Category: MM Curator

 
 

MedeAnalytics is a leader in healthcare analytics, providing innovative solutions that enable measurable impact for healthcare payers and providers. With the most advanced data orchestration in healthcare, payers and providers count on us to deliver actionable insights that improve financial, operational, and clinical outcomes. To date, we’ve helped uncover millions of dollars in savings annually.

 
 

Position Summary

 
 

MedeAnalytics is looking for an experienced Product Manager to execute our State Medicaid product development strategy. This person is a key leader of the product team driving productivity and effectiveness of core product functions and cross functional collaboration. You will be responsible for identifying key features, organizing execution plans of the product roadmap, be responsible for release management ceremonies, and working closely with the Product Owner on backlog prioritization and evaluating client requests. This position coordinates closely with the engineering, platform, and other product teams to ensure enhancements or blockers are addressed within desired roadmap and release development timelines. This is a great opportunity for candidates who want to work in a fast-paced environment and make substantial contributions to helping State Medicaid agencies/Managed Care plans transition to cloud based self service analytics from legacy static reporting systems.

 
 

Essential Duties And Responsibilities

• Develop a deep understanding of the State Medicaid analytics market and unique reporting requirements to create a compelling product vision.
• Create and maintain comprehensive product documentation with the ability to articulate complex functionality.
• Prioritize features and partner with a product owner to deliver software through an Agile development process
• Work with the client teams to ensure client user needs are well understood and represented within the product roadmap
• Foster environment of trust and accountability; lead by example and in a way which characterizes and reinforces Mede cultural values.
• Anticipate and addresses risks, concerns, roadblocks – be forward thinking with great attention to detail
• Act as liaison (broker) for non-standard approvals of design from product and platform teams.
• Understand the business requirements to develop and drive an approach with the product team for data mappings and functionality to be delivered
• Build and represent business cases for large investments to build new products, enter new markets, create new partnerships, etc.
• Works closely with cross-functional development teams to help establish and enforce product quality, standards, and documentation.
• Work with product marketing and PMO to commercialize product offerings and support organizational readiness to sell and deliver your product offerings
• Assist with the creation of impactful summary and investigative reports specific to Medicaid Population Health needs
• Comfortable leading consultative meetings with clients to assist in implementations.

 
 

Education, Experience, And Required Qualifications

The ideal candidate has a proven record of solution driven product development, complex problem solving, and creating standard product features that accommodate client configuration requests.

• 3+ years of enterprise product management experience at a high tech company
• 3+ years working with CCD, HL7, ADT, Rhapsody Engine, APIs
• Practical, solution driven approach with outstanding communication – both written and spoken
• Experience with other third-party groupers such as Johns Hopkins ACG’s or 3M is desired
• Proven results integrating HIE or clinical data exchange messaging with BI reporting tools
• State Medicaid product or industry experience required
• Experience delivering State Medicaid administrative systems preferred
• Self-starter, entrepreneurial, strategic planner with proven ability to drive projects and strong analytical skills
• Ability to effectively apply both business knowledge and technical expertise to support business initiatives and solve business problems.
• Ability to handle multiple competing priorities in a fast-paced environment
• Excellent oral and written communication skills
• Exhibit passion and conviction and the innate ability to inspire passion in others
• Experience defining/prioritizing product requirements
• BA or BS degree
• Travel required: approximately 25%
• Ideal candidate would have enterprise consulting experience delivering Medicaid solutions

 
 

At MedeAnalytics we deeply value each and every one of our committed, inspired and passionate employees. If you’re looking to make an impact doing work that matters, you’re in the right place. Help us shape the future of healthcare by joining #TeamMede.

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-product-manager-at-medeanalytics-3114896102/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

As a Government and Public Services (GPS) Analyst within Deloitte Consulting’s US Delivery Center (USDC), you will support Deloitte leaders in providing strategic and technical consulting services and support business development efforts for Federal and State governments and other public entities. At Deloitte, you can be a part of the transformation of the health care sector, specifically state Medicaid programs. This role includes supporting states with their Medicaid transformation initiatives, contributing to client deliverables, and executing on tasks based on direction from team leads.

At Deloitte’s US Delivery Center (USDC) we help clients achieve a higher level of service in operational efficiency and business value. The USDC leverages scale, talent, and a center delivery model to provide high quality, cost-effective service with standardized processes and procedures. Our US Delivery Centers have been growing since 2014 with significant, continued growth on the horizon. Our delivery centers are based in Mechanicsburg, PA, Lake Mary, FL and Gilbert, AZ.

The Team

Deloitte’s Government & Public Services practice-our people, ideas, technology and outcomes-is designed for impact. Our team of over 15,000+ professionals bring fresh perspective to help you anticipate disruption, reimagine the possible, and fulfill your mission promise.

The Organization Transformation practice is about transforming the organization to support its business strategy. This involves helping our clients move from where they are today to where they need to be in the future. It could include changing the organization’s culture, modernizing specific functions, re-designing the organization structure, and will require a combination of change management actions to execute the transformation. To enable our success, it will be critical to use data and insights to inform better ways of working together.

Required Qualifications

Experience in MS Office Products including Excel, Access, Word and PowerPoint
Effective interpersonal and communication skills
Demonstrated team-building abilities
Creativity, self-confidence, and flexibility
Research, analytical, and problem-solving skills
Bachelor’s Degree or equivalent
Travel up to 10% annually
Limited immigration sponsorship may be available

Preferred Qualifications

Knowledge of Medicaid programs and Federal Health and Human Services Policies
Core Consulting Skills
Experience working with healthcare data
Financial modeling/forecasting
Healthcare reimbursement
Provider reimbursement (e.g., DSH, UPL)
Risk adjustment mechanisms
Knowledge of Health Care Trends
Ability to work independently and on teams

 
 

Clipped from: https://jobs.cbs4indy.com/jobs/medicaid-financial-policy-analyst-location-open-charlotte-north-carolina/619143483-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Exempt/Non-Exempt
Exempt
Scheduled Hours Per Week
40
Myers and Stauffer LC is a certified public accounting and health care reimbursement consulting firm, specializing in audit, accounting, data management and consulting services to government-sponsored health care programs (primarily state Medicaid agencies, and the federal Center for Medicare and Medicaid Services). We have 40+ years of experience assisting our government clients with complex health care reimbursement and provider compliance issues, operate 20 offices and have over 800 associates nationwide.
We Are Committed To Providing Our Employees With
At Myers and Stauffer you will have a career that is rewarding on every level of the organization.
 

• Professional growth and development opportunities
• Educational opportunities leading to certifications
• A diverse, dynamic, and challenging work environment
• Strong leadership, communication, and feedback
• A well-balanced lifestyle, that includes personal and family time in addition to professional and networking opportunities
• Creative and innovative solutions to challenges facing our government clients
   

The Senior Health Care Consultant will perform a variety of tasks related to oversight and administration of Medicaid managed care programs. This position will work collaboratively as part of an interdisciplinary team. The Senior Health Care Consultant will support project requirements that relate to research, policy development and analysis, managed care compliance, payment models and other ad hoc projects required by engagement clients.
This position reports to a Manager or Senior Manager. Health Care Consultants may report to this position.
Essential Functions
 

• Provide effective client management and interact with multiple levels of client staff in the delivery of consulting services
• Supervise staff to ensure timely and quality deliverables
• Provide quality assurance reviews on deliverables and reports completed by team members
• Develop client-specific subject matter expertise to support client engagements
• Assist in completing project deliverables and support the flow of deliverables through required processes
• Maintain client-specific tracking and review tools to support monitoring and compliance of client vendor performance
• Conduct detailed reviews of client vendor materials to ensure quality and compliance
• Conduct state legislative research and provide client support in development of legislative reporting and related materials
• Prepare written analyses and research findings in a manner that projects a detailed and expert understanding of assigned topics
• Prepare written client deliverables and present results/findings
• Support stakeholder engagement activities as needed
• Provide project management support and other ancillary support as requested
• Create and support trainings and training materials
• Maintain security and confidentiality of all protected health information
• Additional responsibilities as assigned
   

Requirements
 

• Bachelor’s degree in public health, social work, social services, human services, business, health care, or related field, Master’s degree preferred
• Minimum 3 years of healthcare experience required; 5 years preferred
• Proficient use of applicable software programs, including Microsoft Excel, Access, Word, etc.
• Must have strong ability to analyze data to identify issues
• Organized and detail oriented with strong problem solving skills
• Demonstrated ability to communicate verbally and in writing
• Effectively multi-task with planning and efficiency
• Must be able to manage multiple deadlines and prioritize assignments
• Ability to work in a team environment
• Must be able to travel based on client and business needs (approximately 0 – 20%)
   

REASONABLE ACCOMMODATION
If you are a qualified individual with a disability you may request reasonable accommodation if you are unable or limited in your ability to use or access this site as a result of your disability. You can request a reasonable accommodation by calling (toll free) or send an email to .
EQUAL OPPORTUNITY EMPLOYER
CBIZ is an affirmative action-equal opportunity employer and reviews applications for employment without regard to the applicant’s race, color, religion, national origin, ancestry, age, gender, gender identity, marital status, military status, veteran status, sexual orientation, disability, or medical condition or any other reason prohibited by law. If you would like more information about your EEO rights as an applicant under the law, please visit these following pages EEO is the Law and EEO is the Law Supplement .
PAY TRANSPARENCY PROTECTION NOTIFICATION
Notice to Applicants and Associates of Affirmative Action Program

 
 

Clipped from: https://jobs.cbs4indy.com/jobs/medicaid-managed-care-senior-consultant-atlanta-georgia/618683010-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Senior Manager / Specialist Leader, Government and Public Services

Healthcare (Medicaid)


Position Summary


The successful candidate will be a senior member of Deloitte’s Government and Public Services consulting organization in the United States. The candidate will serve as a senior team leader on project engagements and lead the development and growth of the practice in support of state and federal government agencies, primarily on Medicaid related issues.


Deloitte State Healthcare Consulting

With more than 40 years of experience in assisting state health and human services agencies in nearly every state, Deloitte understands how delivery works-and how it can work better. Our state health team offers industry-leading insights, solutions, and business practices to help state health agencies solve their most difficult challenges, ranging from modernization of eligibility determination systems and compliance with Federal Health Insurance Exchange requirements to innovative Medicaid tools and services that can help states serve their constituents more effectively.


Deloitte helps state Medicaid agencies design and implement initiatives that improve upon the management of their health programs, overall financial performance, and health outcomes. Our advisory services and solutions focus on four critical areas: policy and program design, analytics, organizational transformation, and ongoing program evaluation. In an environment in which states are being asked to do more with less, Deloitte brings a wealth of knowledge, experience and solutions to help health agencies plan for the future.


The Role

The Senior Manager will focus on selling and delivering consulting services in support of state Medicaid Directors’ agendas. They will help clients manage forward and transform themselves through a highly complex and ever-changing business environment. Consulting services and solutions would include generating new ideas for clients that will help them in this transformational journey and that generate a positive return on investment (ROI). The work will be rooted in the creation of innovative customer engagements for clients, building and leading a world-class team, and driving the development of thought leadership and offerings to create value for clients. Specific responsibilities and expectations include leading client service delivery, sales and marketing, and management of engagement teams.


Requirements:
 

• At least 10 years of healthcare experience working either with a state Health and Human Services agency or with a health plan or consulting company serving healthcare clients. Demonstrated experience working on Medicaid related issues including Medicaid managed care, value-based purchasing, 1115 transformation waivers, social determinants for health, managed long term services and supports, home and community based services, physical and behavioral health coordination, Medicaid enterprise solutions, quality measurement and analytics and fee for service operations
• Track record of leading and growing strong teams of management consultants or other organizational groups, with ability to manage across multiple engagements
• Outstanding leadership skills, verbal and written communication skills, presentation skills, team working skills and ethical standards. This individual should be looked upon as a role model who instills the pride, values and integrity of Deloitte in their team.
• Experience supporting Medicaid programs
• Experience mentoring and coaching others
• Business development experience (pre-sales, proposal, and RFP experience)
• Experience leading teams and managing client/executive relationships
• Willingness to travel at least 25%
• Masters Degree Preferred
  
  

Qualifications:

• Anticipates client needs based on a strong understanding of the client and its industry and marketplace.
• Determines client needs by guiding teams in selecting and applying the most appropriate tools, techniques, and approaches to understand the client’s issues and opportunities.
• Integrates recommendations into a total solution for the client that is consistent with the engagement strategy.
• Challenges and enhances quality by consistently striving for ways to improve deliverables.
• Directs the team to provide exceptional service to the client by responding with a sense of urgency, practicality, accountability, integrity, and respect.
• Communicates regularly with client management on a variety of business topics (e.g., trends, innovations, problem-solving discussions)
• Demonstrate specific service area/competency and/or industry expertise that resulted in tangible value for the client.
• Demonstrates a thorough knowledge of market trends, including opportunities and competitor activities in market assessments.
• Contributes to innovative thought leadership expertise, such as leading the development of complex, market-valued intellectual capital.
• Leverages their business network for contacts in target market to generate leads and brings ideas on innovative ways to identify and pursue new cross-functional sales opportunities, where appropriate.
• Leads development of the sales pursuit strategy and assembles and effectively manages the sales pursuit plan.
• Demonstrates the ability to successfully close the sale and generates enthusiasm in potential clients about working with the Firm.

 
 

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-senior-manager-at-deloitte-3099806472/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Requisition Number: 85732 – 27


Description


The KPMG Advisory practice is currently our fastest growing practice. We are seeing tremendous client demand, and looking forward we don’t 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 you’re 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 Manager State and Local MMIS Data Analytics in Customer & Operations for our Consulting practice.


Responsibilities

• Be on the management team and deliver large, complex public services and state/local government engagements that identify, design and implement creative data analytic and information delivery services for state/local government clients
• Contribute to the vision and architecture of Medicaid Operational Data Store (ODS) and/or Enterprise Data Warehouse (EDW) solutions integrated with a State Medicaid Enterprise Solution
• Develop and execute methodologies and solutions specific to Medicaid reporting including Fraud Recovery, Program Integrity, Third Party Liability, Utilization Review, MARS/SURS compliance and the CMS Transformed Medicaid Statistical Information System (T-MSIS)
• Product knowledge and development understanding of healthcare quality measures including effectiveness, patient safety, efficiency, patient-centered, equitability and timely care from CMS, NCQA and other industry sources
• Hands-on development skills creating Data Analytics, Business Intelligence and Enterprise reporting solutions in the State Medicaid Enterprise Solution market
• Evaluate data analytics 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 along with manage the day-to-day interactions with other project managers
  
  

Qualifications

• Minimum five years of recent experience in the Health and Human Services Medicaid solution delivery market, working for a commercial COTS solution provider or consulting organization with a minimum of eight years of experience managing large, complex healthcare data reporting or analytic systems
• Bachelor’s degree from an accredited college/university in technical sciences or information systems
• Must have served in a team role on a MMIS engagement as a Data Architect, Data Systems Manager, Business Analytics Manager or Artificial Intelligence based Analytics; demonstrated experience leading teams, including staff from diverse organizations to successfully implement and operate data driven analytic solutions
• Proven understanding of data security and data governance (HIPAA, BAA, DURSA) as applied in state Medicaid agency coupled with a willingness and ability to be hands-on to build the Medicaid Data practice; hands-on experience with the Center for Medicare and Medicaid Services (CMS) Outcomes based Certification (OBC) methodology coupled with demonstrated mastery of data modelling, profiling, schema design/implementation and data quality management
• Capable of presenting Medicaid data analysis and reporting 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
• Ability to travel up to 80% of the time and 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 firm’s 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.

 
 

Clipped from: https://www.linkedin.com/jobs/view/manager-state-and-local-mmis-data-analytics-at-kpmg-us-3103155148/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

Found in: S US – 4 hours ago

**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 ahealthcarecompany 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

**Interview Format**

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

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

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

\#ThriveTogether #WorkAtHome

**Scheduled Weekly Hours**

Clipped from: https://us.trabajo.org/job-1373-20220602-336fd05aeefe33eeb319fb8ed22ab5d3?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

• Deloitte • Atlanta, GA 30309

Job #2205379171

•  
• As a Government and Public Services (GPS) Analyst within Deloitte Consulting’s US Delivery Center (USDC), you will support Deloitte leaders in providing strategic and technical consulting services and support business development efforts for Federal and State governments and other public entities. At Deloitte, you can be a part of the transformation of the health care sector, specifically state Medicaid programs. This role includes supporting states with their Medicaid transformation initiatives, contributing to client deliverables, and executing on tasks based on direction from team leads.

At Deloitte’s US Delivery Center (USDC) we help clients achieve a higher level of service in operational efficiency and business value. The USDC leverages scale, talent, and a center delivery model to provide high quality, cost-effective service with standardized processes and procedures. Our US Delivery Centers have been growing since 2014 with significant, continued growth on the horizon. Our delivery centers are based in Mechanicsburg, PA, Lake Mary, FL and Gilbert, AZ.

The Team

Deloitte’s Government & Public Services practice-our people, ideas, technology and outcomes-is designed for impact. Our team of over 15,000+ professionals bring fresh perspective to help you anticipate disruption, reimagine the possible, and fulfill your mission promise.

The Organization Transformation practice is about transforming the organization to support its business strategy. This involves helping our clients move from where they are today to where they need to be in the future. It could include changing the organization’s culture, modernizing specific functions, re-designing the organization structure, and will require a combination of change management actions to execute the transformation. To enable our success, it will be critical to use data and insights to inform better ways of working together.

Required Qualifications

• Experience in MS Office Products including Excel, Access, Word and PowerPoint
• Effective interpersonal and communication skills
• Demonstrated team-building abilities
• Creativity, self-confidence, and flexibility
• Research, analytical, and problem-solving skills
• Bachelor’s Degree or equivalent
• Travel up to 10% annually
• Limited immigration sponsorship may be available

Preferred Qualifications

• Knowledge of Medicaid programs and Federal Health and Human Services Policies
• Core Consulting Skills
• Experience working with healthcare data
• Financial modeling/forecasting
• Healthcare reimbursement
• Provider reimbursement (e.g., DSH, UPL)
• Risk adjustment mechanisms
• Knowledge of Health Care Trends
• Ability to work independently and on teams

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status, or any other legally protected basis, in accordance with applicable law.

 
 

Clipped from: https://www.nexxt.com/jobs/medicaid-financial-policy-analyst-location-open-atlanta-ga-2205379171-job.html?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic&aff=2ED44C72-8FD2-4B5D-BC54-2F623E88BE26&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

THIS POSITION MAY BE TELEWORK ELIGIBLE ON A HYBRID BASIS.


About Us


The Ohio Department of Medicaid (ODM) is committed to improving the health of Ohioans and strengthening communities and families through quality care. ODM is implementing the next generation of Ohio Medicaid to fulfill its bold, new vision for Ohio’s Medicaid program – focusing on the individual rather than the business of managed care.


The goals of the next generation of Ohio Medicaid are:

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

What You Will Do At ODM


Office: Policy


Bureau: Health Plan Policy


Classification: Medicaid Health Systems Administrator 1 (PN 20087188 & 20045424)


Job Overview


The Ohio Department of Medicaid (ODM) is seeking two qualified individuals to join ODM’s Hospital Policy Team. The Hospital Policy Team is responsible for the development and implementation of Ohio Administrative Code (OAC) rules, establishing coverage and reimbursement policies, and managing special programs related to hospital services as part of the Ohio Medicaid Program.


The Positions Will Be Responsible For

• drafting new OAC rules, completing revisions to existing OAC rules, managing the rule filing process, and implementing necessary changes across the agency to support the rules
• amending State Plan pages as necessary
• ensuring policies comply with federal & state regulations, rules, and laws
• collaborating with other areas of ODM, sister state agencies, and external stakeholder groups
• responding to inquiries from internal and external stakeholders
   

Individual Positions Will Be Responsible For


Inpatient Hospital Policy Program Manager (PN 20087188) –

• developing hospital payment & coverage policies related to inpatient hospitals
• developing analysis and models related to hospital franchise fees (HFF), hospital care assurance program (HCAP), and Hospital Additional Payments (HAP)
• evaluating policies related to the regulatory oversight of payments to inpatient hospitals and special programs
• communicating with stakeholders and developing instructional or educational materials to support implementation of inpatient hospital policies and/or MMIS changes
   

Outpatient Hospital Policy Program Manager (PN 20045424) –

• developing hospital payment & coverage policies related to outpatient hospital and ambulatory surgery centers
• Annual updates to Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) codes
• developing analysis and models related to care innovation and community improvement program (CICIP) and supplemental payment programs
• evaluating policies related to the regulatory oversight of payments to outpatient hospitals and ambulatory surgery centers
• communicating with stakeholders and developing instructional or educational materials to support implementation of outpatient hospital and ambulatory surgery center programs and policies and/or MMIS changes
   

Preferred candidates will be detail-oriented, have strong critical thinking and problem-solving skills, the ability to manage multiple priorities, and display great organizational and time management abilities.


What’s In It For You


At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:


Medical Coverage

• Quality, affordable, and competitive medical benefits are offered through the Ohio Med PPO plan.
   

Dental, Vision and Basic Life Insurance

• Dental, vision and basic life insurance premiums are free after one year of continuous service.
   

Time Away From Work and Work/Life Balance

• Paid time off, including vacation, personal, and sick leave
• 11 paid holidays per year
• Childbirth/Adoption leave
   

Ohio Public Employees Retirement System

• OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of their salary towards their retirement. The employer contributes an amount equal to 14% of the employee’s salary. Visit the OPERS website for more information.
  Deferred Compensation
  
  

 
 

• The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.
  Completion of graduate core program in business, management or public administration, public health, health administration, social or behavioral science or public finance; 12 mos. exp. in the delivery of a health services program or health services project management (e.g., health care data analysis, health services contract management, health care market & financial expertise; health services program communication; health services budget development, HMO & hospital rate development, health services eligibility, health services data base analysis).
  
  
  Or 12 months experience as a Medicaid Health Systems Specialist, 65293.
  
  
  Note: education & experience is to be commensurate with approved position description on file.
  
  

   
   

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

  Primary Location
  
  
  United States of America-OHIO-Franklin County-Columbus
  
  
  Work Locations
  
  
  Lazarus 5
  
  
  Organization
  
  
  Ohio Department of Medicaid
  
  
  Classified Indicator
  
  
  Classified
  
  
  Bargaining Unit / Exempt
  
  
  Exempt
  
  
  Schedule
  
  
  Full-time
  
  
  Work Hours
  
  
  8:00AM – 5:00PM
  
  
  Compensation
  
  
  $34.70/hour
  
  
  Unposting Date
  
  
  Ongoing
  
  
  Job Function
  
  
  Health Administration
  
  
  Job Level
  
  
  Individual Contributor
  
  
  Agency Contact Information
  
  
  HumanResources@medicaid.ohio.gov

   
   

   
   

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SCHEDULE : Full-time

Be part of an extraordinary team

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change.

Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Build the Possibilities. Make an extraordinary impact.

The Medicaid Quality Management Health Plan Director is responsible for driving the development, coordination, communication, and implementation of strategic clinical quality management and improvement program within an assigned health plan.

Responsible for working with the regional head of quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement, NCQA accreditation, and compliance with regulatory agencies and other objectives.

Primary duties may include, but are not limited to :

Works with both internal and external customers to promote understanding of quality management activities and objectives within the company and to prioritize departmental projects according to Anthem corporate, regional, and departmental goals.

Maintains expert knowledge of current industry standards, quality improvement activities, and strong medical management skills.

Serves as a resource for the design and evaluation of process improvement plans / quality improvement plans and ensures they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements.

Collaborates with other leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans, year-round medical record review, and overread processes.

Monitors and reports quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements.

Minimum Requirements

Requires BA / BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and 5 years of progressively responsible experience in a healthcare environment or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences

MS or advanced degree in a healthcare-related field (i.e. nursing, health education) or business is strongly preferred.

Previous experience working with NCQA, and HEDIS preferred.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, 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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19.

If you are not vaccinated, your offer will be rescinded unless you provide and Anthem approves a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate.

Anthem will also follow all relevant federal, state, and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 Worlds Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion.

To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require an accommodation to participate in the job application process may contact ability icareerhelp.com for assistance.

REQNUMBER : PS71505

 
 

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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: https://www.mathematica.org/career-opportunities/benefits-at-a-glance.


Mathematica is searching for Medicaid Data Advisory Services Analysts with interest in Medicaid policy and programs at either the state or federal level to support current and emerging data analytics work. Medicaid data analysts will likely be connected to 2-3 projects at a time, with many projects requiring work with multidisciplinary teams and direct-client contact. Projects may span across several policy and programmatic areas: Medicaid managed care programs, value-based purchasing and alternative payment models, long-term services and supports, measures of delivery and quality of services for beneficiaries, and outcomes of innovative programs and policies.


Across All Projects, Medicaid Analysts Are Expected To

• Lead or participate actively and thoughtfully in project teams to implement, monitor, or evaluate policy and programs
• Apply rigorous analytic thinking to the collection, analysis, and interpretation of quantitative data
• Develop expertise in Medicaid data, policy, and programmatic areas
  
  

Specific Project Activities May Include

• Assisting with quantitative analyses using Medicaid enrollment, claims/encounter, financial and program data to support program monitoring, improvement, or evaluation
• Participating in decisions regarding analysis design and methodology
• Reviewing policy, program, and/or data documentation to develop technical specifications for analyses
• Working with developers to compile and analyze data
• Investigating data to identify data quality issues, patterns, or other findings
• Translating analysis findings into actionable information to support clients in making data-driven decisions regarding Medicaid policies and programs
• Providing technical assistance to federal and state Medicaid stakeholders to support the implementation of data collection, monitoring, and reporting programs
• Authoring client memos, technical assistance tools, issue briefs, chapters of analytic reports, user manuals, and webinar presentations summarizing findings
  
  

Position Requirements

• Master’s degree or equivalent in data analytics, public policy, economics, statistics, public health, behavioral or social sciences, or a related field; or a Bachelors degree and equivalent experience
• Experience conducting quantitative analysis work in a health policy or research setting, with experience in Medicaid preferred
• Strong foundation in quantitative methods and a broad understanding of Medicaid program and policy issues.
• Familiarity with Medicaid enrollment, claims, financial, or program data is preferred.
• Excellent written and oral communication skills, including an ability to write clear and concise policy and/or technical memos and documents for diverse stakeholder audiences including program administrators and policymakers
• Demonstrated ability to work on multidisciplinary teams
• Strong organizational skills and high level of attention to detail; flexibility to manage multiple priorities, sometimes simultaneously, under deadlines
  
  

To apply, please submit a cover letter, resume, transcripts (unofficial are acceptable), and contact information for three references. Please also provide a writing sample that demonstrates policy analysis or program operation and monitoring skills, and reflects independent analysis and writing, such as a white paper or decision memo. You will also be asked to provide your desired salary range during the application process.


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.


Available Locations: Princeton, NJ; Washington, DC; Cambridge, MA; Woodlawn, MD; Ann Arbor, MI; Oakland, CA; Chicago, IL; Seattle, WA; Remote


This position offers an anticipated annual base salary range of $70,000 – $95,000. This position may be eligible for a discretionary bonus based on individual and company performance.


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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