Clipped from: https://jobs.myflorida.com/job/TALLAHASSEE-68064861-MEDICALHEALTH-CARE-PROGRAM-ANALYST-FL-32308/994210300/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website.

Requisition No: 795268 

Agency: Agency for Health Care Administration

Working Title: 68064861 – MEDICAL/HEALTH CARE PROGRAM ANALYST

Position Number: 68064861 

Salary:  $1,659.66 – $2,157.56 Biweekly 

Posting Closing Date: 03/02/2023 

Agency Overview:

 
 

The Agency for Health Care Administration (AHCA) is Florida’s chief health policy and planning entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities, and empowering consumers through health care transparency initiatives.

 
 

Under the direction of the Agency Secretary Jason Weida, AHCA is focused on advancing Governor DeSantis’ vision for Florida’s health care system to be the most cost-effective, transparent, and high-quality health care system in the nation. Current Agency initiatives include implementing Florida’s groundbreaking Canadian Prescription Drug Importation Program, overhauling Florida’s healthcare technological ecosystem, and increasing insight in the cost of health care services.

 
 

The Medicaid program provides low-income families and individuals with access to health care.  If you have a desire to use your talent and skills at an organization that provides critical services to millions of individuals and families across the state, AHCA invites you to apply to become an essential member of our team. As one of Florida’s leading state agencies, AHCA’s diverse workforce community of more than 1,400 employees is proud of its efforts to serve the people of Florida.

 
 

Agency Objectives:

 
 

HIGH QUALITY

Emphasizing quality in all that we do to improve health outcomes, always putting the individual first.

 
 

TRANSPARENT

Supporting initiatives that promote transparency and empower consumers in making well informed healthcare decisions.

 
 

COST-EFFECTIVE

Leveraging Florida’s buying power in delivering high quality care at the lowest cost to taxpayers.

 
 

Position Overview:

 
 

This is an exciting opportunity to help shape the quality of health care in Florida. We are seeking to hire a Medical Healthcare Program Analyst who desires to work to enhance the delivery of health care services through the Florida Medicaid Program.  This position requires a candidate who is creative, flexible, innovative, and who will thrive in a fast-paced, team-based work environment.

 
 

This position is located in the Bureau of Medicaid Fiscal Agent Operations (MFAO). MFAO serves as the primary organizational unit within the Agency to provide oversight and monitoring of the Agency’s Medicaid fiscal agent; responsible for the processing of Florida Medicaid claims and multiple supporting systems; ensuring Medicaid providers are properly enrolled into the program, Medicaid recipients receive proper coverage, enrollment into managed care plans; extracting, analyzing, and/or reporting Medicaid data; and ensuring that new Agency systems are planned and procured.

 
 

This position is responsible for ensuring that new and/or updated Medicaid policy is analyzed, tracked, and shared appropriately within the Bureau of Medicaid Fiscal Agent Operations as well as with the Medicaid fiscal agent. 

The incumbent will serve as a primary liaison with Centers for Medicare and Medicaid Services (CMS), other State Medicaid Agencies, and the bureau of Medicaid policy.

The incumbent will assist in high priority tasks including health plan assistance and researching complex enrollment issues.

The incumbent will provide research assistance and Medicaid enrollment/eligibility information to other state agencies and AHCA bureaus.

The incumbent shall possess and maintain up-to-date knowledge concerning the Florida Medicaid Program, including the Florida Medicaid Management Information System (FMMIS), pertinent state and federal laws and administrative rules and codes governing state and federal healthcare programs, Medicaid provider handbooks and Medicaid provider enrollment procedures.

The incumbent shall possess outstanding organizational and formal writing skills.

Answers to the qualifying questions must be supported by your applicant profile and/or resume`.

 
 

Benefits of Working for the State of Florida:

Working for the State of Florida is more than a paycheck. The State’s total compensation package for employees features a highly competitive set of employee benefits including:

 
 

• State Group Insurance Coverage Options, including health, life, dental, vision, and other supplemental insurance options;

• Flexible Spending Accounts;

• State of Florida retirement options, including employer contributions;

• Generous annual and sick leave benefits;

• 9 paid holidays a year and 1 Personal Holiday each year;

• Career advancement opportunities;

• Tuition waiver for courses offered by Florida’s nationally ranked State University System;

• Training and professional development opportunities;

• And more!

 
 

For more information about the Bureau of Medicaid Fiscal Agent Operations, please visit our website at http://ahca.myflorida.com/Medicaid/index.shtml.

 
 

Join us at the Agency for Health Care Administration in fulfilling our mission to provide “Better Health Care for all Floridians.”

 
 

#CB

 
 

KNOWLEDGE, SKILLS, AND ABILITIES

•General knowledge of Florida Medicaid program including managed health care.

 •General knowledge of health care licensing practices in the State of Florida.

 •Ability to conduct research using various information databases.

 •Ability to create reports and effectively present findings.

 •Ability to understand and apply relevant statutes, rules, regulations, policies, and procedures.

 •Ability to research Medicaid provider handbooks to provide guidance with provider enrollment topics.

 •Ability to use Microsoft Office software.

 •Ability to work both independently and as part of a team.

 •Ability to plan, organize, and coordinate work assignments.

 •Ability to communicate effectively verbally and in writing.

 •Ability to establish and maintain effective working relationships with others.

 
 

MINIMUM QUALIFICATIONS REQUIREMENTS

• Two or more years of professional experience relating to health care delivery or health care administration, or two or more years of experience relating to health care regulation involving compliance monitoring of local, state, or federal requirements.
  

Preference given to applicants with:

*A Bachelor’s or advanced degree from an accredited university in the field of health, social services or human services is preferred; documented professional work experience in these fields can substitute on a year-for-year basis for the preferred college education.

*Previous experience working in the Florida Medicaid Management Information System.

*Previous experience researching or analyzing statute, rule, policy, or administrative code.

 
 

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

N/A

 
 

CONTACT:  DEBBIE KELLEY (850) 412-3449

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE.  Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.  Certain service members may be eligible to receive waivers for postsecondary educational requirements.  Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.  Veterans’ Preference documentation requirements are available by clicking here.  All documentation is due by the close of the vacancy announcement. 

Clipped from: https://www.adzuna.com/details/3927510299?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Salary: Location: Company: Employment type: Hours:

 
 

Looking for a way to make an impact and help people?


Join PacificSource and help our members access quality, affordable care!


PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.


Position Overview: Work as an integral part of the case management team to serve as a resource to members and community providers/partners. Work telephonically and in-person to support members with complex psycho-social issues which create barriers to adherence with medical regimens and achievement of optimal health outcomes. Assist with program development, team processes, as well as build effective member, provider and community partner relationships.


Essential Responsibilities:
 

• Utilize motivational interviewing and patient-engagement techniques to support members in achieving optimal health outcomes by effectively utilizing their benefits.
  
• Effectively handle incoming department telephone calls and emails.
  
• Identify member needs and refer to the appropriate internal resources.
  
• Screen case management referral requests from multiple internal and external sources.
  
• Assist case management team to facilitate the case management process.
  
• Create events in Medical Management Platform.
  
• Assist with quality measures.
  
• Assist with member-focused meetings and complete associated administrative tasks as indicated.
  
• Assist with other administrative duties as appropriate, including meeting minutes.
  
• Ensure compliance with applicable state and federal regulations and guidelines in day-to-day activities.
  
• Ensure accurate and timely electronic and documentation within multiple software programs.
  

Supporting Responsibilities:
 

• Manage electronic mailing lists, group phone queue and outgoing mailings.
  
• Participate in team, department, company, and community-related projects/committees as requested.
  
• Meets department and company performance and attendance expectations.
  
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  
• Perform other duties as assigned.
  

Work Experience: Requires a minimum of one year of experience in community service or healthcare agencies providing coordination of services. Call center experience preferred.


Education, Certificates, Licenses: High school diploma required.

Knowledge: Medical terminology. Proficient in Microsoft Office, including Word, Excel, PowerPoint, Medical management software (e.g CaseTrakker Dynamo). Excellent verbal and written communication skills and ability to work independently as well as to work effectively on a team. Good working knowledge of how to access community resources and healthcare system.


Competencies
 

• Building Customer Loyalty
  
• Building Strategic Work Relationships
  
• Contributing to Team Success
  
• Planning and Organizing
  
• Continuous Improvement
  
• Adaptability
  
• Building Trust
  
• Work Standards
  

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 25% of the time. May be required to use personal vehicle for work-related purposes and to meet with members in the community setting. May need to work outside normal work hours.


Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
  
• We are one team working toward a common goal.
  
• We are each responsible for customer service.
  
• We practice open communication at all levels of the company to foster individual, team and company growth.
  
• We actively participate in efforts to improve our many communities-internally and externally.
  
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  
• We encourage creativity, innovation, and the pursuit of excellence.
  

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.


Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

Clipped from: https://careers.hcahealthcare.com/jobs/12084290-medicaid-eligibility-advocate?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description

This position is incentive eligible.

 

Introduction

Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) Medicaid Eligibility Advocate with Grand Strand Medical Center you can be a part of an organization that is devoted to giving back!

Benefits

Grand Strand Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
  
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
  
• Free counseling services and resources for emotional, physical and financial wellbeing
   
  
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
   
  
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
   
  
• Family support through fertility and family building benefits with Progyny and adoption assistance.
   
  
• Referral services for child, elder and pet care, home and auto repair, event planning and more
   
  
• Consumer discounts through Abenity and Consumer Discounts
   
  
• Retirement readiness, rollover assistance services and preferred banking partnerships
   
  
• Education assistance (tuition, student loan, certification support, dependent scholarships)
   
  
• Colleague recognition program
   
  
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
   
  
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
  

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Would you like to unlock your potential with a leading healthcare provider dedicated to the growth and development of our colleagues? Join the Grand Strand Medical Center family! We will give you the tools and resources you need to succeed in our organization. We are looking for an enthusiastic Medicaid Eligibility Advocate to help us reach our goals. Unlock your potential!

Job Summary and Qualifications

The Medicaid Eligibility Advocate is responsible for conduction eligibility screenings, assessment of patient financial requirements, and counseling patients on insurance benefits and co-payments. The Medicaid Eligibility Advocate serves as a liaison between the patient, hospital, and governmental agencies; and is actively involved in all areas of case management.

In this role you will:

* Screen and evaluate patients for existing insurance coverage, federal and state assistance programs, or hospital charity application.

* Re-verifies benefits and obtains authorization and/or referral after treatment plan has been discussed, prior to initiation of treatment. Ensures appropriate signatures are obtained on all necessary forms.

* Obtain legally relevant medical evidence, physician statements and all other documentation required for eligibility determination.

* Complete and file applications. Initiate and maintain proper follow-up with the patient and government agency caseworkers to ensure timely processing and completion of all mandated applications and accompanying documentation.

* Ensure all insurance, demographic and eligibility information is obtained and entered into the system accurately. Document progress notes to the patient’s file and the hospital computer system.

* Participates in ongoing, comprehensive training programs as required.

* Follows policies and procedures to contribute to the efficiency of the office. Covers and assists with other office functions as requested.

* Will be required to make field visits as necessary and will need reliable personal transportation readily available.

Qualifications:

* High School Diploma or GED or related experience in lieu.

* Associate’s degree preferred

* Minimum one year related experience preferred, preferably in healthcare.

* Relevant education may substitute experience requirement.

This role requires you to be fully vaccinated for COVID-19 based on local, state and /or federal law or regulations (unless a medical or religious exemption is approved).

”

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

”

“There is so much good to do in the world and so many different ways to do it.”- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

Be a part of an organization that invests in you! We are reviewing applications for our Medicaid Eligibility Advocate opening. Qualified candidates will be contacted for interviews. Submit your application and help us raise the bar in patient care!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Apply

Clipped from: https://www.ziprecruiter.com/c/MetroPlusHealth/Job/Director-of-Medicaid/-in-New-York,NY?jid=5ebb2468c4286aec&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth 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, MetroPlusHealth‘s network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Under the supervision of the Senior Director of ICM, the Director of Medicaid will provide clinical and administrative oversight for the High-Risk Medicaid and PCS teams ensuring this vulnerable population receives the right care in the most appropriate setting. Manages the day-to-day operations of the clinical and
non-clinical staff ensuring adherence to regulatory requirements, established polices and workflows. The Director ofMedicaid ensures members are receiving the care they need, addressing their medical, behavioral, and social needs while ensuring appropriate linkages to services for them to remain safely in the community.

Job Description

• Participate in the development and articulates the vision and strategic direction for the care management of Medicaid members; collaborates on the implementation of strategies.
  
• Supervises, plans, organizes, prioritizes, delegates, and evaluates, staff and functions of the Medicaid and PCS teams.
  
• Maintains awareness and ensures compliance with NYS Medicaid contractual requirements for both PCS and mainstream member services
  
• Ensures staff adhere to the care management process of screening, assessing, implementing, and evaluating
  
• Monitors and audits the performance and productivity of the Medicaid teams
  
• In collaboration with Data Analytics evaluates the outcomes of the high-risk Medicaid team
  
• Provide clinical support for the review of Quality-of-Care concerns being investigated by the Quality Management Department.
  
• Must be familiar with OMH, DOH, CMS regulations for service delivery with a care coordination approach to service delivery in managed care settings.
  
• Collaborates with the UM Department to manage appropriate member utilization.
  
• Collaborates with MetroPlusHealth customer service department to ensure that member issues and concerns are addressed and resolved in a timely manner.
  
• Analyzes trends and implement departmental initiatives based upon data provided through the reporting of Care Management, Quality, Data Analytics and Audit data.
  
• Maintain communication with the department head, with routine updates on operations, issues, concerns, and other pertinent information.
  
• Perform other duties as assigned by the Senior Director.
  

Minimum Qualifications

• Bachelor’s Degree is required, Master’s Degree preferred
  
• Minimum 10 years professional healthcare management
  
• Must have 5 years or more in a leadership position in health-related setting
  
• Knowledge of care management process and managed care preferred.
  
• Ability to travel within the MetroPlusHealth service area, as needed
  
• Proficiency with the ability to read and interpret medical records, claims data, pharmacy and lab reports, and prescriptions required
  

Licensure and/or Certification Required

• Requires valid and current RN license to practice in the State of New York.
  

Professional Competencies

• Integrity and Trust
  
• Leadership and Management Skills
  
• Customer Focus
  
• Functional / Technical skills
  
• Written/ Oral Communication
  
• Ability to successfully multi-task while under strict timetable
  
• Exceptional Organizational skills
  
• Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive
  
• Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
  
• Excellent time management and organizational skills
  
• Strong problem-solving skills
  
• Ability to prioritize and manage changing priorities under pressure
  
• Proficiency with Microsoft Office applications including Word, Excel, PowerPoint, and Outlook.
  

Clipped from: https://jobs.azahcccs.gov/title-medical-eligibility-specialist/job/23516639?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Medical Eligibility Specialist

AHCCCS

Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.

AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

Medical Eligibility Specialist
Division of Member and Provider Service (DMPS)
 

Job Location:

Address: 7202 E. Rosewood ST, Suite 125, Tucson, Arizona 85710  

Posting Details:

Open until filled: 1st review of resumes on date 02/21/2023
 

Start Date of 04/03/2023

Salary: $51,340 
 

Grade: 20 

This position is eligible for full-time remote work (including virtual office arrangement). Must reside in the State of Arizona. 

Job Summary:

The Division of Member and Provider Services is looking for a highly motivated individual to join our team as a Medical Eligibility Specialist (PAS Assessor). This position is to determine medical eligibility for customers applying for the Arizona Long Term Care Services (ALTCS) program. Comprehensive Pre-Admission Screenings (PAS) are completed during a face-to-face interview using a designated PAS instrument. Work independently and drive either a state vehicle or their personal vehicle to home and institutional settings to complete interviews and/or obtain documentation. Record actions taken on cases, maintains an electronic case file and updates the Health-e-Arizona Plus. A PAS Assessor may also be required to conduct financial eligibility interviews, complete applications and other forms and obtain verification of eligibility factors to determine the customer’s initial and ongoing financial eligibility and share of cost.

Major duties and responsibilities include but are not limited to:

•  Drives a state or personal vehicle to conduct comprehensive interactive pre-admission screenings (initial and reassessments) utilizing HEAplus on all age groups in both institutional and community settings. Explains benefits, eligibility requirements and rights and responsibilities to customers.
  
•  Manage and monitor PAS caseload and timeliness, schedule interviews, enter interview notes and score PAS, document follow-up actions with case notes, complete and close PAS assessments within application timeframes utilizing HEAplus.
  
•  Obtains and reviews medical records and other relevant records; gathers data to support eligibility findings; interacts with informants such as family members and caregivers of customers, physicians and other professionals to identify and evaluate medical and psychosocial conditions.
  
•  Interact with other state agencies such as Adult Protective Services (APS), Division of Developmental Disabilities (DDD) and Department of Child Safety (DCS).
  
•  Contact applicants with the outcome of the PAS assessment and provide appropriate community resources for customers determined not eligible.
  
•  Attends staff meetings and participates in exchange of professional information in support of the program. Works on special projects, completes financial eligibility interviews.
  

Knowledge, Skills & Abilities (KSAs):

Knowledge:

•  Medical, functional and psycho-social problems of the elderly physically disabled and developmentally disabled children and adults.
  
•  Medical terminology and procedures.
  
•  Available community resources, crisis intervention, counseling, advocacy, community relationships, and referral methods.
  

Skills:

•  Demonstrated knowledge of available community resources, crisis intervention, counseling, advocacy, community relationships, and referral methods.
  
•  Fundamental principles of medical nursing services, alternatives to long term care, length of stay, pharmacology and equipment use.
  
•  Experience with caseload management; schedules and timetables; effectively prioritizing; analyzing, assessing and evaluating service provisions and quality of care.
  

Abilities:

•  Strong ability to establish and maintain effective working relationships with professional staff, caregivers, customers’ families, children and adults and with representatives of courts and various other agencies in the community.
  
•  Ability to communicate effectively, both orally and in writing, reading, understanding and applying rules, regulations and policies.
  
•  Ability to Elicit information and gain insight into customers and families; using a personal computer/laptop and computer programs to document information.
  
•  Ability to solve mathematical problems accurately.
   
  

Qualifications:

Minimum:

•  3 years of experience providing social service case management that included individual planning and delivery of health care services; OR Bachelors or Master’s degree with a major in Social Work, Rehabilitation, Counseling, Education, Sociology, Psychology, Nursing or other closely related field OR Graduation from an accredited school of nursing, with an active Arizona RN license.
  
•  Chinle office only: Bilingual (fluent) in Navajo.
  
•  AZ Driver’s License
  

Preferred:

•  Bilingual (Spanish) a plus but not required (All offices other than Chinle)
   
  

Pre-Employment Requirements:

* Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.
* Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
* Travel is required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.

Benefits:

Among the many benefits of a career with the State of Arizona, there are:
* 10 paid holidays per year
* Paid Vacation and Sick time off (13 and 12 days per year respectively) – start earning it your 1st day (prorated for part-time employees)
* A top-ranked retirement program with lifetime pension benefits
* A robust and affordable insurance plan, including medical, dental, life, and disability insurance
* Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
* RideShare and Public Transit Subsidy
* A variety of learning and career development opportunities
* Opportunity to work 100% virtually or remotely on an ad-hoc basis (home office)

By providing the option of a full-time or part-time virtual/remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

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

Retirement:

Lifetime Pension Benefit Program
* Administered through the Arizona State Retirement System (ASRS)
* Defined benefit plan that provides for life-long income upon retirement.
* Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
* Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program
* Voluntary participation.
* Program administered through Nationwide.
* Tax-deferred retirement investments through payroll deductions.

Contact Us:

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

Clipped from: https://diversityjobs.com/career/4546408/Director-Technology-Health-Plan-Cio-Missouri-Medicaid-Missouri-St-Louis?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life’s best work. (sm)

As an individual contributor you will be part of the local leadership team working with internal and external partners to support the successful delivery and maintenance of Information Systems that support the United Healthcare Missouri Medicaid business. You will also be part of a broader team of individual contributors who provide thought leadership and strategic alignment across the Medicaid technology organization. The successful candidate with have demonstrated experience in leading matrixed teams, proven skills driving implementation of programs and initiatives, experience in working with senior leadership and strategic planning in the healthcare industry.

This role requires excellent communication, problem solving skills, curiosity and the ability to be both a doer and a leader. The quality candidate can leverage their business knowledge in the healthcare industry to support daily efforts, innovative IT efforts, and must excel in high impact and escalated crisis situations. This position will be a key contact for IT efforts and will work with the appropriate delivery areas for Community & States IT projects for our Missouri business. The overall goal of this position is to provide executive oversight and leadership in United’s strong matrix environment, so the IT needs of the business and state partners are met, and contractual compliance are achieved.

If you are located in the St. Louise area, you will have the flexibility to work remotely 1-2 days a week*, as well as work in the office as you take on some tough challenges.

Primary Responsibilities:

 
 

 
 

• Relationship Building:
   
  

 
 

 
 

• Build and improve state, Health plan, IT and service unit partnerships to build long-lasting transparent and trusting relationships
  
• Represents UnitedHealthcare at State meetings; interacts with Community & State senior health plan and shared services leaders
  

   
   

 
 

• Leadership:
   
  

 
 

 
 

• Influence, negotiate effectively, and provide recommendations to arrive at win-win solutions with our state partner, Health plan, IT and business service partners related to IT initiatives
  
• Lead change and innovation by demonstrating emotional resilience, managing change by proactively communicating the case for change and promoting a culture that thrives on change
  
• Influence Health Plan, Business Service units, State partners, IT teams employees by fostering teamwork and collaboration, driving employee engagement and leveraging diversity and inclusion
  
• Provide leader oversight and direction to ensure that the IT applications and operations are working effectively, through high levels of engagement with Health Plan leaders and service units
  
• Develop and mentor others while also building awareness to your own strengths and development needs
  
• Active participant in local/regional health plan leadership, operational leadership group, business goals and strategic initiatives
  
• Be a strategic leader contributing to the growth agenda
  

   
   

 
 

• Regulatory and Growth Effectiveness:
   
  

 
 

 
 

• Provides SME (Subject Matter Experience) on business capabilities, such as claims, member, clinical, provider, X.12 transactions, etc to provide a translation of business need into technical requirements for both Growth and regulatory IT initiatives
  
• Strategize and review with business leaders to identify and frame their IT needs, mapping them to strategic plans and prioritizing them
  
• Drive high-quality execution and operational excellence by communicating clear directions and expectations
  
• Play an active role in implementing innovation solutions by challenging the status quo and encouraging others to improve overall effectiveness
  
• Support Program and Project Managers to ensure that programs / projects are delivered on-time, on-budget, on benefit and on-quality and intervene to resolve issues as required
  
• Represent United at mandatory state meetings and influence the design and timeline of state requirements through written recommendations, questions and clarifications, and open feedback forums
  
• Collaborate with other MCOs (Managed Care Organizations) to drive common processes and timelines for state deliverables
  

   
   

 
 

• Performance & Satisfaction:
   
  

 
 

 
 

• Accountable for compliance with state requirements for transaction loading (834, 837, 820, provider files, etc) and compliance on our technology platforms with state needs
  
• Drive sound and disciplined decisions that drive action while effectively using IT and Healthcare business knowledge
  
• Provides leadership to and is accountable for the State and Health Plan satisfaction as it relates to IT initiatives and performance
  
• Partners with leaders to determine funding and budget requirements, timing, and resources for projects
  
• Leverage broader SME (subject matter experiences) and knowledge to review and challenge estimates of IT tasks and drive toward efficient and timely solutions
  

   
   

 
 

• Innovations/ Strategy
  
  
  

 
 

 
 

• Introduce and align Enterprise business and technology innovations to our markets to advance retention and growth across members and providers
  
• Collaborate and provide the subject matter experience to assist with writing winning technology solutions to RFP (Request for Proposal) in support of United’s growth initiatives
  
• Provide designs, options, and executable solutions to existing UHC problems requiring innovative solutions
  
• Provide strategic leadership, collaborate, and subject matter expertise to assist in writing winning technology responses to RFP (request for proposal) in support of UHC growth initiatives
  

   
   

 
 

 
 

 
 

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

Required Qualifications:

 
 

 
 

• 10+ years of professional IT experience or equivalent related experience
  
• 7+ years of professional management experience in a large, enterprise environment
  
• 5+ years of experience leading teams and/or managing workloads for IT team members
  
• 3+ years of professional Director level experience in a large, enterprise environment
  
• Medicare/Medicaid experience
  
• Health care industry experience
  
• Resident of Missouri or willing to relocate
  

 
 

 
 

Preferred Qualifications:

 
 

 
 

• Graduate Degree
  
• Experience leading distributed teams
  

 
 

 
 

Technology Careers with Optum. Information and technology have amazing power to transform the health care industry and improve people’s lives. This is where it’s happening. This is where you’ll help solve the problems that have never been solved. We’re freeing information so it can be used safely and securely wherever it’s needed. We’re creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.(sm)

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission

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

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

Clipped from: https://careers.humana.com/job/17811280/associate-director-hr-business-partner-medicaid-louisville-ky/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

If you are an existing CenterWell or Humana
associate, please apply through go/associatecareers using a Chrome or Edge browser.


 

 
 

Humana is at the nexus of the innovation taking place within healthcare. Broadly speaking, we are one of the most active participants in the sector. This is an exciting company headquartered in a city with an excellent quality of life!

Oliver
Director, Corporate Development and Venture Capital

 
 

I looked for the opportunity for growth and stability and I found it here.

Barry
Manager, Software Engineering Strategic HR Systems

 
 

Humana has really helped my sense of belonging because I feel part of the team.

Rosemary
Senior Consumer Experience Professional

 
 

The best part of this company is the commitment to associates, which naturally leads to commitment to members.

Abigail
Medical Director, Mid-South

 
 

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact yourcareer@humana.com for assistance.

Humana Health and Safety Policy

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working outside of their homes. Learn how we are doing our part

Humana Security Notice

Humana will never ask, nor require a candidate to provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact yourcareer@humana.com to validate the request.

California Residents

If you are a California resident and would like to review our California Consumer Privacy Act (CCPA) Policy click here:

CA Resident Privacy Policy

Clipped from: https://www.linkedin.com/jobs/view/experienced-business-analyst-medicaid-at-gainwell-technologies-3480611811/?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 an Experienced 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

• Nine or 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
  
• 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

• Opportunities to travel through your work (0-10%)
  
• Onsite, remote or Hybrid options may be available from US locations
  
   
  

#LI- Medicaid


The pay range for this position is $86,800.00 – $124,000.00 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 401(k) employer match, comprehensive health benefits , 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 company website and visit our Careers site 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.


 

Clipped from: https://jobs.conduent.com/job/17813383/medicaid-outreach-liaison-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Location: Remote, US

Categories: Customer Support & Administration

Req ID: 2023-78003

Job Description

About Conduent

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.

Job Description

This is a hybrid-position and the candidate will be working both on-site and remotely providing outreach to the community and assistance to our enrolled providers. This is a great step for someone to take the next step in their career. The candidate must be able to organize and prioritize their work day and work in a team environment. The candidate needs to be well versed with Montana Medicaid healthcare programs and policies.

Duties and Responsibilities:

• Provide outreach and face-to-face support to the Montana Healthcare Programs community.
  
• Develop and facilitate education for the provider population including provider community in assigned service area.
  
• Actively promote the use of EDI, DPHHS Provider Information website, and MATH web portal in the provider community.
  
• Attend manager-approved seminars offered by professional associations and speak on behalf of Conduent and DPHHS about the Medicaid environment or participate in workshops and meetings sponsored by providers and DPHHS.
  
• Work with providers to resolve claim issues, including troubleshooting electronic transmission.
  
• Complete additional tasks as assigned by the Provider Relations Manager.
  
• Plan and facilitate training events for providers including webex or MS Teams seminars
  

Desired skills and attributes:

• Self- motivated
  
• Strong communication skills
  
• Outgoing, positive, energetic attitude
  
• Must be willing to travel
  
• Valid U.S. driver’s license
  
• Strong skills with Microsoft Office Suite
  
• Possess excellent public speaking, communication, and presentation skills
  
• Ability to create presentations
  
• Ability to multi-task, manage time and workload effectively
  
• Ability to analyze new situations and apply problem-solving skills
  
• Ability to relate to providers/staff
  
• Ability to remain calm under pressure
  
• Ability to adapt to and incorporate new technologies
  
• Attention to detail
  

Preferred Skills:

• Five or more years in customer service
  
• Two plus years Medicaid or medical insurance experience
  
• Bachelor’s degree preferably in Healthcare Administration, Business Management, Communications, or equivalent years of experience
  

Closing

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.

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.

Clipped from: https://www.indeed.com/viewjob?jk=25c7dde67926c145&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Overview

About Public Consulting Group

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, technology, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG employs approximately 2,000 professionals worldwide—all committed to delivering solutions that change lives for the better. The firm has extensive experience in all 50 states, Canada, and a growing practice in Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com.

Responsibilities

The Medicaid marketplace is changing, and PCG is at the forefront. We are looking for an experienced Medicaid Consultant to join our team and help lead our growth efforts. Deep Medicaid experience is critical, as well as experience working with the Centers for Medicare and Medicaid Services (CMS) and the new streamlined modular certification (SMC) and outcomes-based certification (OBC). Our ideal Medicaid Consultant will provide oversight and direction for scope, schedule, , quality, , communications, risk, and , stakeholder management activities, all while adding deep Medicaid and Medicaid Enterprise Systems (MES) experience and thought leadership

Specific Responsibilities:

• Demonstrated understanding and knowledge of Medicaid, CMS, SMC/OBC, and MES
  
• Conduct Medicaid System Assessments
  
• Help states plan for and execute SMC/OBC activities
  
• Help lead and provide expert level guidance on various projects
  
• Ensure planned results are achieved on time
  
• Work with clients, vendors, team members to establish and achieve project goals
  
• Address problems through risk management and contingency planning
  
• Plan, organize, execute, and monitor and control project activities
  
• Perform project assessments and report on project progress
  
• Facilitate meetings and present project information
  
• Identify, document, and/or escalate issues to appropriate levels
  

Qualifications

Required Skills/Experience:

• Bachelor’s degree or equivalent university degree
  
• 5+ years experience performing project oversight and assessments for a large enterprise grade information technology initiative
  
• 4+ years experience performing performance metrics measurements and reporting to management and executive level staff.
  
• Demonstrated experience working with SMC/OBC
  
• Demonstrated written and verbal communications skills
  
• Ability to influence internal and external stakeholders
  
• Ability to lead/manage others in a matrixed environment
  
• Proficiency in Microsoft applications (Outlook, Word, Excel, PowerPoint, Visio, Project) and project management tools
  

#LI-AH1

#D-PCG

#LI-remote

Compensation

Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, PCG provides the following reasonable range of compensation for this role: $110,000-$140,000

EEO Statement

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.

Job Type: Full-time

Pay: $110,000.00 – $140,000.00 per year

Work Location: Remote