Pfalzgraf Beinhauer Grear Harris Schuller LLP, is seeking an organized office professional with a desire to provide outstanding customer service to our clients and staff. This key position is responsible for supporting our growing Medicaid Department with the ability to analyze and track financial transactions in banking, investment and retirement accounts, compilation and organization of documents, as well as communication with clients, insurance companies, financial institutions and government agencies.

We offer great pay and benefits including health insurance and retirement.
Ideal candidate has 3-5 years’ experience in a small busy office, and strong attention to detail, customer service and computer skills (Word, Excel).

Please submit resume and cover letter to:
Pfalzgraf Beinhauer Grear Harris Schuller LLP, Attn: Amanda Zanner, 455 Cayuga Road, Suite 600, Buffalo, NY 14225 or email via Quick Apply.

Clipped from: https://www.wnyjobs.com/jobpostings/medicaid-coordinator-buffalo-ny-206563/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 

 
 

**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
Categories

 
 

Clipped from: https://www.mendeley.com/careers/job/principal-clinical-business-development-medicaid-3604271?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

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://motherworks.com/job/1412968/medicaid-legal-compliance-manager-work-from-home-express-scripts/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Integrated Care Manager

AHCCCS

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs, and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona.

Integrated Care Manager

AHCCCS

 

Posting Details:

Salary: $90,000 – $95,000 
 

Grade: 25

Job Summary:

The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a Integrated Care Manager. The position will be responsible for assisting the Integrated Care Administrator with the leadership of the DHCM System of Care team as well as supporting the Agency in advancing AHCCCS’ clinical and quality strategies, improving the integrated care delivery system, and monitoring programmatic and contract functions for the adult systems of care, including COE/COT and justice coordination.

Job Duties:

* Lead Crisis system work group and other work related to engagement of crisis providers. Manage grants and programs related to crisis services. Lead development of crisis policies and refinement of crisis delivery system (e.g. Competitive Contract Expansion). Provider monitoring and oversight of crisis vendor contract and related deliverables.

* Provide technical assistance and support to internal staff, MCOs, providers and other stakeholders related to clinical issues and programmatic implementation of integrated care services and Adult Systems of Care services including but not limited to COE/COT, crisis, justice support, care transitions, evaluation tools (e.g. LOCUS and ASAM) and supportive services (e.g. housing, Social Determinants of Health).

* Lead policy and programmatic development efforts related to new treatment modalities, community-based supports, and other initiatives as appropriate. Develop and maintain adult clinical guidance tools.

* Lead staff to achieve outlined goals and completion of quality work products. Support implementation/maintenance of AMS principles and activities within the Unit. Provide coaching, 1:1s, and actively problem solve with staff as needed.

* Participate in Agency and Community-based meetings. Prepare written and verbal responses to meet the needs/requests of stakeholders.

* Provide oversight to the Psychiatric Services Review Board (PSRB) activities and release of AHCCCS members. Actively engage with the Arizona State Hospital (ASH) and other stakeholders regarding processes and services related to PSRB.

* Track and trend the continuum of overlapping issues between crisis, COE/COT, and justice involvement. Work with other Agency staff and/or MCOs to monitor provider outcomes for specialized services (e.g. Secured BHRF, new legislative initiatives).
 

Knowledge, Skills & Abilities (KSAs):

* Clinical expertise in the delivery of behavioral health services and programs, including SMI rules and crisis services

* Knowledge of Arizona Public Behavioral Health system, including AHCCCS/Administrative policies and procedures

* Principles and practices of program planning; assessment skills; Child Family Team (CFT) and Adult Recovery Team(ART) models, and mechanisms of managed (prepaid) health care systems; preventative health practices; organization of health care systems and current trends that affect the systems, and research methodology and process

* Interpreting existing and new rules, laws and agency policy pertaining to the delivery of behavioral health services

* Monitoring policies and procedures that result in integrated behavioral health services with physical health care services, and/or enhance existing processes to achieve better outcomes

* Lead and engage a team of professionals

* Understand and communicate data/health analytics
 

Selective Preference(s):

* Five years clinical and programmatic experience in behavioral health service delivery systems including experience in a public managed care environment

* A licensed clinical social worker (LCSW)

* Registered Nurse or Nurse Practitioner with Psychiatric-Mental Health specialty or a Master’s or higher degree in a behavioral health or health related field

Benefits:

At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

 
 

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

Clipped from: https://jobs.azahcccs.gov/integrated-care-manager/job/16175033?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 Clayton, IN Full Time

Job Posting for Audit Case Disposition Lead (Medicare/Medicaid) at new

Are you interested in helping Government and Public Sector (GPS) clients respond to regulatory and compliance risk events? Are you a leader looking for an energetic environment that offers tremendous growth and development opportunities? If so, Deloitte’s GPS Regulatory & Compliance team could be the place for you! Our Regulatory & Compliance team helps GPS clients implement and operate their regulatory and compliance programs to preserve the reputation and public trust of the agency. 

 
 

Work you’ll do 

As a Manager within our Regulatory & Compliance team, you will:

• Oversee the auditors and investigators, coordinating with clinicians to work leads and cases to completion
• Support the regular reporting of cases, provide insight into case dispositions, and track overpayments
• Review the findings of the completed audits and investigations and will facilitate the proper disposition of each case
• Assist with reporting of results
• Implement, transform and support the operation of compliance programs across industry sectors, including financial services, healthcare, and energy and resources
• Help Federal agencies identify and combat risks related to anti-money laundering, financial crimes and terrorist financing
• Organize and deliver services on a cross-section of complex projects
• Actively participate in the development of business and vendor relationships
• Participate and lead aspects of the proposal development proces
• Responsible for project(s) financials including development of financial plans
• Manages day-to-day interactions with clients and internal Deloitte team
• Displays both breadth and depth of knowledge regarding functional and technical issues
• Displays leadership and business judgment in anticipating client/project needs and developing alternative solutions
• Provide counseling/coaching, oversight, and support for delivery teams and staff
• Actively participate in staff recruitment and retention activities providing input and guidance into the staffing process

 
 

The Team 

Transparency, innovation, collaboration, sustainability: these are the hallmark issues shaping GPS government initiatives today. Deloitte’s GPS practice is passionate about making an impact with lasting change.  Carrying out missions in the GPS practice requires fresh thinking and a creative approach. We collaborate with teams from across our organization in order to bring the full breadth of Deloitte, its commercial and public sector expertise, to best support our clients.  Our aspiration is to be the premier integrated solutions provider in helping to transform the GPS marketplace.

 
 

Our Regulatory & Compliance team helps clients assess and transform the process, controls, and infrastructure needed to address a wide variety of regulatory and compliance risks. Our professionals assist clients with how to best meet regulatory expectations, reduce risk, and become more confident in their programs.

 
 

Qualifications

 
 

Required:

 
 

• Bachelor’s Degree in Accounting, Finance, Economics, Computer Science, Management Information Systems, or related field
• 7+ years experience with Medicare and Medicaid audit
• 4+ years of relevant consulting or industry experience
• 2+ years in a technical or functional lead role
• Experience with Fraud Detection, Prevention, and Risk Assessments
• Experience with improper payments
• Experience with Medicare and Medicaid (MDS) rules and compliance
• Experience mentoring and coaching others
• Proven leadership skills demonstrating strong judgment, problem-solving, and decision-making abilities
• Experience managing senior-level client relationships
• Experience presenting to clients or other decision makers to present and sell ideas to various audiences (technical and non-technical)
• Pre-sales, proposal, and RFP experience

 
 

 
 

Preferred

• Previous Federal Consulting

• Advanced Degree in related field

• CPA, CAMS, and/or CFE certification

• Knowledge of financial statement audit, forensic accounting and/or risk modeling

• Experience working in regulatory compliance programs and/or investigative environment

• (Recruiters can add more bullets if needed)

 
 

How you’ll grow 

At Deloitte, our professional development plan focuses on helping people at every level of their career to identify and use their strengths to do their best work every day. From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to help sharpen skills in addition to hands-on experience in the global, fast-changing business world.  From on-the-job learning experiences to formal development programs at Deloitte University, our professionals have a variety of opportunities to continue to grow throughout their career.  Explore Deloitte University, The Leadership Center.

 
 

Clipped from: https://www.salary.com/job/new/audit-case-disposition-lead-medicare-medicaid/5fe22623-8621-4627-8401-ae478c729c81?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

new

 
 

This position performs the operational oversight role responsible for the day-to-day outreach and engagement (O&E) team and activities of connecting with, engaging with and positively impacting and influencing members in the Medicaid, Medicare, and Whole Health member markets. Responsible for maintaining a highly efficient workforce, meeting outreach and engagement goals, and enhancing the performance of all members of the O&E Team. Works in a matrix environment with the Member Market Leads for Medicare, Medicaid and Whole Health.

• Oversees Outreach & Engagement team including recruiting, hiring, maintaining staffing competencies, productivity, and team ratios; monitoring qualitative and quantitative measures across all O&E team members; and executing corrective actions as necessary.
• Reviews daily activity across O&E team members in establishing direct contact, engagement, and communication and the provision of information on available health services and community support to encourage participation in Magellan’s BH Care Management program.
• Reviews member communications to ensure that successful contact with assigned members include effective communications and descriptions of Magellan’s BH Care Management services including benefits, purpose, process to access services, the Magellan BH Care Management service system, and other available BH services; and ensure that members are being engaged in a manner that is individualized and addresses the member’s needs and means of understanding information.
• Works collaboratively across the Care Management teams to ensure execution of comprehensive and coordinated delivery of services to members.
• Monitors, tracks, and identifies trends in O&E productivity and KPIs in partnership with Quality Team and use to adjust processes, procedures, and policies to improve workforce management productivity and operations metrics, or workflows.
• Monitors individual team member performances for opportunities to improve effectiveness of member communication techniques (for example: motivational interviewing, peer-to-peer engagement); maintain operational dashboard for O&Es and reach out to appropriate training and support resources as needed.
• Ensures that established policies, procedures, and guidelines are followed at high level of quality.
• Works with Member Market Leads to ensure communication and contractual obligations/ goals are aligned to O&E operational, quality, and medical cost KPIs.
• Works with Member Market leads to communicate achievement of performance standards; support ensuring compliance with Medicaid, Medicare, and Commercial regulations and requirements.
• Works with Member Market leads to develop effective communications materials for staff to reach out to members to meet and exceed outreach and engagement targets.
• Manages O&E team to annual expense budget targets.
• Collaborates on the development and implementation of a staff plan, including learning and development strategy, in collaboration with the relevant Magellan leaders
• Participates in goal setting and regular performance reviews of all staff.

Other Job Requirements

Responsibilities

• Health Insurance Sales.
• Administrative Task experience / proficiency.
• Computer software skills.
• Communication skills.
• Motivational Interviewing Training or Certification.
• Experience leading direct customer marketing, direct customer or community engagement or sales education.
• 3+ years of experience in direct to consumer marketing, direct customer or community engagement or sales education.
• Understanding of health plan benefit structures, behavioral/physical health terminology, call center terminology and operations.
• Applicable experience related to one of targeted member markets, including Medicare, Medicaid and Whole Health.
• Strong written and verbal communication skills.

General Job Information

Title

Supervisor, Outreach and Engagement – Medicare & Medicaid

Grade

25

Work Experience

Customer Service, Sales, Supervisory

Education

Bachelors: Marketing, GED (Required), High School (Required)

License and Certifications – Required

License and Certifications – Preferred

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

 
 

Clipped from: https://www.linkup.com/details/b170f8ac90a066fa285a3e12256cf981?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Position:  Director, Product Development Management (Medicaid
Location: Getzville
Director, Product Development & Management (Medicaid) USA-New York-Getzville Position Purpose:
Oversee the product development and management of health and wellness products for the Medicaid (and other government programs) market.
* Design, develop, implement, and manage new and existing products from initial conception through service delivery
* Lead new product development efforts and cross-functional teams to develop and execute detailed project plans, outline workflows, sales and marketing collateral content, staffing models and product pricing, and client reporting specifications
* Monitor market trends to identify new product opportunities or enhancements to existing products
* Review product performance and outcomes and make recommendations for program improvements
* Respond to product inquires and assess new product requests
* Participate in the development of business strategy for the Medicaid market
* Ensures legal and regulatory compliance of new products and product enhancements
* Conduct training sessions for various internal teams on products Education/

Experience:

Bachelor s degree in Communications, Business Administration, or related field. 5+ years experience with health care or Medicaid product development/management, marketing, or project management in a managed care or insurance environment. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. For Fidelis Care Only:
The above responsibilities will apply to the oversight of the Marketplace and Essential Health plan products for Fidelis Care. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Business Development & Sales Full-time

 
 

Clipped from: https://www.learn4good.com/jobs/new-york/management_and_managerial/270643575/e/

 
 

The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. In 2020, ODM introduced a new vision for Ohio’s Medicaid program — one that strengthens Ohio’s future and ensures everyone has the chance to live life to its full potential.


Today, more than 90 percent of Ohio Medicaid members are supported by managed care organizations. During the year ahead, ODM will begin implementing a new vision for care; focusing on the individual, a strong partnership among MCOs and the department, and supporting specialization in addressing critical needs.


A program that puts the individual first


They Are


Adopting Governor DeWine’s philosophy of service to Ohioans, ODM embarked on an aggressive effort to redesign its managed care program. The goal is to provide more personal, holistic care and supports for millions of Ohioans served by Medicaid. Listening to feedback from more than 1,100 individuals and organizations we identified five procurement goals that would put the individual front and center of Medicaid’s program and policy decisions.

• Emphasize a personalized care experience,
• Improve care for children and adults with complex behavioral health needs,
• Improve wellness and health outcomes,
• Support providers in better patient care and
• Increase program transparency and accountability.

 
 

Unless required by legislation or union contract, starting salary will be set at step 1 of the pay range.


Office: Operations


Bureau: Network Management


Classification: Medicaid Health Systems Administrator 1 (PN 20087026)


Job Overview


As the Waiver Provider Supervisor in the Burau of Network Management, Ohio Department of Medicaid (ODM), your responsibilities will include:

• Supervising staff responsible for managing Ohio Home Care Waiver provider oversight activities (developing and implementing training programs for compliance with Ohio Home Care rules, managing the annual Provider Oversight Structural reviews, identifying and analyzing deficiencies, reviewing and accepting/denying Plans of Correction)
• Researching, evaluating, & analyzing state & federal legislation/regulations impacting Medicaid service delivery systems specifically for Home & Community Based Service waiver program
• Responsibility for data analysis of information gathered from the reviews
• Developing and creating comprehensive reports and performance standards for the structural review of contractors and for internal staff
• Developing settlement agreements with ODM Legal when appropriate

 
 

Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 mos. exp. in the delivery of a health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data base analysis).


Or 12 months experience as a Medicaid Health Systems Specialist, 65293.


Note: education & experience is to be commensurate with approved position description on file.


 

• Or equivalent of Minimum Class Qualifications for Employment noted above.
  
  
   

Primary Location


United States of America-OHIO-Franklin County-Columbus


Work Locations


Lazarus 4


Organization


Ohio Department of Medicaid


Classified Indicator


Classified


Bargaining Unit / Exempt


Exempt


Schedule


Full-time


Work Hours


8:00AM – 5:00PM


Compensation


$32.71/hour


Unposting Date


May 2, 2021, 11:59:00 PM


Job Function


Health Administration


Job Level


Manager / Supervisor


Agency Contact Information


HumanResources@medicaid.ohio.gov

 
 

Clipped from: https://www.linkedin.com/jobs/view/waiver-provider-supervisor-medicaid-health-systems-administrator-1-at-ohio-department-of-medicaid-2497788707/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

This position provides leadership for the Community and State Health Plans Medicaid products in their assigned market to support continued growth and innovation. The position is a member of the health plan senior leadership team and will work collaboratively with the CEO, COO and CFO to ensure overall strategies are aligned with the market level business objectives. This position will oversee the Medicaid community agenda and field-based outreach teams to develop market leading provider and community engagement to forge strong external relationships. This position is responsible for forecasting and has accountability in achieving growth (Acquisition and retention) targets. This is an external and internal facing role.

If you are located within a commutable distance to the Greater Philadelphia Region , you will have the flexibility to telecommute* as you take on some tough challenges.

Up to 25% travel, around the state of Pennsylvania, will be required for this role .

Primary Responsibilities:
 

• Develop and execute and continually update overall strategies for Medicaid product offering to maximize product growth, member retention, innovation and member and provider experience
• Drive smart Growth in membership and market share in designated market by developing solid relationships across segments and departments (Network, marketing, clinical, quality, finance).
• Lead, develop and uphold accountability of Medicaid products forecasting models with complete understanding of Auto assignment algorithms, eligibility requirements, self-select, and involuntary vs voluntary term ratios.
• Manage local Medicaid field-based outreach teams and work directly with M&R regional sales leaders to leverage DSNP Outreach strategies and teams across segments.
• Ability to address local market nuances and unique requirements to assure that we are keeping healthcare “local” while maintaining a strong presence in the market
• Partner with local and functional teams to assure appropriate health plan benefit design and value-added services
• Formulate impactful relationships that drive engagement with community-based organizations and faith-based organizations
• Develop and implement provider engagement strategies (including Field-based approaches and face to face visits Providers) in partnership with Network partners that specifically focuses on membership growth and retention and making UHC the insurer of choice for UHC
• Lead and provide oversight for the Field community outreach team that orchestrates member events, potential consumer events, and community-based goodwill and general awareness that make UHC the insurer of choice
• Manage and uphold accountability for marketing, sponsorship and outreach budgets
• Represent the Health Plan at State meetings, community events, and media relations; Assist in developing new county expansions for existing Medicaid; Assist in implementing future product opportunities
• Ensure compliance to health plan State contract for MCO functions entailing Marketing, Communications, Engagement with Community Based Providers and Provider Network and outreach activities.
• Lead and develop top field talent in designated markets, while creating bench strength and opportunities for professional growth within the team

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
 

• Bachelor’s degree
• 5+ years of experience developing and deploying marketing/growth strategies or campaigns with positive outcomes
• Experience building relationships with senior leadership, community or state organizations, providers, advocacy groups, and / or government leadership
• Experience using data analysis to drive results (examples: trend membership, measure ROI, forecasting, measuring growth outcomes or other)
• Experience in Pennsylvania market
• Experience leading teams directly or indirectly
• If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:
 

• Experience in Government Programs (Medicare, Medicaid, LTSS)
• Master’s degree (MPA / MBA)
• Existing relationships with Medicaid referral sources (i.e. CBOs, providers)
• Active health license
• Bilingual

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That’s why you’ll find some of the most amazingly talented people in health care here. We serve the health care needs of low- income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life’s best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Medicaid Growth Leader , Philadelphia, PA, Pennsylvania, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote

Clipped from: https://www.gettinghired.com/job-details/3844451/medicaid-growth-leader-greater-philadelphia-region/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Exton, Pennsylvania

 
 

• Overview
• Success
• Life at Takeda
• Opportunity
• Responsibilities
• Map

Overview

Takeda fosters a collaborative and stimulating work environment filled with opportunity and the chance to make a difference in people’s lives. It is a workplace driven by integrity, one of Takeda’s long-held values that extends to both the patients we serve and our employees who develop and deliver medicines. Across our company, Takeda employees bring together diverse strengths that together create a stronger whole.

As one of the world’s leading biopharmaceutical companies, Takeda is committed to bringing Better Health and a Brighter future to people worldwide. We aspire to bring our leadership in translating science into life-changing medicines to the next level, in our core focus areas; oncology, gastroenterology, neuroscience, rare diseases, plasma-derived therapies, and vaccines.

We are a passionate team doing important work that impacts patients’ lives. If you are driven to create better health and a brighter future, join us!

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Success

What makes a successful member of our team? Check out the traits we’re looking for and see if you have the right mix.

• Collaborative
• Strategic
• Results Driven
• Self-starter
• Versatile
• Team player

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Opportunity

• Since 1781, the values of Takeda-ism (Integrity, Fairness, Honesty, and Perseverance) have guided everything we do—from decision-making to interacting with patients.
• Our people-first mission extends beyond patients to include their families, communities, and our own Takeda family.
• A strong, borderless team, we strive together towards our priorities and inspiring mission.
• Recognized for our culture and way of working, we’re one of only 13 companies to receive Top Global Employer® status for 2021.
• Our people-first mission extends beyond patients to include their families, communities, and our own Takeda family.
• Our vision is of a world with accessible healthcare for all, where prevention measures are exponentially advanced and billions are freed of disease. Our approach is rooted in our patient-centricity and the creation of outstanding treatments that change people’s lives. Building upon a foundation of sustainability, we are committed to contributing to the long-term health of people through disease prevention.

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Manager, Medicaid Rebates

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Job ID R0035507 Date posted 04/21/2021 Location Exton, Pennsylvania

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Job Description

Are you looking for a patient-focused, innovation-driven company that will inspire you and empower you to shine? Join us as a Manager, Medicaid Rebates in our Exton, Pennsylvania office.

At Takeda, we are transforming the pharmaceutical industry through our R&D-driven market leadership and being a values-led company. To do this, we empower our people to realize their potential through life-changing work. Certified as a Global Top Employer, we offer stimulating careers, encourage innovation, and strive for excellence in everything we do. We foster an inclusive, collaborative workplace, in which our global teams are united by an unwavering commitment to deliver Better Health and a Brighter Future to people around the world.

Here, you will be a vital contributor to our inspiring, bold mission.

POSITION OBJECTIVES:

• Leads development, implementation, and management of processes, programs, and policies to ensure that Takeda adheres to all compliance requirements outlined in the Medicaid Drug Rebate Program (MDRP) regulations.
• Responsible for managing Takeda’s MDRP reimbursement process (disputes, adjudications, payments), including DOA authority to sign individual rebates upwards of $1.5MM and annual payments totaling over $2.5 billion.
• Proactively mentors and guides analysts towards completion of government reporting requirements and analyses. Responds to audit requests as needed

POSITION ACCOUNTABILITIES:

• Responsible for managing Takeda’s participation in the Medicaid Drug Rebate Program, including activation of Medicaid price data, and validation, and control of Medicaid rebate payments totaling over $2.5B annually. Ensure all Rebates invoiced to Takeda under the MDRP, including Federal Medicaid, Manage Care Medicaid (MMC), State Pharmaceutical Assistance Programs, State Programs (i.e. Texas Chip), and Federal Medicaid Supplemental programs are paid within the statutory or contractual allotted time. 
• Develop subject matter expertise and analytic skills of top-performing analysts in the Medicaid Rebating group. Drive leadership learning among analysts in a group. Coach/mentor and guide analysts towards improved communication and expectation setting. While supporting the analytics and interpretation of new regulations for the Healthcare Reform Task Force, use the activities and” challenges associated with it to further build influence and trust with key stakeholders and decision-makers.
• Prepares and provides standard Medicaid rebate reports and trend analysis to Market Access group for expanding/establishing Supplemental contracts.
• Review and update Flex Medicaid Rebate Processing system (MRB) with updated contract terms and prices. Maintains knowledge in the operation of MRB. Collaborates with IT to make necessary updates to systems in line with guidance from CMS, OIG, OPA, other regulating entities, and statutes.

EDUCATION, BEHAVIORAL COMPETENCIES, AND SKILLS:

• Bachelor’s degree minimum requirement, Masters degree preferred
• 5-years of experience in the Pharmaceutical industry, preference for Managed Markets, Audit, and/or Finance.
• Ability to think through how decisions will impact Takeda, customers, and stakeholders prior to execution. 
• Experience with Flex suite, Model N® Government Pricing application strongly preferred. Experience with Microsoft Excel required. Experience with any other government contract discount and rebate management systems preferred.

LICENSES/CERTIFICATIONS:

• Relevant license/skills

TRAVEL REQUIREMENTS:

Less than-20%

Location

• Exton PA

This job posting excludes CO applicants

WHAT TAKEDA CAN OFFER YOU:

• 401(k) with company match and Annual Retirement Contribution Plan
• Tuition reimbursement Company match of charitable contributions
• Health & Wellness programs including onsite flu shots and health screenings
• Generous time off for vacation and the option to purchase additional vacation days
• Community Outreach Programs

Empowering Our People to Shine

Discover more at takedajobs.com

No Phone Calls or Recruiters Please.

Locations

Exton, PA

Worker Type

Employee

Worker Sub-Type

Regular

Time Type

Full time

Job ID R0035507

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