Posted on

Actuarial Analyst Medicaid

 
 

Actuarial Analyst – Medicaid USA-Florida-Tampa Position Purpose:
* Assist in financial analysis, pricing and risk assessment to estimate outcomes.
* Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes
* Assist with developing probability tables based on analysis of statistical data and other pertinent information
* Analyze and evaluate required premium rates
* Assess cash reserves and liabilities enable payment of future benefits
* Assist with determining the equitable basis for distributing money for insurance benefits
* Participate in merger and acquisition analysis

Education/

Experience:

* Bachelor s degree or equivalent experience.
* 0-3 years of actuarial experience. License/Certification:
* Passed one actuarial exam.

 
 

Clipped from: https://www.learn4good.com/jobs/tampa/florida/insurance_and_assurance/276704929/e/

Posted on

Manager Medicaid Operations – Oklahoma Medicaid Call Center | Oklahoma City, OK

 
 

BASIC FUNCTION:
This position is responsible for the management oversight of Medicaid claims and customer service in collaboration with HCSC Enterprise Medicaid and in accordance with contractual and regulatory requirements. Serve as point of contact with HCSC Enterprise Medicaid Operations and coordinate with key functional areas across the organization, local vendors, and 3rd party business partners with the development and implementation of Medicaid Operations. Serve as business lead responsible for implementing HFS and CMS regulatory and contract changes (i.e., state fee schedule benefit changes and annual regulatory changes) including process and system changes. Position will also oversee Medicaid Member Services and responsible for managing relationships with local Medicaid vendors.

JOB REQUIREMENTS:

Bachelor Degree and 4 yrs operations experience OR 8 years experience working in health insurance operations
3 to 4 years experience leading and managing teams
Experience in project management
Experience managing operations for Medicaid, Dual Demonstration or other related Medicaid Medicare Advantage programs
Experience in business planning, time management, project management and organization skills with ability to multi-task and manage multiple, concurrent projects and priorities
Experience planning and driving business initiatives through implementation
Possess leadership, communication skills (oral and written) and ability to exercise strong interpersonal skills in varying, cross-functional situations
PC proficiency to include Word, Excel, PowerPoint and Lotus Notes

PREFERRED JOB REQUIREMENTS:

Background in administration of contracts for State and Federal Government.
Experience managing vendor relationships
Facet knowledge preferred
Blue Chip knowledge preferred
*Knowledge of call center management and performance monitoring

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.


Requirements:

Expertise Claims & Customer Service Job Type Full-Time Regular Location OK – Oklahoma City

 
 

Clipped from: https://www.themuse.com/jobs/hcsc/manager-medicaid-operations-oklahoma-medicaid-call-center?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Posted on

Vice President, Market Leader – Medicaid, Behavioral Health, Missouri City, Missouri

 
 

The position leads the Medicaid member market as the subject matter expert and strategic visionary of Behavioral Health clinical care management for Medicaid market members. Serves as the central point of contact to stakeholders for acquisition and retention of key contracts and business. Supports the organization’s ability to acquire, build and manage customer relationships on Medicaid products and services. Responsible for the oversight, maintenance and growth of business line, and is responsible for setting a business plan that informs the company’s go to market strategy for the Medicaid market utilizing defined and leading clinical care management products and services and working with service areas to understand market requirements and ability to deliver services. Liaison and key business partner between the Sales organization, Strategy, Shared Service Operations, Clinical Center of Operational Excellence, Clinical Centers of Excellence, and the Medical Director. Responsible for achieving business objectives and goals, helping to cultivate and foster relationships with current and new customers in the Medicaid market, and collaborating with other service areas of the organization to confirm effective delivery of defined services.
Sets and executes strategic vision and objectives for the Medicaid market using market analysis and industry trends.
Develops and implements long-term strategic initiatives focused on achieving operational excellence in the Medicaid market.
Collaborates with Behavioral Health Medical, Clinical and Shared Service Operations to effectively communicate capabilities, products, and solutions to new and potential Medicaid customers to ensure ability to administer services effectively.
Ensures contract requirements are understood, communicated, and met; deliverables are accurate and delivered in a timely manner; participate in rate setting discussions.
Designs, develops, and implements programs in Medicaid market focused on improving effectiveness, affordability, and quality of care.
Oversees performance of Engagement and Care Management teams in a Matrix reporting relationship alongside the Center of Operational Excellence Leads.
Assumes responsibility for growth, revenue, cost of care, operating gain, quality results and operational efficiency/effectiveness related to the Medicaid business.
Consults with clinical stakeholders to develop improved utilization of effective and appropriate services, including effective member engagement strategies.
Collaborates with Care Management Operations Lead, Engagement Operations Lead, Routine and Complex Care Management and Transition of Care Medicaid Managers to ensure operational goals are aligned to Medicaid’s strategic plan and vision.
Develops and implements action plans to improve performance and department outcomes, manage medical cost trends, and provide leadership periodic updates.
Provides leadership and expertise representing Medicaid in new business activities (RFP responses, new market and product development, etc.) and upsell and cross-sell opportunities with existing clients.
Collaborates on the development and implementation of a staff plan, including learning and development strategy, in collaboration with the relevant Magellan leaders.
Anticipates and acts on emerging healthcare trends to position the Medicaid line of business for the future, in conjunction with other Magellan leaders.
Other Job Requirements

Responsibilities

5 or more years of experience in professional practice
7 years post-degree (masters/doctoral) experience in behavioral health
7 years working with Medicaid populations
Significant experience managing Medicaid clinical operations
10+ years of experience in healthcare with a clinical and/or operations management focus.
10+ years of management level experience in the managed healthcare industry required.
Knowledge of government and CMS policies regarding Medicaid eligibility, programs, and beneficiaries.
Knowledge of managed healthcare delivery systems to include critical components and interdependencies.
Knowledge of the variety of financial and clinical structures viable in the managed care arena.
Knowledge of clinical issues unique to the delivery of mental health and substance abuse services, of strategic planning
and the budget process.
Ability to communicate and advocate at the line through corporate staff levels.
Must possess strong analytical and organizational skills in a multiple site and function environment.
Proven ability to manage operations in a clinical healthcare system.
Strong negotiating and contracting skills.
General Job Information

Title

VP, Market Leader – Medicaid, Behavioral Health

Work Experience

Behavioral Health, Clinical, Management/Leadership
Education

Bachelors: Behavioral Health (Required), Doctorate: Psychology, Masters: Behavioral Health, Masters: Business Administration, MD, PhD

 
 

Clipped from: https://gr8usajobs.com/jobs/vice-president-market-leader-medicaid-behavioral-health-missouri-city-missouri/271365028-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Posted on

Care Management Associate

 
 

Job Description
Position Summary
This position is fully remote however you work in the Eastern Time Zone.

Program Overview:

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP.

Position Summary/Mission:

The Care Management Associate works alongside other DSNP care team members including social workers, care managers and care coordinators to provide the best member experience.

Fundamental Components

• Supports comprehensive coordination of healthcare services through telephonic outreach to and enrollment of our eligible members.
• Our Care Management Associates demonstrate a highly energetic blend of member communication, healthcare navigator and health plan customer support representative.
• The Care Management Associate is responsible for direct member outreach and engagement, facilitating case assignment, and connecting identified members to care managers immediately through a warm transfer.
• Educates and assists members on various elements of Medicaid benefits and services , benefit plan information and available services created to enhance the overall member experience with the company. Utilizes all relevant information to effectively influence member engagement.
• Initiates contact with members who have lost their Medicaid eligibility and fall into the DSNP grace period, to remind them to follow through with their Medicaid and LIS recertification. Assists members with finding resources to help them reapply if necessary.
• Coordinates and sends annual reminders for members at risk of losing LIS, Medicaid, or DSNP eligibility.
• Takes ownership of each customer contact to anticipate customer needs, resolve their issues and connect them with additional services as appropriate.
• Tracks member’s Medicaid certification and eligibility dates and MCO plan information, as well as Medicaid status.
• Researches other general Medicaid programs, benefits and services the members are eligible for and initiate process to inform members of these benefits.
• Completes accurate case documentation as needed.
• Works with National DSNP Program Office Medicaid Policy Manager and State Contract Manager to provide general assistance with Medicaid benefits and entitlements.
• Other Duties as Assigned

Required Qualifications

• Strong collaboration skills and innovative problem-solving abilities.
• Strong verbal and written communication skills
• Ability to work independently, accurately, and efficiently
• Innovative Thinking and “Change Agent” – Looks for, identifies and acts on opportunities to improve how we design, develop, and deliver products and services.
• Empathy towards customers’ needs and concerns.
• Strong experience and working knowledge of Microsoft Office suite.

2-3 years of administrative work experience


Preferred Qualifications

• Knowledge of Medicare and Medicaid benefits, services, program and system design (Health and Welfare, Wealth, other benefits), legal/regulatory requirements.
• Knowledge and understanding of Medicaid eligibility and low-income state resources.

Education

Associate’s degree or equivalent work experience.

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

 
 

Clipped from: https://www.gettinghired.com/job-details/3964519/care-management-associate/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Posted on

Medicaid Eligibility Specialist at CBIZ in East Windsor, New Jersey

Job Description:

Job Description


With over 100 offices and nearly 5,000 associates in major metropolitan areas and suburban cities throughout the U.S. CBIZ (NYSE: CBZ) delivers top-level financial and employee business services to organizations of all sizes, as well as individual clients, by providing national-caliber expertise combined with highly personalized service delivered at the local level.


CBIZ has been honored to be the recipient of several national recognitions:




• 2020 Best Workplaces in Consulting & Professional Services by Great Place to Work®



• 2020 Workplace Excellence Seal of Approval by the Alliance for Workplace Excellence


• Top 101 2020 Best and Brightest Companies to Work For in the Nation


• 2020 Healthiest 100 Workplace in America


• 2021 Top Workplaces USA


CBIZ Benefits & Insurance Services is a division of CBIZ, Inc., providing benefits consulting, HRIS technology, payroll, human capital management, property and casualty, talent and compensation solutions, and retirement plan services to organizations of all sizes. CBIZ is ranked as a Top 20 Largest Broker of U.S. Business (Business Insurance Magazine) and a Top 100 Retirement Plan Adviser (PLANADVISER).



Essential Functions and Primary Duties:

 

  • Assisting patients in applying for financial assistance through Medicaid on behalf of our client facility.
  • Interviewing patients or authorized representatives via phone or in person to gather information to determine eligibility for medical benefits.
  • Obtaining, verifying, and calculating income and resources to determine client financial eligibility.
  • Documenting case records using automated systems to form a record for each client.
  • Following up with applicants to obtain accurate and complete information within strict timeframes.
  • Completing/following up on all forms related to Medicaid eligibility.
  • Performing any additional tasks related to the position assigned by the Manager.

Preferred Qualifications:

 

  • Bachelor’s degree.
  • Knowledge of Medicaid and Charity Care.
  • Experience working in a hospital environment.
  • Ability to speak and read Spanish.

Minimum Qualifications:

 

  • High school diploma/GED.
  • Must be ambitious and self-directed in a fast-paced environment and can perform in a high volume, multitasking setting.
  • Must be trustworthy, professional, detail and goal oriented.
  • Must have exceptional customer service and excellent verbal/written communication skills.
  • Must be able to learn and work with Medicaid eligibility regulations.

 
 

Clipped from: https://www.disabledperson.com/jobs/34783048-medicaid-eligibility-specialist?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Posted on

Data Warehouse Engineer/MD Medicaid Job Owings Mills Maryland

 
 

Position:  Data Warehouse Engineer (MD Medicaid)
Resp & Qualifications PURPOSE :
Provide oversight of a larger group within Data and Informatics (D & I) of resources in the design, develop, test, debug, document, and support all types of applications consistent with established specifications and business requirements to deliver business value. Takes leadership and accountability on coordination of work between multiple D & I teams and supply status to the program management team.

Implement solutions and ensure all milestones are met. Escalate to executive management as needed. PRINCIPLE ACCOUNTABILITIES :

Under the guidance of the Manager the incumbent is responsible for, but are not limited to, the following:
Software Design, Development Leads in designing and defining core reusable assets that support the long-term business strategy for development efforts. Leads in design and solution reviews to ensure adherence to performance guidelines & business requirements. Ensure all project teams code is to CareFirst specifications and ensure proper unit testing is done for all code. Look for standardization and reuse opportunities, abstractions and patterns across classes and components to streamline design and development of BI solutions.

With knowledge of the organization’s infrastructure, hardware, systems software and protocols, act as a consultative resource for strategy, system design, development and/or modifications of software/procedures to solve business solutions across multiple heterogeneous platforms. Drives the solution design and solution review to ensure the technical architecture design meets the technical objectives, business requirements, and standards. Ensures applications are designed for optimum performance and provide suggestions for ways to restructure designs to achieve optimal performance.


Drives the design, develop, test and implementation of maintainable program logic for existing and new application in accordance with the technical specifications. Reports to executive management on all project work and lessons learned as projects are closed. Software Integration Testing Assists in software development and enterprise integration testing, system (end to end) testing, and problem resolution related to business applications and/or related middleware components.


Verifies that the Business


Requirements as defined in the Project


Requirements Document are tested end to end throughout the D & I systems (ODS / EDM / SBI / CBI) . Ensures planning phases include non functional requirements for error handling, service level agreements, capacity planning, and that proper test cases are created. Utilizes HP Application Life Cycle Management toolset (ALM) to record all defects that are discovered during testing and corrected before the final closure of the project.


Coordinate with the enterprise auditing teams as well as external audit requests. This includes tracking all D & I reviews for the fiscal year and participate in all audits with proper D & I project teams: TOS Audit Coordination, CareFirst Corporate Audit Services,and Financial Accounting Performs test data management activities including working with the business to obtain a sufficient test data set, coordinate with operations teams for access by all project / D & I staff to environments / storage of test data sets to perform multiple test cycles, and work with enterprise testing for validation of data that is required outside of D & I.


Ensures all projects comply with Audit, Balance, and Control Framework Standard. This requires the ABC team to work with the project teams to define the ETL audit statistics to be captured in the Audit database. Conducts system integration testing according to all baselined project requirements. Conduct validation cycle hand off to Business End-User / DGS to facilitate UAT phase Ensures proper hand off to D & I Data Governance for UAT and Day to Day production support for project closure.


There should be no outstanding severity 1 or 2 tickets prior to deployment. Works with legal to ensure all new Business Associate Agreements with vendors have a New template that includes a Data Use Agreements section. Obtain a separate sign off on that DUA section of the BAA. Tracks all BAAs for all vendors, consultants, brokers and accounts at CareFirst and present results quarterly to executive management.


Day to Day Support Addresses Magic tickets (OneStop) for issues reported by end users and the Help Desk. Maintains current support contact information for each job. This is currently stored in the Magic database for each JCL job as well as in the team’s Application Support List (see Key Documentation). Presents to Executive Management Quarterly ticket counts, defect trends, and areas for improvement.


Completes analysis, design, development, testing, and deployment of bug fixes as issues are identified. Coordinates and review defect fixes with the Data Governance Team and downstream consumers. By Q2 2016, the team will include taking over management of the D & I defect process. Identifies recurring causes for defects and work with the Development and ABC Teams to address these during the development and validation process.


Coordinates with the ABC Team to provide test data management for defect validation. Coordinates with the D & I Project Intake Team and the D & I Development Team on the prioritization and resourcing of SVETs. Assists end-users with the intake process for an SVET when changes are requested in a production code and there is not an associated Corporate Initiative.


Works with DGS and business users to define requirements for the change requested. Completes analysis, design, development, testing, and deployment per the specifications of a project. Works closely with the project teams as new projects and point releases are deployed to ensure adherence to published standards. Ensure proper deployment procedures are being followed in the production environment and drive the production handover process with the Development Team.


This includes the creation of a Production Support document and completed Deployment Checklist. Ensures sufficient knowledge of any transitioned application has been gained in order to effectively support it. Coordinates all production support handoffs with the CI Project team and the D & I Audit, Balance, and Control team to ensure all Severity 1 and 2 defects are closed. Participate in the yearly Disaster Recovery exercise and run any needed test cases to demonstrate the effectiveness of our Disaster Recovery plans and processes.


Works with Information Security to ensure that proper roles are created for all supported systems. Reviews server utilization (CPU, Memory, & I/O usage) and storage capacity for all supported servers weekly and monthly. Performs annual data growth assessments to determine current year and future data storage needs. Works with IT Operations and Storage Teams to ensure production servers always have a buffer of available storage to prevent issues with unforeseen growth spikes.


Cross-trains production support resources on various technologies used in production support and expand the knowledge base to support different applications. QUALIFICATION REQUIREMENTS BA/BS in Computer Science, Engineering, Math, Acturial Science, Information Systems, or other related IT field or equivalent work experience plus; 5-7 years of experience with database management systems, ETL systems, business intelligence tools, defect management, and testing. Required


Skills and Abilities:


Demonstrated expertise leading specific work or resources on a team to deliver results. Hands on experience in numerous technologies with skills ranging with one or more of the following:

Logical and physical data model design; technical documentation; full-cycle system development, test case creation, audit balance and control metrics, relational and dimensional database systems;
Web-enabling applications;
Java technologies (EJB, JSP, servlet), J2EE Web Service Development, Unix development, SQL Development (PL/SQL or T-SQL),

Experience with SSIS, SSRS, SSAS or SAS or Micro


Strategy or Pryamid Analytics, OLAP Dimensional development, Data Warehousing, Master Data Management (MDM), Customer Data Integration (CDI), IBM Initiate, Oracle, Informatica (9.5.1 or higher) Power


Exchange, Informatica Power Center, Tibco, C#, .NET. Strong SQL and Data Analysis skills, attention to detail are required for this role. Additionally, the ability to obtain and retain business knowledge needed for future contributions. Preferred:

Some Healthcare experience Familiarity with new technologies and how they could be leveraged to benefit the department, new business strategies and corporate initiatives Some knowledge of Big Data Technologies. Department Department: MD Medicaid
– Solutions Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Hire Range Disclaimer Actual salary will be based on relevant job experience and work history.

Where To Apply Please  to apply:  Closing Date Please apply before: 5/21/21 Federal Disc/Physical Demand


Note:


The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US

Must be eligible to work in the U.


S. without Sponsorship REQNUMBER: 14631

 
 

Clipped from: https://www.learn4good.com/jobs/owings-mills/maryland/info_technology/278701137/e/

 
 

 
 

Posted on

Operations Leader – Oklahoma Medicaid job in Oklahoma City, OK

 
 

Job ID: BDP-1040776

Description:

BASIC FUNCTION:

This leadership position is responsible for the management oversight of Medicaid core operation functions in collaboration with internal matrix partners and in accordance with contractual and regulatory requirements. Serve as point of contact with internal matrix partners and coordinate with key functional areas across the organization, local vendors, and third-party business partners with the development and implementation of Medicaid Operations across the organization. This position will coordinate as needed with state regulators to ensure that any necessary requirements, information, or resources necessary to the supported operational functions are received. Directs the development of programs, standards and policies and procedures of program changes and works with other areas of the organization to ensure the requirements of the Medicaid program are met. This position will serve as business lead responsible for implementing Oklahoma Health Care Authority (OHCA) and CMS regulatory and contract changes (i.e., state fee schedule benefit changes and annual regulatory changes) including process and system changes. This position is responsible for ensuring BCBSOK Medicaid claims are processed timely and accurately according the Medicaid contract requirements. The role has indirect oversight of the claims department staff, who monitor billing activities, provide technical assistance, and ensure encounter claims submitted are for actual rendered services performed and meet medical necessity.

Position is responsible for managing relationships with local Medicaid vendors.

JOB REQUIREMENTS:

  • Bachelor Degree and 4 yrs. operations experience OR 8 years’ experience working in health insurance operations
  • 3 to 4 years’ experience leading and managing teams
  • Experience in project management
  • Experience managing operations for Medicaid, Dual Demonstration or other related Medicaid Medicare Advantage programs
  • Experience in business planning, time management, project management and organization skills with ability to multi-task and manage multiple, concurrent projects and priorities
  • Experience planning and driving business initiatives through implementation
  • Possess leadership, communication skills (oral and written) and ability to exercise strong interpersonal skills in varying, cross-functional situations
  • Comfort in working in a dynamic and demanding environment with the potential for rapid change
  • PC proficiency to include Word, Excel, PowerPoint and Lotus Notes

PREFERRED JOB REQUIREMENTS:

  • Background in administration of contracts for State and Federal Government.
  • Experience managing vendor relationships
  • FACETS/TriZetto platform knowledge preferred
  • Knowledge of HIPAA X12 Transaction Sets including 837p, 837i, 270/271, 276/277, 834/835
  • Knowledge of call center management and performance monitoring

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Requirements:

Expertise Government Programs Job Type Full-Time Regular Location OK – Oklahoma City

 
 

Clipped from: https://www.linkup.com/details/f61d5d475a2d8c7b539bf7e2cfa67f3c?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Posted on

Actuarial Director (Medicaid Pricing) – Mason – Anthem

 
 

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.

Actuarial Director (Medicaid Pricing)

Preferred Locations: Atlanta, GA; St. Louis, MO; Indianapolis, IN; Mason, OH; Waukesha, WI; Louisville, KY; Richmond, VA; Virginia Beach, VA; Tampa, FL

Will consider other locations for the most qualified applicant

The Actuarial Director identifies, evaluates and responds to financialrisks inherent in the pricing and development of health insurance products. Position will support Medicaid pricing in multiple states.

Primary duties may include, but are not limited to:

  • Prepares and interprets data and related formulae.
  • Monitors trend of profit and profitability by line of business and/or product.
  • Serves on major, multi-function projects as Actuarial representative.
  • Organizes and directs the staffing and work flow of the section.

Qualifications

  • Requires a BS/BA degree; FSA required from the Society of Actuaries (SOA) with at least 6 years of related experience, or ASA from the Society of Actuaries (SOA) with at least 9 years of related experience; or any combination of education and experience, which would provide an equivalent background.
  • Medicaid pricing experience highly desired.

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.

 
 

Clipped from: https://www.theladders.com/job/actuarial-director-medicaid-pricing-anthemorg-mason-oh_46213602?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Posted on

Medicaid Legal Compliance Manager- Work from home- Express Scripts job in Bedford, Texas, United States of America | Legal jobs at Cigna

 
 

Remote, open to work at home, United States

Role Summary:
The Medicaid Compliance Manager is primarily responsible for managing all external audits initiated by government entities of Cigna’s Medicaid and Medicaid-Medicare Plan (MMP) lines of business. This position will lead a portion of the Medicaid/MMP team, and will be engaged in various compliance efforts, acting as a subject matter expert to support business partners and will need to work with a high degree of independence.  
The Medicaid Compliance Manager must be highly organized with eye for detail and issue management.  They will be accountable to ensure all deliverables are well understood by business owners, meet the requirements of the government entity, and are submitted timely.  A successful candidate must be able to understand business processes and work cross functionally with business owners.   In addition to auditing and leading a small team, the position may also have some responsibility for: (i) reviewing and informing the compliance risk assessment, (ii) communicating with regulatory oversight entities, (iii) working with Medicaid and MMP business leaders to share new or changing guidance, (iv) supporting implementation of new or changing guidance, (v) monitoring compliance with Medicaid and MMP requirements, and (vi) ensuring timely and appropriate closure of any issues.  
 Responsibilities:
•    Report to the Head of Medicaid Compliance;
•    Lead a small team of compliance professionals
•    Ensure  compliance with Medicaid and MMP rules and regulations;
•    Manage all aspect of audits issued by government entities;
•    Maintain good working relationships with internal parties to ensure open lines of communications and timely responses to compliance questions;
•    Assist in the management of Corrective Action Plans (CAPs) and finding remediation for Medicaid and MMP related issues;
•    Remain aware of industry changes and/or trends. 

Qualifications:

  • 7+ years overall experience with healthcare regulatory and compliance matters;
  • 3+ years of Medicaid experience; 
  • Strong knowledge of Medicaid and MMP regulations required;
  • *Experience with team leadership;
  • Strong attention to detail and analytic skills required;
  • Strong problem solving skills required;
  • Bachelors
  • Strong and confident oral and written communication skills required;
  • Ability to work collaboratively with others (and when appropriate influence colleagues in their decision making process) required.

 
 

This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

 
 

Clipped from: https://jobs.cigna.com/us/en/job/CIGNUS21004391?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Posted on

Centers for Medicare & Medicaid Services IT Specialist (Systems Analysis) in Gwynn oak, MD

 
 

Summary

This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI), Business Services Group (BSG), Division of Applications Design and Development (DADD).


As a IT Specialist (Systems Analysis), GS-2210-13, you will perform a wide variety of duties related to the design, development, and implementation of new and modernized IT systems in support of CMS programs.

Learn more about this agency

Responsibilities


  • Plans, coordinates, and performs systems design and development of a major IT functional area, which, may include providing direction to lower-level staff or contract personnel.
  • Analyzes the validation of IT needs and requirements, including data, access needs and security, to design and develop appropriate systems designs, access methods and information security controls.
  • Develops proposals to translate management objectives into advanced IT application systems.
  • Develops and makes presentations on project status and technical issues pertinent to project and prepares other project related documentation such as project plans, schedules, budget documents, and statements of work.
  • Reviews a variety of short, intermediate and long-range studies and projects to assure existing operational systems and methods provide the most effective and efficient manner of operation.

Travel Required

Occasional travel – You may be expected to travel 5% for this position.

Supervisory status

No

Promotion Potential

13

Job family (Series)

2210 Information Technology Management

Requirements


Conditions of Employment

  • You must be a U.S. Citizen or National to apply for this position.
  • You will be subject to a background and suitability investigation.
  • Time-in-Grade restrictions apply.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.


Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.


You must have IT-related experience demonstrating each of the four competencies listed below:
1. Attention to Detail – Is thorough when performing work and conscientiously attends to detail.2. Customer Service – Works with clients and customers (that is, any individual who uses or receives the services or products that your work or unit produces, including the general public, individuals who work in the agency, other agencies, or organizations outside the Government) to assess their needs, provide information or assistance, resolve their problems or satisfy their expectations; knows about available products and services; and is committed to providing quality products and services.3. Oral Communication – Expresses information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information (for example, technical, sensitive, controversial); makes clear and convincing oral presentations; listens to others, attends to nonverbal cues; and responds appropriately.4. Problem Solving – Identifies problems; determines accuracy and relevance of information; uses sound judgment to generate and evaluate alternatives, and to make recommendations.

– AND –

In order to qualify for the GS-13 , you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-12 grade level in the Federal government, obtained in either the private or public sector, to include:

1) Implementing Information Technology (IT) project plans related to system designs or updates;

2) Providing recommendations for improvements to IT systems; and
3) Ensuring that staff and contractors are compliant with IT project plans, policies, or procedures.


Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.


Time-in-Grade: To be eligible, current Federal employees must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.

Click the following link to view the occupational questionnaire: (see application details)

Education


This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: Yes

Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Not Required



Telework Program: CMS is on the forefront of offering flexible working arrangements, and after an initial training period, allows employees the opportunity to participate in telework combined with alternative work schedules at the manager’s discretion. In the current pandemic situation, employees are teleworking full time and supported by a variety of technologies. When CMS returns to normal operations, employees will be expected to return to their normal duty station and schedule. CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program.


The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents . A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at (see application details) .


Additional Forms REQUIRED Prior to Appointment:

  • Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306 .
  • Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9 .
  • Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61 .

If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application . Read more

How You Will Be Evaluated


You will be evaluated for this job based on how well you meet the qualifications above.

Once the announcement has closed, your online application, resume, and CMS required documents will be used to determine if you meet eligibility and qualification requirements listed on this announcement. If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration. Please follow all instructions carefully. Errors or omissions may affect your rating.


Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):

  • Analysis
  • Oral Communication
  • Systems Testing and Evaluation
  • Written Communication

Additional selections may be made from this announcement for similar positions within CMS in the same geographical location. For Central Office vacancies, the “same geographical location” includes Baltimore, Maryland; Bethesda, Maryland; and Washington, D.C. Read more

Background checks and security clearance

Security clearance

Not Required

Drug test required

No

Position sensitivity and risk

Moderate Risk (MR)

Trust determination process

Credentialing , Suitability/Fitness

Required Documents

The following documents are REQUIRED:


1. Resume
showing relevant experience; cover letter optional . Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: (see application details)

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Current CMS employees are REQUIRED to submit a copy of their most recent Notification of Personnel Action (SF-50) at the time of application. Additional documents may also be required to be considered for this vacancy announcement. Click here for a detailed description of the required documents . Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


PLEASE NOTE: A complete application package includes the online application, resume, and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume and CMS required documents, will result in you not being considered for employment.

Benefits

A career with the U.S. Government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new window Learn more about federal benefits .

Review our benefits

Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time, or intermittent. Contact the hiring agency for more information on the specific benefits offered.

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