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Provider Services – Manager Medicaid Provider Network Administration 115-5005 Job in Tulsa, OK – CommunityCare

Clipped from: https://www.careerbuilder.com/job/JMD8862263F12U36UT3?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

JOB SUMMARY: Responsible for oversight of all Provider services and network development functionality specific to the plan’s Medicaid product. Responsible for network adequacy activities, provider contracting, relationship development, provider education and communications and activities specific to operations as directed by the Senior Manager, Provider Network Administration.KEY RESPONSIBILITIES: Build and maintain network including recruitment of providers as needed to attain network expansion and adequacy targets. Develop network adequacy goals and conduct ongoing monitoring to ensure network adequacy compliance with standards established by the State.Participate in the design of value-based reimbursement models in support of business strategies. Participate in development of quality and utilization metrics to achieve healthy outcomes for Medicaid members. Guides, under the direction of the Senior Manager, Provider Network Administration, provider contracting with health systems, hospitals, physician groups, individual practitioners, ancillary services, and community based social services agencies. Facilitate the development of statewide network. Ensure, to the extent possible, consistency with all other product strategies. Ensure contracts meet all regulatory and accreditation requirements.Develop and maintain relationships with health systems and key provider groups leadership. Develop and maintain relationships with community and social service agencies onboarded to assist with Social Determinants of Health (SDOH). Guide provider services representatives to ensure resolution of escalated provider issues. Oversee the planning of plan sponsored health events.Develop and maintain provider manual. Develop and maintain provider education and communication materials. Collaborate with development of plan employee education materials. Assist plan provider relations staff with educating providers on Medicaid product, policies and procedures, and programs.Participate in product strategy development. Develop and recommend updates to policies and procedures. Review member complaints against providers to identify trends. Initiative and program planning. Resource to departments for problem solving provider related issues and contract interpretation. Review and analysis of applicable reports. Attends Medicaid specific operations / leadership meetings. Additional responsibilities as assigned by leadershipQUALIFICATIONS: Ability to process and understand complex information. Ability to organize and oversee multiple complex tasks/projects to completion. Ability to coordinate resources in an effective, cost-efficient manner. Excellent communication and interpersonal skills. Ability to interpret and communicate detailed technical and financial information. Demonstrated knowledge of physician and hospital capitation reimbursement methodologies. Familiarity with healthcare and managed care business operations environments. Strong familiarity with managed care terminology. Proficiency with software systems including Amisys, Microsoft Word and Excel. Ability to converse and write fluently in English. EDUCATION/EXPERIENCE: Bachelor’s degree plus 3 years work related experience. Managerial / Supervisory experience preferred. Demonstrate, through past performance and progressive increases in responsibility, the ability to accomplish goals. Excellent oral presentation and writing skills. Previous physician/hospital contracting and reimbursement development experience. Familiarity with providers and provider issues in a managed care environment. Previous claims software experience, preferably Amisys.CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national originOther details Pay Type Salary Apply Now

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Job ID: 2308931154

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Nurse Medical Management I – InPatient Medicaid | Elevance Health

Clipped from: https://www.linkedin.com/jobs/view/nurse-medical-management-i-inpatient-medicaid-at-elevance-health-3524669881/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description

 
 

Nurse Medical Management I – InPatient Medicaid (JR58761)

 
 

Work Hours: 8am – 5pm, Pacific Standard Time.

 
 

Location: Remote. Must be willing to work from the local office as needed.

 
 

Primary Duties May Include, But Are Not Limited To

 
 

The Nurse Medical Management l is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high-quality, cost-effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards accurately interpreting benefits and managed care products and steering members to appropriate providers, programs or community resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.

 
 

  • Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
  • Ensures member access to medical necessary, quality healthcare in a cost-effective setting according to contract.
  • Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process.
  • Collaborates with providers to assess member’s needs for early identification of and proactive planning for discharge planning.
  • Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.
  • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

 
 

Minimum Requirements

 
 

  • Current active unrestricted RN license to practice as a health professional within the scope of practice in the state of residence.
  • Minimum 2 years acute care clinical experience.
  • 3 years InPatient experience.
  • Must be willing to work from the local office as needed.
  • Must work 8am – 5pm, Monday – Friday, Pacific Time.

 
 

Preferred Qualifications

 
 

  • Utilization Management / Review preferred.
  • Health Insurance experience.
  • Knowledge of Medicaid benefits preferred.

 
 

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

 
 

Be part of an Extraordinary Team

 
 

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

 
 

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.

 
 

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

 
 

Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

 
 

Be part of an Extraordinary Team

 
 

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

 
 

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.

 
 

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

 
 

Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

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Technology Solutions Consultant – Medicaid MMIS | Conduent

Clipped from: https://www.linkedin.com/jobs/view/technology-solutions-consultant-medicaid-mmis-at-conduent-3504101844/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

2022-62682


Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them.


You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.


Are you ready to join an innovative government Healthcare solutions provider supporting over 41 million customers annually?


Do you have practical experience advising on technical aspects of Medicaid MMIS operations and implementations?


About The Team


The Conduent Government Healthcare Solutions (GHS) teams help government agencies leverage data, technology, and business services to achieve public sector transformation and better serve constituents. We offer solutions for Medicaid payments, healthcare, pharmacy benefits management (PBM) and claims processing.


About The Role


The Technology Solutions Consultant – MMIS is the primary technical advisor and solution advocate for our Medicaid Management and Information System module (MMIS) offerings. You will be responsible fordirecting the development of comprehensive technical solutions as part of the sales and proposal management process – planning, advising, and validating technical solution content for our products, proposed implementation schedules, system development lifecycle methodologies, related tools, operations, and more. Your role will also have active participation in product development as an evangelist to bring in market trends in your respective area(s) for consideration and keep product capability relevant for the market.


Responsibilities


  • Provides subject matter expertise to internal pursuit teams for product attributes, product capability, implementation schedules, system development life cycle methodologies, related tools, operations, risk mitigation, market trends, staffing, pricing, and more as they relate to MMIS sales opportunities.
  • Work closely with sales, business stakeholders and technical product team resources to ensure proposed deals include well designed solutions that address customer requirements.
  • Work closely with Conduent stakeholders to ensure proposed deals support corporate goals, including but not limited to maximizing team productivity, profitability, and sustained sales growth
  • Accurately translates technical knowledge and requirements into clear and concise communications that emphasize business value to clients. Collaborate with pursuit and proposal teams to position Conduent products as value-adding, problem-solving, cost-mitigating solutions that meet regulatory requirements
  • Expertly interpret client business needs and capabilities and translates them into marketplace opportunities. Identify how technical solutions and products can address the key needs of a client/prospective client
  • Facilitate solutioning for bid solution gaps
  • Validates services and product functionality solution in written narrative and oral presentations to assure solution adherence and compliance with client requirements
  • Present products and services to clients in sales demonstrations
  • Work with functional and technical product managers to establish baseline project plans and estimates to be leveraged as templates for future deals
  • Mentor other associates to enhance their product knowledge, technical acumen, and technical sales skills.
  • Proactively pursue additional business development opportunities. Collaborate with sales to ensure these opportunities are effectively covered and advanced
  • Communicate effectively (oral and written) in all aspects of the role
  • Provide clarity and guidance on current and emerging technologies, market trends, competition, regulations, and other external areas that could impact Conduent solutions and operations. Advise on the practical/potential application of these technologies to current and future operating models
  • Able to influence a team of diverse stakeholders


Requirements


  • Experience with healthcare and Medicaid business or technical services with government clients across all phases of the program lifecycle
  • Demonstrated experience in implementation or operations of the following key areas: Claims administration, financial services, electronic data interchange, reporting, medical or clinical management, eligibility and enrollment, provider management, member management, project management, quality, and administration of a variety of health and human services programs or other core functions of MMIS or Modules
  • 5+ years’ experience in MMIS delivery/operations, product management or implementations
  • 2+ years’ experience in solution architecture, product sales, technology leadership
  • Knowledge of security, hosting, and infrastructure trends and requirements
  • Experience participating in proposals and related business development functions
  • Proficient writer and editor of proposal and presentation content
  • Strong oral and written communication skills
  • Proficient using SharePoint, Word, PowerPoint, MS Teams
  • Education: Bachelor’s from an accredited institution. Equivalent work experience, certifications and technical credentials will be considered.


Flexible Working


In This Role, We Offer The Following


We recognize that everyone is different and that the way in which people want to work and deliver at their best is different for everyone too.


  • Working remotely from home
  • Working flexible hours – flex your workday times to fit in what you need to get done while meeting client expectations
  • Flexible vacation time – coordinate accordingly with your team and go!


Working with us


Join a rapidly growing organization that can support your career goals.


Working for you


What You Get


  • Career Growth Opportunities
  • Full Benefit Options
  • Great Work Environment


About Us


Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them.


You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.


Join Us


Are you seeking an opportunity to make a real impact in a company that appreciates ideas and new ways of thinking? Come join us and grow with a team of people who will challenge and inspire you to be the best!


Pay Transparency Laws in some locations require disclosure of compensation-related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation or sick time. The estimated salary range for this role is $103,000 – 134,000.


Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.


People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the “Submit” button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduent’s ADAAA Accommodation Policy.


The Colorado Equal Pay for Equal Work Act requires employers to disclose the following information. If the successful applicant will be required to perform work from a physical site outside Colorado, the following information may not apply.Actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation or sick time.


At Conduent, we value the health and safety of our associates, their families and our community. Under our current protocols, we do not require vaccination against COVID for most of our US jobs, but may require you to provide your COVID vaccination status, where legally permissible.

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CMS – IT Specialist

Clipped from: https://www.usajobs.gov/job/710100100?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Department of Health And Human Services

Summary

This is a Senior Level (SL) position located in the Centers for Medicare & Medicaid Services (CMS), Office of Information Technology.


In this position, you will serve as the principal technologist official on the implementation and operation of CMS’ enterprise cloud computing strategy & services, ensuring the optimization of CMS’ information technology (IT) investments and information management practices to continuously enhance the cost-effective delivery of cloud computing services.

Learn more about this agency

Help

Overview

  • Accepting applications

 
 

  • Open & closing dates

03/02/2023 to 03/16/2023

  • Salary

$141,022 – $195,000 per year

  • Pay scale & grade

SL 00

Location

1 vacancy in the following location:

No

  • Telework eligible

Yes—as determined by the agency policy.

  • Travel Required

Not required

  • Relocation expenses reimbursed

No

  • Appointment type

Permanent –

  • Work schedule

Full-time –

  • Service

Competitive

  • Promotion potential

None

  • Job family (Series)

2210 Information Technology Management

  • Supervisory status

No

  • Security clearance

Not Required

  • Drug test

No

  • Position sensitivity and risk

Moderate Risk (MR)

  • Trust determination process

Suitability/Fitness

  • Announcement number

HHS-CMS-SL-2023-11867288

  • Control number

710100100

Videos

 
 

Help

Duties

  • Technical leadership of CMS’ enterprise cloud computing services and overall technical leadership providing expertise and guidance including design, implementation, and operations management of multiple cloud services.
  • Provide strong expertise in programming, software architecture design, cloud-based infrastructure configuration, and cloud security design.
  • Provide overall leadership and management that includes overseeing the engineering team and provide deep knowledge of programming as well as designing interfaces/integrations at a very large enterprise level.
  • Responsible for shaping the CMS’ cloud computing technology strategy and managing the engineering efforts within their organizations.

Help

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.
  • A one-year probationary period may be required upon appointment.

Qualifications

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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.


In order to qualify for this SL, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to at least the GS-15 grade level in the Federal government, obtained in either the private or public sector, to include: 1) knowledge and implementation of products and services to a hybrid cloud ecosystem; 2) Assessing and expanding enterprise programs for maturity and effectiveness and developing a roadmap for improvements; 3) Leading people and teams across multiple organizations to align with critical organization priorities.


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.


Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11867288

Education

This job does not have an education qualification requirement.

Additional information

Bargaining Unit Position: No
Tour of Duty: Flexible

Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Required



To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply.


Workplace Flexibility at CMS: CMS offers flexible working arrangements and allows employees the opportunity to participate in telework combined with alternative work schedules at the manager’s discretion. This position may be authorized for telework. Telework eligibility will be discussed during the interview process.


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 www.opm.gov/rif/employee_guides/career_transition.asp.

Read more

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 windowLearn 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.

How You Will Be Evaluated

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

If you meet the minimum qualifications and education requirements for this position, your application and responses to the online occupational questionnaire will be evaluated under Category Rating and Selection procedures for placement in one of the following categories:

  • Highly Qualified – for those who are superior in the evaluation criteria
  • Well Qualified – for those who excel in the evaluation criteria
  • Qualified – for those who only meet the minimum qualification requirements

The Category Rating Process does not add veterans’ preference points or apply the “rule of three” but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans’ preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher).


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):


  • Building Coalitions/Communications
  • Business Acumen
  • Information Technology
  • Leading People
  • Managing Change

This is a competitive vacancy announcement advertised under Delegated Examining Authority. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would therefore be given new appointments to the civil service; however, benefits, time served and all other Federal entitlements would remain the same.

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 windowLearn 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.

  • As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have – whether you’re a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you’re eligible under their policies.

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: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary 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.


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.


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.

  • Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 03/16/2023 to receive consideration.


    IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.


    We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:

 
 

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month and year (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.

  • To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  • Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
  • After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
  • You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.

To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to Katherine.vaughn@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. Please send all documents in 1 PDF file. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

Agency contact information

Kathy Vaughn

Phone

410-786-1050

Email

Katherine.vaughn@cms.hhs.gov

Address

Office of Information Technology
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

Once your online application is submitted, you will receive a confirmation notification by email. Your application will be evaluated to determine your eligibility and qualifications for the position. After the evaluation is complete, you will receive another email notification regarding the status of your application.


Within 30 business days of the closing date,03/16/2023, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

  • The Federal hiring process is set up to be fair and transparent. Please read the following guidance.

 
 

Help

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: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/

2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary 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.


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.


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.

Help

How to Apply

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 03/16/2023 to receive consideration.


IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.


We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month and year (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.

  • To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  • Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
  • After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
  • You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.

To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.


This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to Katherine.vaughn@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. Please send all documents in 1 PDF file. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

Read more

Agency contact information

Kathy Vaughn

Phone

410-786-1050

Email

Katherine.vaughn@cms.hhs.gov

Address

Office of Information Technology
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

Once your online application is submitted, you will receive a confirmation notification by email. Your application will be evaluated to determine your eligibility and qualifications for the position. After the evaluation is complete, you will receive another email notification regarding the status of your application.


Within 30 business days of the closing date,03/16/2023, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.

Read more

Posted on

Data Scientist job in Remote at Centers for Medicare and Medicaid Services

Clipped from: https://diversityjobs.com/career/4840104/Data-Scientist?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

  • Conduct data science research with statistical and analytical tools used to analyze complex sets of data.
  • Solve technical problems by writing code and explaining data architecture and design to both technical and non-technical audiences,
  • Develop project plans to ensure logistics are handled efficiently, identifying potential bottlenecks and resolving issues within the scope of authority.
  • Direct internal and external process or system reviews, studies, projects, and data validation efforts, which provide a mean for evaluating system performance and vulnerabilities

 
 

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.
  • This is a remote position; however, the position reports to a CMS Office on a periodic basis. Requirements to report to the office will vary and can be discussed at the time of interview.

 
 

 
 

Qualifications
 

ALL QUALIFICATION REQUIREMENTS MUST BE MET BY 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.



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) collaborating with internal or external stakeholders to review specialized healthcare data and recommend solutions; and 2) utilizing at least one of the following programming languages: SAS, VBA, Python, SQL, or R to develop approaches or methodologies for collection, analysis, and interpretation of data; and 3) utilizing business intelligence tools (e.g., Tableau, PowerBI), or geographic information systems (e.g., ESRI ArcGIS) to generate reports or other forms of data visualizations that convey data analyses to technical and non-technical audiences.


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.

Education
 

Education Requirement: In addition to meeting the qualification requirements, all candidates must have the following educational requirements:

Degree: Mathematics, statistics, computer science, data science or field directly related to the position. The degree must be in a major field of study (at least at the baccalaureate level) that is appropriate for the position.

or

Combination of education and experience: Courses equivalent to a major field of study (30 semester hours) as shown in paragraph A above, plus additional education or appropriate experience.

TRANSCRIPTS are required to verify satisfactory completion of the educational requirement listed above. Failure to submit a copy of your transcripts at the time of application WILL result in an ineligible rating. Please see “Required Documents” section below for what documentation is required at the time of application.

Click the following link to view the occupational questionnaire:

Additional information
 

Bargaining Unit Position: Yes, American Federation of Government Employees, Local 1923

Tour of Duty: Flexible


Recruitment/Relocation Incentive: Not Authorized


Financial Disclosure: Not Required


To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply.


Remote-Out Positions at CMS: This is a remote position; however, the position reports to a CMS Office on a periodic basis (e.g. 1-2 times per year). Requirements to report to the office will vary and can be discussed at the time of interview. As such, your pay will be based on your home address. For more information on locality and pay scales, please . Your worksite must be within the United States and you must adhere to all regulations and policies regarding remote work at CMS and in the federal government, including the signing of a remote work agreement.


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. . 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 .

 
 

  •  

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. .

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.

 
 

 
 

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:


2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. . Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.


3. College Transcripts. Since this position requires specific education, you must submit a transcript attesting to your possession of the required education. You may submit an unofficial transcript or a list of college courses completed indicating course titles, credit hours, and grades received. An official transcript is required if you are selected for the position. If selected, you must provide an original document before the final job offer may be extended. If you do not submit a transcript indicating your possession of the required education, you will not be considered for this position.


College Transcripts and Foreign Education: Applicants who have completed part or all of their education outside of the U.S. must have their foreign education evaluated by an accredited organization to ensure that the foreign education is comparable to education received in accredited educational institutions in the U.S. For a listing of services that can perform this evaluation, visit the website. This list, which may not be all inclusive, is for informational purposes only and does not imply any endorsement of any specific agency.


If you are applying for a position for which a state license is issued (e.g., physician, engineer, attorney) possession of a valid and current U.S. professional license by a graduate of a foreign professional school or program is sufficient proof that the foreign education has been determined to be equivalent to the requisite U.S. professional education in that occupational field.


PLEASE NOTE: A complete application package includes the online application, resume, transcripts 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, transcripts and CMS required documents, will result in you not being considered for employment.


Additional Forms REQUIRED Prior to Appointment:

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 .
 

If you are relying on your education to meet qualification requirements:


 

Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from
.

Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

How to Apply
 

Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 03/29/2023 to receive consideration.

IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.


We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:

 
 

  • Official Position Title (include series and grade if Federal job)
  • Duties (be specific in describing your duties)
  • Employer’s name and address
  • Supervisor name and phone number
  • Start and end dates including month and year (e.g. June 2007 to April 2008)
  • Full-time or part-time status (include hours worked per week)
  • Salary

 
 

Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.

 

 
 

  • To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
  • Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
  • After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
  • You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.

 
 

To verify the status of your application, log into your USAJOBS account (), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: .

This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to IRADHACandidate@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.


Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. Also send any transcripts, licenses or certifications as requested in this announcement. Please send all documents in 1 PDF file. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.

Agency contact information

CMS IRA



 

Email

Address

Center for Medicare


7500 Security Blvd


Woodlawn, MD 21244


US

Next steps
 

Once your online application is submitted, you will receive a confirmation notification by email. Within 30 business days of the closing date,03/29/2023, you may check your status online by logging into your USAJOBS account (). We will update your status after each key stage in the application process has been completed.

Fair & Transparent
 

The Federal hiring process is set up to be fair and transparent. Please read the following guidance.

 
 

Posted on

Senior Business Analyst – Medicaid – Gainwell Technologies

Clipped from: https://www.dice.com/job-detail/eb49bd3b-53cd-43e7-89e4-fbf4c64a1d8c?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary


As a Senior Business Analyst – Medicaid at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve – a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.


Your role in our mission


Take charge and focus on how we can meet critical needs to help clients deliver better health and human services outcomes.

 

  • Coordinate workstreams and teams on IT projects to align solutions with client business priorities
  • Demonstrate your knowledge as SME and liaison for clients and internally between technical and non-technical workers to transform requirements into real results
  • Delegate work across teams, and coach and monitor project team members to plan, design and improve complex business processes and modifications
  • Streamline workflows across clients and technical personnel to determine, document and oversee carrying out system requirements
  • Support quality control as you approve and validate test results to verify that all requirements have been met

What we’re looking for


 

  • 5+ more years of experience working as a business analyst or ‘requirements translator’ between technical and non-technical personnel, with 3 or more years of Medicaid and Medicare experience preferred.
    Experience and knowledge with HCPCS and ICD procedure codes and ICD diagnosis code is a plus
  • Knowledge of Microsoft Excel advanced features such as macros and/or relational database software
  • Ability to clearly and concisely translate technical requirements to a non-technical audience
  • Skills working with business processes and re-engineering
  • Curiosity to solve complex problems and strong interpersonal skills to interact with and influence clients and team members
  • A caring team leader who motivates and coaches less experienced resources

What you should expect in this role


 

  • Fully remote, only US location options will be considered
  • Client is in Central time zone
  • #LI-HC1
     

The pay range for this position is $63,100.00 – $90,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our and visit our for all available job role openings.


Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

Posted on

NAMD- Operations Associate

Clipped from: https://www.idealist.org/en/nonprofit-job/c0764d03c0d240d08d161688bd8c2cc2-operations-associate-national-association-of-medicaid-directors-washington?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Overview 

The National Association of Medicaid Directors (NAMD) seeks an Operations Associate to support and be part of a high-functioning, high-quality organization in terms of internal operations and member services.  

About NAMD 

NAMD is a nonpartisan, nonprofit, professional association representing leaders of state Medicaid agencies and Children’s Health Insurance Programs (CHIP) across the country. Members from the 56 states and territories drive major innovations in health care while overseeing Medicaid and CHIP, two of the nation’s most vital health care programs serving millions of beneficiaries.   

The Core Values of NAMD:  

  • Community. We are dedicated to creating a strong, connected, and inclusive fellowship of state and territorial Medicaid leaders.   
  • Non-partisanship. We are committed to advancing the work of state Medicaid leaders and the programs they manage without bias toward one political party or ideology.    
  • Independence. Our priorities and work are directed by our members.   
  • Partnership. We commit to working in partnership with federal officials and other leaders to advance the work of the association and state and territorial Medicaid leaders.    
  • Excellence. We strive for continuous improvement in our service to members, our operations and within the Medicaid and CHIP programs and commit to conducting ourselves and our work with the highest integrity.    
  • Equity. We recognize and honor the diversity of our staff, our association members and the individuals served by Medicaid and CHIP and we strive to conduct our work to ensure diversity, inclusion, and advance equity.    

Core values of the NAMD team:  

  • Mission-driven. We are united in our passion for mission-driven work to make the world a better place.  
  • Community. We are committed to being a strong, connected, and supportive team of peers.  
  • Non-partisanship. We are committed to advancing NAMD’s work with curiosity, and without bias toward one political party or ideology.   
  • Growth and Development. We invest time and attention to developing ourselves to become better people and a stronger team.  
  • Equity. We recognize and honor the diversity of our staff, our association members and the individuals served by Medicaid and CHIP and we strive to conduct our work to ensure diversity, inclusion, and advance equity.    
  • Candor. We communicate with each other with candor, and in the spirit of constructive and collective improvement.  
  • Pride. We strive for high quality in our work and commit to conducting ourselves with the highest integrity.    

Position Description 

The Operations Associate will be a key member of a small, highly collaborative team and will be responsible for supporting key aspects of the day-to-day operations. The Operations Associate will report to the Director of Operations.  

Position Responsibilities 

  1. Provide administrative support for the association: 

a. Scheduling and administrative support for the Executive Director and Deputy Executive Director 

b. Acting as a gatekeeper for external inquiries and requests  

c. Scheduling support for program directors with recurring meetings 

d. Making travel arrangements 

e. Maintaining NAMD’s master calendar  

f. Receiving and organizing information in various databases (e.g., in SharePoint/CRM, Excel) 

 
 

2. Support with core financial functions: 

a. Reviewing and processing expense reports 

b. Invoicing 

c. Processing check requests 

d. Serving as a liaison with the accounting firm  

 
 

3. Office support: 

a. Managing and ordering office supplies 

b. Serving as liaison to telecommunications support contractor (Cox Business- 

phones/Internet) 

4. Support with association meetings: 

a. Assisting with logistics and prep for association meetings 

b. Helping with hosting in-person events (e.g., set up, registration, materials distribution, etc.) 

5. Participation in NAMD core operational activities including: 

a. Attending staff meetings and professional development activities 

b. Performance management and evaluation activities 

 Minimum Qualifications  

In addition, a successful candidate will be committed to strengthening and expanding the operational excellence of NAMD. 

  • Candidates must possess an Associate’s Degree with 2 years of experience supporting senior leaders/executives in an office environment OR 4 years of related work experience (With 2 of those years in supporting senior leaders/executives in an office environment) 
  • Strong organizational skills 
  • Strong Salesforce knowledge and experience 
  • High proficiency and experience with Microsoft Office 
  • Strong verbal and written communication skills 
  • Excellent customer service and interpersonal skills with a practical, positive, service-oriented mindset  
  • Have an optimistic outlook and a flexible, innovative approach to problem-solving  
  • Ability to manage multiple projects 
  • Be a self-starter with ability to seek appropriate guidance 
  • Ability to work independently 
  • Lived experience with the Medicaid program is greatly valued by NAMD .   

General Applicant Information  

This position is located in Washington, DC. In person availability is required with the ability to telework.   

NAMD is an equal opportunity employer and is committed to attracting and retaining a diverse staff and honoring the experiences, perspectives, and unique identity of applicants.  

Posted on

CMS – Deputy Center Director Oversight and Enforcement Policy Center For Program Integrity

Clipped from: http://federalgovernmentjobs.us/jobs/Deputy-Center-Director-Oversight-and-Enforcement-Policy-Center-For-Program-Integrity-709433400.html?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Summary

This position is located in the Center for Program Integrity, Centers for Medicare and Medicaid Services (CMS).

As the Deputy Center Director (Oversight and Enforcement Policy), you will provide executive leadership and direction in developing and implementing Medicare, Medicaid, and Marketplace program integrity programs, strategic direction for CMS, the states, and law enforcement partners, and all actions CPI takes to hold providers and suppliers responsible for fraud, waste, and abuse.”

Overview

  • Open & closing dates

03/01/2023 to 04/01/2023

  • Salary

$141,022 – $212,100 per year

  • Pay scale & grade

ES 00

  • Locations

1 vacancy in the following locations:

No

  • Telework eligible

Yes—as determined by the agency policy.

  • Travel Required

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

  • Relocation expenses reimbursed

No

  • Appointment type

Permanent –

  • Work schedule

Full-time –

  • Service

Senior Executive

  • Promotion potential

None

  • Job family (Series)

0340 Program Management

  • Supervisory status

Yes

  • Security clearance

Not Required

  • Drug test

Yes

  • Position sensitivity and risk

Critical-Sensitive (CS)/High Risk

  • Trust determination process

Suitability/Fitness

  • Announcement number

HHS-CMS-ES-2023-11855155

  • Control number

709433400

This job is open to

  • Senior executives

Those who meet the five Executive Core Qualifications (ECQs).

  • The public

U.S. Citizens, Nationals or those who owe allegiance to the U.S.

Clarification from the agency

All groups of qualified individuals

Duties

  • Integrates program integrity activities and contracting into a strategic framework targeting the highest risk areas and health system issues focusing on preventing fraud, waste, and abuse.
  • Develops and implements innovative program integrity initiatives.
  • Provides executive leadership and direction in developing and implementing Medicare, Medicaid, and Marketplace program integrity programs and provides strategic direction for CMS, the states, and law enforcement partners.
  • Directs the development of Medicare, Medicaid, and Marketplace program integrity strategy and tactics for fee-for-service and managed care financing.
  • Plans and develops methods to monitor program integrity efforts, including provider enrollment, administration, and coordination of CMS’s efforts to curb fraud and abuse in the Medicare, Medicaid, and Marketplace programs.
  • Manages all facets of program integrity functions for Medicare Administrative Contractors and Medicare Integrity Program contractors and manages all Medicare and Medicaid program integrity enforcement activities.

Requirements Conditions of Employment

  • U.S. Citizenship required.
  • Background and/or Security Investigation required.
  • One year SES probationary period required.
  • The Ethics in Government Act, PL 95-521 requires the applicant selected for this position to submit a financial disclosure statement, SF-278, prior to assuming the SES position, annually, and upon termination of employment.
  • Status applicants must submit a copy of their most recent SF-50, Notification of Personnel Action, which verifies status.
  • All initial appointments to an SES position are contingent on approval from OPM’s Qualifications Review Board unless the selectee has successfully participated in an OPM approved SES Candidate Development Program.
  • All male applicants born after December 31, 1959, must have registered for the selective service. You will be required to sign a statement certifying his registration, or the applicant must demonstrate exempt status under the Selective Service Law.
  • Only experience obtained by the closing date of this announcement will be considered.

Qualifications

All competitive candidates for SES positions with the Federal Government must demonstrate leadership experience indicative of senior executive level management capability. To meet the minimum qualification requirements for this position, you must show in your resume that you possess the Fundamental Competencies, five Executive Core Qualifications, and the Professional/Technical Qualifications listed below. Evidence of this experience must be incorporated into your five page resume. Separate narratives for the Executive Core Qualifications and/or Professional/Technical Qualifications will not be accepted or considered. Typically, experience of this nature is gained at or above the GS-15 grade level in the Federal service, or its equivalent with state or local government, the private sector, or nongovernmental organizations.


Fundamental Competencies:
Interpersonal Skills, Oral Communication, Integrity/Honesty, Written Communication, Continual Learning, and Public Service Motivation.


Executive Core Qualifications (ECQs)

  1. Leading Change: The ability to bring about strategic change, both within and outside the organization, to meet organizational goals. Inherent to this ECQ is the ability to establish an organizational vision and to implement it in a continuously changing environment.
  2. Leading People: The ability to lead people toward meeting the organization’s vision, mission, and goals. Inherent to this ECQ is the ability to provide an inclusive workplace that fosters the development of others, facilitates cooperation and teamwork, and supports constructive resolution of conflicts.
  3. Results Driven: The ability to meet organizational goals and customer expectations. Inherent to this ECQ is the ability to make decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks.
  4. Business Acumen: The ability to manage human, financial, and information resources strategically.
  5. Building Coalitions: The ability to build coalitions internally and with other Federal agencies, State and local governments, nonprofit and private sector organizations, foreign governments, or international organizations to achieve common goals.

Professional/Technical Qualifications (PTQs)


This position also requires that you possess PTQs that represent knowledge, skills, and abilities essential for success in this role. The following PTQs must be evident in your resume.

  1. Demonstrated knowledge and experience in managing health care delivery, program integrity, utilization management, or public health program functions within a large-scale health plan/program, including the critical social, political, and economic forces that affect them.
  2. Comprehensive knowledge of laws, policies, and regulations that apply to the administration of health care delivery and program integrity and a demonstrated ability to use this knowledge and associated metrics to assess and improve program effectiveness, management processes, and systems to achieve organizational priorities and results.
  3. Demonstrated experience, in a senior leadership position, dealing and negotiating with a wide range of senior level officials in various government agencies, law enforcement organizations, and/or public and private organizations on complex and controversial issues concerning health care programs, including the protection of the integrity of these programs.

It is STRONGLY recommended that you visit the following Office of Personnel Management (OPM) webpage for more information regarding the Fundamental Competencies and ECQs.

https://www.opm.gov/policy-data-oversight/senior-executive-service/executive-core-qualifications/#url=Overview

If selected, you will be required to complete an ECQ package by drafting narratives for each of the ECQs for submission and certification by an OPM Qualifications Review Board (QRB) in order to be placed in this position. If you are currently serving in a career SES appointment, are eligible for reinstatement into the SES, or have successfully completed an SES Candidate Development Program approved by the Office of Personnel Management (OPM), you will not need to draft the ECQs.

Education

This job does not have an education qualification requirement.

Additional information

Salary for SES positions varies depending on qualifications. The annual salary range is found at the top of this announcement. The selectee for this position may be eligible for annual performance bonuses and performance-based pay adjustments.


Veteran’s Preference does not apply to the SES.
Federal agencies may request information regarding the vaccination status of selected applicants for the purposes of implementing other workplace safety protocols, such as protocols related to masking, physical distancing, testing, travel, and quarantine.


Workplace Flexibility at CMS: CMS offers flexible working arrangements and allows employees the opportunity to participate in telework combined with alternative work schedules at the manager’s discretion. This position may be authorized for telework. Telework eligibility will be discussed during the interview process.


To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce Executive Order 14043 Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a federal job announcement includes the requirement to be fully vaccinated against COVID-19 pursuant to Executive Order 14043, that requirement does not currently apply. Positions with vaccination requirements under authority(ies) separate and distinct from Executive Order 14043 will be clearly identified. HHS may continue to require documentation of proof of vaccination to ensure compliance with those policies. Health and safety protocols remain in effect, in accordance with CDC guidance and the Safer Federal Workforce Task force. Consistent with current guidance, workplace safety protocols will no longer vary based on vaccination status or otherwise depend on the availability of vaccination information. Therefore, to the extent a job announcement states that HHS may request information regarding the vaccination status of selected applicants for the purposes of implementing workplace safety protocols, this statement does not currently apply.

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 windowLearn 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.

How You Will Be Evaluated

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

We use a multi-step process to evaluate and refer applicants:

  1. Minimum requirements: Your application must show that you meet all requirements, including the education and/or experience required for this position. You may be found ‘not qualified’ if you do not possess the minimum competencies required for the position. If your application is incomplete, we may rate you as ineligible.
  2. Rating: A panel of Senior Executives will review your application and evaluate your qualification for this position based on the information in your application. Your application will be rated, based on the extent and quality of your experience, education, and training relevant to the duties of this position. Interviews will be at the discretion of the panel and/or selection official.
  3. Referral: If you are among the top qualified candidates, your application will be referred to a selection official for consideration and possible interview.

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 windowLearn 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.

Required Documents

As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have – whether you’re a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you’re eligible under their policies.

All applicants are required to submit and/or complete the following documents to be considered for the position:

  1. Resume that contains your full name, address and phone number, and does not exceed the five page limit;
  2. Cover Letter (optional);
  3. Online Assessment Questionnaire. To preview the assessment questionnaire, click here: https://apply.usastaffing.gov/ViewQuestionnaire/11855155

NOTE: THE USAJOBS RESUME TEMPLATE MAY RESULT IN A RESUME BEING LONGER THAN FIVE PAGES. PLEASE VERIFY PAGE LENGTH BEFORE SUBMISSION OF APPLICATION.


Applicants who are currently, or were previously, Federal employees must also submit:

  1. An SF-50 showing your current or former civil service status; and
  2. Proof of OPM Qualifications Review Board certification (OPM-approved SES Candidate Development Program graduates), if applicable.

NOTE: Documents submitted that are not listed in the Required Documents section of this announcement will not be considered or forwarded to the rating panel or selecting official.

How to Apply

The application process used to recruit for this position is the RESUME BASED method. Although applicants cannot address the ECQs or PTQs separately, evidence of each must be clearly demonstrated in the five page resume and throughout the rest of the application package.


To be considered for this position, you must submit a complete application no later than 11:59 PM (Eastern Time) on the closing date of the announcement – 04/01/2023. If you fail to submit a complete application prior to the closing time, the application system will not allow you to finish. Requests for extensions will not be granted, so please begin the application process with enough time to finish before the deadline.


ALL APPLICANTS (including Commissioned Corps Officers): You must submit a resume (five-page maximum – resumes that exceed the five-page limit will not be considered). You may also submit an optional cover letter. Separate written narratives addressing the ECQs and PTQs will not be considered.


You must complete the online assessment questions. If your resume does not support the responses in your questionnaire, you may be rated “ineligible.” We recommend that your resume emphasize your level of responsibilities, the scope and complexity of the programs managed, and your program accomplishments, including the results of your actions.


Your five page resume should include the following:

  1. Job Information (Announcement number and title of job for which you are applying)
  2. Personal Information (Full name, mailing address, work and home phone number and email addresses)
  3. Education (College/University name, city and state, major, type and year of degree)
  4. Work Experience (Job title (including series and grade, if Federal employment, duties and accomplishments, employer’s name and address, start and end dates (month and year), hours per week, and salary)
  5. Evidence of experience which addresses the five ECQs and the PTQs.
  6. Other qualifications (Job-related training courses (title and year), skills, certifications and licenses, honors, awards, and special accomplishments).

It is important that your resume be complete and thorough. Please be sure to include and address all ECQs and PTQs in your resume. A sample five-page resume that incorporates the ECQs can be found in OPM’s Guide to Senior Executive Service Qualifications: https://www.opm.gov/policy-data-oversight/senior-executive-service/reference-materials/guidetosesquals_2012.pdf
Steps to submit a complete application:

  1. You must have a USAJobs account and be logged in.
  2. Once you are logged in and all of your application materials are ready, click the “Apply” button.
  3. You must respond to all application assessment questions, carefully following the instructions provided. To preview the questions, click here: https://apply.usastaffing.gov/ViewQuestionnaire/11855155
  4. You will then be asked to upload your resume and optional cover letter. Additional documentation not listed in the Required Documents will not be considered.

Agency contact information Kathy Vaughn

Phone

410-786-1050

Email

Katherine.vaughn@cms.hhs.gov

Address

Center for Program Integrity
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

You will receive an email informing you of the receipt of your application. Applicants who are determined to be highly qualified by the SES rating panel will be referred to the selecting official for further consideration and possible interview, at which time you will be contacted. All applicants will be notified of the outcome of their applications once a final selection is made.

Required Documents

All applicants are required to submit and/or complete the following documents to be considered for the position:

  1. Resume that contains your full name, address and phone number, and does not exceed the five page limit;
  2. Cover Letter (optional);
  3. Online Assessment Questionnaire. To preview the assessment questionnaire, click here: https://apply.usastaffing.gov/ViewQuestionnaire/11855155

NOTE: THE USAJOBS RESUME TEMPLATE MAY RESULT IN A RESUME BEING LONGER THAN FIVE PAGES. PLEASE VERIFY PAGE LENGTH BEFORE SUBMISSION OF APPLICATION.


Applicants who are currently, or were previously, Federal employees must also submit:

  1. An SF-50 showing your current or former civil service status; and
  2. Proof of OPM Qualifications Review Board certification (OPM-approved SES Candidate Development Program graduates), if applicable.

NOTE: Documents submitted that are not listed in the Required Documents section of this announcement will not be considered or forwarded to the rating panel or selecting official.

How to Apply

The application process used to recruit for this position is the RESUME BASED method. Although applicants cannot address the ECQs or PTQs separately, evidence of each must be clearly demonstrated in the five page resume and throughout the rest of the application package.


To be considered for this position, you must submit a complete application no later than 11:59 PM (Eastern Time) on the closing date of the announcement – 04/01/2023. If you fail to submit a complete application prior to the closing time, the application system will not allow you to finish. Requests for extensions will not be granted, so please begin the application process with enough time to finish before the deadline.


ALL APPLICANTS (including Commissioned Corps Officers): You must submit a resume (five-page maximum – resumes that exceed the five-page limit will not be considered). You may also submit an optional cover letter. Separate written narratives addressing the ECQs and PTQs will not be considered.


You must complete the online assessment questions. If your resume does not support the responses in your questionnaire, you may be rated “ineligible.” We recommend that your resume emphasize your level of responsibilities, the scope and complexity of the programs managed, and your program accomplishments, including the results of your actions.


Your five page resume should include the following:

  1. Job Information (Announcement number and title of job for which you are applying)
  2. Personal Information (Full name, mailing address, work and home phone number and email addresses)
  3. Education (College/University name, city and state, major, type and year of degree)
  4. Work Experience (Job title (including series and grade, if Federal employment, duties and accomplishments, employer’s name and address, start and end dates (month and year), hours per week, and salary)
  5. Evidence of experience which addresses the five ECQs and the PTQs.
  6. Other qualifications (Job-related training courses (title and year), skills, certifications and licenses, honors, awards, and special accomplishments).

It is important that your resume be complete and thorough. Please be sure to include and address all ECQs and PTQs in your resume. A sample five-page resume that incorporates the ECQs can be found in OPM’s Guide to Senior Executive Service Qualifications: https://www.opm.gov/policy-data-oversight/senior-executive-service/reference-materials/guidetosesquals_2012.pdf
Steps to submit a complete application:

  1. You must have a USAJobs account and be logged in.
  2. Once you are logged in and all of your application materials are ready, click the “Apply” button.
  3. You must respond to all application assessment questions, carefully following the instructions provided. To preview the questions, click here: https://apply.usastaffing.gov/ViewQuestionnaire/11855155
  4. You will then be asked to upload your resume and optional cover letter. Additional documentation not listed in the Required Documents will not be considered.

Agency contact information Kathy Vaughn

Phone

410-786-1050

Email

Katherine.vaughn@cms.hhs.gov

Address

Center for Program Integrity
7500 Security Blvd
Woodlawn, MD 21244
US

Learn more about this agency

Next steps

You will receive an email informing you of the receipt of your application. Applicants who are determined to be highly qualified by the SES rating panel will be referred to the selecting official for further consideration and possible interview, at which time you will be contacted. All applicants will be notified of the outcome of their applications once a final selection is made.

Posted on

Health Fraud Investigator II – Qlarant

Clipped from: https://www.adzuna.com/details/3954508927?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Salary: Location: Company: Hours:

$61,008 per year – estimated ?

Remote, OR

Qlarant

Full time

 
 

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.

Are you skilled in reviewing Medicaid claims and source records? Do you have a track record of exceeding expectations, meeting deadlines and handling multiple assignments? If that sounds like you, Qlarant has the perfect opportunity! We have an immediate opening for a Healthcare Fraud Investigator II on our UPIC SW Medicaid investigations team. This position could be based in our Dallas or Easton, MD offices or home-based in most states in the continental US. Qlarant offers an excellent benefits package that includes healthcare, two retirement plans and a generous leave program.

As a Healthcare Fraud Investigator II working on our Unified Program Integrity Contractor (UPIC) team for the Southwest Jurisdiction, you can contribute to our efforts to make a positive difference in the future of the Medicare and Medicaid programs. Our UPIC Southwest team identifies and investigates fraud, waste and abuse in the Medicare and Medicaid programs covering 7 states.

This is a mid-level professional position that performs evaluations of investigations and makes field level judgments of potential Medicaid and Medicare fraud, waste, and abuse that meet established criteria for referral to law enforcement or administrative action.

Essential Duties and Responsibilities include the following. Other duties may be assigned

  • Utilizes leads provided by the team and referrals from government and private agencies, works with the team to prioritize complaints for investigation, and then investigates, conducts interviews and reviews information to make potential fraud determination.
  • Determines investigation or case appropriateness of fraud, waste and abuse issues in accordance with pre-established criteria.
  • Based on contract requirements, may refer potential adverse decisions to the Lead Investigator/Manager/Medical Director or designee.
  • Conducts interviews of witnesses, informants, and subject area experts and targets of investigations.
  • Identifies, collects, preserves, analyzes and summarizes evidence, examines records, verifies authenticity of documents, and may provide information to support the preparation of attestations/referrals
  • Drafts investigation reports, evaluates investigation reports, and promotes effective and efficient investigations.
  • Initiates and maintains communications with law enforcement and appropriate regulatory agencies including presenting or assisting with presenting investigation or case findings for their consideration to further investigate, prosecute, or seek other appropriate regulatory or administrative remedies.
  • Testifies at various legal proceedings as necessary.
  • Identifies opportunities to improve processes and procedures.
  • Has the responsibility and authority to perform their job and provide customer satisfaction.

Supervisory Responsibilities: This job has no supervisory responsibilities.

Required Skills
 

  • Ability to work independently with minimal supervision
  • Ability to communicate effectively with all members of the team to which he/she is assigned
  • Ability to grasp and adapt to changes in procedure and process
  • Ability to effectively resolve complex issues
  • Ability to mentor other associates
  • Additional required skills include:

 
 

  • Report writing and documentation
  • Federal and State Policy research
  • Reviewing Medicaid claims and source records
  • Proficiency in Microsoft Excel and Word
  • Attention to detail

Required Experience
 

  • Bachelor’s Degree and two years’ experience in investigations/fraud detection or healthcare programs required. Equivalent education and experience may be combined.
  • Experience reviewing Medicaid claims or exposure to Medicaid (administrative, investigative, data, or otherwise) is stronly preferred.
  • Prior successful experience with CMS and OIG/FBI or similar agencies preferred.
  • Certification in an applicable program such as Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification or successful completion of a law enforcement academy preferred.

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.

 
 

  • Ability to work independently with minimal supervision
  • Ability to communicate effectively with all members of the team to which he/she is assigned
  • Ability to grasp and adapt to changes in procedure and process
  • Ability to effectively resolve complex issues
  • Ability to mentor other associates
  • Additional required skills include:

 
 

  • Report writing and documentation
  • Federal and State Policy research
  • Reviewing Medicaid claims and source records
  • Proficiency in Microsoft Excel and Word
  • Attention to detail

 
 

  • Bachelor’s Degree and two years’ experience in investigations/fraud detection or healthcare programs required. Equivalent education and experience may be combined.
  • Experience reviewing Medicaid claims or exposure to Medicaid (administrative, investigative, data, or otherwise) is stronly preferred.
  • Prior successful experience with CMS and OIG/FBI or similar agencies preferred.
  • Certification in an applicable program such as Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator Certification or successful completion of a law enforcement academy preferred.

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.

Posted on

Director, Network Provider Relations (Michigan/Medicaid-Remote) | CVS Health

Clipped from: https://www.linkedin.com/jobs/view/lead-director-network-provider-relations-michigan-medicaid-remote-at-cvs-health-3505730229/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description

 
 

The Michigan Medicaid Network State Director manages and oversees compliance with our Network responsibilities as provided within the State Medicaid contractual requirements as outlined below:

 
 

  • This Position will manage separate functions for external provider engagement representatives and internal provider relations representatives to ensure successful Provider Relationships, Network Performance including Clinical and Affordability Targeted Improvements as identified.
  • The State Network Director will manage and deploy the Medicaid National Provider Engagement Program through the Local Market Network Engagement Provider Representatives within their respective Leadership
  • The State Network Director will manage and direct the internal / external Network Provider Relations staff to ensure “best in class” Provider Relationships
  • The State Network Director will assist in the recruitment of new providers as needed and maintain compliance with all network access requirements.
  • Develops and implements training programs and educational materials for providers as well as for internal staff and aligns Network functions with Operations and Claims as needed.
  • Assist and develop Network Action Plans to ensure Network Compliance with any and/all State Network Compliance requirements


 
 

Role/responsibilities

 
 

  • Manages Local Provider Engagement Team to Deploy National Engagement Model
  • Manages Local Provider Relations staff to ensure Market Leading Provider Satisfaction
  • Provides direction to operations teams regarding policy and procedures related to claims/providers.
  • Facilitates Provider Advisory Group and JOC meetings to work with management to implement changes via coordination with Quality Management to develop appropriate provider Clinical measure improvements and implement those measures in the provider community.
  • Oversees the monitoring of executed provider contracts to ensure Network Access meets State requirements.
  • Coordinate’s provider information with Member Services and other internal departments as requested.
  • Provides service to providers by resolving problems and advising providers of new protocols, policies, and procedures.
  • Develops training materials for staff and provider network; oversees staff responsible for initial and ongoing provider in-services and provider education; develops and implements provider satisfaction surveys.
  • Participates in Grievance and Appeals meetings, tracks and trends provider grievances, monitors staff for timely compliance;
  • Compiles data and staff metrics in order to complete regulatory deliverables; participates in all internal compliance audits and Regulatory reviews.
  • Researches, reviews, and prepares response for all governmental, regulatory and quality assurance provider complaints ; timely and continuous reconciliation of provider records; oversees Provider Access and Availability by reviewing Appointment Availability Audits conducted by staff.
  • Provides support and maintenance assistance for websites, portals, directories, manuals, and dashboards; plans, coordinates, and conducts provider forums and monthly webinars; develops communications including newsletters, notifications and Fax Blasts.
  • Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with Member Services and other internal departments.
  • Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions. Monitors staff performance, including weekly staff metrics; coaches and mentors’ staff on performance issues or concerns.
  • Promotes and educates providers on cultural competency


 
 

Pay Range

 
 

The typical pay range for this role is:

 
 

Minimum: $ 100,000

 
 

Maximum: $ 227,000

 
 

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

 
 

Required Qualifications

 
 

  • Minimum of 5 to 7 years recent Managed Care Network experience in Provider Relations & Employee Supervision with 3-5 Years Medicaid Network
  • Excellent interpersonal skills and the ability to work with others at all levels
  • Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards
  • Excellent analytical and problem-solving skills
  • Strong communication, negotiation, and presentation skills
  • Knowledge of Michigan Medicaid.


 
 

Preferred Qualifications

 
 

Master’s degree preferred.

 
 

Candidates to reside in applicable State or surrounding State.

 
 

Education

 
 

  • Bachelor’s degree in a closely-related field or an equivalent combination of formal education and recent, related experience.


 
 

Business Overview

 
 

Bring your heart to CVS Health

 
 

Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

 
 

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

 
 

We strive to promote and sustain a culture of diversity, inclusion and belonging every day.

 
 

CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.