Category: Curator- Job Hunter

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.  It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

 
 

This is an exceptional opportunity to do innovative work that means more to you and those we serve. 

 
 

Nurse Case Manager l – Pediatrics (Medicaid) PS58871

 
 

Location: This is a work@home position that requires member-facing visits within the West Tennessee area. You must reside in the state of Tennessee within 1.5 hours driving distance to Cordova, Tennessee.

 
 

Work Hours: 8am – 4:30pm, Monday – Friday. No holidays or weekends.

 
 

The Nurse Case Manager I
(West Tennessee) is responsible for performing care management within the scope of licensure for Pediatric members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning. Primary duties may include but are not limited to:

• Ensures member access to services appropriate to their health needs.
  
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
  
• Coordinates internal and external resources to meet identified needs.
  
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
  
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
  

 
 

Qualifications

Minimum Requirements:

 
 

The health and safety of our associates, members and communities is a top priority for Anthem.  This priority has become increasingly important as we continue to face the challenges of the COVID-19 pandemic.  Anthem believes vaccination is the best way to reduce the spread of COVID-19 and protect our members, our communities, our families and ourselves. To minimize the risk of transmission of the COVID-19 virus and maintain a safe and healthy workplace, vaccination is required for this role. (At Anthem, fully vaccinated means it has been at least two weeks since you have received the second dose of a two-dose vaccine such as Moderna or Pfizer, or the single dose of a single dose vaccine, such as Johnson & Johnson).

 
 

If you do not meet the requirements for this position, we encourage you to review other positions that currently allow virtual work.  If you have a medical or sincerely held religious reason for not being vaccinated, consistent with applicable law, Anthem will consider requests for reasonable accommodation on this basis.  Should you have any questions regarding the requirement after applying, email TalentAcquisition_VaccinationSupport@anthem.com.

 
 

• BA/BS in a health-related field; 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
  
• Current, unrestricted RN license in the state of Tennessee required.
  
• 1+ years experience working with pediatric patients.
  
• Must reside in Tennessee.
  

 
 

Preferred Qualifications:

• MS Word and MS Excel proficient.
  

 
 

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/7720108-nurse-case-manager-pediatrics-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

At Wider Circle, our team is on a mission to connect neighbors for better health, and we’re looking for equally passionate colleagues across the country to help us make a positive impact on the communities we serve. We are growing at warp speed to reach those who need us most, paving the way to become 1 million members strong. We are proud to support a culture of caring, diverse and visionary change-makers who enjoy working in a fast-paced environment and experiencing new things, every day. We partner with health plans and physician groups in neighborhoods across the country to provide fun and educational in-person and virtual programs for members who share similar interests and life experiences. Think of us as a social group with a bigger purpose: Helping Medicare and Medicaid members get the care they deserve while surrounded by a trusted circle of friends, close to home. Today, Wider Circle is proud to bring its unique neighborhood care programs to more than 320 communities in 5 different languages. Join us as we build connections for better health in communities across the country.

Wider Circle is looking for a Vice President of Operations to lead our Medicaid division with the following skills:

Top Five Skills

 
 

Connects with the Mission

Wider Circle’s mission should be a significant factor in this person’s desire to consider the position. The right person will be a values-driven individual who immediately aligns with Wider Circle’s values, connects and compliments teammates, and demonstrates the appropriate passion within their personal life.

Outspoken and Resolute

To create value for our Medicaid sponsors, we need to engage hard-to-reach members and find new ways to engage them that balance outcomes and economics. To find new solutions, we work in groups and create a contest of ideas. The ideal candidate will defend their reasoning through debate and challenge and have the grit to stay the course.

Health Plan End Market Experience

The right candidate understands our customers – Health Plans and Payer organizations such as Medicare Advantage & Medicaid Plans. This individual will have 3-5 years of experience in a health services startup, health provider, or other organization serving health plans.

Flexibility

Responding to members’ and customers’ needs with the consistency and passion that typify Wider Circle requires flexibility. Work processes, work teams, and speed adjust to meet those needs, and this individual would like this type of work dynamic.

High Clock Speed

For us, clock speed is the pace at which a person likes to go about their work. It’s a matter of preference more than anything. At Wider Circle, the pace of work tends to be fast, and this individual would prefer that pace of work.

Responsibilities

• Manage the service delivery for our Medicaid sponsors
  
• Lead the implementation of new Medicaid programs
  
• Lead the implementation of services with new Medicaid MCO’s
  
• Develop staffing plans, operational metrics, and budgeting to meet the Company’s objectives for its Medicaid services
  
• Participate in the development of new content and process solutions
  
• Manage the execution and reporting of Medicaid service design experiments
  
• Develop operational processes specific to each Medicaid program
  
• Manage the data retrieval and analysis of data from the system of record to provide actionable recommendations to the COO
  
• Create and maintain operating procedures and processes
  
• Lead the development of a Quality Assurance program for the Medicaid services
  
• Manage the creation of training materials and collaboration with the training team
  

Requirements

• 10+ years of experience working with low-income individuals
  
• 10+ years of service delivery experience
  
• Demonstrated project & vendor management experience
  
• Experience working at investor-backed startups
  
• Experience working at growth-stage startups is a plus
  
• Demonstrated experience with service or campaign development is a plus
  
• Bachelor’s degree is required, Master’s degree preferred
  
• Exceptional working knowledge of GSuite, Salesforce, and reporting databases such as Tableau.
  

Benefits

As a venture-backed company, Wider Circle offers competitive compensation including:

• Comprehensive health coverage including medical, dental, and vision
  
• 401(k) Plan
  
• Paid Time Off
  
• Employee Assistance Program
  
• Health Care FSA
  
• Dependent Care FSA
  
• Health Savings Account
  
• Voluntary Disability Benefits
  
• Basic Life and AD&D Insurance
  
• Adoption Assistance Program
  
• Training and Development
  

And most importantly, an opportunity to make the world a better place!

Clipped from: https://www.glassdoor.com/job-listing/vp-of-operations-medicaid-wider-circle-JV_KO0,25_KE26,38.htm?jl=1007394891962&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

*Description* The Senior Project Manager manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Senior Project Manager work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors..

*Responsibilities*.

*Where you Come In* The Senior Project Manager designs, communicates, and implements an operational plan for completing the project; monitors progress and performance against the project plan; takes action to resolve operational problems and minimize delays. Identifies, develops, and gathers the resources to complete the project. Prepares designs and work specifications; develops project schedules, budgets and forecasts; and selecting materials, equipment, project staff, and external contractors.

Communicates with other operational areas (ie, Provider, IT, Medicaid, etc..

.) in the organization to secure specialized resources and contributions for the project. Conducts meetings and prepare reports to communicate the status of the project.

Sets priorities, allocates tasks, and coordinates project staff to meet project targets and milestones. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction.

Exercises considerable latitude in determining objectives and approaches to assignments..

*What Humana Offers* We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being.

We also provide excellent professional development & continued education..

*Required Qualifications – What it takes to Succeed*. Bachelor’s degree. Minimum of 5 years of Project Management experience and successful project management implementations.

Proficient in MS Office to include MS Project. Strong verbal and written communication skills. Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

We will require?full COVID vaccination for this job as 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 documentation for a medical or religious exemption consideration where allowed by law..

*Preferred Qualifications*. PMP certification.

Provider data and processes knowledge and/or experience.*Additional Information – How we Value You*. Benefits starting day 1 of employment. Competitive 401k match.

Generous Paid Time Off accrual. Tuition Reimbursement. Parent Leave. Go365 perks for well-being. Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work..

Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M.*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 correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. 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.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

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.*Scheduled Weekly Hours* 40.
 

To apply for this position you will complete an application form on another website provided by or on behalf of Humana. Please note Apply4 Tech Jobs is not responsible for the application process on any external website.

 
 

Clipped from: https://www.apply4techjobs.com/job-in-Birmingham-Alabama-USA/PROVIDER-SENIOR-PROJECT-MANAGER-MEDICAID-REMOTE-VIRTUAL-IN-US-76ca0b268ffbc3e480/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortune Top 50 Company.
Medicaid New Market Transitions Director
Location: The ideal candidate would be located in an Eastern or Central time zone with a 50% travel expectation, yet this position will consider other Anthem locations.
Anthem’s Government Business Group’s Medicaid New Market Transition team is looking for a Medicaid New Market Transitions Director to join its team. This high-performing individual contributor will be responsible for creating and executing strategies and tactical plans to win new business (new markets, alliance partnership, acquisitions, etc.). Leads, oversees, develops and ensures successful procurement of new business, resulting in increased Medicaid growth and P&L opportunities and expansion of Anthem’s market footprint. Focus for this role will be on initial ground game development, state and legislative relationship development in coordination with Government Relations, regulatory and compliance.
Primary duties may include, but are not limited to:
+ Creates and executes the initial market strategy enabling Anthem to win the business by understanding the key needs of the customer (State, Provider, Alliance, etc.) in partnership with multiple matrix partners including Finance, Government Relations, Diversified Business Group, Network, Operations and Clinical organizations.
+ Identifies and develops new relationships and advocacy in the market(s) with state, provider, and not for/non- profit organizations.
+ Develops and supports new innovative programs and market specific pilots targeting growth including internal and external vendor partnerships.
+ Provides business expertise in each new business venture to proactively understand what Anthem’s portfolio currently can offer, what will need to be developed, and the ROI to ensure there is a mutually beneficial outcome for both parties when building new programs.
+ Prior to engaging in procurement activities, builds brand recognition with community partners in partnership with the Medicaid Marketing organization to better support RFP activities and win new business.
Qualifications
Minimum Requirements:
Requires a BA/BS degree in a related field and a minimum of 8 years of leadership experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications:
+ Experience in a health plan leadership role and leadership role in M&A and/or RFP activities.
+ Experience and knowledge of MCO most notably in the Medicaid industry is strongly preferred.
+ Demonstrated results in three or more of the following areas required: Product Development, Market Strategy, Market Research or Risk Management.
+ Experience in building strong client relationships with key stakeholders including clients, government agencies, and vendor partners.
+ Excellent written, oral and interpersonal communication skills with the proven ability to negotiate expectations between multiple parties.
+ Experience interacting confidently with senior management, as s subject matter expert and comfortable with influencing decision-making.
Applicable to Colorado Applicants Only
Annual Salary Range*: $124,404 – $155,505
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
* The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting.  The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future.  No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
REQNUMBER: PS61432-2583
 

 
 

Clipped from: https://www.recruit.net/job/transition-director-jobs/D7AECB1293F54D52?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

SEE how you can make a difference! Be part of an innovative company that cares about its associates and helps members enjoy the wonders of sight through healthy eyes and vision.

Versant Health provides vision care to 37 million members nationwide! To ensure your continued success we provide opportunities for advancement and development. Our associates remain engaged through a comprehensive compensation and benefits package which includes health and dental insurance, tuition reimbursements, 401(k) with company match, pet insurance and FREE vision insurance for you and your family.

Scope and Purpose of Position
Develop strong external and internal relationships to achieve client satisfaction, revenue objectives for existing customers in an assigned segmentation and geography of Business.

Manage, retain and grow assigned book of business, including large high profile and complex Government Sponsored clients (i.e. Medicaid/Medicare lines of business), to achieve individual and corporate goals. Internal liaison to implementation and operations areas for clients. Coordinate introduction/orientation/implementation meetings with internal business partners when applicable for new/existing groups.

Essential Functions
 

• Provides strategic leadership and solution based support to expand and maintain business relationships with existing large and complex accounts
  
• Demonstrates individual ownership and accountability in development client and broker relationships
  
• Communicate effectively, consistently and frequently with assigned client base. Continuously working to improve customer loyalty
  
• Ongoing liaison/consultant through meetings, plan reviews, care calling, etc. in accordance with Client Service guidelines to ensure client loyalty, retention and satisfaction
  
• Lead implementation from a client management team perspective, partnering with internal departments, with the responsibility of successful implementation
  
• Ability to effectively manage high profile and complex clients in a book of business encompassing $15,000,000 to $40,000,000
  
• Meet all assigned revenue, client retention and profitability goals
  
• Notify Team leader of potential growth opportunities as well as escalated client concerns, continued negative feedback or ‘red flags’ within assigned book of business
  
• Present renewals and recommendations and coordinate implementations for renewals, benefit changes and unit adds with Implementation and Contracting teams
  
• Coordinate implementations for new sales with Sales Team as overall project manager through completion of implementation
  
• Determine growth opportunities and benefit design, coordinate proposal and finalize sale, as well as, group communication needs (summary plan descriptions, provider lists, etc.) and benefit fair needs and expectations
  
• Review and assure that client receives all requested reports, satisfaction results and performance guarantees within the timeframe requested
  
• Inform senior management of market trends that affect the management of assigned book of business
  
• Strategic support for sales presentations and marketing, when needed
  
• Adhere to privacy and confidential and proprietary company policies and procedures (i.e. HIPAA)
  
• Participate in any/all training and educational activities necessary to fulfill at least the minimum requirements as specified within your departmental goals. This is in addition to the completion of any activities necessary for the maintenance of professional affiliations or organizational requirements
  
• As required by changing business needs, complete additional responsibilities as assigned
  
• Maintain appropriate insurance licenses
  
• Ability and willingness to travel as required
  

Education and Experience
 

• Bachelor’s Degree preferred
  
• Knowledge and experience in the insurance, health, or vision care industry
  
• Years of experience 3-5
  
• Prior Account Management or Customer Service experience desirable
  
• Life/health insurance license required (within 6 months of hire)
  
• Computer knowledge/skills needed
  
• Travel domestically: valid driver’s license required
  

Essential Responsibilities related to Physical Demands/Work Environment
The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the associate is required to stand, use hands and fingers to handle, feel, pick or pinch, and talk or hear most of the time. The associate is occasionally required to stand, walk, and reach with hands and arms. The associate must frequently lift and/or move up to 20 pounds. The noise level in this location is moderate (use of computers, printers and machines). Ability and willingness to travel as required.

HIPAA & Security Requirements
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.

We provide equal employment opportunities (EEO) to all associates and applicants for employment without regard to race, color, religious beliefs, sex, gender identity, sexual orientation, age, marital status, national origin, ancestry, physical or mental disability or history of disability, genetic information, status as a protected veteran or disabled veteran, or any other status protected by Federal, state or local law.

We take pride in our recruiting process and follow a merit-based employee recruitment practice with extensive screening steps. We will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.

This policy extends to all associates and to all aspects of the employment relationship. Any associate who violates this policy will be subject to disciplinary action up to and including termination.

 
 

Clipped from: https://www.glassdoor.com/job-listing/senior-client-manager-government-programs-medicare-medicaid-versant-health-JV_IC1155583_KO0,59_KE60,74.htm?jl=1007396384697&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve.

Manager l Utilization Management (Inpatient) – Texas Medicaid (PS62128)

Location for External candidates: Texas residents only. [email protected]

The Manager I HCMS / Utilization Management (Texas Medicaid) is responsible for managing a team of physical and/or behavioral health practitioners responsible for coordinating member service, utilization, access, care management and/or concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services for one or more member product populations of varying medical complexity ensuring the delivery of essential services that address the total healthcare needs of members. Primary duties may include, but are not limited to:

• Manages and oversees team responsible in case finding and coordinating cases that involve comorbid conditions.
  
• Coordinates service delivery to include member assessment of physical and psychological factors.
  
• Responds to member, provider, and state complaints and inquiries.
  
• Partners with providers to establish short and long-term goals that meet the member’s needs, functional abilities, and referral sources requirements.
  
• Identifies members with potential for high-risk complications.
  
• Reviews benefit systems and cost benefit analysis.
  
• Evaluates medical, mental health and substance abuse service for cost containment.
  
• Supports program compliance and assists in identifying opportunities to improve the customer service and quality outcomes.
  
• Attends state meetings, implements state changes.
  
• Supports quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting.
  
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
  

Qualifications

Minimum Requirements:

• Requires a BA/BS; 5 years of experience in Health Care Management; or any combination of education and experience, which would provide an equivalent background.
  
• Current active unrestricted RN license in the state of Texas required. Must be a Texas resident.
  
• 1 year managed care industry work experience.
  
• 1 year experience using FACETS.
  
• 1+ years working in medical management interpreting and applying member contracts, member benefits, and managed care products.
  
• 1+ years experience working with Interqual criteria, Milliman Care Guidelines, and/or Texas State Medicaid criteria (TMPPM.)
  
• 1 year experience leading others formally (direct reports or Team Lead) or informally (SME, Project management, etc)
  
• 5 years’ experience using MS Word and MS Excel.
  

Preferred Qualifications:

• Proficient using FACETS
  
• Experience using ACMP, HIP (Health Information Platform) and/or Care Compass a plus.
  
• MSN, MPH, MPA, MSW or MBA with Health Care Concentration preferred.
  
• Certified Case Manager Certification preferred.
  

Applicable to Colorado Applicants Only

Annual Salary Range*: $82,240 – $102,800

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

• The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
  

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

Clipped from: https://getwork.com/details/f70331fd37f15aac61f81e7d66a4e078?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Requirements: 

• BA/BS degree
  
• Minimum of 5 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry
  
• Or any combination of education and experience which would provide an equivalent background
  

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

Qualifications

Requirements: 

• BA/BS degree
  
• Minimum of 5 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry
  
• Or any combination of education and experience which would provide an equivalent background
  

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/7852552-medicaid-state-operations-analyst?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve.

Manager l Utilization Management (Inpatient) – Texas Medicaid (PS62128)

Location for External candidates: Texas residents only. [email protected]

The Manager I HCMS / Utilization Management (Texas Medicaid) is responsible for managing a team of physical and/or behavioral health practitioners responsible for coordinating member service, utilization, access, care management and/or concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services for one or more member product populations of varying medical complexity ensuring the delivery of essential services that address the total healthcare needs of members. Primary duties may include, but are not limited to:

• Manages and oversees team responsible in case finding and coordinating cases that involve comorbid conditions.
  
• Coordinates service delivery to include member assessment of physical and psychological factors.
  
• Responds to member, provider, and state complaints and inquiries.
  
• Partners with providers to establish short and long-term goals that meet the member’s needs, functional abilities, and referral sources requirements.
  
• Identifies members with potential for high-risk complications.
  
• Reviews benefit systems and cost benefit analysis.
  
• Evaluates medical, mental health and substance abuse service for cost containment.
  
• Supports program compliance and assists in identifying opportunities to improve the customer service and quality outcomes.
  
• Attends state meetings, implements state changes.
  
• Supports quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting.
  
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
  

Qualifications

Minimum Requirements:

• Requires a BA/BS; 5 years of experience in Health Care Management; or any combination of education and experience, which would provide an equivalent background.
  
• Current active unrestricted RN license in the state of Texas required. Must be a Texas resident.
  
• 1 year managed care industry work experience.
  
• 1 year experience using FACETS.
  
• 1+ years working in medical management interpreting and applying member contracts, member benefits, and managed care products.
  
• 1+ years experience working with Interqual criteria, Milliman Care Guidelines, and/or Texas State Medicaid criteria (TMPPM.)
  
• 1 year experience leading others formally (direct reports or Team Lead) or informally (SME, Project management, etc)
  
• 5 years’ experience using MS Word and MS Excel.
  

Preferred Qualifications:

• Proficient using FACETS
  
• Experience using ACMP, HIP (Health Information Platform) and/or Care Compass a plus.
  
• MSN, MPH, MPA, MSW or MBA with Health Care Concentration preferred.
  
• Certified Case Manager Certification preferred.
  

Applicable to Colorado Applicants Only

Annual Salary Range*: $82,240 – $102,800

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

• The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
  

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

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SEE how you can make a difference! Be part of an innovative company that cares about its associates and helps members enjoy the wonders of sight through healthy eyes and vision.

Versant Health provides vision care to 37 million members nationwide! To ensure your continued success we provide opportunities for advancement and development. Our associates remain engaged through a comprehensive compensation and benefits package which includes health and dental insurance, tuition reimbursements, 401(k) with company match, pet insurance and FREE vision insurance for you and your family.

Scope and Purpose of Position
Develop strong external and internal relationships to achieve client satisfaction, revenue objectives for existing customers in an assigned segmentation and geography of Business.

Manage, retain and grow assigned book of business, including large high profile and complex Government Sponsored clients (i.e. Medicaid/Medicare lines of business), to achieve individual and corporate goals. Internal liaison to implementation and operations areas for clients. Coordinate introduction/orientation/implementation meetings with internal business partners when applicable for new/existing groups.

Essential Functions
 

• Provides strategic leadership and solution based support to expand and maintain business relationships with existing large and complex accounts
  
• Demonstrates individual ownership and accountability in development client and broker relationships
  
• Communicate effectively, consistently and frequently with assigned client base. Continuously working to improve customer loyalty
  
• Ongoing liaison/consultant through meetings, plan reviews, care calling, etc. in accordance with Client Service guidelines to ensure client loyalty, retention and satisfaction
  
• Lead implementation from a client management team perspective, partnering with internal departments, with the responsibility of successful implementation
  
• Ability to effectively manage high profile and complex clients in a book of business encompassing $15,000,000 to $40,000,000
  
• Meet all assigned revenue, client retention and profitability goals
  
• Notify Team leader of potential growth opportunities as well as escalated client concerns, continued negative feedback or ‘red flags’ within assigned book of business
  
• Present renewals and recommendations and coordinate implementations for renewals, benefit changes and unit adds with Implementation and Contracting teams
  
• Coordinate implementations for new sales with Sales Team as overall project manager through completion of implementation
  
• Determine growth opportunities and benefit design, coordinate proposal and finalize sale, as well as, group communication needs (summary plan descriptions, provider lists, etc.) and benefit fair needs and expectations
  
• Review and assure that client receives all requested reports, satisfaction results and performance guarantees within the timeframe requested
  
• Inform senior management of market trends that affect the management of assigned book of business
  
• Strategic support for sales presentations and marketing, when needed
  
• Adhere to privacy and confidential and proprietary company policies and procedures (i.e. HIPAA)
  
• Participate in any/all training and educational activities necessary to fulfill at least the minimum requirements as specified within your departmental goals. This is in addition to the completion of any activities necessary for the maintenance of professional affiliations or organizational requirements
  
• As required by changing business needs, complete additional responsibilities as assigned
  
• Maintain appropriate insurance licenses
  
• Ability and willingness to travel as required
  

Education and Experience
 

• Bachelor’s Degree preferred
  
• Knowledge and experience in the insurance, health, or vision care industry
  
• Years of experience 3-5
  
• Prior Account Management or Customer Service experience desirable
  
• Life/health insurance license required (within 6 months of hire)
  
• Computer knowledge/skills needed
  
• Travel domestically: valid driver’s license required
  

Essential Responsibilities related to Physical Demands/Work Environment
The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the associate is required to stand, use hands and fingers to handle, feel, pick or pinch, and talk or hear most of the time. The associate is occasionally required to stand, walk, and reach with hands and arms. The associate must frequently lift and/or move up to 20 pounds. The noise level in this location is moderate (use of computers, printers and machines). Ability and willingness to travel as required.

HIPAA & Security Requirements
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.

We provide equal employment opportunities (EEO) to all associates and applicants for employment without regard to race, color, religious beliefs, sex, gender identity, sexual orientation, age, marital status, national origin, ancestry, physical or mental disability or history of disability, genetic information, status as a protected veteran or disabled veteran, or any other status protected by Federal, state or local law.

We take pride in our recruiting process and follow a merit-based employee recruitment practice with extensive screening steps. We will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.

This policy extends to all associates and to all aspects of the employment relationship. Any associate who violates this policy will be subject to disciplinary action up to and including termination.

 
 

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Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortune Top 50 Company.
Medicaid New Market Transitions Director
Location: The ideal candidate would be located in an Eastern or Central time zone with a 50% travel expectation, yet this position will consider other Anthem locations.
Anthem’s Government Business Group’s Medicaid New Market Transition team is looking for a Medicaid New Market Transitions Director to join its team. This high-performing individual contributor will be responsible for creating and executing strategies and tactical plans to win new business (new markets, alliance partnership, acquisitions, etc.). Leads, oversees, develops and ensures successful procurement of new business, resulting in increased Medicaid growth and P&L opportunities and expansion of Anthem’s market footprint. Focus for this role will be on initial ground game development, state and legislative relationship development in coordination with Government Relations, regulatory and compliance.
Primary duties may include, but are not limited to:
+ Creates and executes the initial market strategy enabling Anthem to win the business by understanding the key needs of the customer (State, Provider, Alliance, etc.) in partnership with multiple matrix partners including Finance, Government Relations, Diversified Business Group, Network, Operations and Clinical organizations.
+ Identifies and develops new relationships and advocacy in the market(s) with state, provider, and not for/non- profit organizations.
+ Develops and supports new innovative programs and market specific pilots targeting growth including internal and external vendor partnerships.
+ Provides business expertise in each new business venture to proactively understand what Anthem’s portfolio currently can offer, what will need to be developed, and the ROI to ensure there is a mutually beneficial outcome for both parties when building new programs.
+ Prior to engaging in procurement activities, builds brand recognition with community partners in partnership with the Medicaid Marketing organization to better support RFP activities and win new business.
Qualifications
Minimum Requirements:
Requires a BA/BS degree in a related field and a minimum of 8 years of leadership experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications:
+ Experience in a health plan leadership role and leadership role in M&A and/or RFP activities.
+ Experience and knowledge of MCO most notably in the Medicaid industry is strongly preferred.
+ Demonstrated results in three or more of the following areas required: Product Development, Market Strategy, Market Research or Risk Management.
+ Experience in building strong client relationships with key stakeholders including clients, government agencies, and vendor partners.
+ Excellent written, oral and interpersonal communication skills with the proven ability to negotiate expectations between multiple parties.
+ Experience interacting confidently with senior management, as s subject matter expert and comfortable with influencing decision-making.
Applicable to Colorado Applicants Only
Annual Salary Range*: $124,404 – $155,505
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
* The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting.  The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future.  No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company’s sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
REQNUMBER: PS61432-2583
 

 
 

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