Category: Curator- Job Hunter

 
 

• Mathematica • Ann Arbor, MI 48104
  

Job #2148400880

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• Position Description*:
  

Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding using data science and analytics. Our work yields actionable information to guide decisions in wide-ranging policy areas, from health, education, early childhood, and family support to nutrition, employment, disability, and international development. Mathematica offers our employees competitive salaries, and a comprehensive benefits package, as well as the advantages of being 100 percent employee owned. As an employee stock owner, you will experience financial benefits of ESOP holdings that have increased in tandem with the company’s growth and financial strength. You will also be part of an independent, employee-owned firm that is able to define and further our mission, enhance our quality and accountability, and steadily grow our financial strength. Learn more about our benefits here: ~~~.

Mathematica is searching for Medicaid Data Advisory Services Analysts with interest in Medicaid policy and programs at either the state or federal level to support current and emerging data analytics work. Medicaid data analysts will likely be connected to 2-3 projects at a time, with many projects requiring work with multidisciplinary teams and direct-client contact. Projects may span across several policy and programmatic areas: Medicaid managed care programs, value-based purchasing and alternative payment models, long-term services and supports, measures of delivery and quality of services for beneficiaries, and outcomes of innovative programs and policies.

Across all projects, Medicaid analysts are expected to:

• Lead or participate actively and thoughtfully in project teams to implement, monitor, or evaluate policy and programs
  
• Apply rigorous analytic thinking to the collection, analysis, and interpretation of quantitative data
  
• Develop expertise in Medicaid data, policy, and programmatic areas
  

Specific project activities may include:

• Assisting with quantitative analyses using Medicaid enrollment, claims/encounter, financial and program data to support program monitoring, improvement, or evaluation
  
• Participating in decisions regarding analysis design and methodology
  
• Reviewing policy, program, and/or data documentation to develop technical specifications for analyses
  
• Working with developers to compile and analyze data
  
• Investigating data to identify data quality issues, patterns, or other findings
  
• Translating analysis findings into actionable information to support clients in making data-driven decisions regarding Medicaid policies and programs
  
• Providing technical assistance to federal and state Medicaid stakeholders to support the implementation of data collection, monitoring, and reporting programs
  
• Authoring client memos, technical assistance tools, issue briefs, chapters of analytic reports, user manuals, and webinar presentations summarizing findings
  
• Position Requirements*:
  
• Master’s degree or equivalent in data analytics, public policy, economics, statistics, public health, behavioral or social sciences, or a related field; or a Bachelors degree and equivalent experience
  
• Experience conducting quantitative analysis work in a health policy or research setting, with experience in Medicaid preferred
  
• Strong foundation in quantitative methods and a broad understanding of Medicaid program and policy issues.
  
• Familiarity with Medicaid enrollment, claims, financial, or program data is preferred.
  
• Excellent written and oral communication skills, including an ability to write clear and concise policy and/or technical memos and documents for diverse stakeholder audiences including program administrators and policymakers
  
• Demonstrated ability to work on multidisciplinary teams
  
• Strong organizational skills and high level of attention to detail; flexibility to manage multiple priorities, sometimes simultaneously, under deadlines
  

To apply, please submit a cover letter, resume, transcripts

 
 

 
 

 
 

Clipped from: https://www.nexxt.com/jobs/medicaid-data-advisory-services-analyst-ann-arbor-mi-2148400880-job.html?utm_campaign=google_for_jobs&utm_source=google&utm_medium=organic&aff=2ED44C72-8FD2-4B5D-BC54-2F623E88BE26&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

The Research Foundation for Mental Hygiene, Inc. is seeking a qualified candidate to fill the full-time position of Director of Medicaid Financial Data Analytics at the New York State Office of Mental Health (OMH). This position will be located either in Albany or NYC, depending on the selected candidate’s location. The candidate will work in conjunction with OMH staff and other State Agencies (DOH, DOB, OPWDD, OCFS, OASAS) to architect and manage data marts containing NYS Medicaid data integrated with multiple related data sources and support complex analysis and projects involving financial restructuring and Medicaid policy for the behavioral health system.

FUNCTION AND SCOPE

The Director of Medicaid Financial Data Analytics will be responsible to manage Oracle database specialists and business intelligence specialists to build and maintain data marts that are necessary to support a wide range of OMH initiatives relating to financial restructuring, support for community mental health system, and the development of financing for new programs. The candidate will also be responsible to manage recurring and ad-hoc reporting activities. The Director of Medicaid Financial Data Analytics will need to serve as a liaison between program/clinical subject matter experts and information technology experts, manage, train, and mentor data analysts, and work with internal and external stakeholders. The candidate will need to manage and be a part of various data related project teams composed of consultants, State employees, and external data analysts, implementing data solutions, and identifying and resolving technical issues. The candidate will need to have a deep understanding of the scope of State data resources, how they interact, and how actionable data can be derived from combining information from multiple data sources.

The selected candidate should have experience with Business Intelligence and/or Data Mining tools, prefer five or more years of experience with NYS Medicaid data or other similar healthcare claims data. The candidate should also have familiarity with OMH-specific data sources (that experience should include the development of claim netting processes, and cohort analysis within the behavioral health environment). Preference will be given to candidates with demonstrated experience in Behavioral Health programs and related healthcare systems.

RESPONSIBILITIES INCLUDE BUT ARE NOT LIMITED TO:

• Perform business analysis, database design and analysis, DBA functions, and SQL/PL/SQL coding.
  
• Working with the OMH Bureau of Strategic Financial Direction (SFD), other OMH bureaus, and other State agencies on multiple projects in a fast-paced, dynamic, team environment.
  
• Manage SFD Data Analysis Team, recruit new team members, and assist other OMH staff with making strategic hires of people with good “data fluency” skills.
  
• Coordinate Data Analysis project pipeline, working on priorities with SFD Bureau Director.
  
• Produce new custom data marts as decision support tools for executives working on fiscal initiatives and maintain/enhance existing data infrastructure.
  
• Maintain/enhance technical environment for Data Visualization and Data Mining tools, encouraging staff to enhance technical skills in these vital areas.
  
• Train and mentor data analysts in SQL and PL/SQL development, tabular data and business intelligence reporting on the SFD team, and other groups within OMH.
  
• Manage multiple, simultaneous projects with OMH Staff, internal and external consultants, and Interagency teams to support data analysis initiatives to address specific questions and support decision making, combining leadership, project management, and soft skills with technical expertise.
  
• Maintain data algorithm for Medicaid Health and Recovery Plan (HARP) Eligibility and produce the HARP eligibility list every month.
  
• Communicating clearly with business subject matter experts to determine needs and requirements, and to develop these into technical specifications.
  
• Providing technical assistance to ITS staff and various of data analysts groups to help complete projects and build shared OMH data infrastructure.
  
• Developing innovative ways to visualize healthcare data in a Behavioral Health environment, to always be working towards solutions for the next generation of OMH data needs.
  

QUALIFICATIONS

• The candidate must have a Master’s degree or higher from an accredited college in Accounting, Computer Science, Economics, Finance, Public Administration, Business Administration, Information Systems, or a related field.
  
• Candidate must have a minimum of five years of data analysis experience, with five or more years of PL/SQL and SQL writing experience in a relational database environment with very large datasets.
  
• Candidate should have a minimum of two years’ experience with tabular datasets (Power BI, Power Pivot, SSAS, with DAX/MDX experience a plus).
  
• Candidate must have a minimum of five years’ experience with ETL processes, and have a background in advanced statistical analysis, financial forecasting, information systems, and healthcare economics.
  
• Candidate must have a minimum of five years of experience with and be very proficient and innovative with using Microsoft Excel’s advanced functionality as a fiscal data analysis tool.
  

Work Location: Dependent on candidate’s location, the work location would be at one of the addresses listed below:

• 330 Fifth Avenue, 9th Floor, New York, NY 10001-3101 (NYC Field Office) or
  
• 44 Holland Ave, 7th floor, Albany, NY 12229 (Central Office)
  

In accordance with NYS Office of Mental Health regulations, RFMH employees are required to be fully vaccinated.

Note: If the selected candidate is located in NYC, travel to OMH Central Office in Albany, NY will be required 2-4 days per month.

Salary: Based on experience.

To Apply: Submit an application on our website by April 26th, 2022 at https://rfmh.applicantpro.com/jobs/. Click on Employment Opportunities. Please note only applications submitted through our website will be considered.

The Research Foundation is a private not-for-profit corporation and is not an agency or instrumentality of the State of New York. Employees of the Research Foundation are not state employees, do not participate in any state retirement system, and do not receive state fringe benefits. Excellent Benefits Package. Employer/Minority/Women/Disabled/Veteran Employer. VEVRAA 41 CFR 60-300.5(a) compliant.

Clipped from: https://www.ziprecruiter.com/c/Research-Foundation-for-Mental-Hygiene,-Inc./Job/Director-of-Medicaid-Financial-Data-Analytics/-in-New-York,NY?jid=cd23914bd276f12e&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Found in: Talent US Sponsored – 4 hours ago

Albany, United States Public Consulting Group Full time

Medicaid Program Advisor – Fiscal Analysis in Albany, NY

 
 

Staffing Solutions Organization LLC (SSO), a wholly owned subsidiary of Public Consulting Group, is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.

 
 

This individual will assist the Department of Health’s Office of Health Insurance Programs (OHIP) Division of Health Plan Contracting and Oversight (DHPCO) with the oversight of the fiscal solvency of the Managed Long Term Care plans. The incumbent will be responsible for the development, analysis and oversight associated with the Medicaid Managed Care Operating Cost Reports for 30 Managed Long Term Care Partial (MLTC) Plans, 9 Programs of All Inclusive Care for Elderly ( PACE) Plans, 8 Medicaid Advantage (MA) Plans, 9 Medicaid Advantage Plus (MAP) Plans, 34 Medicare Advantage Plans and 1 Fully Integrated Dual Advantage for Individuals with Developmental Disability ( FIDA-IDD) Plan. Additionally, the incumbent will also perform review and analysis of the Medical Loss Ratio and monitor overall plan solvency for the above listed lines of business.

Specific duties include:

• Assist in the development of quarterly financial reports to collect financial information from the Medicaid Managed Care Organizations (MCOs) in NY inclusive of Medical Loss Ratio reporting and oversight
  
• Review and oversee timely filing and accuracy of all MCOs financial reporting (MLTC and Mainstream Plans)
  
• Conduct reviews of MCOs financial reporting and operating status, including compliance with Public Health Law, regulations and policies as well as the federal regulations
  
• Communicate findings and collaborate with MCOs to improve accuracy of financial reporting
  
• Attend and lead meetings with MCO’s to discuss fiscal issues and develop plan of resolution
  
• Review and Evaluate plan Solvency
  
• Review and evaluate MCO expansions, mergers and acquisitions for MLTC and Mainstream plans.
  
• Assist in automating and standardizing financial reports for analysis of fiscal status of the MCO
  
• Develop ad-hoc financial reports extracting data, as necessary.
  
• Review and evaluate MCO provider and management contracts for compliance with the financial standards and requirements in PHL
  
• Expect to supervise 1-2 staff as unit grows.
  
• Hold meetings with staff, assign work and oversee the completions of assignments in an effective and efficient manner.
  
• Complete performance evaluations for assigned staff.
  
• Other duties as may be required.
  

 
 

Basic Qualifications:

• Bachelor’s degree in business, finance or related field. 
  
• Eight (8) years of work history in finance or healthcare. 
  

Desired Characteristics:

• Strong Excel and data analytics skills. 
  
• Strong communication skills (written and oral).
  
• Ability to present data to parties with varying backgrounds.
  
• Ability to work independently.
  
• Must be a United States Citizen or a Permanent Resident of the United States in order to be considered.
  

   
 

*Employees must follow established work schedules. The usual work schedule is 40 hours per week, Monday through Friday. Normal work hours are 8:00 a.m. to 4:30 p.m. unless otherwise specified by the supervisor, this includes a half hour unpaid lunch break. Total work hours must equal 40 hours per week.

 

All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an e-Verify participant.

 
 

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

 
 

Clipped from: https://us.trabajo.org/job-1448-20220422-cbfc5e629df8a84b8f52d2f33c8ed4fe?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Point32Health

Canton, MA

Posted 11 hours ago

Still actively hiring

Canton, MA

Posted 11 hours ago

Still Active

Job Description

We enjoy the important work we do every day on behalf of our members.

Please note: As of January 18, 2022, all employees including remote employees must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

Job Summary

Under the supervision of the Data Principal, Medicaid, this individual will be responsible for supporting critical data reporting functions for the Risk Adjustment Department (RAD) including risk adjustment submissions to CMS and state agencies, internal data reconciliations, data transfer between Point32Health and external stakeholders such as vendors and provider organizations. This individual will have strong analytical skills and the ability to synthesize large data sets and complex information into key insights. This individual will work effectively across business areas and often lead collaborative projects. This person will need to follow complex business processes, consider options when problems arise, and to identify and escalate issues appropriately.

Job Description

DUTIES/RESPONSIBILITIES what you will be doing (top five):

Data Submission Integrity

• Support Medicaid manager across a range of activities, including monthly encounter data submission to the Executive Offices of Health and Human Services (MassHealth) and other States or Federal agencies
  
• Monitor ongoing encounter data response files to identify and address discrepancies in a timely manner
  
• Review monthly error reports, perform trend analysis, investigate critical errors and work with the appropriate business area on resolution
  
• Enhance and automate existing reconciliation and reporting code using advanced SAS and/or SQL skills
  
• Interface with IT for implementation of enhancements and timely resolution of production issues pertaining to state government and risk adjustment data submission, including issue investigation, business requirements, user acceptance testing and post implementation monitoring
  

Reporting and Data Management

• Use Tableau/Cognos/Excel to create a monthly submission dashboard and run submission reconciliations to effectively track acceptance rates and submission trends
  
• Create various reconciliations and adhoc reports
  
• Use SAS to extract and transform data to create reports from multiple sources
  
• Assist with the implementation of new program vendors, including data file transfers and reviews of internally received files for completeness, reasonability, and accuracy
  

Collaboration with Internal / External Stakeholders

• Collaborate effectively with risk adjustment leadership and with other internal stakeholders including Claims, Member Operations, Information Technology and Provider Information to ensure that process enhancements and submission mechanisms are maintained and monitored
  
• Collaborate with federal agencies, vendor data management staff, and industry trade associations to remain up to date with changes and updates from EOHHS and other state agencies.
  
• Effectively communicate regulatory updates to team and department leadership, escalate risks appropriately
  

Analytics

• Conduct ad hoc analyses specific to risk score trends, data/claims submissions and program performance to support risk adjustment analytics; deliver timely and accurate information to contracted provider groups
  
• Perform data analytics to support ongoing and upcoming risk adjustment initiatives
  

Administration

• Support the creation and management of business policies and procedures and knowledge repositories for the department as needed
  

Requirements

QUALIFICATIONS what you need to perform the job

Education, Certification And Licensure

• Bachelors degree required, background in health informatics, business analysis programming, IT, finance, quantitative techniques, or a related discipline.
  

EXPERIENCE (minimum Years Required)

• 3-5 years of experience in progressively responsible analytical data management roles in a complex operational setting or consulting role.
  
• Previous experience working in the healthcare / health insurance sector either for a health plan, provider group, healthcare IT / management consultancy or auditing firm and/or experience working with large data sets in a technical capacity.
  
• Understanding of claims systems, provider information, and Medicaid/Medicare preferred.
  

Skill Requirements

• Expertise in SAS Enterprise Guide/ SAS Base and SQL/ProcSQL
  
• Experience with database software and reporting tools such as SQL Server, Oracle, and Cognos
  
• Expertise in data management and controls, IT processes, and utilizing analytical tools
  
• Comfortable working with large data sets from disparate sources, and able to identify relevant patterns and trends
  
• Experience with Alteryx, Cloudera, and Tableau is a plus
  
• Proficient in Microsoft Excel, PowerPoint, and Word
  
• Experience developing and updating detailed documentation of policies and procedures
  
• Engaged, critical thinker, organized, detail-oriented, resourceful, and self-motivated
  
• Must possess maturity, a high degree of professionalism and be able to deal with complexity and uncertainty and/or business decision ambiguity in the face of incomplete information
  
• Strong interpersonal and communication skills with an ability to work collaboratively with both internal and external stakeholders
  

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required.
  
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
  
• May be required to work additional hours beyond standard work schedule.
  

What we build together changes our customer’s health for the better. We are looking for talented and innovative people to join our team. Come join us!

Please note: As of January 18, 2022, all employees including remote employees must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

BenefitsClipped from: https://directlyapply.com/jobs/point32health/62627aa40c2781c4a5f244ad?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Louisiana Healthcare Connections and Centene Corporation are hiring for a Behavioral Health, Provider Network Specialist II within or near the following parishes: East or West
Baton Rouge, Ascension, East and West
Feliciana, Pointe
Coupee, and Iberville. Once it is safe to do so, this role will see providers in these areas. 

As a PNS II you will be the face of the health plans to our providers. Highly qualified applicants should have behavioral health background, top notch communication skills, provider facing experience (which can include office managers, clinic support, billing managers, ect). Claims experience is a plus. If this is you, apply today!  

Additional responsibilities may include: 

• Perform health plan provider orientations and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within the provider network. Act as liaison between providers and the health plan to enhance the business relationship.
  
• Conduct initial provider orientations as well as ongoing educational outreach
  
• Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface
  
• Perform detailed HBR (Health Benefits Ratio) analyses, Health Information data Information Set (HEDIS) analyses, and create reports for provider Review provider performance by both quantitative metrics and qualitative factor.
  
• Act as a liaison between the provider and the health plan ensuring a coordinated effort in improving financial and quality performance
  
• Provide information and status updates for providers regarding incentive agreements
  
• Conduct site visits when required
  
• Perform other contracting duties as requested, including but not limited to recommending changes to pricing subsystems, submitting changes to provider related database information and assisting in the completion of special project
  

Our Comprehensive Benefits Package:

• Flexible work solutions including remote options, hybrid work schedules and dress flexibility
  
• Competitive pay
  
• Paid Time Off including paid holidays
  
• Health insurance coverage for you and dependents
  
• 401(k) and stock purchase plans
  
• Tuition reimbursement and best-in-class training and development
  

Key Words: Behavioral, Behavioral Health, Behave, Pay for Performance, P4P, Risk Adjustment, RA, Medicaid, Medicare, , Market Place, WellCare, Centene, Provider Performance Specialist, Medicare, Medicaid, Network, Networking,  Provider, Provider Relations, Network Contracting, Network Development, Healthcare, STARS, Medicaid, CHIP, Medicare Advantage, CMS Guidelines, Sales, Provider Connect, Provider Connection, Provider Data, Provider Affairs, Physician Liaison, Provider, Communications, Revenue Cycle, Revenue Analyst, Contract Specialist, Contract, Claims, Claims Billing, Revenue Cycle Support Representative, ROI, Physicians, Patients, Facilities, Configuration, Managed Care, MCO, provider reimbursement and analysis, Credentialing, Education 

Licenses/Certifications: Current state driver’s license.

Education/Experience:

• Bachelor’s degree in related field or equivalent experience.
  
• 2+ years of combined managed healthcare and provider reimbursement experience.
  
• Advanced knowledge of Microsoft Excel.
  
• Clinical or health information management (HIM) experience preferred.
  
• Claims processing and/or managed care experience preferred.
  

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

 
 

Clipped from: https://jobs.centene.com/us/en/job/1314973/Provider-Network-Specialist-Behavioral-Health?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Acumen America is looking for an Executive Director with 15+ years of experience to lead, grow, and resource the Medicaid Innovation Collaborative, a new, innovative program to advance health equity in Medicaid. Knowledge of and experience with Medicaid is a must.

About Acumen


Acumen is changing the way the world tackles poverty by investing in companies, leaders and ideas. We invest patient capital in businesses whose products and services are enabling the poor to transform their lives. To date, Acumen has positively impacted 309 million lives by investing $137M in 139 innovative, early-stage companies in Africa, Latin America, South Asia, and the United States. But investment isn’t only about capital, we’ve been investing in innovators for years, connecting with emerging leaders around the world and engaging them in collective dialogue, moral inquiry, and skill building.


About Acumen America


Acumen America focuses on investing in early-stage social enterprises developing products and services for underserved, low-income Americans. Since 2015, we have invested in 31 companies reaching over 69M low-income Americans. These companies are led by founders that reflect the diversity of the U.S.: 55% of companies were founded by BIPOC founders and 39% are led by founders that identify as women, and 80% of companies were founded outside of San Francisco and New York.


Medicaid Innovation Collaborative, a joint venture


We recently launched Medicaid Innovation Collaborative. Our partners in this program are The Center for Health Care Strategies and Adaptation Health. Together, we aim to improve health and wellbeing for low-income Americans through improved partnership between State Medicaid Agencies; Medicaid Managed Care Organizations; and private sector, market-based, digital innovations.


The Medicaid Innovation Collaborative delivers hands-on technical assistance to State Medicaid Agencies, deep beneficiary research to center on Medicaid members, and an Innovation Showcase to highlight the best innovations from across the country that are poised to meet States’ health equity priorities. In the first cohort, Arizona, Hawaii, and West Virginia are participating, with a focus on innovative solutions for maternal behavioral health and adolescent behavioral health.


About The Role


The Executive Director will be responsible for leading and growing the Medicaid Innovation Collaborative including refining the strategy and operating model, building long-term funding and partnerships, driving daily operations, representing the work in public fora, and leading a small team of skilled professionals who are passionate about closing the health equity gap in Medicaid. Accountabilities include”


Leadership & Management

• Work closely with the MIC Advisory Board (made up of national leaders from across the Medicaid innovation ecosystem) to ensure that MIC operations align with its vision and provide well-defined opportunities for board engagement
  
• Lead strategic planning, resourcing needs, and oversight of the organization
  
• Help define the model with MIC founding partners
  
• Lead day-to-day operations of MIC cohorts and ensure MICs long-term success
  
• Serve as the external face for MIC in high-level public and private forums with potential funders, decision makers, media, and other stakeholders
  
• Develop and manage MIC staff, incorporating principles of diversity, equity, inclusion, and access
  
  
  

Relationship & Stakeholder Management

• Manage relationships with key stakeholders including State Medicaid Directors, funders, foundations, MCOs, community members, etc.
  
• Build partnerships to expand MIC impact on Medicaid beneficiaries
  
• Develop relationships with founders and investors working to innovate within Medicaid, connect to and network with the private sector healthcare ecosystem.
  
  
  

Budget & Fundraising
 

• Lead, organize and execute fundraising: identify, reach out to and pitch to potential sponsors; establish and manage relationship with funders
  
• Develop and oversee budget
  
  
  

Skills And Qualifications

• 15+ years of progressive leadership and management experience in healthcare, Medicaid, or closely related area
  
• Bachelor’s degree in Public health and or related area or equivalent experience
  
• Graduate degree in Health or related field or equivalent experience preferred
  
• Experience successfully working with a Board of Directors
  
• Experience with long term resource management (fundraising, long-term budgeting)
  
• Ability to coach staff to execute strategy within a budget
  
• A team builder and leader with strong emotional intelligence and social skills who can work with diverse groups of people
  
• Action-oriented and entrepreneurial; ability to adapt to quick, changing situations and comfort with an early-stage organization
  
• Exceptional written and verbal communication skills; a persuasive and passionate communicator with the ability to listen to and present ideas clearly
  
• Experience managing diverse set of stakeholders and partners
  
• Experience specifically focused on health equity is preferred
  
• Demonstrated commitment to and understanding of diversity, equity, inclusion and belonging
  
• Permanently authorized to work in the U.S.
   
  

Deadline


Apply as early as possible as applications will be reviewed and interviews scheduled on a rolling basis.

 
 

Clipped from: https://www.linkedin.com/jobs/view/executive-director-medicaid-innovation-collaborative-at-acumen-2996560595/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Resp & Qualifications

PURPOSE:
The Appeals Specialist I is responsible for the initial analysis of appeals correspondence, and determination of next steps for Commercial and Government Program lines of business. Responsible for collecting, organizing and tracking information to facilitate and expedite processing of appeals received from a variety of sources.   

ESSENTIAL FUNCTIONS:

• Prioritize, research and analyze all pertinent information in preparation of an appeal request.  Access the appropriate database to implement accurate and timely entry of appeal or reconsideration correspondence and updates the appropriate referral source communication system.  Assigns cases to the nurse for research and completion. Performs file coordination activities including, but not limited to filing of all active files, purging of files for transport to off-site storage.
  
• Utilizes professional written and verbal communications to assist in responses of all appeals based on State and Federal requirements for all lines of business. Interacts regularly with and responds to internal and external stakeholders, without breaching confidentiality of medical information.
  
• Assists Supervisor and Appeals Specialist II and III with unit projects and other duties related to the appeals and reconsideration process. Communicates with Supervisor to offer feedback regarding continuous improvement of unit workflow and processes.   Actively participates in monthly meetings and discussions regarding quality appeal research, data entry and to problem solve any issues regarding the appeal intake/entry process.
  

QUALIFICATIONS:

Education Level: High School Diploma.

Experience: 3 years experience in settings such as managed care, health care or insurance payor environment.

Preferred Qualifications:
College Degree.
Knowledge of CareFirst system, Member/Provider Service, Claims or Care Management experience a plus.

Knowledge, Skills and Abilities (KSAs)

• Knowledge and understanding of medical terminology.
  
• Demonstrated problem solving and decision-making skills, including the ability to exercise good judgement. 
  
• Strong organizational and analytical skills.
  
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
  

Department

Department: Maryland Medicaid

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before:05/18/2022

Federal Disc/Physical Demand

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

PHYSICAL DEMANDS:

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

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

 
 

Clipped from: https://carefirstcareers.ttcportals.com/jobs/8739951-appeals-specialist-i-maryland-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Position: Risk Adjustment Analyst (Medicaid)Client: Kaiser PermanenteLocation: 100% RemoteDuration: 12 contract (potential for extension)Job Overview:Analytical and operational support of the Risk Adjustment departmentCalculation of monthly revenue accruals relating to the ACA, Medicare and Medicaid lines of businessCollaborate and help implement risk adjustment operational goals and metrics, in support of the organization’s strategyMonitor and analyze the effectiveness of programs, processes, infrastructure and reporting and suggest changes to improve results and effectivenessEnsure timely, accurate and complete submission of risk adjustment data to CMS and reconciliation of plan paymentsStay informed about CMS and industry trends and best practices and utilize this knowledge to refine and advance risk adjustment programsQualifications:3 years of SAS development experience (required)Rich experience dealing with CDPSRx modelingFamiliarity with Centers for Medicare & Medicaid Services/Affordable Care Act risk modelingSharepoint experience and knowledge in utilizing Power BI for data visualizationPrevious Medicaid experience is nice to haveWhat’s in it for you:Advance your career and knowledge-base at one of the largest healthcare companies in the countryFully remote workplace dynamic

 
 

Clipped from: https://www.recruit.net/job/medasource:-medicaid-jobs/12DFB842191468EB?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Location field must contain ‘city, state’ or a zip code to perform a radius search (e.g., Denver, CO or 46122 ). City and state must be separated by a comma followed by a space (e.g.

, Houston, TX ) Thrivas Medicaid Eligibility Specialist Miami , Florida Apply Now Miami, FL (1 year agoLarge public health system provider is currently hiring a Medicaid Eligibility Specialist. The position is Monday through Friday from 8:30 a.m. until 5:30 p.m.

with some weekend requirements. This is a permanent opportunity within the organization and will provide full benefits after the successful completion of a 90 day probationary period. The starting pay is up to $17 per hour, depending on experience.The ideal applicant will have previous experience as an enrollment specialist focused on Medicaid patients eligibility. Applicants with extensive background in customer service focused roles that are professional, articulate, highly organized and bilingual are strongly encouraged to apply.

Bilingual is not a requirement to qualify for this position.The Medicaid Specialist is responsible for interviewing uninsured patients to determine eligibility for government medical funding. The Specialist will provide guidance to the patient through the application process and provide updates and contact with overseeing governmental agency (NBHD) regarding eligibility status. The Medicaid Specialist must be organized, efficient and compassionate. Intermediate computer skills are required.

Requirements 1+ years of Medicaid enrollment experience Recent employment in relevant role Intermediate computer skills Type 30 wpm or greater

 
 

Clipped from: https://www.rapidinterviews.com/job/medicaid-eligibility-specialist-with-thrivas-staffing-agency-in-miami-apc-6234?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 2,500 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1.9 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.


Blue Cross Blue Shield of Arizona helps to fulfill its mission of inspiring health and making it easy by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.


For Internal Use Only:


GEN 28-30


PURPOSE OF THE JOB


This position serves as BCBSAZ’s Clinical Trainer and is responsible for the researching, writing and the delivery of behavioral health and integrated care trainings for Providers, community members, stake holders and community partners. This position serves all contracted Providers in all lines of business (RBHA/ACC) in direct partnership with BCBS, the Medicaid Business


Segment Clinical Team, AHCCCS and Arizona Workforce Development Alliance. This position is responsible for the delivery of required behavioral health and integrated care trainings throughout the network.


Required Qualifications

• Required Work Experience
  
• At least three (3) years’ practice and training-related experience
  
• Required Education
  
• Master’s degree in Behavioral Health field
  
• Required Licenses
  
• Independent license such as LPC, LCSW, LMFT, or LISAC
  
• A valid Arizona driver license with an acceptable driving record
  
• Required Certifications
  
• N/A
  
  
   
  

Preferred Qualifications

• Preferred Work Experience
  
• N/A
  
• Preferred Education
  
• N/A
  
• Preferred Licenses
  
• N/A
  
• Preferred Certifications
  
• N/A
  
  
   
  

Essential Job Functions And Responsibilities

• Develop and create trainings based upon behavioral health evidenced based theories and integrated care interventions for all levels of Providers (Peer, BHP, BHT, PCPs, etc.)
  
• Provide beginner level, experienced and master level trainings for all levels of Providers and attendees
  
• Provide professional development and skill-based training for licensed therapists and psychologists contracted with BCBS, Medicaid Business Segment and community partners
  
• Provide behavioral health training for community members and tribal members throughout Northern Arizona
  
• Provide training on the Children’s System of Care required trainings and other Health Plan required trainings
  
• Consults with organizational leaders, QM, and workgroups to develop and respond to training needs and requests
  
• Simultaneously manages multiple, complex training projects
  
• Posts and manages clinically sponsored trainings
  
• Develops and conducts follow-up assessments to determine training needs in the network
  
• Uses formal instructional design methodology to develop and support sophisticated, complex and/or enterprise-wide, competency-based training, skills, and educational tools for the network
  
• Incorporates feedback gathered from participants and other relevant audiences to improve training, processes, and products
  
• Serves as a curriculum/course development lead in partnership with subject matter experts internally and externally to BCBSAZ
  
• Perform all other duties as assigned
  
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements
  
  
   
  

Required Competencies

• Required Job Skills
  
• Experience using Microsoft Office products, Video recording/editing software, Webinar based platforms (i.e., Zoom),
  
  
   
  

Relias Learning Management System, Eventbrite, WordPress Website functions

• Plan large scale events/conferences
  
• Ability to prioritize work
  
• Ability to communicate effectively both verbally and in writing
  
• Knowledge of the behavioral health and health care integration
  
• Required Professional Competencies
  
• N/A
  
• Required Leadership Experience and Competencies
  
• N/A
  
  
   
  

Preferred Competencies

• Preferred Job Skills
  
• N/A
  
• Preferred Professional Competencies
  
• N/A
  
• Preferred Leadership Experience and Competencies
  
• N/A
  
  
   
  

Our Commitment


BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.


Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

 
 

Clipped from: https://www.linkedin.com/jobs/view/clinical-trainer-medicaid-at-blue-cross-blue-shield-of-arizona-3028281177/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic