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Proposal Research Consultant – Anthem

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.

 
 

https://getwork.com/details/b77467c97aa705b416b93d2939043787?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Senior Operations Manager – Medicaid | Conduent

Operations Manager

The Operations Manager is expected to be a key staff position throughout all solution deployment, certification, operational, and maintenance activities.

Requirements:

  • A minimum of five (5) years of demonstrated experience in project management for a State Medicaid Agency with operations similar to PRMP, a large healthcare management organization of a similar size, or an organization of comparable size implementing IT projects
  • A minimum of three (3) years of demonstrated experience in project management for implementation of information systems
  • A minimum of a bachelor’s degree or a minimum of four (4) years related experience
  • Certification in Project Management, preferably from the Project Management Institute (PMI®)
  • Knowledge of Project Management standards and best practices, including the PMBOK®
  • If not located in PR, must travel 75% of the time to be onsite. Would prefer someone to relocate.
  • Must be bilingual

Responsibilities include but are not limited to:

  • Supports project activities to ensure a smooth transition from implementation to the maintenance and operations phase of the contract
  • Manages and oversees the overall solution operations
  • Ensures timely and effective execution of all project maintenance activities
  • Oversees, supports, and monitors day-to-day activities involving the ongoing maintenance of the solution
  • Supports timely delivery of assigned project deliverables
  • Ensures understanding and agreement between stakeholders and the contractor
  • Manages ongoing risks and issues of the project
  • Provide day to day contracted services to external clients. Contracted services may include technical or non-technical customer support, transaction processing and sales & marketing services.
  • Provides leadership to managers and senior professional staff.
  • Adapts and executes functional or departmental business plans and may contribute to the development of strategy.
  • Decisions are guided by resource availability and functional objectives.
  • Requires comprehensive understanding of concepts and principles within own discipline and knowledge of others.
  • Participates in the definition of the business strategy along with the clients and the upper managers.
  • Drives the overall business unit performance to meet SLAs, adhere to business unit metrics and accomplish account performance.
  • Leads innovation and efficiencies of business opportunities, applying processes improvements and/or new systems.
  • Drives the management of the employee teams through coaching and developing, addressing people matters, identifying development needs.
  • Identifies and resolves complex technical, operational and organizational problems.
  • Manages multiple related teams, sets priorities and allocates resources.
  • Proactively manages resources (budget/ human/time) to meet department goals.
  • Manages the client relationship ensuring customer satisfaction.
  • Generates reports on performance measurement and KPIs in order to facilitate business decisions.
  • Responsible for business unit compliance with organizational policies and local regulations.
  • Responsible for the successful implementation and execution of the business continuity plan (BCP).
  • Applies in-depth understanding of how own discipline integrates with related areas.
  • Performs other duties as assigned and complies with all policies and standards.

 
 

https://jobs.conduent.com/de/job-de/13710972/senior-operations-manager-medicaid-guaynabo-pr/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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COORDINATOR, MEDICAID job with Denver Public Schools

STUDENT EQUITY AND OPPORTUNITY (SE&O)

 
 

Traditional 235 work days

 
 

FTE: 1.0

 
 

Salary Range: $48,618 – $59,054

 
 

Essential Functions and Objectives:

 
 

S upports individuals, teams and/or departments through facilitating and regulating a series of activities and work streams. Carries out specific tasks based on established procedures, to ensure a broader set of priorities and objectives are met. Primary focus on execution of assig ned tasks in a specific area of responsibility, with a non-technical scope and a high degree of customer service.

 
 

Develop and execute ezEdMed & Random Moment Time Study trainings to ove r 200 school sites and to provide supporting leadership to the department. Represent the department and district internally and externally. Work closely with the department supervisor in strategizing to maximize revenue and provide maximum resources and impact for kids and families. Establishes and maintains excellent customer service relations, and performs all other duties as assigned.

 
 

– Provides administrative support and assists in carrying out specific activities, such as: distribution of materials, process documentation, conducting training, organizes and submits reports, coordinates responses, develops procedures, and maintaining records and files.

 
 

– Assesses and troubleshoots, escalates problems and interacts with stakeholders across the district to resolve problems related to area of responsibility. Exercises discretion to make exceptions to policy. Documents exceptions for compliance record keeping and reporting.

 
 

– Ensures appropriate key stakeholder involvement in planning, goal-setting, and implementation to achieve buy-in of work products. Ensures purposeful, positive and professional interactions and relationships with all stakeholders.

 
 

– Identifies process inefficiencies and proposes solutions, identifies opportunities through external research on trends in resources, programs, and services and internal research with stakeholders, and supports improvement efforts in order to ensure smooth execution with appropriate participation and support across the district.

 
 

– Development and execute free care trainings to over 200 school sites, including overall content and arrangements. Manage reporting of ezEdMed, Enrich, RMTS, and the CO School Medicaid Consortium. Follow-up on missing documentation.

 
 

– Schedules and delivers onsite training materials to switch over to electronic documenting and webinars to over 200 schools. Provide subject matter expertise and training within the Medicaid Department, including the Outreach &Enrollment (O&E) Specialists.

 
 

– Develop and maintain the State of CO Random Moment Time Study (RMTS) roster in conjunction with the supervisor. Strategize with supervisor to improve RMTS survey compliance and response quality.

 
 

– Monitor Medicaid allowable health licensure documentation and ensure accurate alignment with State claims processing and with state cost reporting processes. Ensure response compliance and documentation to state audits, financial and desk reviews.

 
 

– Provide training to district service providers and other leadership staff on ezEdMed, Parent Consents, State of CO Time Study, O&E Services, and reimbursement revenue. Assist supervisor in strategizing for the department to maximize district reimbursement revenue.

 
 

– Coordinate with CDE, CO Department of Health Care Policy and Finance (HCPF), and the State’s contractor, Public Consulting Group (PCG) in submitting and updating school district data.

 
 

– Represent DPS Medicaid Department at various events and meetings internally and externally with community agencies, parent groups, and local and State government agencies.

 
 

K nowledge, Experience & Other Qualifications:

 
 

– Two (2) or more years of experience in customer service and training.

 
 

– Colorado Driver’s license and meets district insurability requirements, or the ability to travel throughout the District required.

 
 

– Knowledge with Google Suite.

 
 

– Effective time management and organizational skills.

 
 

– Effective communication skills.

 
 

– Strong attention to detail.

 
 

– Effectively handle multiple demands and competing deadlines. – The ability to take responsibility for one’s own performance.

 
 

– Work collaboratively with others on a team.

 
 

– High degree of integrity in handling confidential information.

 
 

– Advanced Google Sheet/Excel functions (e.g. vLookup, pivot tables, etc.) for reviewing data, preferred.

 
 

– Medicaid Outreach and Enrollment and business operations, preferred.

 
 

– Federal and state rules regarding Medicaid, Children’s Health Insurance Plan (CHIP) and other public assistance programs, preferred.

 
 

E ducation Requirements:

 
 

– High School Diploma/GED required.

 
 

– Bachelor’s Degree is preferred.

 
 

Additional Information:

 
 

– Work Year Calendars (including accrued time off):  http://thecommons.dpsk12.org/Page/1129

 
 

– Benefits (including DPS contributions):  http://thecommons.dpsk12.org/Page/1397

 
 

– Compensation Structures:  http://thecommons.dpsk12.org/Page/244

 
 

– Employee must live and work with a permanent home address in Colorado while working for Denver Public Schools.

 
 

About Denver Public Schools:

 
 

Denver Public Schools is committed to meeting the educational needs of every student with great schools in every neighborhood. Our goal is to provide every child in Denver with rigorous, enriching educational opportunities from preschool through high school graduation. DPS is comprised of nearly 200 schools including traditional, magnet, charter and alternative pathways schools, with an enrollment of more than 90,000 students.

 
 

DPS has become the fastest-growing school district in the country in terms of enrollment and the fastest-growing large school district in the state in terms of student academic growth. Learn more at dpsk12.org .

 
 

Denver Public Schools is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, age, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

 
 

https://www.topschooljobs.org/job/1246189/coordinator-medicaid/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Director of Proposal Strategy – Medicaid

Location: Louisville, KY

JobFamily: Marketing

Req #: PS59015

Date Posted: Oct 14, 2021

Share Job:

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.

Our Government Business Division’s Growth Team is looking for a Director of Proposal Strategy to join its Proposal and Capture Group.  Our Director of Proposal Strategy is a People Leader role responsible for leading the strategy, planning, and direction of individual Medicaid proposals, ensuring that the strategy and content identified in our Capture work translate to the proposal in a compliant and compelling way.

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

Primary duties may include, but are not limited to: Plans, organizes, and manages the work of the Proposal Management unit to support Medicaid, Duals, and specialty products business acquisition in new and existing markets. Oversees all aspects of the proposal development process. Develops bid strategies and strategic positioning of growth opportunities on individual RFPs, RFIs and other sole source opportunities. Conducts in-depth strategic/market research. Provides analytical and strategic development support, including the analysis and synthesis of business, technical, and government documents with a high attention to detail. Works closely with senior management, health plan leaders, and broad cross-functional staff. Serves as primary interface to the Business Owners and Functional Leaders during the proposal development process. Manages contracted/outsourced resources to augment existing staff to respond to proposals. Hires, trains, coaches, counsels, and evaluates performance of direct reports. 

Qualifications

Requires a BA/BS degree in a related field and a minimum of 7 years of related experience including prior leadership experience; or any combination of education and experience, which would provide an equivalent background. 

Highly preferred experience:

 -Experience with Medicaid business development pursuits.

-Experience with large Healthcare backed custom Government proposals. 

-Experience leading the strategy of multiple competing proposal life cycles at once.

-Experience presenting to, liaising with Executives, and cultivating relationships at the Executive level.

-Association of Proposal Management Professional (APMP) membership and certification preferred. 

-MBA or MPH preferred. 

-Ability to travel.

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.

 

https://anthemcareers.ttcportals.com/jobs/7690114-director-of-proposal-strategy-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Business Systems Analyst – Medicaid Enterprise System

FULL_TIME

Montgomery, AL

14 hours ago

Public Consulting Group

Overview

Overview Public Consulting Group, Inc. (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986 and headquartered in Boston, Massachusetts, PCG has over 2,500 professionals in more than 60 offices worldwide. PCG s Technology Consulting practice offers a full spectrum of quality Information Technology (IT) services to help state and local government agencies at every stage of the IT life cycle. Through its specialized IT services, PCG s Technology Consulting team finds cost-effective ways to help agency partners deliver successful IT systems that enhance the lives of the user base.

 
 

To learn more, visit Responsibilities Specific Responsibilities: Serve as business analyst and subject matter expert on project engagements. Identify and recommend client business process improvements. Facilitate and manage software development life cycle activities, such as requirements sessions. Coordinate the user acceptance testing process. Communicate and/or translate business challenges to IT and assist in developing solutions.

 
 

Serve as liaison between various stakeholder groups and other third-party vendors. Create artifacts and formal deliverables relative to project initiatives. Contribute to project work plans, and other formal project management deliverables relative to project initiatives. Prepare other written reports and materials for clients. Identifies, documents, resolves and/or escalates issues to the appropriate level.

 
 

Qualifications Required Skills/Experience: Self-directed and comfortable working directly with clients to determine needs, clarify tasks and expectations, and present work products and findings 3+ years of business analysis experience 3+ years of MES (Medicaid) experience Bachelor’s degree from an accredited college/university Knowledge and experienced in business requirements validation and test case creation and review (e.g., verification of requirements coverage) Demonstrated ability to work cooperatively within and among teams Desired Skills/Experience: Experience providing IV services or similar oversight activities (e.g., QA).

 
 

Completed Project Management Institute (PMI) Project Management Professional (PMP) certification, or similar Project Management certification. Experience in Medicaid program application, eligibility, and enrollment operations and policy #D-PCG #LI-AH1 EEO Statement Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law.

 
 

PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work. Connect With Public Consulting Group! Connect with Public Consulting Group Job LocationsUS-CA-Sacramento | US Posted Date2 months ago(8/5/2021 1:38 PM) Job ID 2021-6925 # of Openings 1 Category Consulting Type Regular Full-Time Practice Area Technology Consulting Public Consulting Group is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, protected veteran status, or status as a qualified individual with a disability. VEVRAA Federal Contractor.

 
 

 
 

Associated topics: analyze, business analytic, business intelligence, business systems analyst, consult, guidance, law, monitor, regulation, valuation analyst

 
 

https://www.rapidinterviews.com/job/business-systems-analyst-medicaid-enterprise-system-with-public-consulting-group-in-montgomery-j2c-1969?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Actuary Job in GWYNN OAK, MD

Requirements

Requirements Conditions Of Employment

  • You must be a U.S. Citizen or National to apply for this position.
  • You will be subject to a background and suitability investigation.

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-13, 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-12 grade level in the Federal government, obtained in either the private or public sector, to include:

 
 

A. I have one year (52 weeks) of actuarial experience equivalent to GS-12 level AND qualifying specialized experience equivalent to the GS-12 grade level in the Federal Government obtained in either the private or public sector, to include:1. Provide actuarial guidance in review of cost estimates, payment models, or managed care programs; 2. Develop project plans or coordinating project tasks and deliverables; AND

3. Analyzing, interpreting, or communicating actuarial data and information; AND I possess a bachelor’s degree that included courses in actuarial science, mathematics, relevant statistics, business, finance, economics, insurance, or computer science totaling at least 24 semester hours. This course work included a minimum of 12 semester hours of mathematics that included differential and integral calculus and one or more courses in mathematics for which these calculus courses were prerequisites.

 
 

B. I have one year (52 weeks) of actuarial experience equivalent to GS 12 level AND qualifying specialized experience equivalent to the GS-12 grade level in the Federal Government obtained in either the private or public sector, to include:1. Provide actuarial guidance in review of cost estimates, payment models, or managed care programs; 2. Develop project plans or coordinating project tasks and deliverables; AND

3. Analyzing, interpreting, or communicating actuarial data and information; AND I possess a combination of education and experience that includes both of the following requirements: technical work experience in actuarial support work or in mathematics; AND completion of a minimum of 24 semester hours of courses in actuarial science, mathematics, relevant statistics, business, finance, economics, insurance, or computer science at a four-year college or university. This course work must have included a minimum of 12 semester hours of mathematics that included differential and integral calculus and one or more courses in mathematics for which these calculus courses were prerequisites. (TRANSCRIPTS REQUIRED AT TIME OF APPLICATION).

 
 

C. I have completed a minimum of 24 semester hours of courses in actuarial science, mathematics, relevant statistics, business, finance, economics, insurance, or computer science at a four year accredited college or university. This course work must have included a minimum of 12 semester hours of mathematics that included differential and integral calculus and one or more courses in mathematics for which these calculus courses were prerequisites (TRANSCRIPT REQUIRED AT TIME OF APPLICATION); AND one year of professional actuarial experience equivalent to the GS-12 level AND Associateship in the Society of Actuaries or the Casualty Actuarial Society or being an Enrolled Actuary. (PROOF OF ASSOCIATESHIP/ENROLLMENT REQUIRED AT TIME OF APPLICATION).

 
 

Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., 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.

Education

TRANSCRIPTS are required to verify satisfactory completion of the educational requirement listed above. Please see “Required Documents” section below for what documentation is required at the time of application.

 
 

Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11257659

Additional information

Bargaining Unit Position: Yes

Tour of Duty: Flexible

Recruitment/Relocation Incentive: Not Authorized

Financial Disclosure: Not Required

 
 

Full-Time Telework Program for CMS Employees: 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.

 
 

Additional Forms REQUIRED Prior to Appointment:

  • Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
  • Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
  • Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.

If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.

How You Will Be Evaluated

If you meet the minimum qualifications and education requirements for this position, your application and responses to the online application will be evaluated under Category Rating and Selection procedures for placement in one of the following categories:

  • Best Qualified – for those who are superior in the evaluation criteria
  • Well Qualified – for those who excel in the evaluation criteria
  • Qualified – for those who only meet the minimum qualification requirements

The Category Rating Process does not add veterans’ preference points or apply the “rule of three” but protects the rights of veterans by placing them ahead of non-preference eligibles within each category. Veterans’ preference eligibles who meet the minimum qualification requirements and who have a compensable service-connected disability of at least 10 percent will be listed in the highest quality category (except in the case of professional or scientific positions at the GS-09 level or higher).

 
 

Once the announcement has closed, your online application, resume, transcripts and CMS required documents will be used to determine if you meet eligibility and qualification requirements listed on this announcement. If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration. Please follow all instructions carefully. Errors or omissions may affect your rating.

 
 

Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):

  • Actuarial Science
  • Analysis
  • Oral Communication
  • Writing

This is a competitive vacancy announcement advertised under Delegated Examining Authority. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would therefore be given new appointments to the civil service; however, benefits, time served and all other Federal entitlements would remain the same.

 
 

Additional selections may be made from this announcement for similar positions within CMS in the same geographical location. For Central Office vacancies, the “same geographical location” includes Baltimore, Maryland; Bethesda, Maryland; and Washington, D.C.

Background checks and security clearance

Security clearance

Not Required

Drug test required

No

 
 

http://federalgovernmentjobs.us/jobs/Actuary-616941100.html?utm_source=fjgFeed&utm_medium=rss&utm_term=none&utm_content=none&utm_campaign=none&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Medicaid Claims Data Specialist (Research Associate) – Office of Health Affairs

Full-time, Part-time

Charleston, WV 25301

Updated 2 days ago

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Job description

Commute time

Description

The Office of Health Affairs are West Virginia University is seeking applications for a Medicaid Claims Data Specialist (Research Associate) located in Charleston, WV.  The Medicaid Claims Data Specialist is a key participant in the State-University partnership between the West Virginia University Office of Health Affairs and the West Virginia Department for Health and Human Resources (WV DHHR). Overarching responsibilities include implementation and management of a data science training program to assist faculty and staff at Office of Health Affairs in analyzing administrative Medicaid claims and other state data sources. This position will also be responsible for working with the WV DHHR to leverage data resources and support analytic needs, overseeing the use of state data sources for research at West Virginia University, participating in interdisciplinary research and evaluation teams, and providing oversight and management of other data analysts and personnel embedded within the Department for Health and Human Resources. The Medicaid Claims Data Specialsit will be an employee of the West Virginia University Office of Health Affairs, however, this individual will be embedded within the Department for Health and Human Resource’s Bureau for Medical Services and will work full-time out of the Office of Health Affairs offices in Charleston, West Virginia.

 
 

In order to be successful in this position, the ideal candidate will:

  • Provide training in the analysis of administrative Medicaid claims data using SAS or other statistical analysis packages to other faculty, staff, and students at West Virginia University
  • Serves as a University representative and liaison to the West Virginia Department of Health and Human Resources for the planning and performance of projects, programs and activities involving health data analytics and program evaluation. 
  • Oversee data governance and data stewardship for the West Virginia University Office of Health Affair
  • Manage a standardized data science training program for faculty and staff in the West Virginia University Office of Health Affair
  • Work as part of a team to advance the partnership between the West Virginia University Health Sciences Center and the West Virginia Department of Health and Human Resources
  • Oversee and conduct analyses of Medicaid claims data and other state data sources at the direction of leadership within the Office of Health Affairs or Department for Health and Human Resource
  • Support both West Virginia University faculty as well as leadership within the Department for Health and Human Resources in using Medicaid claims data as well as other state data sources to answer research questions of interest to the stat
  • Manage the use of state data sources for independent research by faculty, staff, and students at West Virginia University
  • Ensure that data analytic and research/evaluation activities are compliant with University-level policies for the responsible conduct of research as well as federal, and state policies.
  • Provides consultation to faculty and government partners regarding preparation of research proposals, design and methodology, data analytics and interpretation of results
  • Conduct or direct special projects as assigned.
  • Act in other matters and capacities as delegated by leadership within the Office of Health Affairs

Qualifications

  • PhD in health or data science-related field; or equivalent amount of combined education and work experience.
  • Two (2) years experience
  • Record of research and achievement in health outcomes and policy research (health services research, public health informatics, health policy, clinical outcomes) as evidenced by publications and / or sustained involvement in a research program.
  • Experience conducting research/evaluation using large administrative claims data sources within the healthcare industry or academic or governmental sectors
  • Experience training and managing other data analysts
  • Extensive knowledge and experience in utilizing large administrative claims databases for research, program evaluation, and policy development.
  • Experience training others in how to analyze administrative claims data using SAS or other statistical package
  • Proficiency in the use of standard statistical analysis packages such as SAS or
  • Ability to project and maintain a positive and collaborative attitude
  • Record of accomplishments in the area of health data analytics.
  • Experience managing other data analyst
  • Strong ability to communicate goals, methods, and results of research initiatives with key stakeholders
  • Proficiency presenting the results of data analyses to diverse groups of stakeholders

At West Virginia University, we pride ourselves on a tireless endeavor for achievement. We are home to some of the most passionate, innovative minds in the country who push their limits for the sake of progress, constantly moving the world forward. Our students, faculty and staff make this institution one of the best out there, and we are proud to stand as one voice, one university, one WVU.

 
 

Find out more about your opportunities as a Mountaineer at http://hr.wvu.edu/.

https://www.snagajob.com/jobs/632277453?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Senior Manager of Pharmacy Audit, Medicaid – Indianapolis, IN, Telecommute with Client Facing

Careers at UnitedHealth Group

 
 

We’re creating opportunities in every corner of the health care marketplace to improve lives while we’re building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life’s best work. SM

 
 

Clinical

 
 

Compassion. It’s the starting point for health care providers like you and it’s what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you’re also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life’s best work. SM

 
 

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you’ll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life’s best work. SM

 
 

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that’s improving the lives of millions. Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably. There’s no room for error. Join us and start doing your life’s best work.(sm)

 
 

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

 
 

Primary Responsibilities:

  • Lead diverse team of investigators and analysts in pursuit of FWA identification
  • Responsible for administering audit plan for the state
  • Drive resolution to key pharmacy audit escalations across business partners such as network compliance and relations, finance, Medicaid Fraud Control Unit
  • Collaborate on proactive solutions with key clients, client services, and legal team related to FWA matters
  • Serve as central point of contact and subject matter expert for FWA for the state
  • Anticipate client’s needs and proactively builds relationship through ongoing meetings, presentations, escalations, and resolution of issues
  • Design policy and procedures around new FWA initiatives
  • Direct responsibility for metrics, recoveries, and IOI generated under program for key clients
  • Assesses and interprets pharmacy audit requirements and needs of client / client account management
  • Collaborate with, and present to, senior business leaders to deliver highlights of emerging FWA trends
  • Adapts department plans and priorities to address business and operational challenges
  • Create and execute audit communication plans for the state and providers
  • Ensure that recoupment is collected in a timely, accurate manner and in accordance with State policies
  • Participate in all State, provider or member meetings as requested by the State
  • Provide expert testimony, on behalf of the state, at Administrative Law Judge Hearings
  • Excellent verbal and written communication skills

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

 
 

Required Qualifications:

  • Bachelor’s Degree, or higher. Equivalent work experience will be considered
  • Indiana State Pharmacy Technician Licensure or Indiana Pharmacist License (or ability to obtain within 90 days of hire)
  • National Pharmacy Technician Certification or licensed Pharmacist
  • 5+ years of experience in Pharmacy or Healthcare industry, preferably PBM
  • 2+ years of relevant experience managing a team and/or managing a client
  • Proficiency utilizing MS Office: Word, Excel, PowerPoint, and Outlook
  • Experience with data analysis and manipulation of data
  • Ability to travel up to 15% (For applicants within commutable distance to Indianapolis travel would be 5%)
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Preferred Qualifications:

  • Bachelor’s degree in health care administration, nursing, health information administration or related field
  • Certified Fraud Examiner and/or Registered Health Information Administrator
  • Pharmacy or healthcare audit experience
  • PBM experience
  • Experience managing a client
  • Advanced Excel proficiency
  • Medicaid claims processing, data management, pharmacy practices, and the Indiana Medicaid program
  • Organized with effective and persuasive communication skills

Demonstrated Skills:

  • Highly flexible, open to change and new information
  • Demonstrated leadership of team and bench strength development
  • Manages ambiguity, adapting behavior and work methods to changing organization, adapting best practices in all processes
  • Establishes trust and credibility and follows through on commitments
  • Effective data analysis and interpretation skills
  • Ability to focus on key metrics and frame their overall impact on business objectives
  • Uses careful listening, tact, and candor in all communication
  • Demonstrated problem solving skills; ability to dig into the details
  • High employee engagement and manger index/values
  • Excellent presentation skills

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

 
 

Careers with OptumRx. We’re one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You’ll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There’s no better place to help people live healthier lives while doing your life’s best work.(sm)

 
 

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

 
 

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

 
 

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

 
 

Job Keywords: Senior Manager of Pharmacy Audit, Medicaid, Indianapolis, IN, Indiana, Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote

 
 

2022155

 
 

https://www.gettinghired.com/job-details/5280583/senior-manager-of-pharmacy-audit-medicaid-indianapolis-in-telecommute-with-client-facing/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Posted on

Babylon Health Community Health Worker (Medicaid) Job in Mississippi

Benefits

About the Community Health Worker position:

Babylon Health is recruiting for multiple full-time Community Health Worker positions that will join our population health team and have the opportunity to support our Medicaid patients.

This position is currently remote but as public health guidelines evolve, there will be a requirement to travel from time to time.

Start Date:

Early September

Schedule:

You will be scheduled for shifts Monday to Friday from 8 AM – 5PM and 9 AM – 6PM (1 hour for lunch)

WHAT YOU’LL WORK ON

  • Our Community Health Workers will join a multidisciplinary team of physicians, nurses and social workers to provide comprehensive care to our Medicaid patients.
  • You’ll have the opportunity to work with underserved populations and be an advocate for those who need support and resources. We provide care in a variety of ways – you’ll connect with our patients in-person (once public health guidelines change), on the phone, embedded (on site) in the physician office or hospital or in the home as needed.
  • You’ll have the opportunity to work closely with our integrated care team to improve patient access to community and government service agencies.
  • Be a part of our mission to put an affordable and accessible health service in the hands of every person on earth.

WHAT WE’RE LOOKING FOR

  • Experience working with Medicaid/Medicare/Vulnerable Populations
  • Experience as a Community Healthcare Worker or similar position – being an advocate for patients and underserved communities
  • The ability to navigate multiple computer systems and software (we use G-Suite, Slack and an EHR)
  • Experience working with the aged, blind and disabled (ABD) would be considered an asset

WHO YOU ARE (optional)

  • The compensation range for this role will be shared during the early interview stages.
  • 4 weeks’ paid vacation
  • 401k’ with employer matching contribution
  • Benefits include bonus, medical insurance, vision, and dental coverage
  • Incredible growth opportunities with a global health tech startup with a meaningful mission

WHAT WE OFFER

Whether you work in one of our amazing offices or a distributed team, Babylon is highly collaborative and fun! You’ll have a chance to work in a fast-paced environment with experienced industry leaders. We have a learning environment where you can make an impact.

WHO WE ARE

We are a team on a mission, to put accessible and affordable healthcare in the hands of every person on earth. Our mission is bold and ambitious, and it’s one that’s shared by our team who shares our values, to dream big, build fast and be brilliant. To achieve this, we’ve brought together one of the largest teams of scientists, clinicians, mathematicians and engineers to focus on combining the ever-growing computing power of machines, with the best medical expertise of humans, to create a comprehensive, immediate and personalized health service and make it universally available.

At Babylon our people aren’t just part of a team, they’re part of something bigger. We’re a vibrant community of creative thinkers and doers, forging the way for a new generation of healthcare. We’re only as good as our people. So, finding the best people is everything to us. We serve millions, but we choose our people one at a time…

 
 

https://www.glassdoor.com/job-listing/community-health-worker-medicaid-babylon-health-JV_KO0,32_KE33,47.htm?jl=4162647605&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Posted on

Louisiana Medicaid CMO, RVP Health Services

About this job

Description

The LA Medicaid CMO, RVP Health Services (CMO) relies on medical background to create and oversee clinical strategy for the region. The CMO requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.

Responsibilities

Job Title:  Louisiana Medicaid CMO, RVP Health Services

Location:  Work from Home in Louisiana Temporarily (Office will be opened in Baton Rouge)

Job Description

The CMO will provide medical leadership and strategy for the Health Services Operations with fiscal responsibility for trend management.

  • Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF) according to the Humana’s Medicaid policies

 
 

F

 
 

 
 

https://careers.humana.com/job/12369524/louisiana-medicaid-cmo-rvp-health-services-remote/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic