Category: MM Curator

Job Description

Description

The Project Manager 2 manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Manager 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Where you Come In

The Project Manager 2 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 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. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

• Workflow Analysis
• Interpersonal Relationships
• Project Coordination
• Communication Effectiveness
• Conduct Meetings
• Detail-Oriented
• Interpersonal Relationships
• Project Coordination
• Communication Effectiveness
• Conduct Meetings
• Detail-Oriented
• Working Independently

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

• Minimum of 3 years progressive experience managing mid to large scale projects
• Prior experience with Medicaid
• Proven ability to understand cost benefit analysis and return on investment
• Knowledge of MS Office
• Strong communication skills, both written and verbal
• Strong analytical and reasoning skills
• Proven ability to understand capacity and effectively plan resourcing
• Must be able to work Monday through Friday 8am to 5pmEST hours
• For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
• If progressed to offer, you will be required to:
• Provide proof of full vaccination OR
• Commit to weekly testing, following all CDC protocols, OR
• Provide documentation for a medical or religious exemption consideration.
• This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.

Preferred Qualifications

• PMP

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

Work-At-Home Requirements

• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

The ideal candidate will have IT BANKING OR FINANCE Project responsible for planning, coordinating, and implementing projects within the decided-upon budget, timeline, and scope. They will also effectively monitor and present project updates to relevant stakeholders, clients, or project team… Read more

 
 

 
 

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Job Description
Aetna Better Health of Michigan is seeking an experienced Chief Operating Officer (COO) for its managed Medicaid business. The ideal leader is strategic, committed to developing employees, and relentless in pursuing change that is best for the organization and its customers. On a daily basis, the COO is responsible for overseeing all operational activities of various Plan functional areas through direct and indirect reporting lines to: Claims, Provider Services, Information Technology, Grievance and Appeals, Member Services, Configuration, Contracting, Enrollment and supporting functional areas. The COO will assist the Plan CEO in the successful growth and performance of the Plan. The COO also interfaces, collaborates, and works cooperatively with corporate office functional leaders and centralized shared services business departments. The individual needs a deep understanding of claims, value-based contracts, TPL/COB, and Pharmacy. The ideal candidate will have extensive knowledge of government programs such as Medicaid, Medicare, or Dual Eligible including government affairs, legal, and an in-depth compliance background. The individual must understand how compliance and quality programs (NCQA and HEDIS) affect the Plan. The candidate needs to be proficient on credentialing, provider relations (internal and external), network development (ensuring adequacy and mix) and how that affects the provider experience. The candidate will need a high acumen on the marketing of Medicaid, effective member and provider communications, the mission imperative on community programs and the interaction of SDOH (housing, employment, CHW, peer specialists, and nutrition). They should have a working knowledge of the interaction between physical and behavioral health, and the outstanding characteristics of behavioral health in taking care of the Medicaid population. The COO is a valued leader in the organization and an extension of the CEO both within the Plan and externally with the regulatory agencies Michigan Department of Health and Human Services (MDHHS) and other state departments.

Required Qualifications
– 10+ years work experience that reflects a proven track record of proficiency in the Medicaid managed care operational competencies noted.
– Proven ability to work collaboratively across many teams, prioritize demands from those teams, synthesize information received, and generate meaningful conclusions.
– Proven ability to conceive innovative ideas or solutions to meet client’s requirements.
– The individual must be able to build a climate of trust and respect with regulators, prospective and existing clients, and our internal growth partners such as health services, service operations, and finance/actuarial personnel.
– Proven leadership and negotiation skills – must have demonstrated leadership with meaningful initiatives such as: business process optimization, enterprise business project management/consulting, financial strategic planning and analysis, mergers and acquisitions, risk management.

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
See above.

Education
Bachelor’s degree or equivalent.

Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand – with heart at its center – our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

 
 

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Resp & Qualifications

COMPANY SUMMARY:

CareFirst, Inc., and its affiliated companies, generally referred to as CareFirst BlueCross BlueShield (CareFirst), is the Mid-Atlantic region’s largest private sector health insurer, serving the healthcare needs of 3.5 million members in Maryland, the District of Columbia, and portions of northern Virginia. The Company offers a comprehensive portfolio of products and services to individuals and groups, as well as state and federal government sponsored plans. With a market share almost three times that of the closest competitor, the company commands 45 percent penetration across the region.

In July 2018, Brian D. Pieninck assumed the role of President and CEO after serving as the company’s COO of Strategic Business Units and IT Division. Under his leadership, the organization completed an extensive review of its operations and clinical programs, resulting in an expansive 3-year strategy to grow and diversify the company’s core business. Along with a 5-year vision to drive the transformation of the healthcare experience across the continuum of its members, partners, and communities, the company has placed a renewed and intentional focus on fostering a mission-based culture, which drives every decision the company makes. The organization employs over 5,600 full-time employees in Maryland, Northern Virginia, the District of Columbia, and West Virginia. CareFirst has earned multiple workplace awards recognizing its leadership in diversity and inclusion, wellness engagement, and creation of a supportive and equitable work environment for all employees.

At CareFirst, you are part of an inspired, collaborative team that is building the healthcare experience we want for our families and our future. Every day, we make a meaningful difference in the communities where we live and work.

We practice empathy, seek to understand, invest in inclusion, demand equity and nurture belonging every day for our employees and the communities we serve. We rely on the rich diversity of our employees’ experiences and backgrounds to achieve our mission. Every year we host a Week of Equity and Action where we deepen our investment and commitment to diversity, equity, and inclusion. During this week thousands of employees engage in workshops and volunteerism with the goal of bettering themselves and our community.

• Women make up around 70% of CareFirst’s employee population, and over 50% identify as BIPOC (Black, Indigenous, and people of color).
• We have 9 resource groups that connect employees over shared identities (LGBTQ, veteran status, race, etc.) and passions (climate change, healthy living, leadership development).
• Employees are encouraged to give back and volunteer in their communities with their civic engagement hours.

As a not-for-profit, CareFirst regularly ranks among the most philanthropic organizations with $65 million invested in the community in 2020 to improve overall health, and increase the accessibility, affordability, safety, and quality of healthcare throughout its market area. The company’s employees consistently add to this impact by devoting thousands of volunteer hours to numerous community organizations and social causes. The company’s continued efforts to reinvest in community health care programs has repeatedly earned CareFirst regional accolades as a leading corporate philanthropist, including the No. 2 and No. 7 spots on the Baltimore Business Journal and Washington Business Journal’s 2019 list of top corporate givers, respectively.

PURPOSE:
Expert clinical practitioner responsible for providing direct management and oversight of all behavioral health services to include all functions of behavioral health care management and the programs and services that support the behavioral health and substance use disorder patient care populations. Provides strategic leadership in design and implementation of a cogent behavioral health strategy to ensure strategic alignment with divisional and corporate goals, and with the needs of members, providers and accounts.


ESSENTIAL FUNCTIONS:

• Develops departmental policies and procedures for behavioral health services. Provides strategic direction, and develops and maintains quality-improvement programs to optimize patient care. Oversees care coordination activities related to behavioral health and substance use disorder.

 
 

• Collaborates with physicians/provider leaders to ensure service expectations are being met.

 
 

• Serves as a resource for the behavioral health management team and other departments.

 
 

• Establishes the workflow of care managers, social workers and discharge planners.

 
 

• Presents status of key performance indicators and make recommendations on continuous improvement opportunities to the executive leadership team.

 
 

• Maintains and develops relationships with key thought and business leaders in the health care delivery marketplace.

 
 

• Directs the strategic and the day-to-day activities of the Department, including coaching and guiding individuals and teams in order to implement departmental, divisional, and organizational mission/goals. Recruits, retains and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Develops annual goals, and prepares, monitors, and analyzes variances of departmental budgets in order to control and appropriately allocate resources.

SUPERVISORY RESPONSIBILITY:
This position manages people.


QUALIFICATIONS:


Education Level: Master’s Degree in Mental Health; education can be in one or more of the following areas: Social Work, Psychology, Nursing or Counseling

Licenses/Certifications:
LCSW- License Clinical Social Worker or
LMAFT – Lic-Marriage & Family Therapy or
LPC-Licensed Professional Counselor

Experience:

• 8 years post masters clinical behavioral health/psychiatric experience.
• 3 years management experience.

Preferred Qualifications:

• Doctoral degree in Psychiatric Nursing or Mental Health

Knowledge, Skills and Abilities (KSAs)

• Ability to communicate effectively verbally and in writing.
• Knowledge of health benefits industry, products, trends, consumer market, and competitive intelligence.
• Knowledge and proficiency in use of metrics and measures in managing programs and services.
• Strong organizational skills to manage multiple projects, issues and priorities.
• Extensive knowledge of managed care delivery guidelines and systems.
• Extensive knowledge of behavioral health diagnoses.
• Demonstrated application and knowledge of best behavioral health clinical practices.
• Demonstrated advanced knowledge and skills in the areas of clinical expertise, evidence-based practice, and providing the related consultation, education, mentoring.
• Requires ability to model excellence in advanced behavioral health clinical practice within a specialty population.
• Skilled at being persistent, modifying tactics based upon reading another person’s statements and body language.
• Ability to mentor and coach associates to accomplish goals, provide objective evaluation of associate performance, and implement strategies to improve individual and team-based performance as needed.
• Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Department

Department: DC Medicaid – Health Administration

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

#LI-JH3

 
 

 
 

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Job Description

Position Description: Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding using data science and analytics. Our work yields actionable information to guide decisions in wide-ranging policy areas, from health, education, early childhood, and family support to nutrition, employment, disability, and international development. Mathematica offers our employees competitive salaries, and a comprehensive benefits package, as well as the advantages of being 100 percent employee owned. As an employee stock owner, you will experience financial benefits of ESOP holdings that have increased in tandem with the company’s growth and financial strength. You will also be part of an independent, employee-owned firm that is able to define and further our mission, enhance our quality and accountability, and steadily grow our financial strength. Learn more about our benefits here.Mathematica is searching for professionals with experience generating insights from data on Medicaid policy and programs at either the state or federal level. In particular, we are looking for individuals who can apply data analytics to support current and emerging work across any number of areas related to monitoring and improving Medicaid programs such as: Value-based purchasing and alternative payment models, enrollment trends, measures of delivery and quality of services for beneficiaries, and to discern outcomes of innovative programs and policies.The successful candidate will join our group of over 400 health policy professionals, including staff with degrees in data analytics, public health, public policy, economics, behavioral or social sciences, economics, and other relevant disciplines. We offer our employees a stimulating team-oriented work environment, competitive salaries, and a comprehensive benefits package, as well as the advantages of employee ownership.Duties of the position:Participate actively and thoughtfully in multidisciplinary teams, drawing on your past experience with Medicaid programsHelp conduct research and technical assistance projects on topics related to state and federal Medicaid policyApply rigorous analytic thinking to the collection and interpretation of quantitative data including analysis of Medicaid administrative dataBring creative ideas to the development of proposals for new projectsAuthor project reports, memos, technical assistance tools, issue briefs, and webinar presentationsContribute to the growth, expertise, and institutional knowledge of staff working in the Medicaid areaPosition Requirements: Qualifications:3-8 years of experience working in health policy or health research, with a substantial portion of that time related to some aspect of the Medicaid program at the state or federal levelMasters or doctoral degree or equivalent experience in data analytics, public health, public policy, economics, behavioral or social sciences, economics, or other relevant disciplinesDemonstrated ability at modeling program outcomes would be idealStrong foundation in quantitative methods and a broad understanding of health policy issuesExcellent written and oral communication skills, including an ability to explain observations and findings to diverse stakeholder audiences including program administrators and policymakersDemonstrated ability to provide task leadership and coordinate the work of multidisciplinary teamsStrong organizational skills and high level of attention to detail; flexibility to lead and manage multiple priorities, sometimes simultaneously, under deadlines To apply, please submit a cover letter, resume, writing sample, and salary expectations at the time of your application. Available Locations: Washington, DC; Princeton, NJ; Cambridge, MA; Woodlawn, MD; Ann Arbor, MI; Chicago, IL; Oakland, CA; Seattle, WA This position offers an anticipated annual base salary of $90,000 – $140,000. This position may be eligible for a discretionary bonus based on company and individual performance. Various federal agencies with whom we contract require that staff successfully undergo a background investigation or security clearance as a condition of working on a project. If you are assigned to such a project, you will be required to obtain the requisite security clearance. In accordance with Executive Order 14042 and its implementing guidelines, all Mathematica employees must provide documentation that they have been fully vaccinated or obtain an accommodation through Human Resources by providing documentation from a licensed health care provider that they are unable to be vaccinated against COVID-19 because of a disability (which would include medical conditions) or provide an attestation that they are entitled to an accommodation because of a sincerely held religious belief, practice, or observance. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

 
 

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Job Description

*Job Description*The Pharmacist Director – Californa Medicaid develops and leads clinical pharmacy organization and selects and builds a strong team through training, diverse assignments, coaching, risk-taking, empowerment, performance management and other development techniques. The Director is responsible for achieving financial results consistent with KPM objectives and will champion strategic direction and tactical game plans for delivery of pharmaceutical care. Will improve operational efficency by directing and changing enhancements to business processes, policies, and infra-structure. The Pharmacy Director plans and executes clinical pharmacy budget, participates in and influences external and internal pharmaceutical/health development efforts, and actively supports Aetna sales and on-going customer relations efforts.*Required Qualifications*- A current, unrestricted clinical license to practice pharmacy in the State of California is required- Candidate must reside within California, ideally near or within the Sacramento market- Degree in Pharmacy; Business degree a plus.- 3+ years experience in managed care or completion of a managed care pharmacy residency- 5+ years administrative experience- Ability and willingness to travel up to 30% – Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.*COVID Requirements**COVID-19 Vaccination Requirement*CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.*Preferred Qualifications*- 5+ years Managed Medicaid Pharmacy Experience- Completion of Accredited Residency Program specific to Medicaid Pharmacy*Education*B. S. Pharmacy at minimumPharm. D. preferred*Business Overview*At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

 
 

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This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Program Operations and Local Engagement, Drug and Health Plan Operations Group (DHPOG).


As a Nurse, GS-0610-12, you will be focusing in the areas of clinical quality improvement programs; utilization management and clinical standards impacting health service delivery.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-12, 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-11 grade level in the Federal government, obtained in either the private or public sector, to include: (1) Researching policies regarding clinical aspects of program operations; (2) Interacting with internal and external stakeholders to provide clinical nursing advice or guidance.


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.

 
 

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Description Medicaid Program Manager (WMS2 / ETS) 71044515

Per Governor Inslee’s Proclamation 21-14 state employees must be fully vaccinated. Your vaccine status will be verified upon acceptance of a contingent job offer.

Please note, medical or religious accommodation may be available once an offer of employment is made.

Medicaid Services is looking for a seasoned Program Manager who is comfortable leading a team of professionals to accomplish complex technical goals within the Medicaid Management Information System – ProviderOne.

The ideal candidate would be an extremely organized facilitator with excellent writing skills who enjoys collaborating.

About the Division :

Medicaid Services, within the Division of Enterprise Technology Services (ETS), is responsible for providing contract oversight for ProviderOne operations and leadership for Medicaid system enhancement and funding efforts.

In addition, Medicaid Services is responsible for the administration of the ProviderOne system, a mission critical provider payment system.

ProviderOne is a federally certified Medicaid Management Information System (MMIS). ProviderOne also supports Medicaid programs administered by the Department of Social and Health Services and medical payments by the Department of Corrections.

ProviderOne processes over two million claims per month and processes / pays claims in excess of $13 billion annually to providers of services to Medicaid clients statewide.

About the position :

The Medicaid Program Manager is a senior technical expert and managerial professional responsible for directing and controlling the critical IT Enhancement Projects and Medicaid Enhancement implementations.

The position has responsibility for project management of HCA’s Medicaid Enterprise System’s release work plans for large enhancements as assigned, status reports, vendor payment deliverable review / acceptance issue resolution, risk identification and mitigation process and project close-out and transition to operations.

This position operates in a complex authorizing and governance environment with a very diverse set of Project stakeholder interests.

As a result, this position must be able to direct, lead, facilitate and coordinate work among a variety of internal and external Project stakeholders and must be able to direct the resolution of technical and business issues between HCA staff, partner agency technical staff and vendor technical staff.

This position is eligible to telework and is typically not required to report on-site. Duties

Some of what you will do :

• Direct and control of all components of the assigned Medicaid Enterprise System enhancements including ProviderOne application technology architecture as enhanced to support design functions and operational capabilities.
• Collaborate with external partner operations and vendor staff to ensure detailed work plans are developed and maintained for all technical tasks and deliverables, Develop HCA Enhancement Project status reporting mechanisms and maintain up-to-date status reports in accordance with established reporting cycles.
• Direct of planning of enhancement implementation, assess technical and business operational readiness and coordinate with HCA ProviderOne, DSHS and HBE operations staff for development of integrated Operations and Maintenance and CMS certification processes.
• Supervises management analysts in documentation and reporting activities. Manages the work of Management Analysts and other internal SMEs to maintain or enhance existing Medicaid processes.
• Provide expert technical ProviderOne leadership and work cooperatively with executive management, division directors, program managers, and other stakeholders internal and external to HCA to develop technical solutions and enhancements within the ProviderOne application.
• Collaborate with HCA Enterprise Architecture in development and ongoing updates to HCA’s federally required Medicaid Information Technology Architecture (MITA) 5-year roadmap specifically related to business, information, and technology architectures strategy documents.
• Independently serve as an expert professional / technical consultant with responsibility for the management of ETS / P1O Service Level Agreement (SLA) with contracted vendors.
• Actively track, analyze, and report Vendor’s performance levels and compare against the criteria established in the SLAs to enforce performance penalties as necessary, prepare list of Issues, investigates root causes of performance gaps and proposes corrective actions, and executes detailed performance improvement.

Qualifications

Required Qualifications :

• Bachelor’s Degree in Computer Science, Business / Public Administration, or closely related field. Information Technology project management experience may substitute year for year, for the Bachelor’s Degree.
• Five (5) years of progressively responsible experience as an Information technology project management professional working with mission-critical payment and / or eligibility systems.
• Five (5) years of experience with Medicaid Enterprise Systems (MES) and / or Medicaid, Health and Human Services or Public Health policies.
• Experience providing leadership or supervision to technical staff and highly skilled professionals.

Desirable Qualifications :

• A working knowledge of the HCA organization, mission, and goals.
• Knowledge of HCA and Washington State Office of the Chief Information Officer (OCIO) project management and governance principles and processes.
• Experience using expert project management skills, to include a strong understanding of techniques and methodologies necessary to support the System Development Life Cycle (SDLC).

This includes requirements definition, design, development system / integration testing, end user acceptance testing, conversion, training and implementation.

In addition, project management methodologies around scope control, configuration management, risk management and mitigation, issue management, communications and change management.

• Applied knowledge of the Washington State personnel policies and labor relations.
• Project Management Institute (PMI) certification.
• Ability to manage multiple concurrent initiatives and balance quality of work with aggressive deadlines.
• Ability to understand and communicate complex operational and technical information both orally and in writing, facilitate meaningful communications with non-technical policy makers and stakeholders, negotiate agreement with contractor and with stakeholders with differing demands and expectations across a broad spectrum managerial administrative and professional staff including the Centers for Medicare and Medicaid Services, contracted vendors HCA, HBE and DSHS staff, federal and state auditors, internal and external customers and private sector consultants.

Demonstrated knowledge of and experience with development and management of service level agreement key performance indicators and other related metrics.

• Ability to support effective communications within and across the Division, throughout the Agency and with a variety of external stakeholders, Ability to resolve complex MMIS system problems and develop strategic recommendations for system changes, ability to think analytically and strategically, and create innovative solutions.
• Ability to sponsor and / or lead workgroups and work teams to achieve high quality results.
• Expert with Microsoft Project, Outlook, Excel, Word, and PowerPoint.
• Commitment to quality, diversity and public service values including a demonstrated commitment to providing superior customer service.

 
 

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Job Description

Title upon hire will be Education/Outreach Coordinator. Part-time Employee/ 8 Hours per Week Remote About Us Integrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review. At IntegrityM, we offer a culture of opportunity, recognition, collaboration, and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees’ professional development. Large company perks…Small company feel http://www.integritym.com We are now seeking an Education/Outreach Coordinator to join our team. Responsibilities Assists with beneficiary, provider, and stakeholder outreach and education services. Prepares and presents training presentations to internal and external individuals. Serves as a subject matter expert in Medicare and Medicaid to stakeholders. Provides assistance with the development and submission of fraud alerts and program vulnerability reports to CMS. Performs quality assurance (QA) by reviewing auditor/investigator case notes. Assists with preparation of a quarterly newsletter distributed to stakeholders. Qualifications Requirements Bachelor’s degree preferred. A minimum of 3 years’ experience with Medicare and Medicaid that demonstrates broad knowledge of both programs. Experience with or knowledge of more than one Medicaid program is a plus. Experience with outreach/coordination with a variety of stakeholders, preparing and delivering training presentations, and acting as subject matter on Medicare and Medicaid. Prior work experience on a Unified Program Integrity Contractor (UPIC) and/or Zone Program Integrity Contractor (ZPIC) contract is a plus. Knowledge of or experience with medical review, audits, or investigations is a plus. IntegrityM is an Equal Opportunity Employer and we do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, and gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

 
 

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Found in: Talent US – 11 hours ago

Sacramento, United States KPMG Consulting Services Full time

The KPMG Advisory practice is currently our fastest growing practice. We are seeing tremendous client demand, and looking forward we dont anticipate that slowing down. In this ever-changing market environment, our professionals must be adaptable and thrive in a collaborative, team-driven culture. At KPMG, our people are our number one priority. With a wealth of learning and career development opportunities, a world-class training facility and leading market tools, we make sure our people continue to grow both professionally and personally. If youre looking for a firm with a strong team connection where you can be your whole self, have an impact, advance your skills, deepen your experiences, and have the flexibility and access to constantly find new areas of inspiration and expand your capabilities, then consider a career in Advisory.

KPMG is currently seeking a Director State and Local CA Medicaid in Customer & Operations for our Consulting practice.

Responsibilities:

• Manage and deliver large, complex public services and state/local government engagements that identify, design and implement creative business and technology services for Medicaid government clients
• Develop and execute methodologies and solutions specific to the public sector and state/local government industry coupled with proven experience with Medicaid and MMIS modernization, with preference for prior work with large Medicaid programs in the western United States
• Handle engagement risk, project economics, planning and budgeting, account receivables and definition of deliverable content to help to ensure buy-in of proposed solutions from top management levels
• Develop and maintain relationships with many senior managements at state/local government agencies, positioning self and the firm for opportunities to generate new business
• Evaluate projects from a technical stance, helping to ensure that the development methods used are correct and practical; evaluate risks related to requirements management, business process definition, testing processes, internal controls, project communications, training and organizational change management
• Manage the day-to-day interactions with client managers

Qualifications:

• Minimum ten years of recent experience in the Health and Human Services Medicaid solution delivery market, working for a commercial off-the-shelf (COTS) solution provider or consulting organization with a minimum of eight years of experience managing large, complex technology projects on the scale of a State Medicaid Maintenance Management Information System (MMIS) solution along with proven experience with Medicaid and MMIS modernization
• Bachelors degree of technical sciences or information systems from an accredited university or college
• Prior experience and has served in a team supervisory role on at least one MMIS implementation and one MMIS M&O engagement such as Program Manager, Module Project Manager, Solution Architect, Technical Solution Lead, or Quality/Testing Manager
• Demonstrated experience leading teams of more than twenty staff, including staff from diverse organizations to successfully implement and operate technology-based solutions; experience and relationships with states in the western United States preferred
• Hands-on experience with the Center for Medicare and Medicaid Services (CMS) Medicaid Information Technology Architecture (MITA), Medicaid Certification Lifecycle, associated toolkit and CMS checklists
• Capable of presenting Medicaid topics to large, varied audiences in either written or verbal presentation format and experience in working on customer proposals or deal capture teams in the State Medicaid market
• Travel may be up to 80-100%

Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future
KPMG LLP (the U.S. member firm of KPMG International) offers a comprehensive compensation and benefits package. KPMG is an affirmative action-equal opportunity employer. KPMG complies with all applicable federal, state and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other category protected by applicable federal, state or local laws. The attached link contains further information regarding the firms compliance with federal, state and local recruitment and hiring laws. No phone calls or agencies please.

At KPMG, any partner or employee must be fully vaccinated or test negative for COVID-19 in order to go to any KPMG office, client site or KPMG event. In some circumstances, individuals who are not fully vaccinated may also be required to have a reasonable accommodation to not be fully vaccinated for COVID-19.

 
 

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