State of Alaska

 
 

 Anchorage, AK Full Time

Job Posting for Medicaid Program Specialist I (Telehealth Coordinator – PCN 06-N16006) at State of Alaska

This position is open to Alaska Residents only.
 Please check our residency definition to determine if you qualify.

 
 

What you will be doing:
The Medicaid Program Specialist I is a long term non-perm position located in Anchorage, within the Division of Senior and Disabilities Services(SDS) serving as a Telehealth Coordinator. This position is partially funded by the Mental Health Trust Authority to help the department meet established goals to deliver services through telehealth technology in order to allow rural communities to receive Waiver and Personal Care services more efficiently. Under the direction of the Research and Analysis Unit Manager, this position will be responsible for maintaining and enhancing the telehealth and videoconferencing capabilities of this division, while analyzing and tracking the cost of the telehealth program, serving as the primary trainer and as a subject matter expert in utilizing telehealth to deliver services. This position will also assist in analyzing assistive technology applications and act as a subject matter for the use of videoconferencing technologies by this division.
 
Our organization, mission, and culture:
The Research and Analysis Unit provides information, research, and analysis products to state and national stakeholders including representatives of Senior and Disabilities Services and Health and Social Services. The unit specializes in business process development and diagramming, data maintenance, statistical analysis, report writing and publishing, account management for Harmony (division’s database) and training associated with the use of SDS data systems and processes. As an IT liaison, the unit advises the division on technical developments and collaborates with Health and Social Services, Enterprise Technology Services on a variety of projects.
 
The benefits of joining our team:
The Research and Analysis Unit is a group of individuals who are excellent problem solvers and are passionate about supporting the Division of Senior and Disabilities Services and its mission by providing, implementing and supporting a variety technology based solutions. There are always advancement opportunities available within the division.
 
The working environment you can expect:
Position is located in Anchorage, AK.  Currently Division staff are teleworking due to ongoing public health concerns brought on by the pandemic.  At this time, application needs to be able to work from home until such time as they are asked to come back to the office.
 
Who we are looking for:
•   Excellent communication and customer service skills
•   Note taking and documentation skills
•   Team-player and a self-starter
•    Experience utilizing and supporting videoconferencing and/or telehealth hardware and software
•    Proficiency in the use of Microsoft Office Products

A cover letter is NOT required for this position. Your complete application, including supplemental questions will be used to determine which applicants will advance to the interview phase of the recruitment and selection process.

To view the general description and example of duties for an Medicaid Program Specialist I please go to the following link: https://www.governmentjobs.com/careers/Alaska/classspecsOne year of experience as a Medicaid Program Associate with the State of Alaska or the equivalent with another employer.

OR

Four years of any combination:
Post-secondary educational course work in public health, economics, public policy, legal studies, finance, business, or computer sciences from an accredited college (2.67 semester or 4 quarter hours equals 1 month)

AND/OR

Experience health insurance administration, health insurance management information system, or health insurance finance and accounting; experience monitoring medical or public assistance programs for fraud or quality; experience conducting policy research and analysis; experience drafting health insurance policy; experience developing health insurance programs; experience examining medical claims, coding, billing, or patient information for reimbursement; or experience in a medical or healthcare field.

Substitutions:
Certification as a Program Integrity Professional, Professional Coder, Professional Biller, Medicaid Professional, or other equivalent certification will substitute for one year of the required education and/or experience. At time of interview applicant(s) are requested to submit: 
1. If using postsecondary education to meet the minimum qualifications, a copy of your transcript(s) will be required if you are selected for an interview.
2. Contact information for three professional references (at least 1 must be a current or former supervisor)
3. Most recent performance evaluation (if available)]
 
 Please read the below information carefully. This applies to your application submission. 

 SUPPLEMENTAL QUESTIONS
For your application to be evaluated you must answer the Supplemental Questions.  Be specific in your answers and tell us how you acquired the relevant experience. Please use complete sentences and proof-read your submissions when answering the supplemental questions. Your responses will be considered a writing sample and will be used to determine which applicants will advance to the interview phase of the recruitment process.
 
 
 EDUCATION 
To verify education being used to meet the required minimum qualifications, you must fill in the Education section of the application. If you have not obtained a degree, please indicate the number of units completed. Copies of transcripts are required to verify educational credentials being used to meet the minimum qualifications for a position and are required with each application.  (Unofficial are okay, please ensure that the institution/URL name is listed on the transcripts). Transcripts can be attached at the time of application, provided at the time of interview or if not provided, transcripts will be required prior to appointment.
 
 SPECIAL INSTRUCTIONSFOR FOREIGN EDUCATION 
Education completed in foreign colleges or universities may be used to meet the above requirements, if applicable. If utilizing this education you must show that the education credentials have been submitted to a private organization that specializes in interpretation of foreign educational credentials and that such education has been deemed to be at least equivalent to that gained in conventional U.S. education programs; or an accredited U.S. state university reports the other institution as one whose transcript is given full value, or full value is given in subject areas applicable to the curricula at the state university. It is your responsibility to provide such evidence when applying.  Omission of required documentation listed will result in an incomplete application and you will not receive further consideration.
 
 WORK EXPERIENCE
When using work experience not already documented in your application, please provide the employer name, your job title, dates of employment, and whether full-or part-time. Applications will be reviewed to determine if the responses are supported and minimum qualifications are clearly met. Work experience needed to meet the minimum qualifications must be documented in the application.  If the application does not support minimum qualifications, the applicant may not advance to the interview and selection phase of the recruitment.  A resume will not be used to determine that minimum qualifications have been met for the position in which you are applying.
 

 If you are currently or previously been appointed to a flexibly staffed position please ensure your work experience within a flexibly staffed position indicates the actual dates employed at each level.  Ensure your time and any subsequent flex promotion(s) are documented as a separate position. This is required as there are minimum qualifications that require experience at a particular level in which the lower level may not be considered. If this information is not accurately reflected in your application this may cause the processing of your application for consideration to be delayed.
 
 NOTE: Attaching a resume or curriculum vitae is not an alternative to filling out the application in its entirety. Noting “see resume or CV” or any similar response on any portion of your application may lead to a determination your application is incomplete and removal from consideration for this job posting.
 
 The State of Alaska does not provide VISA Employer sponsorships.
 
 RECRUITMENT SCOPE
 

This position is open to Alaska Residents only.
 Please check our residency definition to determine if you qualify.

 MULTIPLE VACANCIES
This recruitment may be used for more than one (1) vacancy. The applicant pool acquired during this recruitment may be used for future vacancies for up to ninety (90) days after this recruitment closes. Interested applicants are encouraged to apply to each recruitment notice to ensure consideration for all vacancies.
 
 APPLICATION NOTICE
You can ONLY apply for this position through the Workplace Alaska website or via hardcopy application. If you accessed this recruitment bulletin through a job search portal such as ALEXsys or any other database, you MUST use a Workplace Alaska online or hardcopy application to successfully apply. Instructions on how to apply with Workplace Alaska may be found on the Workplace Alaska “How to Apply” webpage, found here: http://doa.alaska.gov/dop/workplace/help/

 NOTICE
Questions regarding the application process can be directed to the Workplace Alaska hotline at 800-587-0430 (toll free) or (907) 465- 4095. If you choose to be contacted by email, please ensure your email address is correct on your application and that the spam filter will permit email from the’govermentjobs.com’ domains.  For information on allowing emails from the ‘governmentjobs.com’ domains, visit the Lost Password Help page located at https://www.governmentjobs.com/OnlineApplication/User/ResetPassword.

 EEO STATEMENT
The State of Alaska complies with Title I of the Americans with Disabilities Act (ADA). Individuals with disabilities, who require accommodation, auxiliary aides or services, or alternative communication formats, please call 1-800-587-4095 in Juneau or TTY: Alaska Relay 711 or 1-800-770-8973 or correspond with the Division of Personnel & Labor Relations at: P. O. Box 110201, Juneau, AK 99811-0201. The State of Alaska is an equal opportunity employer.

WORKPLACE ALASKA APPLICATION QUESTIONS & ASSISTANCE
 Questions regarding application submission or system operation errors should be directed to the Workplace Alaska hotline at 1-800-587-0430 (toll free) or (907) 465-4095 if you are located in the Juneau area. Requests for information may also be emailed to recruitment.services@alaska.gov.
 
 For applicant password assistance please visit:
https://www.governmentjobs.com/OnlineApplication/User/ResetPassword
 
 For specific information in reference to the position please contact the hiring manager at:
 
 Name:  Anastasiya Podunovich, Research and Analysis Unit Manager
 Phone: (907) 269-3477
 Email: anastasiya.podunovich@alaska.gov

 
 

Clipped from: https://www.salary.com/job/state-of-alaska/medicaid-program-specialist-i-telehealth-coordinator-pcn-06-n16006/ccd5081e-331f-4184-a982-593d7d3147bf?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Location: New Rome, OH
The Director, Finance is responsible for the oversight of all financial activities for the plan including but not limited to financial statements, audit activities, active participation in the annual budget process and reconciliation of operational staff. The director is a critical member of management who provides membership, financial results and support during the budgeting process. The director is the main point of contact and develops partnerships with other departments including Implementations, Sales, Account Management, Informatics, Customer Service, and corporate accounting regarding membership.

Responsible for managing and supporting a team of finance professionals. The director is required to interface with all levels of management and outside vendors in order to resolve funding issues, accounts receivable balances and any finance related issues. The director also provides ongoing direct support to cost center managers regarding staffing and around G Expenses. Financial Management Oversee key financial aspects of operational activities (Revenue, Expenses, Management Fee & Intercompany) Ensure accurate and timely processing of cash receipts (accounts receivable & network administration fees) Directs the individual and consolidated reporting of results for cost centers.

Develop budget projections (forecasts, reforecast) and monitors performance monthly. Maintain and review Operating Revenue models for new business and strategic planning needs Responsible for leading the annual operating budget plans Validate and ensure all costs that are associated with the family of companies are passed onto the plans Provide financial oversight to ensure contract compliance with suppliers Ensure accurate and timely invoicing of clients for service performed by plan Provide financial compliance and oversight for contracts between plan and outside vendors Act as a liaison with internal and external business partners on all financial matters Review and provide approval for claims processor payment and dispute costs as necessary Administration Manage the daily activities of the Finance Administration staff.

Act as a liaison with internal and external business partners Review and provide sign off on business quotes for claims processor Ensure all membership and quarterly reporting is accurate and distributed to management Provide ACFC corporate with organizational wide cost allocation to support business model Communicate with all departments managers on span of control, staff and cost center expenses Develop and maintain a process to provide reliable critical metrics to management Hire, train, coach and evaluate performance of direct reports

Education and

Experience:

Five to Ten years Accounting/Finance Leadership Experience Managed Care/Medicaid experience preferred Bachelors Degree required, Masters Degree preferred

 
 

Clipped from: https://www.learn4good.com/jobs/ohio/finance/305937973/e/

Description


The Director, Business Intelligence solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Director, Business Intelligence requires an in-depth understanding of how organization capabilities interrelate across the function or segment.


Responsibilities


The Director, Business Intelligence describes the tools, technologies, applications and practices used to collect, integrate, analyze, and present an organization’s raw data in order to create insightful and actionable business information. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.


Required Qualifications


Bachelor’s Degree and 10 years of technical experience in data analysis and intelligence OR Master’s degree and 5 years of experience
5 or more years of leadership experience
Knowledgeable in process improvement and metrics development
Knowledgeable in regulations governing health care industries
Prior Leadership Experience
5 – 10 years of experience in Compliance for a Health Plan
Familiarity with contract writing, negotiation and interpretation
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and Access
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Preferred Qualifications


MBA or graduate degree in a management field
Ability to anticipate and be proactive around next steps in large initiatives simultaneously
Broad understanding of our businesses and connectedness to key Humana constituent areas
Relationship focused and can represent the office of the CRO well to both internal and external audiences
Familiarity with contract writing, negotiation and interpretation
5 – 10 years of experience in Compliance for a Health Plan
3 or more years of people leadership experience in building, managing and/or developing high-performing teams.
Knowledgeable in regulations governing health care industries
Knowledge of Humana’s internal policies, procedures and systems


Additional Information


Scheduled Weekly Hours


40

Clipped from: https://us.trabajo.org/job-640-20210513-130361cfe0e620116c2b5de8d8a3ed33?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 

Humana Birmingham, AL

**Description**

The Strategy Advancement Advisor builds local market presence for Humana Healthy Horizons, the Medicaid business of Humana Inc., preparing the markets for upcoming bids for state Medicaid managed care programs. The Strategy Advancement Advisor works with Business Development Market VPs to understand the healthcare landscape, setting strategy and solutions to improve health and well-being outcomes for our members, and establishing relationships with key partners at the state and local levels. **Responsibilities**

Strategy Advisor, Medicaid & Dual-Eligible Growth Strategy

+ Collects and analyzes state-specific health and social determinants of health data to create a foundational understanding of a state’s health care and Medicaid landscape + Works with Market VP, Business Development to develop the framework and strategies to address the health care needs and priorities within a state + Advises Market VP, Business Development to identify key organizations and associations, advocacy programs, and support networks to develop robust networks and partnerships + Works with Community Outreach and Engagement Lead, Business Development to build visibility and credibility of Humana Healthy Horizons in local markets + Exercises independent judgment and decision making on complex issues regarding approach, engagements, and works under minimal supervision + Uses independent judgment requiring analysis of variable factors and determining the best course of action

**Required Qualifications**

+ Bachelors’ Degree + Six or more years of experience in healthcare, health plan or public health strategy, community engagement and/or member/patient outreach. + Excellent leadership and organizational skills. + Skilled in project management and community engagement and development + Exercises professional judgment and demonstrates strong facilitation, conflict management and consensus building skills. + Ability to prioritize, organize, and coordinate multiple projects simultaneously. + Experience coordinating/leading a remote team. + Must be passionate about contributing to an organization focused on continuously improving consumer experiences. + Must have a separate room with a locked door that can be used as a home office, to ensure you have absolute and continuous privacy while you work. + Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.

**Preferred Qualifications**

+ Master’s degree + Experience with Medicaid + Data analysis + Understands the fundamentals of effective community engagement specific to Medicaid enrollees, including those with behavioral health needs and varied health literacy.

**Additional Information**

+ Schedule 8-5 CST or EST time, based on business needs + Limited travel, based on business needs

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website

If you are an Internal Candidate and you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

**Scheduled Weekly Hours**

40

Clipped from: https://www.ziprecruiter.com/c/Humana/Job/Strategy-Advisor,-Medicaid-&-Dual-Eligible-Growth-Strategy/-in-Birmingham,AL?jid=c67e628f4d40cb48&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Job Description:
 

The Wisconsin Medicaid Liaison presents a rewarding opportunity to support the Medicaid Members experience. This includes assisting with enrollment and continued enrollment of low-income families with children, pregnant women, the elderly, and persons with disabilities in Medicaid programs. In addition, the Medicaid Liaison provides infrastructure support required for performing eligibility determinations for Medicaid and FoodShare, manages the federal supplemental security income and social security disability insurance programs, and issues FoodShare benefits.

This is all done with a strong focus on equity inclusion, member focus groups, provider focus groups, surveys, and survey analysis.

As a Gainwell resource you will be working alongside of Division of Medicaid Services (DMS) staff to:

• Work directly with members, community partners, and other stakeholders throughout the State of Wisconsin.
• Act as a liaison to resolve both simple and complex issues.
• Assist members and community partners with clarifying policy or resolving case/application issues.
• Speak in public and deliver pre-approved presentations and assist with stakeholder trainings.
• Become a trusted advisor to the community partners and members.
• Proactively analyze trends and synthesizes data.
• Re-evaluate processes and outreach design.

Requirements

• Exceptional interpersonal skills; ability to communicate with diverse audiences, tactful, mature, and flexible.
• Ability to take initiative, to work both independently and as a member of a team.
• Resourceful, well organized, dependable, efficient, and detailed oriented
• A strong sense of empathy and passion to deliver solutions that change lives.
• Proficient in comprehending and applying information from complex rules, regulations, policies, and procedures.

Qualifications

Experience with public healthcare programs and assisting Medicaid members in obtaining services. Degree in a health, social science, or policy related focus and/or at least two years relevant work experience.

Clipped from: https://motherworks.com/job/1459155/wisconsin-medicaid-liaison-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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 care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

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

Title:  Medicaid State Ops Director for Washington State 

Location: Washington State 

Once the Offices re-open this postiion will work out of our Seattle Washington Office.

The Medicaid State Ops Director is responsible for operations functions, including coordination between internal departments, ensuring the appropriate strategy, tactics and processes are in place to affect solid organizational operations and oversight.

Primary duties may include, but are not limited to:

• Resolves programmatic challenges related to operations including member issues, provider claims issues, contract configuration issues, etc.
• Serves as liaison to Health Plan support services, which could include: Claims, Enrollment, NCC, PDM/PDQ, configuration; Quality, Regulatory Compliance, IT, Reimbursement policy, etc.
• Identifies opportunities for Operational Excellence and works to create seamless processes between shared services and the Health Plan.
• Develops and implements key operational indicators to be used for monitoring and analysis of the Health Plan operations.
• Serves as a liaison with state regulatory agencies when appropriate

Qualifications

• Live in Washington State 
• BA/BS in Business, Healthcare Administration or related field;
• 10 years of relevant experience including 8 years of in-depth experience in managed care operations;
• Any combination of education and experience, which would provide an equivalent background.
• Master’s degree preferred.
• Six Sigma Black Belt preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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/6689555-medicaid-state-ops-director?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Principal, Clinical Business Development (Medicaid)

• Job Reference: 277138095-2
• Date Posted: 4 May 2021
• Recruiter: Humana
• Location: Bridgeport, Connecticut
• Salary: On Application
• Sector: Healthcare & Medical
• Job Type: Permanent

Apply for this job now

Job Description

*Description* The Market Development Principal provides support to assigned health plan and/or specialty companies relative to Medicare/Medicaid/TRICARE product implementation, operations, contract compliance, and federal contract application submissions. The Market Development Principal provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience..*Responsibilities* The Medicaid Behavioral Health Business Development Principal provides support to assigned business development team and/or specialty companies relative to Medicaid mental health and substance abuse business strategy and solutioning, implementation, operations, contract compliance, and federal contract application submissions. The Market Development Principal provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical and Medicaid behavioral experience. Responsibilities The Medicaid Behavioral Health Business Development Principal serves as the primary resource and SME for business development. Ensures that RFP content and clinical model is meeting or exceeding corporate and state Medicaid requirements. Works with senior executives to develop and drive segment or enterprise-wide functional strategies. Advises one or more areas, programs or functions and provides recommendations to senior executives on matters of significance, and as an advanced subject matter expert competent to work at very high levels in multiple knowledge and functional areas across the enterprise. Required Qualifications + Bachelors Degree + Experience in fully integrated physical and behavioral clinical models + 10 years working experience in leading mental health and substance abuse Medicaid strategy for complex populations + 10 years working experience in leading Medicaid strategy for complex populations + 10 or more years of program design, execution and measurement in the Medicaid population + 5 years of project/people leadership + Experience as subject matter expert in Medicaid RFP process + Strategic thinking and planning capabilities + Organized and detail-oriented + Excellent presentation and communication skills, both internal and external audiences + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + Able to effectively work in Matrix organization and influence senior leadership level key stakeholders Preferred Qualifications + Graduate Degree + Experience evaluating competitor capabilities, determining where there are gaps and making recommendations to close them Additional Information.Limited travel.*Scheduled Weekly Hours* 40

 
 

Clipped from: https://jacksonaiqjobs.com/jobs/principal-clinical-business-development-medicaid-bridgeport-connecticut/277138095-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

– Share the health plans passion for evidence-based medicine and be comfortable applying evidence-based guidelines. Collaborate with other senior leaders in efforts that enhance the quality of care delivery, improve outcomes, and improve value delivered to our members.
– The Medical Director can expect to perform the following functions
– Support pre-admission review, utilization management, concurrent and retrospective review process and case management.
– Provide professional leadership and direction in the utilization/cost management (UM) and clinical quality improvement (QI) of the health plan, as measured by benchmarked UM and QI goals.
– Work collaboratively as a clinical resource to other plan functions that interface with medical management such as provider relations, member services, benefits, claims management, etc.
– Ensure members receive safe, effective, equitable, efficient, timely and patient-centered health care services within their health plan benefits.
– Carry out medical policies at the health plan consistent with NCQA and other regulatory bodies.
– Participate and/or chair clinical committees and work groups as assigned.
– Review medical care, medical service, and pharmacy requests against established clinical guidelines and make approval and denial determinations in accordance with evidence-based standards, organizational policies and procedures, and regulatory requirements.
– Identify potentially unnecessary services and care delivery settings, and recommend alternatives, as appropriate.
– Review appeals of medical and pharmacy denials against established clinical guidelines and make approval and denial determinations in accordance with evidence-based standards, organizational policies and procedures, and regulatory requirements.
– Identify opportunities for corrective action plans to address issues and improve plan and network managed care performance.
– Collaborate with Provider Networks and Medical Director team in creating and maintaining programs that incentivize providers to achieve selected utilization/cost and quality outcomes.
– Participate in the retrospective review and analysis of plan performance from summary data of paid claims, encounters, authorization logs, compliant and grievance logs, and other sources.
– Provide periodic written and verbal reports and updates as required in the Quality Management Program description, the Annual QI Work Plan.
– Assure plan conformance with legal and regulatory requirements; support NCQA qualification activities, including site visits and response to accrediting and regulatory agency feedback.
– Participate in risk management, claims administration, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, nutrition service review, provider orientation, credentialing, profiling, etc.
– Conduct quality improvement and outcomes studies as directed by the state and federal regulatory agencies, the Quality Management Committee, Medical Advisory Committee, Peer Review Committee, and management.
– Support grievance process, as led by Chief Medical Officers, ensuring a fair outcome for all members.
– Monitor member and provider satisfaction survey results and implement changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and plan participants.
– May be asked to chair various health plan committees, such as Quality Management subcommittees on Peer Review or Credentialing.
– Promote wellness and ensure programs of prevention, education and outreach to members and providers consistent with the companys Mission, Ambition, and Values
– Perform and oversee in-service staff training and education of professional staff.
– Contribute to the development of strategic planning for existing and expanding business; recommend changes in program content in concurrence with changing markets and technologies.
– Participate in key marketing activities and presentations, as necessary, to assist the marketing effort.

 
 

Clipped from: https://gr8txjobs.com/jobs/medical-director-medicaid-temple-texas/277571445-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Job Details

Posted

1 day ago

Location

Seneca, SC

Summary

• Our client is looking ‘Project Manager – Project Lead’ for their Medicaid System that is a challenging, fast-paced team environment. They are a best-practice Project Management Team.
• This position involves coordinating projects with Medicaid IT Staff and the Medicaid IT Services staff .
• This is a 9-months contract position to start off and comes with a possibility of extension.
• Local candidates preferred as there will be face-to-face interview for shortlisted candidates and there is also a 75 % possibility of remote work.

Roles & Responsibilities

• Under limited supervision, the Project Manager manages and coordinates all tasks associated with one or more small-to-large projects or a component of a larger project of minimal to moderate complexity and risk. The Project Manager will report to the Medicaid IT Services PMO Manager.
• This is an individual contributor position with no responsibilities for human resource management (e.g., hiring, performance management). Candidates must be self-starters and highly motivated.
• Follows established Software Development Life Cycle (SDLC) of Medicaid IT Services.

 
 

• Develops and maintains documentation throughout the entire project lifecycle.
• Is responsible for managing and directing the initiation, planning, execution, control, and closeout phases of the project lifecycle for small to large projects.
• Coordinates and manages projects using project management methodologies from inception through completion.
• Develops work plan(s).Controls scope and schedule to ensure project deliverables, milestones and required tasks completed as planned and on time.
• Oversees the development and execution of communication plan.
• Prepares status reports and provides updates to project stakeholders, sponsors, champion, etc.
• Identifies potential problems.
• Facilitates problem resolution by determining or recommending and implementing a risk mitigation strategy.
• Possesses ability to build a collaborative and high-performing project team with project resources.
• Works within the structure of Change Management and Release Management to coordinate implementations to the Medicaid System.
• This position may require working more than 40 hours per week on an as-needed basis, including weekends.

Preferred Qualifications

• Healthcare Claims Processing
• Process Development and Management

Minimum Qualifications

• A bachelor’s degree and 4-6 years of project management experience.
• Project Management Professional (PMP) certified.
• Project Management. Strong organizational skills.
• Strong analytical, conceptual, and problem solving skills.
• Knowledge of Software Development Life Cycle.
• Advanced Microsoft Word, Excel, and Microsoft Project.
• Soft skills Required: Effective Communication Skills (written and oral), Adaptability, Flexibility, Self-motivation, Time Management, Ability to work effectively in a stressful environment.

 
 

Clipped from: https://www.monster.com/job-openings/medicaid-project-manager-project-lead-seneca-sc–79c68541-48d3-4842-80c1-2daa4b37df25?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Job Description

*Provider Network Account Executive II–Medicaid* Location: Palm Beach Gardens, FL Primary Job Function: Provider Network ID*: 19484.*Job Brief* Senior Provider Relations Opportunity. Work from home! 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 ..*Responsibilities:* The AE II is responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers. Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations. AE II maintains in depth understanding of Plan’s contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues. Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the Plan’s territory in keeping w/State and Federal contact mandates for all products. Identifies, contacts and actively solicits qualified providers to participate in Plan at new and existing service areas and products, assuring financial integrity of the Plan is maintained and contract management requirements are adhered to, including language, terms and reimbursement requirements. Maintains complete understanding of Plan reports and metrics and uses them to evaluate the performance of assigned providers/practices/facilities, determining, communicating and implementing plans for providers to improve performance and measuring ongoing performance. Uses data to develop and implement methods to improve relationship. Assists in corrective actions required up to and including termination, following Plan policies and procedures. Supports the Quality Management department with the credentialing and re-credentialing processes, investigation of member complains and any potential quality issues. Maintains a functional working knowledge of Facets, including the provider database and routinely relays information about additions, deletions or corrections to the Provider Maintenance Department. Maintains and delivers accurate, timely activity and metric reports as required. Identifies and maintains strong partnerships with appropriate internal resources and stakeholders..*An AE II’s accounts/assignments include:* + those that are most complex, a higher number of multiplepractice locations and multi-specialty practices and multiple providers. + A total practice annual pay amount over $1M + Those that impact a total member population of a minimum of 5,000 or more.The appropriate minimum number of member population impact for the AE II level is determined by each Plan according to their business environments. The AE II is responsible for managing an ongoing Provider Network Management organization project or program. Will develop/implement/manage programs and projects that support/impact high dollar and high member provider groups. The AE II is responsible for participating or independently developing and implementing Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor and support new AE’s. The AE II will assist AE I’s in resolving/managing issues with Providers. The AE II has knowledge of Plan policies and procedures related to provider contracting, provider credentialing, provider billing and payment, provider incentive programs and other key State and Federal regulatory requirements related to providers, claim adjudication systems, provider file database requirements and relevant software applications; working independently and managing complex projects and programs both as an independent owner and team leader, training and mentoring skills, interacting at an executive level internally and externally..*Education/Experience:* + Bachelor’s Degree or equivalent educaiotn and experience preferred. + 3 to 5 years experience in a Provider Services position working with providers preferred. + 5 to 10 years experience in the managed care/health insurance industry with demonstrated successes. + Substantive Account Executive experience with high impact, high dollar, extremely visible and critical provider groups..*Other Skills:* + Medicaid experience required. EOE Minorities/Females/Protected Veterans/Disabled

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