Posted on

PROVIDER SENIOR PROJECT MANAGER MEDICAID REMOTE

 
 

*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

Posted on

Wider Circle VP of Operations, Medicaid Job in Remote

 
 

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

Posted on

Proposal Research Consultant- Anthem

 
 

Description:

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.

 
 

 
 

Location:  Any of the following states:  IN, OH, GA, VA, CA, NV, MO, KY, CT, NH, ME, WI, NY.  The selected candidate must reside within a commutable distance to an Anthem office in any of the above-mentioned states.  

 
 

 
 

The Proposal Research Consultant is responsible for managing subject matter content in the proposal library and related data sources to be used for completing Request for Proposals to accurately present the organization’s capabilities to potential clients. Primary duties may include, but are not limited to:

  • Serves as content expert and key knowledge source for proposal development.
  • Manages the accuracy of library database entries including researching answers and establishing information pipelines with key subject matter experts (SMEs).
  • Disseminates information to the proposal writing staff.
  • Proofreads, edits, and standardizes proposal text. Edits proposal responses for structure, completeness, accuracy, organizational consistency, and appropriateness of content.
  • Researches company websites and other internal and external resources to identify new organizational products and initiatives and engages appropriate SMEs for further information.
  • Improves the efficiency of all aspects of the proposal library process, including proposal submissions, content matter, content verifications, and audits.
  • Provides guidance and training to proposal associates regarding how to effectively search, filter and navigate the database and use the tool, as well as improve the style and quality of proposal responses via new messaging or sales stories.

Qualifications

Minimum Requirements:  Requires a BA/BS degree in a related field or business area and a minimum of 4 years of related experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications:  Prior healthcare industry experience strongly preferred. Strong technical and custom writing skills, as well as grammatical and editing skills; this includes the ability to write about different brands or products in a unified voice and effectively translate verbiage from SMEs into compelling prose is strongly preferred.

 
 

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/7744338-proposal-research-consultant-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Medicaid Data & Analytics Product Owner Liaison | Accenture

 
 

The Medicaid Data & Analytics Product Owner Liaison (POL) is responsible for product planning and delivery though the product lifecycle. They partner with the State Product Owner (PO) and technology architects to create and sell a compelling vision for the product that will achieve stakeholder objectives. The POL then works with the State PO, project manager, and technology architects to prioritize the product backlog into epics and features that maximize business value. The POL further refines backlog items as needed, participates in Agile Scrum ceremonies, and clarifies business requirements for the Scrum team. The POL operates with limited supervision and must demonstrate excellent time management, work planning, and communication.

Minimum of 4 years Business analysis experience for data and analytics systems development including business process design, requirements gathering, documentation, and testing

Minimum of 4 years Microsoft Office experience including Excel and Word

Minimum of 2 years Working with healthcare claim or encounter data

Minimum of 1 year Work experience as a Product Owner, Product Manager, or related role

Minimum of 1 year Agile Scrum 1 years SQL experience to facilitate analysis and testing Preferred Skills TX Medicaid business and systems knowledge Experience creating queries and reports using SAP Business Intelligence BusinessObjects Previous work experience as a Project Manager Experience developing data warehouse and business intelligence solutions

What We Believe

We have an unwavering commitment to diversity with the aim that every one of our people has a full sense of belonging within our organization. As a business imperative, every person at Accenture has the responsibility to create and sustain an inclusive environment.

Inclusion and diversity are fundamental to our culture and core values. Our rich diversity makes us more innovative and more creative, which helps us better serve our clients and our communities. Read more here

Equal Employment Opportunity Statement

Accenture is an Equal Opportunity Employer. We believe that no one should be discriminated against because of their differences, such as age, disability, ethnicity, gender, gender identity and expression, religion or sexual orientation.

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

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

For details, view a copy of the Accenture Equal Opportunity and Affirmative Action Policy Statement.

Requesting An Accommodation

Accenture is committed to providing equal employment opportunities for persons with disabilities or religious observances, including reasonable accommodation when needed. If you are hired by Accenture and require accommodation to perform the essential functions of your role, you will be asked to participate in our reasonable accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodations once hired.

If you would like to be considered for employment opportunities with Accenture and have accommodation needs for a disability or religious observance, please call us toll free at 1 (877) 889-9009, send us an email or speak with your recruiter.

Other Employment Statements

Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States.

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

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

The Company will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. Additionally, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-data-analytics-product-owner-liaison-at-accenture-2756299074/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 

Posted on

Provider Network Analyst Senior – Medicaid [ Expert User in Facets & SQL ] | AmeriHealth Caritas

 
 

Job Brief


The Provider Network Analyst Sr. will be responsible for being the go to person for research and analyst of provider issues. Experience with claims and billing required. Knowledge of Medicaid market preferred.


Your career starts now. We’re looking for the next generation of health care leaders.


At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.


Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at


Responsibilities


Responsible for research and analysis related to provider network issues. Supports new business provider recruitment and contracting or responsible for research and analysis related to provider claims issues. Identifies systematic and procedural issues resulting in processing reports and initiating actions to produce reports. Extracts manipulates, and evaluates accuracy of provider data for new implementations or responsible for ensuring plan stays in compliance with provider contracts.


Gathers complex statistical data analysis to identify financial and non-financial impacts and process and system improvements. Uses provider contract maintenance software to create provider contract templates and creates files associating contract templates and other credentialing forms. Assists with and coordinates configurations and testing and generates new reports as required.


Education/ Experience


  • Bachelor’s Degree preferred or an equivalent education and experience.
  • Facets configuration knowledge preferred
  • Building queries using SQL, MS Access, or other technical analysis tools.
  • 1 to 2 years managed care or related experience.
  • Advanced experience with sophisticated databases with 3 to 5 years analytical experience in the Healthcare industry.
  • Superior analytical skills.
  • Proficiency with Microsoft Office Suite (Word, Excel, Power Point).
  • Full competence in report preparation, layout and design.
  • Ability to plan, organize and handle multiple tasks.
     

Share

 
 

Clipped from: https://www.linkedin.com/jobs/view/provider-network-analyst-senior-medicaid-expert-user-in-facets-sql-at-amerihealth-caritas-2756202894/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Posted on

Business Development Capture Director – Medicaid (Anthem)

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.

Our Government Business Division’s Growth Team is looking for a Business Development Capture Director – Medicaid to join its Business Development and Capture Group. Our Business Development Capture Director is a high-performing individual contributor role responsible for positioning and capture execution of Medicaid health plan procurement and reprocurement opportunities. He/she is responsible for managing the strategy and preparations for upcoming Medicaid RFPs. He/she partners with Plan Presidents to lead the cross functional team of health plan leaders and business development to identify gaps, mitigate risks, and develop solutions and strategy in months prior to an RFP.


[This position can work remotely from any US Anthem location]


Primary duties may include, but are not limited to: Monitor and evaluate white space opportunities to make go/no-go recommendations to executive leadership. Develop and execute plans for the pursuit and capture of all Medicaid managed care procurement opportunities, including Alliance partnership opportunities. Leads the cross functional team of Growth Partners, Health Plan leaders, and Alliance partners (as applicable) to develop winning strategies and identify and mitigate risks and opportunities. Participates in bid decisions and develops recommendations for gate reviews. Collaborates with Health Plan Presidents and Health Plan leaders to understand current and emerging customer needs and requirements. Obtains market intelligence and competitive data to develop market strategy. Participates in all levels of proposal development and draft review, providing active feedback and recommendations for improvement. Provides mentorship and coaching to other members of the broader Business Development team.


Qualifications


Requires a BA/BS degree in a related field; 10 years of leadership/management experience in health care management, marketing products, and managing significant business results; or any combination of education and experience, which would provide an equivalent background.


Highly preferred experience:


-Previous P&L and/or business development experience and project management experience in Medicaid managed care setting.


-Experience leading capture and proposal activities for significant opportunities ($1B and more) strongly preferred.


-Experience in a capture function or executive leadership function for a managed care based product for state Medicaid agencies.


-State Medicaid agency experience or federal agency experience with CMS.


-MBA preferred.



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://www.adzuna.com/details/2560183086?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Contracting Officer Representative | Centers for Medicare & Medicaid Services

 
 

Summary This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI), Business Services Group, Division of Central Contract Services. As a Contracting Officer Representative, GS-1101-9, you will perform assignments in support of local or centralized procurement activity, or in the audit/review of that activity. Responsibilities Interprets acquisition policy, guidance/provisions, news, including information and clarity on new and revised acquisition policies. Assists in conducting market research; developing acquisition strategies; prepares/develops contractual documentation. Develops and maintains an acquisition policy database within the Business Services Group Resource Center (SharePoint). Reviews and analyzes a variety of special and recurring reports and recommends corrective action on deficiencies. Develops and communicates written guidance on acquisition policy. Requirements Conditions of Employment Qualifications ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT. Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration. In order to qualify for the GS-09, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-07 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Assisting in the development of procurement packages to include statements of work, cost estimates, or schedules of deliverables. 2) Reviewing procurement or acquisition proposals for compliance with policies or regulations. 3) Interpreting acquisition policy and guidance related to contracts, grants, or cooperative agreements in order to advise stakeholders.


  • OR
  • Substitution of Education for Experience: You may substitute education for specialized experience at the GS-09 level by possessing a Master’s or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree or LL.B. or JD, if related to the position being filled.
  • OR
  • Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-07 grade level may be used to qualify applicants for positions at the grade GS-09. Therefore, only education in excess of 1 full year of graduate level education may be used to combine education and experience. TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see “Required Documents” section below for what documentation is required at the time of application. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (eg, Peace Corps, AmeriCorps) and other organizations (eg, professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11248297 Education Additional Information Bargaining Unit Position: Yes Tour of Duty: Flexible Recruitment/Relocation Incentive: Not Authorized Financial Disclosure: Not Required Telework Policy: CMS is on the forefront of offering flexible working arrangements, and after an initial training period, allows employees the opportunity to participate in telework combined with alternative work schedules at the supervisor’s discretion. In the current pandemic situation, employees are teleworking full time and supported by a variety of technologies. When CMS returns to normal operations, employees will be expected to return to the physical office duty station. CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page. The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp. Reasonable Accommodation Requests: If you believe you have a disability (ie, physical or mental), covered by the Rehabilitation Act of 1973 as amended and Americans with Disabilities Act 1990 as amended, that Reasonable Accommodation Requests: If you believe you have a disability (ie, physical or mental), covered by the Rehabilitation Act of 1973 as amended and Americans with Disabilities Act 1990 as amended, that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a reasonable accommodation in your online application. Requests for Reasonable Accommodations for the USA Hire Competency Based Assessments and appropriate supporting documentation for Reasonable Accommodation must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for Reasonable Accommodations are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments, if you received the link after the close of the announcement. To determine if you need a Reasonable Accommodation, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments here: https://help.usastaffing.gov/Apply/index.php?title=Reasonable\_Accommodations\_for\_USA\_Hire.

 
 

Clipped from: https://www.linkedin.com/jobs/view/contracting-officer-representative-at-centers-for-medicare-medicaid-services-2766272701/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Quality Improvement Manager for Increasing Health Opportunities (Medicaid Health Systems Administrator 1) | Ohio Department of Medicaid

 
 

The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. In 2020, ODM introduced a new vision for Ohio’s Medicaid program — one that strengthens Ohio’s future and ensures everyone has the chance to live life to its full potential.


Today, more than 90 percent of Ohio Medicaid members are supported by managed care organizations. During the year ahead, ODM will begin implementing a new vision for care; focusing on the individual, a strong partnership among MCOs and the department, and supporting specialization in addressing critical needs.


A program that puts the individual first


They Are


Adopting Governor DeWine’s philosophy of service to Ohioans, ODM embarked on an aggressive effort to redesign its managed care program. The goal is to provide more personal, holistic care and supports for millions of Ohioans served by Medicaid. Listening to feedback from more than 1,100 individuals and organizations we identified five procurement goals that would put the individual front and center of Medicaid’s program and policy decisions.


  • Emphasize a personalized care experience,
  • Improve care for children and adults with complex behavioral health needs,
  • Improve wellness and health outcomes,
  • Support providers in better patient care and
  • Increase program transparency and accountability.


Unless required by legislation or union contract, starting salary will be set at step 1 of the pay range.


Working Title: Quality Improvement Manager for Increasing Health Opportunities


Classification: Medicaid Health Systems Administrator 1 (PN 20091838)


Office: Health Innovation & Quality


Bureau: Health Research & Quality


Job Overview


As Quality Improvement Manager for Increasing Health Opportunities within the Ohio Department of Medicaid (ODM), you will be charged with synthesizing current research, policies, and programmatic information to develop and determine the effectiveness of interventions aimed at improving health opportunities at a population level. This will involve collaborating with other state agencies, other offices within the Ohio Department of Medicaid-ODM (Policy, Data Governance, Managed Care), ODM-contracted managed care entities, academic medical centers, community based organizations, and Medicaid providers to understand needs and priorities across the health system. A great deal of the work will involve synthesizing what is learned from your research and interactions within ODM and with other entities into succinct written and oral recommendations regarding potential programmatic, process, and policy improvements. This will involve working closely with other members of the ODM team. You will also be a part of the quality improvement project work aimed at reducing health disparities. This work includes developing and selecting measures to assess Ohio’s progress towards reductions in health disparities. You will use the insights gained from your interactions within ODM, as well as your research, and collaboration to draft and refine ODM’s Strategy for Increasing Health Opportunity. Successful applicants will think flexibly, easily adapt to new situations and contexts, have excellent written and oral communication skills, and engage in rigorous critical thinking and analysis of information for improvement.


Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 mos. exp. in the delivery of a health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data base analysis).


Or 12 months experience as a Medicaid Health Systems Specialist, 65293.


  • Or equivalent of Minimum Class Qualifications for Employment noted above.


Primary Location


United States of America-OHIO-Franklin County-Columbus


Work Locations


Lazarus 5


Organization


Ohio Department of Medicaid


Classified Indicator


Classified


Bargaining Unit / Exempt


Exempt


Schedule


Full-time


Work Hours


8:00AM – 5:00PM


Compensation


$33.69/hour


Unposting Date


Nov 5, 2021, 10:59:00 PM


Job Function


Health Administration


Job Level


Individual Contributor


Agency Contact Information


HumanResources@medicaid.ohio.gov

 
 

 
 

Clipped from: https://www.linkedin.com/jobs/view/quality-improvement-manager-for-increasing-health-opportunities-medicaid-health-systems-administrator-1-at-ohio-department-of-medicaid-2756822104/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Investigator – Medicaid Fraud Division

The Office of Attorney General Keith Ellison — one of Minnesota’s largest public law offices and recently recognized as a Star Tribune 2021 Top Workplace — has a clear mission: we help Minnesotans afford their lives and live with dignity, safety, and respect. We are a dynamic group of dedicated professionals who could all work elsewhere but choose public service as a calling, and we are actively building an internal culture that supports that calling.

The Office is seeking a highly capable individual with the skills and drive to uncover, investigate, and stop fraudulent claims made to taxpayer-funded public health insurance programs. This investigator makes a difference in the lives of vulnerable people and contributes to the economic well-being of Minnesotans and our state.

Responsibilities: Investigators conduct criminal investigations into health care providers suspected of defrauding the Minnesota Medicaid program. The investigator reviews complaints against public health care providers; evaluates and analyzes claims data, medical records, and financial records; conducts research and surveillance; interviews victims, witnesses, and targets of investigations; participates in the execution of search warrants; drafts reports summarizing investigative findings; and works with attorneys to prepare cases for prosecution. Investigators are required to testify about their findings at criminal jury trials.

Qualifications:

  • Bachelor’s degree or demonstrable similar experience;
  • Good academic credentials;
  • Ability to perform assigned job responsibilities with a high level of professionalism;
  • Proven ability to show excellent judgement, character, and work ethic;
  • Proficiency in Microsoft Office; and
  • Demonstrated skill in
  • Research and writing
  • Critical thinking; and
  • Communication.       

Preferred Qualifications:

  • Fluency in Spanish, Hmong, Somali, or other relevant language for Minnesota;
  • Education or experience in one of the following fields:
  • Accounting or finance; economics or statistics; criminal justice, law enforcement, or investigations; healthcare or nursing.

Why Work For Us: We offer a great benefits package! The State of Minnesota offers a comprehensive benefits package including low cost medical and dental insurance, employer paid life insurance, short and long term disability, pre-tax flexible spending accounts, retirement plan, tax-deferred compensation, generous vacation and sick leave, and 11 paid holidays each year.

Public service with this office may qualify applicants to have part of their student loans forgiven under a federal student loan forgiveness program for state government employees. (Visit www.studentaid.ed.gov/sa/repay-loans/forgiveness-cancellation/public-service for more information.)

Application Information: Interested applicants must apply online through the State of Minnesota Careers website, which is the State’s official application and hiring site. The deadline for applications is November 1, 2021.

If you have any questions about the application process, please contact K.C. Moua at kc.moua@ag.state.mn.us or (651) 757-1279.

Note: The Attorney General’s Office greatly encourages, celebrates and values diversity. It is an equal opportunity employer which does not discriminate on the basis of race, creed, color, national origin, religion, sex, marital status, sexual orientation, gender identity, age, disability, or military status. If you need reasonable accommodation for a disability, please call K.C. Moua at (651) 757-1279 or (800) 627-3529 (Minnesota Relay).

Clipped from: https://www.idealist.org/en/amp/government-job/be1de39710294c3f989290bca59aad2a-investigator-medicaid-fraud-division-office-of-the-minnesota-attorney-general-saint-paul?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Posted on

Internship – Actuarial Sciences | Centers for Medicare & Medicaid Services

About the role:

 
 

As a Student Trainee (Actuarial Sciences), you will work under the general supervision of a Division Director and provide support to team members who perform actuarial, economic, and demographic studies to estimate CMS program expenditures.

 
 

What you’ll do:

 
 

  • Perform basic mathematical computations of experimental of other types of data to a form suitable to support higher-graded actuaries’ development of cost estimates, health expenditure analyses, and financial status evaluations.
  • Prepare graphs, spreadsheets, or other materials used to communicate the results of mathematical computations and the findings of statistical analyses.

 
 

Requirements:

 
 

  • You must be a U.S. Citizen or National to apply for this position.
  • You must possess a cumulative GPA of 3.0 or higher on a 4.0 scale.

You will be subject to a background and suitability investigation.

  • You must sign a Pathways Participant Agreement before starting employment.
  • You must be 16 years old to be employed by the Federal government.
  • Applicants who graduate college at the conclusion of the Spring 2022 semester may only be considered if they remain enrolled and are also accepted for enrollment for the Summer 2022 or Fall 2022 semester.

 
 

Qualification Requirements:

 
 

  • GS-03: Completion of 1 full academic year of education above high school. One full academic year post high-school is defined as 30 credits for degrees that require a total of 120 semester hours or 90 quarter hours for degrees that require a total of 180 quarter hours.
  • GS-04: Completion of 2 full academic years of education above high school OR an Associate’s or equivalent degree. Two full academic years post high-school is defined as 60 credits for degrees that require a total of 120 semester hours or 90 quarter hours for degrees that require a total of 180 quarter hours.

 
 

TRANSCRIPTS are required at the time of application to verify satisfactory completion of education as part of the program eligibility and qualification requirements. You must submit an unofficial transcript from your Institution attesting to your possession of the required education. All unofficial transcripts must include the following: current overall GPA, enrollment status, major, and the number of credits for each course. If you do not submit a transcript indicating your possession of the required education, you will not be considered for this position.

 
 

You MUST apply through USAJOBS to be considered.

 
 

To see the full list of qualifications and eligibility criteria, click apply to review the job announcement on USAJOBS.

 
 

Apply by 10/27/21!

Clipped from: https://www.linkedin.com/jobs/view/internship-actuarial-sciences-at-centers-for-medicare-medicaid-services-2759269836/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic