Wake County, NC Full Time

Job Posting for Analyst, CJ Specialist/Investigator II, Medicaid Investigations at State of North Carolina

THE STARTING SALARY FOR A NEW HIRE TO THIS POSITION IS LIMITED TO THE RECRUITMENT RANGE OF  $ 33,960 to $ 46,713. Salary offers for the selected candidate are based on the candidate’s education and experience related to the position, as well as our agency budget and equity.

The North Carolina Department of Justice, led by the Attorney General of North Carolina, represents the State of North Carolina in court and provides legal advice and representation to most state government departments, agencies, officers, and commissions. The Department also represents the State in criminal appeals from state trial courts, and brings legal actions on behalf of the state and its citizens when the public interest is at stake. 

This position is located in the Medicaid Investigations Division of the Department of Justice.  The Attorney General’s Medicaid Investigations Division investigates and prosecutes health care fraud committed by Medicaid providers and the physical abuse of patients and embezzlement of patient funds in Medicaid-funded facilities. These cases protect and recover taxpayers dollars that can be used to provide needed medical services to Medicaid enrollees.  These cases also protect our most vulnerable elderly and disabled citizens.

Our Medicaid Investigations Division (MID) is staffed by Department of Justice attorneys, investigators, auditors, analysts, and a nurse investigator, paralegals, and administrative staff.  MID provides state and national training opportunities to aid employees in understanding the complexities of health care fraud investigations.  This position has the opportunity to work cases in state and federal court in partnership with law enforcement agents with federal and state agencies such the Office of Inspector General, FBI, IRS, NC State Bureau of Investigations, Sheriff’s Offices, and Police Departments.

Over the past decade, the NC MID has recovered more than $500 million and helped win more than 450 criminal convictions in health care fraud and abuse cases.

The Attorney General’s office and the Medicaid Investigations Division are committed to ending Health Care Fraud. The link below is provided for your information.
https://www.ncdoj.gov/Top-Issues/Stop-Health-Fraud-(1).aspx

The primary purpose of this analyst position is to provide criminal intelligence and data analysis, data organization and data presentation assistance to Medicaid Fraud Financial Investigators pertaining to investigations of Medicaid fraud and abuse. The employee assists Medicaid Fraud Financial Investigators and one or more teams of attorneys and investigators in the detection, investigation, and punishment of fraudulent and non-fraudulent violations of applicable criminal and civil laws pertaining to fraud and abuse by Medicaid providers and in administration of the Medicaid Program.

This analyst will also support the investigation of Medicare and other federal health care fraud cases and investigations which are primarily related to Medicaid fraud involving complex financial analysis. This individual will

• prepare detailed spreadsheets and charts, review medical records, prepare written investigative reports, research public records, analyze facts and documents, and assist in the collection and storage of evidence.
• receive, document, research, gather information, and prepare reports of referrals from citizens, providers, recipients, and other professionals within and outside of the Medicaid agency who report Medicaid fraud abuse.
• must be able to suggest leads to investigators and assist in preparation of investigative requests for records, subpoenas and search warrants.
• must also perform administrative duties to include preparation of management reports and other duties as needed.
• This investigator typically works in the office, but may occasionally be required to work in the field to obtain pertinent information.

The successful candidate must undergo and successfully complete a comprehensive background check as part of the hiring process.

This position is subject to the Fair Labor Standards Act. This position will require travel and overnight travel.
 

 Note to Current State Employees:
The salary grade for this position is GN08.  State employees are encouraged to apply for positions of interest even if the salary grade is the same as, or lower than, their current position.  Please detail ALL work history including non-state service experience.  If selected for this position, a new salary will be recalculated taking into consideration the quantity of relevant education and experience, funding availability, and internal equity. Based upon these factors, a pay increase MAY or MAY NOT result. 

The State of North Carolina offers employer paid health insurance plus ten paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information at Employee Benefits. 

 
 

 
 

 
 

Considerable knowledge of criminal justice and law enforcement procedure, terminology, and personnel policies and practices.

Ability to interpret, apply, and communicate statutory regulations of the assigned area.

Ability to analyze, interpret, recommend, and implement policy and procedural guidelines. Ability to instruct and explain standards and procedures.

Ability to establish effective working relationships, including seeking compliance with regulations.

Ability to express oneself clearly and concisely, tactfully and professionally  in oral and written form,

Ability to work independently and use sound judgment in making decisions.

Strong skills in utilizing word processing, spreadsheet, and database software, email functions, and Internet Web browser skills.  The employee must have knowledge of modern office procedures, practices, and equipment including Word, Excel, Access, email, Internet browsers, relational databases, and an effective working knowledge of Medicaid coverage policy and claims processing and data systems. 

Strong organizational skills and file management skills.

Strong problem solving skills; the ability to make inferences and deductions from a vast array of intelligence sources pertaining to criminal activities and organizations.

Must have the ability to learn and adapt to ever-changing computer software; the ability to provide written and oral briefings, reports and training to law enforcement agencies on trends and patterns of criminal activity and new and existing analytical techniques in criminal intelligence; the ability to exercise judgment and discretion in establishing, applying and interpreting policies, procedures, and administrative rules; and the ability to establish and maintain effective working relationships with multi-agency personnel and administrators.

Must comply with rules and regulations regarding confidentiality and the dissemination of information using proper judgment with regard to sensitive and critical information and maintain confidentiality as required by applicable laws and regulations.

The employee must have a thorough knowledge of the intelligence process and methodology. 

Bachelor s degree from an appropriately accredited institution and two years of administrative and/or technical experience in criminal justice or law enforcement as it relates to the area of assignment, or an equivalent combination of education and experience.Please be sure to complete the application in full.

Note the following: If multiple applications are submitted to an individual posting, only the most recent application received prior to the closing date will be accepted. Applications must be submitted by 5:00 PM on the closing date

Resumes and cover letters:   To receive credit for your work history and credentials, you must list the information on the online application form. This information is used to determine if you meet the requirements of the position, and if you are selected, it is used to determine a salary offer.

Using the terms “See Resume” or “See Attachment” will not be accepted and your application will be rejected as incomplete.  Cover letters are highly encouraged but not required.    

Transcripts:  Degrees must be received from appropriately accredited institutions. A copy of your transcripts indicating the degree received can be uploaded with your application.

If a transcript has been requested, your application will be considered incomplete if  you do not provide one. Using a photograph of your diploma is not acceptable.
   
Credit for foreign degrees will only be given if verification of degree certification is attached to your application.  Transcripts for foreign degrees have to be evaluated by an organization like World Education Services to determine US equivalency.

Any licenses or certificates must be included in the appropriate section of the application form.

Veterans Preference: Applicants seeking Veteran’s Preference must attach a copy of their DD-214 or discharge orders.

Application status: To check the status of your application, please log in to your account.  Upon the closing date, applications are “Under Review” and will be screened by Human Resources for the qualified applicants. The hiring process may take an average of 6 – 8 weeks.  All applicants will be notified by email once a position is filled.

NeoGov Help Line: If you are having technical issues submitting your application, please call the NeoGov Help Line at 855-524-5627. If there are any questions about this posting, other than your application status, please contact the NC DOJ Human Resources office.

The NC Department of Justice is an Equal Opportunity Employer. The NC Department of Justice uses Merit-Based Recruitment to select from among the most qualified applicants to fill positions subject to the State Human Resources Act. 

CONTACT INFORMATION:
NC Department of Justice
Human Resources Office
Lisa Sasser, Recruitment Specialist
114 W. Edenton Street
Raleigh, NC 27603
919-716-6490      

Clipped from: https://www.salary.com/job/state-of-north-carolina/analyst-cj-specialist-investigator-ii-medicaid-investigations/4ff5d70e-1cd8-4538-ab32-cbaa01e0bfa5?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Actuarial and Reimbursement Intern

AHCCCS

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs, and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona.

Actuarial and Reimbursement Intern

AHCCCS

Posting Details:

Salary: $12.15 hr
 

Grade: 04

Job Summary:

The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as an Actuarial and Reimbursement Intern. This position may be on a part-time or full-time basis up to but not exceeding six months, depending on the scheduling needs of the Intern. The position will provide the Intern opportunities to work closely with experienced analytical and actuarial staff, apply quantitative skills in support of important agency projects and gain exposure to health finance and state government. During the position, the intern must reside in Arizona and be available to work in-person from AHCCCS’ Phoenix office.

Job Duties:

* Develop queries in Cognos to pull service utilization data. Perform detailed analysis of the data in support of agency decision making.

* Compare and analyze AHCCCCS coverage and fee-for-service rates to other states.

* Research academic studies to support modeling of program change impacts used in capitation rate setting.

* Conduct ongoing variance analysis of projected impacts of policy changes and actual experience.

* Summarize state and federal regulations

* Contribute to creation of fund sourcing models used in projecting state cost impacts.

* Assist in preparing Access Monitoring Analysis report

* Support for various actuarial and rate setting tasks

 

Knowledge, Skills & Abilities (KSAs):

* Demonstrated knowledge with Excel, Access and other MS Office applications

* Data analysis and research methods

* Medicaid and managed care payment principles

* Collection, organization, and summary of large data sets using Excel and Access

* Internet research to track rate-setting issues, methodology updates and federal requirements

* Strong ability to work and communicate with a broad spectrum of professionals, and effectively present information both orally and in writing.

 

Selective Preference(s):

* Computer skills: Cognos Reports and Google Suite.

* Current pursuit of degree in a quantitative field, such as actuarial science, data analytics, math or statistics

* Team and interpersonal skills and Verbal and written communication skills

* Interest in Health Finance and Public Service

 

Benefits:

At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.

For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

 
 

Clipped from: https://jobs.azahcccs.gov/actuarial-and-reimbursement-intern/job/17121652?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Dice is the leading career destination for tech experts at every stage of their careers. Our client, Chandra Technologies, Inc., is seeking the following. Apply via Dice today!


Hourly Rate 71 W2 82 CTC1099 Job Description The NC Department of Health and Human Services (DHHS) Information Technology Division (ITD) is seeking Enterprise, Technical and Solutions Architects to perform work associated with the Medicaid Enterprise Systems (MES) project. This person will responsible for the architectural definition, procurement and implementation of highly complex and innovative Medicaid Enterprise Modular solutions. In addition, these roles will participate within an industry best-practice Enterprise Architecture methodology and will oversee the implementation and operation of various vendor-provided technology solutions. This role must be able to collaborate with product-, business- and process owners to evaluate their needs and to translate those needs into highly effective functional and non-functional requirements. This role is responsible for creating several comprehensive technology and information architectures related to various functional business solutions, while providing strategic direction throughout the development process and ensuring that the solution aligns with the Medicaid Enterprise Architecture Modular vision and strategy. In addition, the role will include oversight and compliance with Federal and Statewide Technical Architecture requirements, risk identification and planning. This role requires a person that possesses a strong and diverse background in both traditional and modern business solution- and application architecture concepts, tools and practices. This person must have hands on working knowledge of various platforms including legacy, service oriented and cloud-based solution architectures – Cloud based Architectures are required. Required Knowledge, Skills and Abilities Extensive ability to plan, design and implement complex Medicaid business solution in collaboration with functional solution vendors. Extensive familiarity with architectural evaluation, design and analysis of enterprise wide systems throughout the full implementation life cycle including procurement through operations Extensive hands on experience with overseeing and aligning vendor-based application solutions and architectures to deliver robust system solutions that will align with Medicaid Modular System Integration goals and objectives Extensive familiarity with application programming interfaces and service-oriented design and development to assure seamless integration between various Vendor Functional Modules offered as SaaS or Cloud Hosted Solutions. Ability to identify customer requirements, analyze alternatives and conduct product recommendations related to software, platform and network configurations. Ability to closely collaborate with Enterprise Architecture to ensure functional solutions comply with Enterprise Architecture and CMS 7 Standards and conditions Strong ability to perform as a high functioning architecture team member within a highly flexible and loosely coupled environment, supporting multiple concurrent business-oriented development workstreams. Extensive experience leveraging cloud technologies Strong leadership and guidance on test planning, automation and continuous improvement and deployment processes Superior communication to ensure stakeholders, project managers, developers, and software vendors are aligned with the software development process Extensive business continuity, backup, recovery, high availability and archiving implementation and oversight to ensure vendor solutions align with State expectations. Experience with data integration and data mapping to ensure interoperability between vendor solutions and MES modules Proficiency with the use of Microsoft Word, Excel, PowerPoint, Visio and Project Preferred Knowledge, Skills and Abilities Familiarity with healthcare and healthcare insurance solutions and information architectures, especially Medicaid or similar industry Familiarity with HIPAA rules and regulations Familiarity with CMS certification processes Experience drafting and evaluating RFP’s or other procurement documents Experience working within TOGAF, FEA or other Enterprise Architecture frameworks Required Skills Knowledge of the Medicaid Systems and Solutions (7 years) Knowledge of the MITA Business, Information and Technical architectures (7 years) Extensive familiarity with relational databases as well as other types (Graph Database, NoSQL) and the relative advantages and disadvantages of each (7 years) Extensive familiarity with business intelligence, analytical and reporting tools (7 years) Experience leveraging cloud technologies (5 years) Excellent general IT knowledge (applications development, testing, deployment, operations, documentation, standards, best practices. (7 years) Experience with Technical Proposal Evaluations (7 years) Excellent verbal and written communication skills with the ability present to both technical and business audiences. (7 years) Experience participating or leading projects using an Agile methodology. (7 years) Experience working with various vendors and coordinating with the Systems Integrator (7 years) Preferred Skills Experience with data integration and mapping (5 years) Knowledge on Claims and Financial Processing (5 years) experience in Data Governance, Modelling and Architecture (5 years) Medicaid Architect MITA Business Knowledge, Agile, Technical Proposal Evaluations Higher Competitive Rates will be considered for consultants with advanced skill set Corp to Corp Resumes are welcome Consultants may need a criminal background check

 
 

Clipped from: https://www.linkedin.com/jobs/view/medicaid-architect-at-dice-2656941648/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

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

Responsibilities

Job Title: Louisiana Medicaid CMO, RVP Health Services

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

Job Description

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

• Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF) according to the Humana’s Medicaid policies and procedures.
• Participate in Quality Operations including chair Quality Management Committee, complete initial peer review on quality of care complaints, complete peer-to-peer written and verbal communications.
• Oversee administrative budget for regional HSO & Quality Improvement including approve/deny expense reports & requisition requests for department members.
• Oversee Quality Improvement and HEDIS/STARS metrics improvement with PCP offices and IPAs.
• Participate in regional level committees and meetings setting medical necessity strategies.
• Provide oversight and direction for the implementation of regional clinical programs and strategies, as well as, developing and implementing market level strategies.
• Manage internal operational/functional relationships related to profitability.
• Assist with network development and provider contracting with various providers and ancillary providers.
• Serve as clinical liaison with inpatient facilities and joint operating committees to maintain facility relationship and problem solve; especially reviewing contracts as to clinical services.
• Well-versed on financial aspects of various levels of risk bearing contracts and possess the ability to gain traction and adoption of the providers.
• Ability to thrive in a highly matrix environment.

Required Qualifications

• 8 or more years of management experience
• A current and unrestricted license in Louisiana and willing to obtain licenses, as needed, for various states in region of assignment
• MD or DO degree
• Board Certified in an approved ABMS Medical Specialty
• Excellent communication skills
• 5 years of established clinical experience
• Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products
• Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
• Prior experience within the Louisiana Department of Health
• Experience working with the Medicaid population or Medicaid Managed Care, PEDS, OB-GYN, Drug Abuse/Addiction, or Behavioral Health
• Master’s Degree

#PhysicianCareers

Scheduled Weekly Hours

40

 
 

Clipped from: https://www.glassdoor.com/job-listing/louisiana-medicaid-cmo-rvp-health-services-humana-JV_IC1150033_KO0,42_KE43,49.htm?jl=4019754988&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

MVP Consulting Raleigh, NC

NC Department of Health and Human Services (DHHS) Information Technology Division (ITD) seeks an IT Product Management Group Supervisor/Manager to join the Medicaid Enterprise System (MES) project. Technology, Business, and Policy expertise are key.
REQUIRED/DESIRED SKILLSSkillsRequired/
DesiredExperienceKnowledge of Enterprise IT Systems, system integration principles, and associated change management best practices.Required7 YearsHas an understanding of CMS’ Seven Standards and Conditions and the Medicaid programRequired7 YearsDemonstrated ability to manage multiple priorities and projects, function in a fast-paced moving constantly changing, deadline driven environmentRequired7 YearsProficient use of Microsoft Project, Word, Excel, PowerPoint, Access, and Adobe softwareRequired7 YearsSkills in persuasion, negotiation, relationship management, conflict resolution, and effective oral and written communication at all levelsRequired7 YearsProven track record of launching successful user-focused products preferably in the enterprise, analytics or healthcare space.Required7 YearsPrevious experience creating business use cases, requirements, and process maps/data flows.Required7 YearsExperience working in a combination of business analysis, product management, project management and/or software application development.Required7 YearsExcellent communication skills and attention to detail with specific experience developing, editing, and presenting summaries, reports, and complex inRequired7 YearsProven experience and working knowledge of agile development methodologies, environment and tools.Required7 YearsExperience using or implementing Cloud technologies IaaS, PaaS, SaaS.Highly desired7 YearsExperience handling HIPAA and PII data.Highly desired7 Years7+ years of experience in product management in a healthcare or government settingHighly desired7 YearsManaged Care knowledge or experienceHighly desired7 YearsMITA knowledge or experienceHighly desired7 YearsMedicaid Program knowledge or related HealthCare Information System experienceHighly desired7 Years

 
 

Clipped from: https://www.ziprecruiter.com/c/MVP-Consulting/Job/Business-Integration-Product-Manager-(system-integration,-CMS-Seven-Standards,-Medicaid)/-in-Raleigh,NC?jid=229523479cada47b&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description of Work


THE STARTING SALARY FOR A NEW HIRE TO THIS POSITION IS LIMITED TO THE RECRUITMENT RANGE OF $ 33,960 to $ 46,713. Salary offers for the selected candidate are based on the candidate’s education and experience related to the position, as well as our agency budget and equity.


The North Carolina Department of Justice, led by the Attorney General of North Carolina, represents the State of North Carolina in court and provides legal advice and representation to most state government departments, agencies, officers, and commissions. The Department also represents the State in criminal appeals from state trial courts, and brings legal actions on behalf of the state and its citizens when the public interest is at stake.


This position is located in the Medicaid Investigations Division of the Department of Justice. The Attorney General’s Medicaid Investigations Division investigates and prosecutes health care fraud committed by Medicaid providers and the physical abuse of patients and embezzlement of patient funds in Medicaid-funded facilities. These cases protect and recover taxpayers dollars that can be used to provide needed medical services to Medicaid enrollees. These cases also protect our most vulnerable elderly and disabled citizens.


Our Medicaid Investigations Division (MID) is staffed by Department of Justice attorneys, investigators, auditors, analysts, and a nurse investigator, paralegals, and administrative staff. MID provides state and national training opportunities to aid employees in understanding the complexities of health care fraud investigations. This position has the opportunity to work cases in state and federal court in partnership with law enforcement agents with federal and state agencies such the Office of Inspector General, FBI, IRS, NC State Bureau of Investigations, Sheriff’s Offices, and Police Departments.


Over the past decade, the NC MID has recovered more than$500 million and helped winmore than 450criminal convictions in health care fraud and abuse cases.


The Attorney General’s office and the Medicaid Investigations Division are committed to ending Health Care Fraud. The link below is provided for your information.


https://www.ncdoj.gov/Top-Issues/Stop-Health-Fraud-(1).aspx


The primary purpose of this analyst position is to provide criminal intelligence and data analysis, data organization and data presentation assistance to Medicaid Fraud Financial Investigators pertaining to investigations of Medicaid fraud and abuse. The employee assists Medicaid Fraud Financial Investigators and one or more teams of attorneys and investigators in the detection, investigation, and punishment of fraudulent and non-fraudulent violations of applicable criminal and civil laws pertaining to fraud and abuse by Medicaid providers and in administration of the Medicaid Program.


This analyst will also support the investigation of Medicare and other federal health care fraud cases and investigations which are primarily related to Medicaid fraudinvolving complex financial analysis. This individual will

• prepare detailed spreadsheets and charts, review medical records, prepare written investigative reports, research public records, analyze facts and documents, and assist in the collection and storage of evidence.
• receive, document, research, gather information, and prepare reports of referrals from citizens, providers, recipients, and other professionals within and outside of the Medicaid agency who report Medicaid fraud abuse.
• must be able to suggest leads to investigators and assist in preparation of investigative requests for records, subpoenas and search warrants.
• must also perform administrative duties to include preparation of management reports and other duties as needed.
• This investigator typically works in the office, but may occasionally be required to work in the field to obtain pertinent information.
  
  

The successful candidate must undergo and successfully complete a comprehensive background check as part of the hiring process.


This position is subject to the Fair LaborStandards Act. Thisposition will require travel and overnight travel.


Note To Current State Employees


The salary grade for this position isGN08.State employees are encouraged to apply for positions of interest even if the salary grade is the same as, or lower than, their current position. Please detail ALL work history including non-state service experience. If selected for this position, a new salary will be recalculated taking into consideration the quantity of relevant education and experience, funding availability, and internal equity. Based upon these factors, a pay increase MAY or MAY NOT result.


The State of North Carolina offers employer paid health insurance plus ten paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information atEmployee Benefits.


Knowledge, Skills And Abilities / Competencies


Considerable knowledge of criminal justice and law enforcement procedure, terminology, and personnel policies and practices.


Ability to interpret, apply, and communicate statutory regulations of the assigned area.


Ability to analyze, interpret, recommend, and implement policy and procedural guidelines. Ability to instruct and explain standards and procedures.


Ability to establish effective working relationships, including seeking compliance with regulations.


Ability to express oneself clearly and concisely, tactfully and professionally in oral and written form,


Ability to work independently and use sound judgment in making decisions.


Strong skills in utilizing word processing, spreadsheet, and database software, email functions, and Internet Web browser skills.The employee must have knowledge of modern office procedures, practices, and equipment including Word, Excel, Access, email, Internet browsers, relational databases, and an effective working knowledge of Medicaid coverage policy and claims processing and data systems.


Strong organizational skills and file management skills.


Strong problem solving skills; the ability to make inferences and deductions from a vast array of intelligence sources pertaining to criminal activities and organizations.


Must have the ability to learn and adapt to ever-changing computer software; the ability to provide written and oral briefings, reports and training to law enforcement agencies on trends and patterns of criminal activity and new and existing analytical techniques in criminal intelligence; the ability to exercise judgment and discretion in establishing, applying and interpreting policies, procedures, and administrative rules; and the ability to establish and maintain effective working relationships with multi-agency personnel and administrators.


Must comply with rules and regulations regarding confidentiality and the dissemination of information using proper judgment with regard to sensitive and critical information and maintain confidentiality as required by applicable laws and regulations.


The employee must have a thorough knowledge of the intelligence process and methodology.


Minimum Education And Experience Requirements


Bachelor s degree from an appropriately accredited institution and two years of administrative and/or technical experience in criminal justice or law enforcement as it relates to the area of assignment, or an equivalent combination of education and experience.


Supplemental and Contact Information


Please be sure to complete the application in full.


Note the following: If multiple applications are submitted to an individual posting, only the most recent application received prior to the closing date will be accepted. Applications must be submitted by 5:00 PM on the closing date


Resumes and cover letters: To receive credit for your work history and credentials, you must list the information on the online application form. This information is used to determine if you meet the requirements of the position, and if you are selected, it is used to determine a salary offer.


Using the terms “See Resume” or “See Attachment” will not be accepted and your application will be rejected as incomplete. Cover letters are highly encouraged but not required.


Transcripts:Degrees must be received from appropriately accredited institutions. A copy of your transcripts indicating the degree received can be uploaded with your application.


If a transcript has been requested, your application will be considered incomplete if you do not provide one. Using a photograph of your diploma is not acceptable.


Credit forforeign degreeswill only be given if verification of degree certification is attached to your application. Transcripts for foreign degrees have to be evaluated by an organization like World Education Services to determine USequivalency.


Any licenses or certificates must be included in the appropriate section of the application form.


Veterans Preference:Applicants seeking Veteran’s Preference must attach a copy of their DD-214 or discharge orders.


Application status:To check the status of your application, please log in to your account. Upon the closing date, applications are “Under Review” and will be screened by Human Resources for the qualified applicants. The hiring process may take an average of 6 – 8 weeks. All applicants will be notified by email once a position is filled.


NeoGov Help Line:If you are having technical issues submitting your application, please call the NeoGov Help Line at 855-524-5627. If there are any questions about this posting, other than your application status, please contact the NC DOJ Human Resources office.


The NC Department of Justice is an Equal Opportunity Employer.The NC Department of Justice uses Merit-Based Recruitment to select from among the most qualified applicants to fill positions subject to the State Human Resources Act.


Contact Information


NC Department of Justice


Human Resources Office


Lisa Sasser, Recruitment Specialist


114 W. Edenton Street


Raleigh, NC 27603


919-716-6490

 
 

Clipped from: https://www.linkedin.com/jobs/view/analyst-cj-specialist-investigator-ii-medicaid-investigations-at-state-of-north-carolina-2649110106/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company, it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health benefits companies and a Fortune Top 50 Company.

Receives a moderate level of guidance and direction in providing operational and administrative support for the implementation, auditing and resolution of loading issues for payment innovation programs.

Primary duties may include, but are not limited to:

+ Provides support for assigned provider contracts.

+ Obtains and analyzes financial performance and quality metrics.

+ Support and facilitates value-based JOCs (Joint Operating Committee meetings).

+ Develops and maintains contact database and disseminates communications to providers as necessary.

+ Aggregate and analyze provider data from various sources to recommend and implement solutions to assist with provider collaboration activities.

+ Collaborates with provider contractors and network relations reps to meet provider service needs.

+ Encourages providers to act on patient outreach opportunities.

+ Continues to build knowledge of the organization, processes and customers.

+ Performs a range of mainly straightforward assignments.

Qualifications

+ Requires a BA/BS degree; 3 years experience in database maintenance related to health care; or any combination of education and experience, which would provide an equivalent background.

+ Provider environment experience preferred.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS48952-Kentucky
 

Clipped from: https://us.trabajo.org/job-822-20210721-36a28a530b7bad464b5971fe83b5f1d2?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description:

Company Description

Ask ITC Inc. which is backed by a $500 million Microtek group company, provides an industry leading blend of technology, business consulting, and outsourcing services. Ask IT is a minority-owed enterprise; it has been founded on providing the highest quality possible and on the devotion to customer satisfaction.
 

Job Description

Role Name: Mainframe Tester/Analyst

Duration: 12 Months

Location: Clemson, SC

REQUIRED SKILLS (RANK IN ORDER OF IMPORTANCE):

MAINFRAME, MVS COBOL, JCL, SOFTWARE TESTING, CREATION OF TEST SCENARIOS

SOFT SKILLS REQUIRED:

EFFECTIVE COMMUNICATION SKILLS (WRITTEN AND ORAL), ADAPTABILITY, FLEXIBILITY, SELF-MOTIVATION, PROBLEM SOLVING, ANALYTICAL THINKING, TIME MANAGEMENT, ABILITY TO WORK EFFECTIVELY IN A STRESSFUL ENVIRONMENT

PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE):

CA-ADS, SQL, SERENA CHANGEMAN OR OTHER

Additional Information

All your information will be kept confidential according to EEO guidelines.

Clipped from: https://us.trabajo.org/job-822-20210721-1bd93ba516ec3fe8f834316bab21399d?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

11 hours ago

 
 

Excelraise, LLC is a rapidly growing full service IT solutions integrator and talent management company headquartered in Denver, CO. Our valued client*s includes fortune 500 companies, Government Agencies.

Currently we are looking for a qualified individual to work as a MySQL Database Administrator with our direct client
in Clemson, SC.

***This is Onsite Position***

Our direct client is seeking a MySQL professional with the knowledge and experience along with comparable communication and interpersonal skills to enable success on this high-visibility project.

DAILY DUTIES / RESPONSIBILITIES:
The MySQL DBA is responsible for working closely with both the project development team (scrum/sprint teams) and with the Clemson Database Administrators to provide MySQL DBA support for numerous application and infrastructure databases.

REQUIRED SKILLS:

• The MySQL DBA role has four major attributes: software development leadership, project management skills, people skills, and domain knowledge in enterprise class multi-tier web-based application development projects. Candidates must display excellence in all areas.
• Previous experience in health care related information technology, insurance information technology, Medicaid Management Information Systems (MMIS), Medicaid eligibility, or social services eligibility, while not absolutely necessary, will be helpful.
• Proven MySQL DBA experience in supporting enterprise applications in Linux environments, preferably Redhat or Oracle Linux.
• Experience with MySQL cluster
• Understanding of IT development and implementation projects.
• Understanding of database scalability and operations.
• Project planning experience, including effort estimation on technical tasks and resource allocation.
• Strong written and oral communications skills, including the ability to give presentations to project management. Strong proficiency in English is required.
• Impeccable integrity. This project will have very high visibility and will impact significant expenditures of public funds. Candidates must be confident with their abilities to make correct decisions and the courage to speak out when necessary.
• Willingness and ability to effectively engage with people and organizations on a continuous basis.
• Experience with Microsoft SQL Server is desirable, but not required.

PREFERRED SKILLS:

• Hands-on experience with managing MySQL performance and availability 24×7.
• Experience with configuring monitoring and alerting for MySQL databases and clusters.
• Hands-on experience with MySQL upgrades, patching, and re-hosting.
• Healthcare industry experience and/or experience managing PHI/PII data.
• MS SQL Server knowledge and support experience is a plus, but not required.
• Vendor management experience.
• Medicaid Management Information System (MMIS) experience
• Medicaid operations experience.
• Public sector experience is a plus.

REQUIRED EDUCATION:

• Bachelor’s degree in a technical, business, or related field. Masters degree is desirable.

 
 

• Clipped from: https://www.glassdoor.com/job-listing/mysql-database-administrator-mmis-medicaid-excelraise-llc-JV_IC1155185_KO0,42_KE43,57.htm?jl=1007188781045&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description:

Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortun

3 days ago

 
 

Clipped from: https://us.trabajo.org/job-640-20210711-3a42280daa28067334083869fafaf59a?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic