Category: Curator- Job Hunter

 
 

Description

Job Description:

Leidos is seeking a Business Development Professional to lead the business development and capture activities within our Centers for Medicare & Medicaid (CMS) portfolio.  This position location is in the Baltimore, MD area with local and extended travel expected up to 10% of the time.  The position is focused on identifying, qualifying, and capturing opportunities within CMS programs, continuing to build the Leidos reputation and business pipeline, executing the BD process, maintaining a high win probability, and growing business within the CMS domain.

Primary Responsibilities:

• Proactively identify new business opportunities.  Perform market research to qualify new business opportunities, including analysis of customer budgets, capabilities required, current customer preferences, competitive environment assessments, and incumbent strengths and weaknesses.
• Coordinate and conduct meetings with customers, competitors, clients, and teammates to develop market insight on requirements, acquisition strategy, acquisition timing, and contract vehicle choices.
• Work with program and management team in call plan development and execution, and provide detailed reports on follow up activities after plan execution.
• Serve as Capture Manager for selected opportunities, either all the way to award or in the early capture phase.
• Participate as required in the Leidos business development process, including pipeline reviews, opportunity gate reviews, black hat sessions, and proposal reviews.
• Collaborate with Leidos Account Managers, IDIQ PMs, other BD personnel and capture and line management to support cross enterprise objectives and customer engagement.
• Support overall strategic planning and linking pursuits/capture activities which support the business development metrics for awards, submits, and pipeline.
• Interact routinely with various levels of management, functional leads, other staff, and customers.
• Brief business development status to senior management when material changes occur and as required by the Leidos business development process.

Basic Qualifications:

• Bachelor’s degree and 12-15 years of prior relevant experience.
• Proven track record of successful business development at a variety of acquisition sizes.
• Demonstrated access to and relationships with key CMS CMMI and CCSQ customers and industry partners.
• Excellent written and verbal communication skills are essential.
• Leadership skills to develop, organize and execute significant BD activities, including building industry teams, assessing win probability, and executing customer call plans.
• Prior experience supporting business development and capture efforts for CMS agencies.
• Strong, respected relationships within the CMS community
• Ability to gain internal support, operate independently with limited supervision and feedback, and establish a solid working relationship with technical staff, division managers, and peers in the Group and across Leidos.
• Self-starter and ability to manage time independently without direct supervision.
• The ability to operate at the senior level and influence, negotiate and close.
• Candidates must be US Citizens and be eligible to obtain a security clearance.

Preferred Qualifications:

• A technical degree is highly desired
• Proximity to CMS Baltimore location desired, but not required

External Referral Bonus:

Eligible

Potential for Telework:

Yes, 10%

Clearance Level Required:

None

Travel:

Yes, 10% of the time

Scheduled Weekly Hours:

40

Shift:

Day

Requisition Category:

Professional

Job Family:

Business Development

 
 

Clipped from: https://www.fox8jobs.com/jobs/business-development-professional-cms-centers-for-medicare-and-medicaid-baltimore-maryland/287758747-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

• Job Reference: 287390679-2
• Date Posted: 19 May 2021
• Recruiter: Humana
• Location: Tulsa, Oklahoma
• Salary: On Application
• Sector: Healthcare & Medical
• Job Type: Permanent

Apply for this job now

Job Description

*Description* Job Description Summary The Medicaid Oklahoma Pharmacy Director monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs to mitigate cost trend and improve health outcomes. The Medicaid Pharmacy Director works on problems of diverse scope and complexity ranging from moderate to substantial..*Responsibilities*.*Location:* work at home Oklahoma only Humana’s Oklahoma Medicaid Pharmacy Director will be responsible for the operations of all pharmacy-related activities for our Oklahoma Medicaid contract. They will leverage a broad understanding of managed care and Pharmacy Benefit Management (PBM) to develop and implement strategies and programs to drive trend and improve health outcomes. The Pharmacy Director will monitor the drug development pipeline and medical literature, while providing clinical support for internal and external stakeholders..*Essential Functions and Responsibilities:* + Oversee prior authorization requirements and criteria to ensure compliance with programmatic requirements + Engage leadership with Humana Pharmacy Solutions (HPS) programs and lead the pull-through of HPS initiatives aligned with Medicaid + Manage the Humana Oklahoma Medicaid plan relationship with our corporate pharmacy claims team + Monitor programs and procedures to ensure compliance with state and federal regulations; implement and maintain processes to assure adherence + Identify applicable and effective local and national pharmacy trends by conducting analysis of drug spend, utilization, and approval scenarios + Recommend quality and resource management solutions to reduce waste and unnecessary treatment + Initiate and implement programs to identify pharmacy and prescription fraud, waste, and abuse + Create methods to promote the improvement of enrollee outcomes by encouraging the use of appropriate pharmaceuticals + Maintain and review the pharmaceutical formulary + Develop and manage qualified Medicaid pharmacy staff.*Role Essentials* + Must have an active Pharmacy License in Oklahoma + Minimum three (3) years of experience in managed care and/or PBM experience + Successful track record in facilitating and consulting across teams and managing projects + Thrives in a fast paced, multi-project work environment while still ensuring attention to detail + Excellent communication skills, both oral and written + Proficiency in Microsoft Word, Excel, & PowerPoint + Expertise in working collaboratively and communicating with individually different positions and all levels of management positions.*Role Desirables* + Medicaid experience + Advanced knowledge of pharmacy programs, policies, and procedures across Medicaid managed care plan operations + Master’s degree in Public Health, Business, or related field.*Additional Information* 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

 
 

Clipped from: https://bonzojobs.com/jobs/clinical-pharmacy-lead-tulsa-oklahoma/287390679-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Community Health Worker (Medicaid)

JIRA, Technical support, Goal oriented, Workflow, Content development, Medicaid, Leadership

Contract W2, 12 Months

$35 – $38

Job Description

Important Note: Statewide travel up to 25% of the time is required in the performance of the work for this position as soon as COVID related restrictions are lifted. Travel may include some evenings and weekend days.

The primary purpose of this position is to assist with the coordination of NC FAST Medicaid readiness activities, which includes the development of readiness materials, plan, and approach for virtual and in-person delivery to NC FAST users. This person will work with and guide/track the workflow of a team of NC FAST Readiness Liaisons tasked to design and deliver virtual interactive webinars and in-person deliverables to county Child Services staff. In addition to resource coordination and project management responsibilities, this position is required to provide critical, daily guidance & assistance, such as Lead Reviews on all content development, organization of readiness schedule, materials, and delivery to ensure deadlines are met. This person will work closely with Implementation Team leaders to understand the priorities and expectations of all stakeholders. S/he will also collaborate with NC FAST and Medicaid subject matter experts to all information & strategies align with program and policy requirements. Other duties include roll-out planning and scheduling and status reporting.

SKILL REQUIRED:

 

 

 

 

 

 

 

 

•  

 Clipped from: https://www.dice.com/jobs/detail/medicaid-transformation-readiness-lead-innoza-tech-llc-durham-nc-27701/91018136/%28650485%29?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Clipped from: https://www.snagajob.com/jobs/628760512?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Director Provider Network Management–Medicaid

Updated today

Amerihealth

Baton Rouge, LA 70802

Full-time, Part-time

Refer friends, get paid!

View commute time

Job Brief

Experienced Provider Relations Executive needed at a Premier Medicaid Health Plan.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

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 Plan’s 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 department’s 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:

• Bachelor’s degree in Business or health related disciplines such as Healthcare Administration or Healthcare management, or an equivalent business experience and education required. Master’s Degree preferred
• A valid Driver’s 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 8–10  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

 
 

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.

This is a work from home position.

Primary Duties May Include, But Are Not Limited To

The Medicaid State Operations Analyst role is responsible for researching, analyzing, documenting and coordinating the resolution of escalated and/or complex claims issues for the Health Plan and requires expert knowledge of all systems, tools and processes.

• Receiving and responding to state or federal regulatory complaints related to claims.
• Managing health plan dispute escalations.
• Quality review of various dispute outcomes.
• Managing complex system issues.
• Managing state updates.

 
 

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.


Qualifications

• Requires a BA/BS;
• 5 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry; or any combination of education and experience, which would provide an equivalent background.

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-state-operations-analyst-at-anthem-inc-2557668998/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Job Description

Job Responsibilities: Will be responsible for delivery of Detailed System Design Document (DSDD) for multiple modules.Act as a liaison between the client and technology teams.Provide support in developing use cases, workflow diagrams, and gap analysis to create or modify requirements documents and design specifications.Track and report status of work assignments and escalate issues and risks.Analyze user requirements and client business needs using standard procedures.Apply business analysis knowledge to review and analyze systems problems to identify solutions.Experience/Preferred Skills Required:5+ years of business analysis experiencewith a healthcare industry with domain knowledge of Medicare, Medicaid, or healthcare verticals.Experience with Claims and Encounters, Eligibility, or Reference.Knowledge of Claims Adjudication and Medicaid Pricing experience with Systems Development Life Cycle (SDLC) and understand the requirements management life cycle.Can elicit, document, analyze and verify requirements.About Us:At CNSI, we strive to be the market leader and most trusted partner for innovative and transformative technology-enabled solutions that improve health outcomes and reduce costs. We’re passionate about helping our clients improve the health and well-being of individuals and families. We succeed when our clients succeed.Innovation and commitment to our mission are core to our DNA. And through our shared values, we foster an environment of inclusion, empowerment, accountability and fun! You will be offered a competitive compensation and benefits package.CNSI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status or any other status protected by applicable Federal, state, or local law. We are proud of our diversity and encourage all qualified applicants to apply.#LI-Remote#LI-CV1 Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor 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. However, 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 contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

 
 

Clipped from: https://dailyremote.com/remote-job/mid-level-business-analyst-medicaid-medicare-remote-579272?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description


The Senior Provider Relations Professional is responsible for day to day front line network provider relationship management for Humana’s South Carolina Medicaid plan through provider contracting, provider training, education, and provider relations. Work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Exercises independent judgement and works under minimal supervision.


Responsibilities


Key Role Objectives


* Develop and maintain provider relationships to optimize provider engagement, performance and satisfaction.
* Ensure prompt resolution of provider inquiries or concerns and appropriate education about participation in Humana’s South Carolina Medicaid plan.
* Communication of Humana’s policies and procedures and provider training/orientation materials.
* Participate in provider training and provider orientation sessions.
* Execute on Humana’s South Carolina provider network development strategies to ensure a sufficient network for meeting the health care needs of Humana’s South Carolina Medicaid plan members. This will include provider contracting.
* Work with internal corporate partners to ensure cross-department communication and resolution of provider’s issues.
* Work with internal resources to provide the Perfect Experience in all provider interactions (e.g. claims, reimbursement, and provider enrollment/credentialing) with Humana’s South Carolina Medicaid plan.


Required Qualifications


* Bachelor’s Degree
* 4 or more years of progressive experience in managed care operations and provider relations
* Exceptional relationship management skills
* Excellent written and verbal communication skills
* Proficiency in analyzing, understanding, and communicating complex issues
* Thorough understanding of managed care contracts, including contract language and reimbursement
* Ability to manage multiple priorities in a fast-paced environment
* Knowledge of Microsoft Office applications
* Must be passionate about contributing to an organization focused on continuously improving consumer experiences
* Must reside in South Carolina


Preferred Qualifications


* Master’s Degree
* Experience with the South Carolina Medicaid


Additional Information


This position will be “work at home”, however, you will be required to travel to provider offices within the South Carolina Market up to 50% of the time.


Associate must reside in South Carolina.


Scheduled Weekly Hours


40

 
 

Clipped from: https://us.trabajo.org/job-640-20210519-754ef10be1438b113b281e2f45fc2787?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

 
 

Job Details

Posted

1 day ago

Location

HINDS 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: 25 – HINDS COUNTY, Mississippi

Agency: 0665 – MEDICAID DIVISION

 
 

Clipped from: https://www.monster.com/job-openings/medicaid-specialist-i-ms–587b4342-904b-4305-9b8c-a99662bb78c5?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

State Medicaid Data Warehouse Analytics SME

Are you a Medicaid Management Information System (MMIS) subject matter expert with technical/functional State Medicaid Data Warehouse Analytics experience? Do you want to help us transform the Medicaid market as it embraces modularization and we help our clients create a new future for Medicaid technology?


Work you’ll do

• Work on implementing MMIS or Medicaid Data Warehouse for State Medicaid Agencies
• Provide system level expertise across multiple computing platforms and technologies and work to influence direction around information management at the Enterprise Level
• Work with program managers, state directors and other key stakeholders, build sustainable relationships with key stakeholders responsible for information and performance management in client’s organization
• Organize knowledge transfer to clients
• Develop and manage vendor relationships
• Present in workshops for client education
• Manage team s on a data warehousing engagement
  
   

The team

Our Health Technology team implements repeatable solutions to solve our government clients’ most critical health technology related issues. We advise on, design, implement and deploy solutions focused on government health agencies “heart of the business” issues including claims management, electronic health records, health information exchanges, health analytics and health case management.

Our clients seek a fresh perspective on how to leverage reusable, interoperable and flexible solutions that will enable them to reduce costs, improve health outcomes and respond to public health crises. Professionals will use their deep health, government and technology consulting experience to strategically help solve our client’s technology challenges.

Qualifications

Required:

3+ years of experience within a Consulting or Health Technology environment

State MMIS experience

Data Warehouse experience

Bachelor’s Degree from an accredited College or University

Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future

Desired:

Experience within Medicaid Management Information systems (MMIS), Medicaid or Commercial Health Care claims, Provider Management and/or Eligibility data

Experience implementing a data warehouse for State Medicaid Agency

Experience with one of more of the following: SQL/PLSQL, ETL, Cognos, R, Python, Tableau, QlikView, Power BI, Business Objects

Experience in designing, analyzing, supporting and developing data warehouse objects, data quality processes, fact and dimension tables, logical and physical database design, data modeling, reporting process metadata and ETL processes.

Experience working in Cloud based environment (AWS or Azure)

Healthcare Data Analytics

Oral and written communication skills, including presentation skills (MS Visio, MS PowerPoint

Ability to travel

Clipped from: https://www.linkedin.com/jobs/view/state-medicaid-data-warehouse-analytics-sme-at-deloitte-2551293726/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic