able to establish collegial relationships with physicians, office staff & community agencies.

 
 

• Functioning within the patient centered model of care, demonstrates a commitment to meeting the patient’s needs and expectations.

 
 

• Functioning within the team-based model of care, demonstrates a commitment and accountability to the MGB CP RSO’s and Medicaid ACO team.

 
 

• Collaborate with MGB CP Program Manager on the effectiveness & staffing needs for the Medicaid ACO Programs regarding PHM/QPE programs and MGB CP initiatives.

 
 

• Demonstrates initiative and creativity to continuously improve services, work processes, and other activities that affect quality and utilization.

 
 

• Is aware of and follows applicable policies and procedures for general safety, attendance, punctuality, and appearance.

 
 

• Performs all duties as assigned.

Other duties and Responsibilities:

• Assumes accountability for professional growth and development.

 
 

• Acts as a clinical resource to CRS’ in Medicaid ACO programs and in their resource finding function.

 
 

• Provides assessment of patient/families and creates clinical care plan to ensure patient/family needs for community services are met.

 
 

• Advocates on behalf of patients/families to gain access to services and resources within Medicaid ACO programs.

 
 

• Presents and discusses clinical cases during formal case review with Medicaid ACO Community Partners staff.

 
 

• Identifies quality of care issues and reports the concerns to the appropriate person.

 
 

• Collects, prepares and reports data as directed.

 
 

Minimum requirements:

• A registered nurse or MSW/LICSW licensed to practice in Massachusetts

 
 

• Minimum of 3-5 years’ experience in community health setting, adult and pediatric experience preferred.

 
 

• Valid MA driver’s license. Limited travel to practices/offices.

Skills/Abilities/Competencies Required

• Demonstrated supervisory skills required

 
 

• Excellent organizational skills.

 
 

• Excellent oral, written, and telephonic skills.

 
 

• Critical thinking and problem solving ability

 
 

• Demonstrated competency working with health care setting computer systems.

 
 

• Demonstrated competency working with Microsoft Office, Excel, Word and PowerPoint.

 
 

• Ability to handle routine work, unexpected priorities and multi-task.

 
 

• Requires autonomy in decision making using sound judgment based upon clinical information & experience.

EEO Statement

Equal Opportunity Employer

Primary Location MA-Somerville-PCP Somerville Work Locations PCP Somerville 399 Revolution Drive Somerville 02145 Job Professional/Managerial Organization Partners Community Physicians Organization(PCPO) Schedule Full-time Standard Hours 40 Shift Day Job Employee Status Regular Recruiting Department Practice Operations Job Posting May 29, 2021

15 hours ago

Clipped from: https://us.trabajo.org/job-617-20210603-46ef83d6afc55a192c7bc9df2760c219?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Anthem Atlanta, GA

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.

Director I Medicaid State Operations

Develops, directs, plans and evaluates the goals and objectives of the business unit for assigned State. Primary duties may include, but are not limited to:

Establishes state/regional strategic plans and objectives to meet business unit goals. Assumes leadership role in implementing corporate initiatives, including special project planning and budget management. Resolves complex financial, legal, or politically sensitive issues. Leads program development to ensure members, network providers, and community partners successfully participate in programs. Manages local provider network including network assessment and development, issue identification and contractual issues (PCP, specialist, hospital, and ancillary). Plans, directs, and secures the resources (people, material, data and support) for staff to effectively accomplish operational needs and strategic initiatives. Maintains appropriate staffing levels and provides oversight of indirect reporting associates. Motivates associates to accomplish goals and objectives. Develops and implements budget and a strong team through training and effective organizational development practices. In collaboration with and in support of the National Field Operations, assumes all management functions for a state/regional/field office. Ensures all policies and procedures related to Field Operations are compliant with all applicable laws and regulations governing the State Sponsored Business. Champions initiatives by developing and managing State rate negotiations and key relationships with government, regulatory, Medicaid/SCHIP and other stakeholders as appropriate. Provides coordinated analysis and regional solutions to issues. Guides implementation of programs and strategies. Collaborates with senior management to develop and implement new programs to enhance relationships with key stakeholders and to promote programs and services. Collaborates with Marketing Management to develop marketing strategies for member recruitment and retention for all assigned lines of business. Directs strategic planning on marketing, network maintenance and development and program advocacy in assigned area. Resolves programmatic challenges related to program operations including member issues, provider claims and provider network. Manages projects and issues across departmental and divisional lines to facilitate timely resolution. Represents business unit on national/state/regional boards, task forces, and work groups that impact the health care delivery system and other key health care issues. Hires, trains, coaches, counsels, and evaluates performance of direct reports.  This position may be filled at a higher level based on experience.

Requires BA/BS degree in a related field; 8 years management experience in the health care field; specific contract negotiation experience in both provider network management and state rate contracting; or any combination of education and experience, which would provide an equivalent background. Masters degree 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.

Clipped from: https://www.ziprecruiter.com/c/Anthem/Job/Director-I-Medicaid-State-Operations/-in-Atlanta,GA?jid=97b88b2613f9aaaf&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Oregon Medicaid PBM Manager

Oregon Medicaid PBM Manager – Virtual

REMOTE – But must be in OREGON.

Full Time Permanent Opportunity

Must live in Oregon / some travel to Salem through the year

Responsibilities:

Manage the Client Pharmacy Team on the Oregon account to maintain all aspects of the PBM and Drug Rebate services for the State including:

 
 

• Maintaining an up-to-date drug reference file in the system
• Providing all aspects of pharmacy claim processing through the Client Pharmacy Services Module
• Coordinating a Prospective Drug Utilization Review program
• Operating a Federal Medicaid Drug Rebate Program as well as a State Supplemental Drug rebate program including oversight of 340B drug administration
• Overseeing the operation of a pharmacy, prior authorization, and technical call center for providers
• Overseeing the pharmacy and physician administered drug prior authorization review process and working with the other account pharmacists
• Assisting the state with pharmacy desk level audits using claim details from the system
• Providing ongoing training to pharmacy providers and State staff as needed
• Producing annual reports as well as other executive administration duties as they pertain to the State pharmacy program.

Essential Functions:

• Serve as the primary point of contact with the State Pharmacy Policy Director and State pharmacy staff including administration of scheduled status meetings.
• Primary liaison between the State Pharmacy Policy Director and the Client Pharmacy Team
• Oversight of all PBM and Drug Rebate services performed by Client in Oregon including supervision of the drug rebate and pharmacy call center teams.
• Responsible for working with State staff on Pharmacy-related issues, policy implementation, modernization, and program management.
• Responsible for making the final clinical decision on pharmacy issues referred to Client from the State.
• Oversee Prospective drug utilization review programs for the State including assisting the State in completing the annual CMS DUR Report.
• Oversee Drug Rebate team and operations management.
• Produce status reports on PBM Drug Rebate operations as required by State contract requirements.
• Work with Oregon account leadership to maintain all pharmacy related service level agreements and help achieve account financial and growth goals.

 
 

Experience:

• At least three (3) years of experience in managing a pharmacy benefit management system.
• Detailed knowledge of Medicaid at the state and/or federal level.
• Detailed knowledge of pharmacy-related aspects of Medicaid.
• A bachelor’s degree in Pharmacy is required. PharmD preferred.
• A minimum of two (2) years’ experience in managing operational aspects in large-scale operations environment.
• Working knowledge of HIPAA regulations and requirements.

Knowledge, Skills, Abilities:

• Oregon licensed pharmacist required
• Ability to communicate succinctly and accurately in both written and verbal English.
• Ability to work independently and in a team environment.
• Ability to work effectively and efficiently under stringent timelines.
• Ability to analyze and resolve difficult logic and processing issues.
• Excellent organizational, written, and oral communication skills
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Proficient PC abilities (basic knowledge in MS Office), work organization, and problem resolution skills.

 
 

 
 

Clipped from: https://westcoast-jobs.com/jobs/oregon-medicaid-pbm-manager-idanha-oregon/297888584-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description
The Associate Director, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Associate Director, Utilization Management Nursing requires a solid understanding of how organization capabilities interrelate across department(s).
Responsibilities
As Humana’s Medicaid membership continues to grow, the National Medicaid Clinical Operations team is expanding our shared services organization to enhance the clinical delivery process. The Associate Director, Utilization Management Nursing uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), and could lead multiple managers or highly specialized professional associates.
Detailed Responsibilities include:
Leads National Medicaid Utilization Management process and teams responsible for supporting new Medicaid Market Clinical Operations delivery including:
– Developing and implementing Clinical Prior Authorization policies, processes, detailed workflows, and leading the Centralized Utilization Management Outpatient operations team;
– Hiring and directly leading a team of Utilization Management nurses and support staff responsible for reviewing and processing clinical authorizations and clinical claims reviews;
– Working closely with Medicaid market Utilization Management leaders to collaboratively design processes for market staff to manage full spectrum of Utilization Management authorizations;
– Working with Market Medical Directors and vendors to develop processes for routing cases for medical necessity decisions;
– Develop IT business requirement, rule development, and training content for administering utilization management process in Humana’s clinical systems;
– Collaboratively develop Utilization Management reporting requirements to assure operational oversight and address state reporting requirements for supporting all Medicaid states;
– Implementing operational support tools and identifying operational best practices and process opportunities;
– Assure compliance with state timeframes for turnaround times on authorization requests and delivery of Utilization Management services.
– Participate in on-call rotation program to provide after hours, 24/7 clinical coverage requirements.
Required Qualifications
*Bachelor’s Degree in Nursing;
*Active Compact Registered Nurse license, without restrictions or disciplinary action;
*7+ years of Utilization Management nursing experience
*5+ years of Managed Care experience
*5+ years of Utilization Management operational leadership experience
*2+ years of Medicaid experience
*2+ years developing collaborative partnerships with enterprise cross-functional teams
*Recent working knowledge and familiarity with MCG medical criteria and administering clinical practice guidelines
*Ability to lead large scale projects, across cross-functional enterprise teams
*Demonstrated experience and recommendations from peers as a customer-focused, team player, with collaborative approach to leading
*Ability to participate in on-call rotation program to provide after hours, 24/7 clinical coverage requirements
Preferred Qualifications
*Master’s Degree in Nursing or Business-related field
Additional Information
This position is open to working remote (with the ability to support and work in Eastern Time Zone)
Scheduled Weekly Hours
40

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Description

The LA Medicaid CMO, RVP Health Services (CMO) relies on medical background to create and oversee clinical strategy for the region. The CMO requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.

Responsibilities

Job Title: Louisiana Medicaid CMO, RVP Health Services

Location: Work from Home in Louisiana Temporarily (Office will be opened in Baton Rouge)

Job Description

The CMO will provide medical leadership and strategy for the Health Services Operations with fiscal responsibility for trend management.
 

• Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF) according to the Humana’s Medicaid policies and procedures.
• Participate in Quality Operations including chair Quality Management Committee, complete initial peer review on quality of care complaints, complete peer-to-peer written and verbal communications.
• Oversee administrative budget for regional HSO & Quality Improvement including approve/deny expense reports & requisition requests for department members.
• Oversee Quality Improvement and HEDIS/STARS metrics improvement with PCP offices and IPAs.
• Participate in regional level committees and meetings setting medical necessity strategies.
• Provide oversight and direction for the implementation of regional clinical programs and strategies, as well as, developing and implementing market level strategies.
• Manage internal operational/functional relationships related to profitability.
• Assist with network development and provider contracting with various providers and ancillary providers.
• Serve as clinical liaison with inpatient facilities and joint operating committees to maintain facility relationship and problem solve; especially reviewing contracts as to clinical services.
• Well-versed on financial aspects of various levels of risk bearing contracts and possess the ability to gain traction and adoption of the providers.
• Ability to thrive in a highly Matrix environment.

Required Qualifications
 

• 8 or more years of management experience
• A current and unrestricted license in Louisiana and willing to obtain licenses, as needed, for various states in region of assignment
• MD or DO degree
• Board Certified in an approved ABMS Medical Specialty
• Excellent communication skills
• 5 years of established clinical experience
• Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products
• Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications
 

• Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
• Prior experience within the Louisiana Department of Health
• Experience working with the Medicaid population or Medicaid Managed Care, PEDS, OB-GYN, Drug Abuse/Addiction, or Behavioral Health
• Master’s Degree

#PhysicianCareers

Scheduled Weekly Hours

40

 
 

Clipped from: https://www.myvalleyjobstoday.com/jobs/louisiana-medicaid-cmo-rvp-health-services-metairie-louisiana/293553616-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Overview

Title: MetroPlus Health Plan – Medicaid Compliance Specialist BJJ

Company: MetroPlus Health Plan

Location: New York City – New York – USA

Type: Full Time

Category: Healthcare, Doctor/Physician

Salary:

Medicaid Compliance Specialist – MetroPlus Health PlanJob Description About NYC Health + Hospitals MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, Me

 
 

Clipped from: https://newhealthjobs.com/job/metroplus-health-plan-medicaid-compliance-specialist-bjj/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Position


Description


Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding using data science and analytics. Our work yields actionable information to guide decisions in wide-ranging policy areas, from health, education, early childhood, and family support to nutrition, employment, disability, and international development. Mathematica offers our employees competitive salaries, and a comprehensive benefits package, as well as the advantages of being 100 percent employee owned. As an employee stock owner, you will experience financial benefits of ESOP holdings that have increased in tandem with the company’s growth and financial strength. You will also be part of an independent, employee-owned firm that is able to define and further our mission, enhance our quality and accountability, and steadily grow our financial strength. Learn more about our benefits here.


Mathematica is searching for professionals with experience generating insights from data on Medicaid policy and programs at either the state or federal level. In particular, we are looking for individuals who can apply data analytics to support current and emerging work across any number of areas related to monitoring and improving Medicaid programs such as: Value-based purchasing and alternative payment models, enrollment trends, measures of delivery and quality of services for beneficiaries, and to discern outcomes of innovative programs and policies.


The successful candidate will join our group of over 400 health policy professionals, including staff with degrees in data analytics, public health, public policy, economics, behavioral or social sciences, economics, and other relevant disciplines. We offer our employees a stimulating team-oriented work environment, competitive salaries, and a comprehensive benefits package, as well as the advantages of employee ownership.


Duties Of The Position

• Participate actively and thoughtfully in multidisciplinary teams, drawing on your past experience with Medicaid programs
• Help conduct research and technical assistance projects on topics related to state and federal Medicaid policy
• Apply rigorous analytic thinking to the collection and interpretation of quantitative data including analysis of Medicaid administrative data
• Bring creative ideas to the development of proposals for new projects
• Author project reports, memos, technical assistance tools, issue briefs, and webinar presentations
• Contribute to the growth, expertise, and institutional knowledge of staff working in the Medicaid area
  
  

Qualifications


Position


Requirements:

• 3-8 years of experience working in health policy or health research, with a substantial portion of that time related to some aspect of the Medicaid program at the state or federal level
• Masters or doctoral degree or equivalent experience in data analytics, public health, public policy, economics, behavioral or social sciences, economics, or other relevant disciplines
• Demonstrated ability at modeling program outcomes would be ideal
• Strong foundation in quantitative methods and a broad understanding of health policy issues
• Excellent written and oral communication skills, including an ability to explain observations and findings to diverse stakeholder audiences including program administrators and policymakers
• Demonstrated ability to provide task leadership and coordinate the work of multidisciplinary teams
  
  

Strong organizational skills and high level of attention to detail; flexibility to lead and manage multiple priorities, sometimes simultaneously, under deadlines


To apply, please submit a cover letter, resume, writing sample, and salary expectations at the time of your application.


This position offers an anticipated annual base salary of $90,000 – $140,000. This position may be eligible for a discretionary bonus based on company and individual performance.


Available Locations: Washington, DC; Princeton, NJ; Cambridge, MA; Woodlawn, MD; Ann Arbor, MI; Chicago, IL; Oakland, CA; Seattle, WA


Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on a project. If you are assigned to such a project, you will be required to obtain the requisite security clearance.


We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-researcher-at-mathematica-2559023129/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Overview:

About Public Consulting Group

Public Consulting Group, Inc. (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has over 2,500 professionals in more than 60 offices worldwide. PCG’s Technology Consulting practice offers a full spectrum of quality Information Technology (IT) services to help state and local government agencies at every stage of the IT life cycle. Through its specialized IT services, PCG’s Technology Consulting team finds cost-effective ways to help agency partners deliver successful IT systems that enhance the lives of the user base. To learn more, visit https://www.publicconsultinggroup.com/technology-consulting/

 
 

Responsibilities:

• Provide Medicaid program operations subject matter expertise and business requirements analysis on large-scale IT projects.
• Work with clients to provide consulting support (e.g., policy expertise, requirements validation, technical support).
• Create Medicaid system applications, eligibility, and enrollment system test cases and identify appropriate test case parameters
• Review vendor test cases to verify Medicaid policy requirements coverage
• Work with client project staff to understand and verify documentation of system requirements.
• Perform project assessments in support of IV&V and quality assurance projects, including providing recommendations for risk mitigation and acceptance.
• Monitor the technical aspects of the project and the vendor and/or client activities providing input and guidance that supports efficiencies to the client and project.
• Understand various software development life cycle methodologies and how they are used
• Oversees development of all deliverables, monthly reports and other work products
• Maintain project plans and schedules
• Participate in business development by identifying new opportunities and assisting with proposal development

Qualifications:

Required Skills/Experience:
 

• Self-directed and comfortable working directly with clients to determine needs, clarify tasks and expectations, and present work products and findings
• 3+ years of business analysis experience
• Bachelor’s degree from an accredited college/university
• 3+ years of experience in Medicaid program application, eligibility, and enrollment operations and policy
• Knowledge and experienced in business requirements validation and test case creation and review (e.g., verification of requirements coverage)
• Demonstrated ability to work cooperatively within and among teams
• Jackson, MS local

Desired Skills/Experience:
 

• Experience providing IV&V services or similar oversight activities (e.g., QA).
• Completed Project Management Institute (PMI) Project Management Professional (PMP) certification, or similar Project Management certification.

#LI-AH1

#D-PCG

EEO Statement:

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

Clipped from: https://www.glassdoor.com/job-listing/medicaid-specialist-public-consulting-group-JV_IC1141371_KO0,19_KE20,43.htm?jl=4074471829&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Pay: Competitive/hour

Agency: Children and Families

Working Title: GOVERNMENT OPERATIONS CONSULTANT II – 60064452 – ESS Program Medicaid Policy

Salary: TBD

 

 
 

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Responsible for financial leadership, decision support, and strategic consultation to the Ohio 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.

Primary duties may include, but are not limited to:

• 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.
• Maintains trends that are appropriate given premium reimbursement.
• Reviews, analyzes, reports, and presents financial results. Provides decision support for business unit President and senior management teams’ operational and business goals.
• 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.
• Directs Health Plan preparation of annual operating/capital budget and forecasts to provide senior leadership with tools necessary to maximize investment of resources.
• Directs interface with regulatory and audit personnel and technical consultants as required to ensure fiscal accountability.
• Supporting the pricing actuaries on premium rate actions.
• 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.
• Helping to support the plan president on setting and achieving health plan goals.

Qualifications

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.

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/6754586-finance-director-government-business-division-ohio-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic