Category: Curator- Job Hunter

 
 

R-271734


Description


The Manager, Quality Improvement implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Manager, Quality Improvement works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.


Responsibilities


The Manager, Quality Improvement monitors quality investigations and compliance processes.

• Manages quality management system, department SharePoint, and department reporting. Audits processes as needed for compliance.
  
• Completes and submits reports to CMS and state regulators as required for clinical studies.
  
• Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
  
• Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
  
• Must reside in Ohio and travel within the state for State meetings
  
• Excellent communication and relationship building skills
  
  
  

Required Qualifications

• Bachelor’s Degree in related field or equivalent experience
  
• 3 or more years of leadership experience to include team leadership or supervisory position with hiring, training, coaching
  
• 5 years’ experience in the health service industry, healthcare administration, Or healthcare related consulting Or in a fast paced insurance or managed care setting
  
• Understanding of healthcare quality measures CMS, HEDIS, Ohio State Guidelines etc.
  
• Comprehensive knowledge of Microsoft Office Word, Excel, Visio and PowerPoint
  
• Strong problem solving, data-analysis, and critical-thinking skills with the ability to operate and drive progress with limited information and ambiguity
  
• Strong presentation skills using PowerPoint and ability to communicate with all levels
  
• Must be available to work Monday – Friday 8:00-5:00 with flexibility
  
• Must be available to travel within the state of Ohio to attend State Mandated Meetings as required by state
  
• For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
  
  
  

If Progressed To Offer, You Will Be Required To

• Provide proof of full vaccination or commit to testing protocols OR  
  
• Provide proof of applicable exemption including any required supporting documentation
  
• Medical, religious, state and remote-only work exemptions are available.
  
  
  

Work At Home Requirements

• Must have a separate room with a locked door that can be used as a home office to ensure you and your members have absolute and continuous privacy while you work.
  
• Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.
  
  
  

Travel (see Additional Information)

• This position will require travel to State Mandated Meetings within the state of Ohio
  
• Must have a Valid driver’s license with reliable transportation and the ability to travel within the state of Ohio, as required
  
• This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
  
  
  

Preferred Qualifications

• Knowledge of Humana’s internal policies, procedures and systems
  
• Previous quality or process improvement experience in a hospital or physician office practice
  
• Quality improvement experience with the Medicaid population
  
• Certified Professional in Health Care Quality by the National Association for Healthcare Quality (NAHQ)
  
• Certified QI Associate by the American Society for Quality
  
• Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers
  
  
  

Additional Information


Onsite Travel


In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.


#ThriveTogether #WorkAtHome


Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.


If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed) If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.


Scheduled Weekly Hours


40

 
 

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** MUST BE WILLING TO PHYSICALLY WORK NEAR SUNRISE, FLORIDA, 33323**

Position Summary:

 

Reporting directly to the Vice President, Compliance & Privacy Officer, this position supports the Community Care Plan Compliance Program by developing and implementing content for compliance and privacy education and training; conducting and/overseeing compliance and privacy audits and investigations; participating in the development and maintenance of policies and procedures; and serving as a compliance and privacy resource.

Qualifications:

 

• Bachelor’s degree or equivalent education and experience required.
  
• 5-8 years regulatory healthcare compliance experience.
  
• 3-5 years works for management experience required
  
• Knowledge and experience with Florida Medicaid required
  
• Knowledge and understanding of Florida Healthy Kids Program (CHIP) preferred
  

WORK SCHEDULE:

As a continued effort to provide a safe and productive work environment, Community Care Plan is currently following a hybrid work schedule. Staff are able to work from home 3 days a week and will report to the office 2 days a week.****
* The company reserves the right to change the work schedules based on the company needs.

Essential Duties and Responsibilities:

 

• Assists in the development and implementation of Annual Compliance Work Plan and Annual Compliance Audit Plan.
  
• Maintains and reviews contract and regulatory documentation necessary to maintain compliance and privacy standards.
  
• Manages and supports the review and revision of operational policies and procedures to ensure compliance with contract and state and federal laws and regulations.
  
• Creates, implements, and maintains compliance and privacy policies and procedures.
  
• Creates, implements, monitors, and tracks compliance and privacy training and education.
  
• Conducts compliance audits to review established and newly executed operational processes and controls to ensure compliance with contract and state and federal laws and regulations
  
• Conducts compliance and privacy risk assessments and develops and monitors progress with corrective action plans when applicable.
  
• Assists in the identification, analysis and resolution of compliance and privacy issues.
  
• Processes and documents requests for information.
  
• Creates and implements compliance and privacy tracking, trending, and reporting tools.
  
• Assists in compliance and privacy investigations.
  
• Acts as a compliance and privacy resource for operational departments.
  
• Provides guidance to various operational departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language.
  
• Leads Compliance/SIU team members.
  
• Assists in special investigative unit activities as needed to ensure program integrity compliance.
  

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Skills and Abilities:

 

• Planning, organizing and prioritizing work activities and the ability to manage several tasks at once.
  
• Effectively communicate  in writing.
  
• Knowledge and experience with Florida Medicaid required.
  
• Knowledge and understanding of Florida Healthy Kids Program (CHIP) preferred.
  

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear.

The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move up to 15 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

 
 

Clipped from: https://www.learn4good.com/jobs/online_remote/finance/1015366259/e/

Location: Dania
 

 
 

 
 

Job Information

AnalyticsSolution Analyst – MedicaidWho You’ll Work WithYou will be based in our Atlanta, Boston, Chicago, Dallas or Southern California office as part of our global Social, Healthcare and Public Entities (SHaPE) team.You will be a part of the Medicaid and Health and Human Services Domain team which provides unique data, expert insights and analytics capabilities to both Medicaid Managed Care organizations and State Health and Human Services Departments to support program design, benefit delivery optimization and growth.You will have the opportunity to collaborate globally with other Healthcare Insights colleagues, HSS domains (pre/post-acute, behavioral health, Healthcare service & technology, Private equity, Medicare, etc.), McKinsey integrative consultants and other McKinsey teams.What You’ll DoYou will be responsible for the development of solution services for our clients.In this role, you will gain deep exposure to our Medicaid and State Health and Human Services domain proprietary assets and actively engage with domain leadership (state, managed care organizations, provider and investors) to build assets/capabilities and participate in our near-term investment focus areas. You will also be a core member of our solution leadership team and will contribute to knowledge and capability-building by working closely with the Medicaid and State Health and Human Services team to develop our next generation tools and insights.QualificationsBachelor’s degree; graduate degree preferred (MBA, MHA) in healthcare/medical related discipline (e.g., M.D., R.N.)3+ years of work experience in the field of advanced analytics (preferably healthcare analytics) and/or business intelligenceHealthcare insurance experience; Medicaid or health and human services experience is preferredExperience conducting research on state and federal healthcare programs; experience working with large databases, data visualization tools and statistics preferredWorking knowledge of SQL; knowledge of Hadoop, Hive, Tableau, R, Rshiny is a plusStrong problem-solving skills with the ability to process complex information, break it into logical steps/tasks to help solve the problemStrong entrepreneurial drive; committed to team and personal developmentStrong team player in a dynamic and changing environmentPassionate about making healthcare better via technologyDemonstrates product development acumen; ability to vision, prioritize and execute solution development and roadmap enhancementsAbility to provide leadership over and influence individuals and across multiple stakeholders from different levels, backgrounds by tailoring approachGood steward of resources with a track record of using resources effectivelyCOVID-19 vaccination mandate:Employment with McKinsey & Company, Inc. in the United States and Canada is conditioned on proof of full vaccination against the COVID-19 virus (with a WHO-approved or Health Canada-approved COVID-19 vaccine, as applicable) or approval of an exemption due to a qualifying medical condition or sincerely held religious belief prior to start date.FOR U.S. APPLICANTS: McKinsey & Company is an Equal Opportunity/Affirmative Action employer.All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by applicable law.FOR NON-U.S. APPLICANTS: McKinsey & Company is an Equal Opportunity employer. For additional details regarding our global EEO policy and diversity initiatives, please visit… For full info follow application link.Equal Opportunity Employment Disclaimer McKinsey & Company is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, national origin, disability, veteran status, and other protected characteristics.

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• 10+ years of enterprise sales and/or program/product management experience with a focus on Federal Government customers.
  
• 8+ years of sales experience selling enterprise software, hardware, networking infrastructure, managed hosting services or cloud computing services.
  
• BA/BS degree required
  
• Experience in working with enterprise accounts
  

Job summary
Would you like to own driving the revenue for a leader in the Cloud Computing business with Federal customers? Would you like to be part of a team focused on increasing awareness and adoption of Amazon Web Services by engaging with key Federal systems integrators and solutions providers who are reinventing their IT strategy by adopting and delivering cloud computing solutions? Do you have the business savvy, government sales experience and the technical background necessary to help further establish Amazon as a leading cloud platform provider?

As an Account Manager within Amazon Web Services (AWS) you will have the exciting opportunity to help drive the growth and shape the future of an emerging technology.Your broad responsibilities will include developing and managing a growing customer base across the U.S. Health & Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) operating division. You will drive business and technical relationships and launch customers at a rapid rate by helping to define, identify, and pursue key opportunities. This includes determining the most effective go-to-market strategies, and collaborating with the Public Sector Sales, Legal, Marketing, Product, Contracts and Executive leadership along the way.

You will establish deep business and technical relationships through your knowledge of the customer’s mission and the environment. You will have day-to-day interactions with these agencies and our eco-system of partners (SI’s and ISV’s) that support these customers. The ideal candidate will possess a business background that enables them to drive an engagement at the CXO level. You should also have a demonstrated ability to think strategically about the mission, product, and technical challenges, with the ability to build and convey compelling value propositions.
 

• Drive revenue and market share in a defined region
  
• Serve as a key member of the AWS Public Sector team in helping to drive adoption of the overall AWS market and technical strategy.
  
• Maintain an accurate and robust pipeline and forecast of business opportunities.
  
• Set a strategic sales plan for your target markets in line with the AWS strategic direction.
  
• Understand the technical considerations and certifications specific to the public sector.
  
• Identify specific prospects/partners/channels to approach while communicating the specific value proposition for their business and use case.
  
• Develop and manage the sales pipeline by engaging with prospects, partners, and key customers.
  
• Work closely with the customer base to ensure they are successful using our web services, making sure they have the technical resources required.
  
• Understand the technical requirements of your customers and work closely with the internal development team to guide the direction of our product offerings for developers.
  
• Prepare and deliver business reviews to the senior management team regarding quarterly and yearly strategies to align with revenue growth expectations.
  
• Manage complex contract negotiations and liaison with the legal group.
  
• Accelerate customer adoption and customer satisfaction
  
• Location is Arlington, VA
  
• 25% travel required
  

Inclusive Team Culture
Here at AWS, we embrace our differences. We are committed to furthering our culture of inclusion. We have twelve employee-led affinity groups, reaching 40,000 employees in over 190 chapters globally. We have innovative benefit offerings, and host annual and ongoing learning experiences, including our Conversations on Race and Ethnicity (CORE) and AmazeCon (gender diversity) conferences. Amazon’s culture of inclusion is reinforced within our 14 Leadership Principles, which remind team members to seek diverse perspectives, learn and be curious, and earn trust.

Work/Life Balance
Our team puts a high value on work-life balance. It isn’t about how many hours you spend at home or at work; it’s about the flow you establish that brings energy to both parts of your life. We believe striking the right balance between your personal and professional life is critical to life-long happiness and fulfillment. We offer flexibility in working hours and encourage you to find your own balance between your work and personal lives.

Mentorship & Career Growth
Our team is dedicated to supporting new members. We have a broad mix of experience levels and tenures, and we’re building an environment that celebrates knowledge sharing and mentorship. We care about your career growth and strive to assign projects based on what will help each team member develop into a better-rounded professional and enable them to take on more complex tasks in the future.

 

• Solid technical background in software applications, networking, big data analytic tools, web app development, etc.
  
• Technical degree in engineering or computer science
  
• MBA preferred
  
• Direct experience selling with the Centers for Disease Control and Prevention
  
• Extensive customer network
  
• Track record for exceeding quota
  
• Meets/exceeds Amazon’s leadership principles requirements for this role
  
• Meets /exceeds Amazon’s functional/technical depth and complexity
  

Amazon is committed to a diverse and inclusive workplace. Amazon is an equal opportunity employer and does not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status. For individuals with disabilities who would like to request an accommodation, please visit https://www.amazon.jobs/en/disability/us.

 
 

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State of NebraskaLincoln, NE

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• Do you enjoy working in a fast paced work environment and can work with limited supervision?
  
• If so, the Department of Health and Human Services is looking for you!
  
• Apply today and start your first step in an exciting new career where you will be “Helping people live better lives.”
  
• DHHS State of Nebraska values our employees as well as a supportive environment that strives to promote Diversity, Inclusion, and Belonging.
  
• We recruit, hire, train, and promote in all job qualifications and at all levels without regard to race, color, religion, sex, age, national origin, disability, marital status, sexual orientation, or genetics.
  
• Location: Nebraska State Office Building – LincolnSchedule: Mon-Fri: 8a-5p Examples of WorkThis position, under immediate supervision, performs routine, clerical accounting work involving the preparation, maintenance, coding and processing of financial transactions, records and reports and performs related work as assigned.
  
• Successful candidates will be organized, have excellent customer service skills, and demonstrate support of the team.
  
• Qualifications / RequirementsREQUIREMENTS: Coursework/training or experience in public contact, customer service, and/or performing and applying office/clerical support procedures, including the use of a personal computer, associated software, and office equipment.
  
• PREFERRED: Experience and proficiency using Excel, Word, and Outlook Experience and proficiency using NFOCUS, Enterprise One, and/or MMIS OTHER: Specific positions in this class may require an employee to possess a valid driver’s license in order to perform work related travel.
  
• Position may require long periods of sitting and occasional light lifting.
  
• Knowledge, Skills and AbilitiesKnowledge of: the principles and practices of clerical accounting/bookkeeping methods, forms and techniques; the methods of filing and maintaining accounting records; mathematical functions related to accounting processes; word processing and spreadsheet computer software programs.
  
• Skill in: listening to and understanding information and/or instructions received to perform assigned tasks; entering data into spreadsheets or data bases.
  

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ACCENTURE’s Flexible Workforce solves clients’ toughest challenges by providing cross-industry expertise, unmatched innovation, World-class tech and talent. We help bring it all together to deliver tangible business outcomes for our clients with contractors and our extended workforce opportunities. Accenture is consistently recognized on FORTUNE’s 100 Best Companies to Work for and Diversity Inc’s Top 50 Companies for Diversity lists. And that’s just the beginning. Now is the perfect time for you to consider opportunities through our Flexible Workforce.


What’s In It For You

• Collaborate with a diverse network of people
  
• Actively deliver innovative solutions for Accenture’s clients
  
• Apply your skills and experience to help drive business transformation
  
• Work locally or remotely, significantly reducing or eliminating the demands to travel
  
  
  

Project Description


Medicaid Customer Service Agents provide unbiased assistance to Medicaid and Health Care Services Providers with questions regarding Medicaid and Program patient eligibility, medical claims, eligibility statuses, and other Health Care Services questions.


Responsibilities

• Handle customers, referral sources, and administrative department inquires
  
• Communicate with insurance companies and/or support prior authorization requests
  
• Document all providers/customers encounter in clear and concise logs
  
• Ensure customer satisfaction and assisting them with issues/concerns related to their health
  
• Transfer providers/clients to other Contact Center units as needed
  
• Develop knowledge of customer needs and trends to improve customer satisfaction and loyalty
  
• Meet individual performance standards/metrics
  
• Willing to perform other duties that may be assigned by management
  
  
  

Minimum Qualifications

• High School diploma or GED
  
• 6 months of Customer Service experience
  
• Proficiency with Microsoft Office
  
• Typing speed of at least 30 wpm
  
  
  

Preferred Qualifications

• Medicaid experience, or similar health care services
  
• 6 months experience in a professional call center environment
  
  
  

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States and with Accenture (i.e., H1-B visa, F-1 visa (OPT), TN visa or any other non-immigrant status).


Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.

Accenture is a Federal Contractor and an EEO and Affirmative Action Employer of Females/Minorities/Veterans/Individuals with Disabilities.


Equal Employment Opportunity

All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.


Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.


Accenture is committed to providing veteran employment opportunities to our service men and women.

 
 

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Clipped from: https://diversity.usnlx.com/philadelphia-pa/director-medicaid-contract-

Job Information

Emergent Holdings Philadelphia, Pennsylvania

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This position could be located in any major metropolitan areaResponsible for the strategic vision and operational expertise to successfully lead the EM Medicaid Program including the management of the AmeriHealth investments and Blue Cross Complete. Prepare and implement business plans and strategies to ensure profitable operations, meet short-term objectives, and support long-term growth and success. Manage and monitor all Medicaid contract provisions and conditions to ensure accurate and consistent administration, executive reporting, and performance to optimize business success and sustainability. This includes managing contracts that summarize the compilation operational parameters, service targets, work to reduce corporate liability, and minimize the risk of contractual breaches. *Responsible for accurate and consistent Medicaid contract performance analysis ensuring issues/opportunities are identified and appropriately presented to senior executives and the board for mitigation and adherence. *Responsible for optimizing business performance opportunities to ready the organization for the Medicaid bid cycle. *Responsible for the creation and issuance of monthly Medicaid scorecards and business material and the reporting at various business unit levels for internal senior executive leaders, as well as the EH Board of Directors and BCBSM. *Responsible for Medicaid business reporting of the demonstration of contract performance and offer suggestion of risk mitigation, identification of opportunity, escalation of operational issues, and monitoring of performance and adherence to contract provisions. *As a strategic partner of EH and BCBSM, responsible for conducting ongoing Medicaid program assessments and make recommendations for strategic initiatives, goals, and objectives. *Responsible for tracking multiple business/strategy/IT initiatives to assure desired outcomes and spending levels are being achieved. *Enables the creation and review of legal formation and legal agreement contractual documents (NDAs, SOWs, MSAs, Letters of Intent, etc.) *Proactively manage trends, analyze contract parameters, and forecast if operational goals are being met as outlined and expected in the contract. *Performs ad-hoc projects, research, and analysis in support of key stakeholders. *Provide oversight of compliance requirements as well as the development of protocols and monitoring programs that assess compliance of large-scale company contracts. *Participate in development of annual departmental budget, monitor budget and identify budget discrepancies. Research cause and make recommendations. *Responsibility for balancing workload to optimize the effectiveness of the department. QUALIFICATIONS *Bachelor’s degree in Business Administration or Finance required (Master’s degree or Juris Doctorate preferred). Continuous learning is required. Certification or progress toward certification is highly preferred and encouraged. *Ten (10) years of experience in contract management, insurance business or relevant combination of education and experience may be considered in lieu of degree. *Seven (7) years of relevant experience which provide the necessary skills, knowledge, and abilities. *Five (5) years of prior management or supervisory experience. *Previous experience in the insurance industry experience preferred. *Experience working in healthcare, insurance, finance, compliance or legal. *Experience managing merger, acquisition, or divestiture transactions. *Experience working with and managing contracts and legal parameters. *In-depth experience in Medicaid regulations. *Knowledge and understanding of legal requirements involved in operating contracts. *Ability to analyze the operations of a business unit and identify the key performance drivers. *Analytical abilities to assemble various data components into a clear, concise picture of financial and operational performance. *Strong presentation skills, both developme

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Overview


Contacts and assists VNSNY CHOICE members with Medicaid applications and recertification. Enters and updates member demographic information into the Recertification Tracking Tool. Identifies and investigates problematic recertification cases and presents for resolution. Works under general supervision.


Responsibilities

• Reviews patient referrals and determines eligibility for Medicaid. Processes Medicaid applications. Conducts follow up contact with members when additional information is needed. Ensures proper documentation is recorded in the Recertification Tracking Tool..
  
• Submits Medicaid applications to Human Resources Administration (HRA) office.
  
• Assists members with any inquiries in regards to surplus payments and fee assessments when member claims hardship.
  
• Submits Stensen, Milestone, and PA applications to HRA for SSI members who have lost coverage.
  
• Prepares problem/escalated cases for management to review and resolve.
  
• Prepares weekly and monthly productivity reports for Management to review.
  
• Analyzes and investigates recurring issues; takes appropriate action including escalation to Senior Medicaid Recertification Coordinator or Supervisor. .
  
• Sends out Medicaid Recert packets to members in preparation for their Medicaid recertification.
  
• Develops and sends lists of members that need to be disenrolled to the Member Eligibility Unit (MEU) (non recertified, expired, non-compliant, or ineligible members).
  
• Scans, files into document repository; retrieves files as requested.
  
• Monitors members in the recertification process to ensure resolution.
  
• Participates in special projects and performs other duties, as required.
   
  

Qualifications


Education: Associate’s Degree in health, human services, other related discipline or equivalent work experience required.


Experience: Minimum two years experience in health care, insurance, or social services processing bills and Medicaid applications required. Effective oral, written, verbal communication and customer service skills required. Personal Computer skills including Microsoft Word and Excel required. Analytical skills, including compilation and analysis of data, report creation and recommendations based on findings preferred.

 
 

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• About NYC Health Hospitals MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
  
• As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlus network includes over 27,000 primary care providers, specialists and participating clinics.
  
• For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
  
• Position Overview: The primary goal of the Care Manager is to optimize members health care and delivery of care experience with expected cost savings due to improved quality of care.
  
• This is accomplished through engagement and understanding of the members needs, environment, providers, support system and optimization of services available to them.
  
• Care Manager is expected to assess and evaluate members needs, be a creative, efficient and resourceful problem solver.
  
• In collaboration with the members care team, a plan of care with individualized goals and interventions is developed, implemented and outcomes evaluated.
  
• Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required If needed, ability to travel within the MetroPlus service area to participate in facility visits, community events, home visits or other community meetings, including conferences.
  
• Registered Nurse or LMSW/LCSW with current NYS license by Jobble
  

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MVP Consulting Albany, NY

HBITS-03-11881

The Project Manager will work closely with Medicaid Data Warehouse (MDW) program staff to provide project management to projects within the MDW.

Specific duties include but are not limited to:

• Manage project using a Project Management Body of Knowledge (PMBOK) based project management methodology containing well defined and documented processes, templates, and guidelines for all project phases, the adherence to which is required and managed by a formal Project Management Office.
  
• Prepare and manage Project Management Plan including but not limited to: scope statement, schedule, budget, quality plan, risks, issues and communication plan, etc)
  
• Prepare documents such as presentations, and meeting materials
  
• Track Project performance to ensure goals are being met
  
• Identify and facilitate communications with stakeholder groups
  
• Utilize formal project change process and communicate changes with all stakeholders
  
• Conduct periodic stakeholder analysis sessions to synchronize expectations, and facilitate lessons learned
  
• Develop transition plan(s) and execute those plans to ensure orderly transition to Operations
  
• Work with the Enterprise Portfolio Management Office (EPMO) to ensure project management activities at the MDW are in alignment with EPMO standards
  

Project Manager
Plans, organizes and integrates cross-functional information technology projects that are significant in scope and impact.

Expert 84+ months: Candidate is able to provide guidance to large teams and/or has extensive industry experience and is considered at the top of his/her field

1. 84 months of experience in managing, multiple IT projects where weekly interactions and communications with Executive level stakeholders were required. Please site type of interaction, Executive’s title, and frequency of interaction/communication.
   
2. 84 months of experience in managing COTS software implementation projects and/or in-house application development (SDLC) projects.
   
3. 60 months of experience in developing and maintaining schedules in Microsoft Project.
   
4. 60 months experience working with State, Federal or Local government agencies.
   
5. 48 months of experience in managing software implementation projects or in-house application development projects using industry standard project methodologies, reporting into a formal project management office (PMO) and tracking project schedule and budget performance.
   
6. 60 Months working on IT projects in the Healthcare industry, Medicaid or Medicare Systems.
   
7. College degree Information Technology or Computer Science or similar field of study
   
8. 24 months holding (PMP) Project Management Professional Certification
   

Clipped from: https://www.ziprecruiter.com/c/MVP-Consulting/Job/Project-Manager-(COTS,-SDLC,-MS-Project,-Govt.-Exp.,-PMO,-Medicaid-or-Medicare)/-in-Albany,NY?jid=2038b581c9e38739&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic