Clipped from: https://louisiana.talentify.io/job/medicaid-pre-release-enrollment-coordinator-2-baton-rouge-la-la-louisiana-3712748?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Summary

The MPRE Coordinator 2 position is part of a three-member team that supports Medicaid’s Justice-involved Pre-Release Enrollment Program as well as other justice-involved initiatives undertaken by Medicaid. The Pre-Release Enrollment Program provides Medicaid coverage for the offender population and is a collaborative effort, working with the Louisiana Department of Public Safety & Corrections (DPS&C) and partners with community groups that work with formerly incarcerated persons. A key role of this position will be to advance the monitoring and evaluation of the program. This position is domiciled at the Louisiana Department of Health’s office in Baton Rouge, Louisiana.

Job Description

• Assist the LDH Program Manager in all areas of daily program functions including researching Medicaid eligibility and resolving application issues, ensuring the accuracy of program data, communicating with stakeholders, and periodic program monitoring.

• Work collaboratively with staff of DPS&C’s prison facilities, Medicaid’s managed care plans, and other LDH programs.

• Assist with the coordination, planning and evaluation of Medicaid’s Pre-release Enrollment Program and other justice-involved initiatives

• Assist LDH management with day-to-day tasks and serve as a secondary contact and provide functional back-up support in the unit supervisor’s absence.

• Research multiple databases to resolve individual Medicaid application and enrollment issues for internal and external partners.

• Responsible for data analysis and writing monthly, mid-year and annual reports.

• Represent the department at relevant conferences, regional events and stakeholder meetings. Some in-state travel is expected, including travel to other state offices and correctional facilities.

• Conduct research on topics related to program or target population as needed.

• Assist with the preparation and execution of conference calls, webinars, and meetings.

• Develop and update documentation about the program for internal and external audiences such as operations manuals, reports, white papers, abstracts and fact sheets.

• Facilitate meetings, trainings as needed.

• Assist with data integrity efforts including verifying data accuracy.

• Other tasks as directed.

 
 

Required Qualifications:

• Bachelor’s degree.

• Minimum of 3 years professional experience in Medicaid programs, the justice-involved population, or criminal justice system.

• Minimum 2 years of professional experience with writing business documents such as reports, abstracts and memorandums.

• Minimum of 1 year of professional experience with planning and leading meetings, committees, or coalitions.

• Advanced ability to problem-solve and research between multiple computer systems or databases.

• Proficient in Microsoft Office applications, including Word, Excel, Access and Power Point.

• Strong verbal and written communications skills and ability to communicate concepts to a range of audiences. .

• Must be able to pass a background check and gain admittance to correctional facilities.

 
 

Desired Qualifications:

• Master’s degree in health administration, business administration, information technology, or public health, Juris Doctor or other advanced degree in relevant field.

• Minimum of 3 years professional experience in Medicaid programs, the justice-involved population, or criminal justice system.

• Minimum of 2 years professional experience with data analysis software such as SAS, SQL, R, Python.

• Experience with scholarly journal article writing, submissions and publications.

• Experience with health outcomes/policy research or study/survey design.

 
 

Required Attachment(s)

 
 

Please upload the following documents in the Resume/Cover Letter section.

• Detailed resume listing relevant qualifications and experience;
  
• Cover Letter indicating why you are a good fit for the position and University of Louisiana Systems;
  
• Names and contact information of three references.
  

 
 

Applications that do not include the required uploaded documents may not be considered

Posting Close DateThis position will remain open until filled.

 
 

Note to Applicant:

 
 

Applicants should fully describe their qualifications and experience with specific reference to each of the minimum and preferred qualifications in their cover letter. The search committee will use this information during the initial review of application materials.

References will be contacted at the appropriate phase of the recruitment process.

This position may require a criminal background check to be conducted on the candidate(s) selected for hire.

As part of the hiring process, applicants for positions at the University of New Orleans may be required to demonstrate the ability to perform job-related tasks.

Salary range is $47,000-$57,000

Clipped from: https://www.helpwanted.com/962679f91137402b9af0388ab2ca7dd2-Manager-Enrollment-Benefits-Configuration-Medicaid-job-listings?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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Manager, Enrollment & Benefits Configuration – Medicaid

Point32Health

Hopedale, MA 01747

Posted 3 days ago

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• Job Type(s)
  

Full Time

• Industry
  

Administrative, Clerical

• Job Description
  

The Manager, Enrollment and Benefits Configuration is responsible for overseeing all department operations pertaining to data entry, maintenance and reconciliation of member data as well as the documentation and configuration of plans and benefits.

Job Description

• Responsible for ensuring the quality, timeliness and compliance of all organizational processes and reporting as they relate to member data and benefit configuration.
  
• Accountable for the enrollment reconciliations for multiple lines of business and is accountable for the premium reconciliation which includes oversight of rate tables, the generation of expected premiums. This role is responsible for the timely reporting of enrollment and premium discrepancies to Government agencies and external business partners.
  
• Participate in the development and implementation of regulatory, corporate and new business initiatives as it relates to member data and/or plan benefits and documentation. This role will initiate and leads cross departmental activities to improve the quality of member data and is responsible for bringing such projects to completion.
  
• Serves as the key enrollment contact externally, with state agencies and has primary responsibility to ensure all required reporting functions are delivered accurately and timely. This position will independently assess business needs and solution options and present proposals for implementation of business process change to meet an evolving business model and regulatory requirements.
  
• Leads and coordinates development, testing and implementation of key department projects and with other departments within Tufts Health Plan, internal staff and external parties.
  
• Represent the Enrollment and Benefit Configuration team on enterprise wide projects such as the annual production of 1099-HC and 1095 forms, the MLR Reimbursement process, audits and compliance initiatives.
  
• Leads the team in the identification, organization and execution of key initiatives, innovation and process improvements for the department
  
• Oversees day-to-day operations to ensure that all member data is entered accurately into the member enrollment, benefit configuration and revenue applications and that incoming requests are processed within the required time frames. Manages accurate and timely processing of enrollment and premium reconciliations to meet state and federal requirements for MassHealth, QHP and the Unify lines of business.
  
• Initiates interdepartmental projects to improve the quality of the member data and staff workflow process. Serves as the business owner and subject matter expert to bring projects to completion. Continually looks for new opportunities to achieve efficiencies.
  
• Leads team members in performing their daily responsibilities: provides feedback and coaching via regular one-on-one meetings; and holds regular staff meetings to provide training and information. As a Manager, this role is also responsible for measuring employee productivity and coaching staff to reach optimal performance and quality; conducting formal performance appraisals; and, when necessary, appropriate disciplinary action in a timely manner and in accordance to Tufts Health Plan Human Resources policies and procedures.
  
• Makes manager-level decisions for the department regarding issues affecting data quality, and trains and delegates accordingly. Trouble-shoots problems related to the file loading processes and other member-related functions, and works with the appropriate resources to get them resolved. Develops and monitors quality reports to identify issues proactively when possible.
  
• Maintains a thorough understanding of the member enrollment, benefit configuration and revenue applications, data integrity and its impact on other parts of the organization. Establishes, builds, and maintains positive working relationships with other Tufts Health Plan departments, including Claims, Medical Management, Marketing, Product Management, Member Services, Pharmacy, Clinical Services, Network Contacting and IT to ensure that all data is processed efficiently and with accuracy.
  
• The person in this position maintains professional growth and development through self-directed learning activities and involvement in professional, civic, and community organizations; encourages a high work ethic within the department by demonstrating appropriate and acceptable behavioral skills; encourages and precipitates a collaborative work environment among team members; and develops benchmarks for best practices related to all major functions.
  
• Participates as team leader and/or team member on special projects as assigned and all other duties as assigned.
  

Requirements

EDUCATION:

1. Bachelors Degree, or equivalent work experience required; Advanced degree preferred in business or related to health care industry.
   

EXPERIENCE:
 

• 5 to 7 years working with operational and technical aspects of managed care required; healthcare experience preferred, particularly in the areas of claims and/or enrollment processing.
   
  
• Supervisory experience required.
  

SKILL REQUIREMENTS:

• Experience with analysis of operational issues and advanced problem solving skills required.
   
  
• Experience using SQL Server or Microsoft Access to create queries is a strong plus.
  
• Proven track records for establishing, building, and maintaining relationships.
  
• Demonstrated verbal, written and presentation skills.
  
• Ability to work collaboratively as a member of cross-functional teams.
  
• Ability to negotiate and resolve differences.
  
• Ability to motivate staff to achieve a high level of performance.
  
• Ability to be flexible and adapt to change as a result of industry and organizational changes.
  
• Ability to streamline and improve operational processes and metrics.
  

What we build together changes our customer’s health for the better. We are looking for talented and innovative people to join our team. Come join us!

Please note: As of January 18, 2022, all employees including remote employees must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

About Us:

Point32Health is a leading health and wellbeing organization, delivering an ever-better health care experience to everyone in our communities. Building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

At Point32Health, were working to reshape the world of health care by pushing past the status quo and delivering even more to the diverse communities we serve: more innovation, more access, more support, and healthier lives. And we want people like you on our side to make it even better.

This job has been posted by TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID:R4714

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Manager, Enrollment & Benefits Configuration – Medicaid jobs in Hopedale, MA

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Clipped from: https://www.glassdoor.com/job-listing/advisory-services-analyst-medicaid-mathematica-JV_IC1138213_KO0,34_KE35,46.htm?jl=1007897954643&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

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 analysts with experience in Medicaid policy and programs at either the state or federal level. In particular, we are looking for individuals who can support current and emerging work across any number of areas related to monitoring and improving Medicaid programs such as: 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, data analytics, and outcomes of innovative programs and policies. Additionally, Medicaid analysts will work on or support project management, change management, and business development. Medicaid analysts work on a variety of projects spanning policy and programmatic areas. These projects range from data analytics to program evaluation and implementation support. Candidates do not need to have experience in all of these areas but should have substantial experience in at least one of them.

Medicaid analysts will likely be connected to 2-3 projects at a time, with many projects requiring team leadership and direct-client contact. Across all projects, Medicaid analysts are expected to:

• Lead or participate actively and thoughtfully in multidisciplinary teams to implement and monitor policy and programs, drawing on your past experience with Medicaid programs
  
• Apply rigorous analytic thinking to the collection and interpretation of quantitative and/or qualitative data, including analysis of Medicaid administrative data, managed care data, and site visits or telephone interviews with state and federal officials, health plan representatives, and providers
  
• Bring creative ideas to the development of proposals for new projects
  
• Provide the direction and organization needed to help keep projects on time and on budget and facilitate communications across and between internal and external stakeholders
  
• Contribute to the growth, expertise, and institutional knowledge of staff working in the Medicaid area
  

Specific project or new business development activities may include:

• Conducting research projects on topics related to state and federal Medicaid policy
  
• Providing technical assistance to federal and state Medicaid stakeholders
  
• Assisting with quantitative analyses using Medicaid enrollment, claims/encounter, financial and program data to support program monitoring, improvement, or evaluation
  
• Developing technical specifications, user manuals, and other documentation to support the implementation of reporting systems and analytic tools
  
• Authoring client memos, technical assistance tools, issue briefs, chapters of analytic reports, and webinar presentations
  

Position Requirements:


 

Qualifications:

• Master’s degree or equivalent in data analytics, public policy, economics, statistics, public health, behavioral or social sciences, or a related field, and at least 3 years of experience working in health policy or health research, with a substantial portion of that time focused on some aspect of the Medicaid program at the state or federal level; or a bachelor’s degree and at least 7 years of state or federal Medicaid experience.
  
• Strong foundation in quantitative and/or qualitative methods and a broad understanding of Medicaid program and policy issues
  
• 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 lead tasks or deliverables and coordinate the work of 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; 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.

Clipped from: https://www.ziprecruiter.com/c/004-Humana-Insurance-Company/Job/RN,-Clinical-Educator-Louisiana-Medicaid/-in-Winnfield,LA?jid=d20df71f70c256c4&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description

Humana Healthy Horizons in Louisiana is seeking a RN, Clinical Educator (Nursing Educator 2) who will plan, direct, coordinate, evaluate, develop, and/or deliver trainings and education programs for professional nursing, social work, and nonclinical personnel. The RN, Clinical Educator (Nursing Educator 2) work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The RN, Clinical Educator (Nursing Educator 2) develops educational goals and plans for new associate orientation, ongoing training, and professional development in virtual and in person instructor-led trainings. Training programs may include, but not be limited to, Care Management, Utilization Management, and/or Compliance throughout Humana Healthy Horizons organization supporting Louisiana Medicaid.

• Selects appropriate training materials.
  
• Creates an environment that is conducive to learning and exchanging information, engages the learner, and produces the desired outcomes.
  
• Monitors training personnel records to ensure that associates have met all company training requirements for company, quality, and regulatory compliance.
  
• Analyzes course evaluations in order to judge effectiveness of training sessions, develops new training based upon identified needs, and implements suggestions for improvements.
  
• Evaluates the relevance of online resources to complement the facilitated experience in the fields as appropriate.
  
• 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.
  

               
 

Required Qualifications

• Must reside in the state of Louisiana.
  
• Unrestricted Registered Nurse (RN) license in the state of Louisiana.
  
• Minimum two (2) years of work experience in training and learning development.
  
• Experience in the development of educational materials.
  
• Understanding of curriculum design and adult learning principles.
  
• Proficiency in Microsoft Office applications including Outlook, PowerPoint, Word and Excel.
  
• Strong presentation skills in presenting virtually and in person.
  
• Strong collaboration and communication skills.
  
• Experience working with multiple layers of leadership within an organization.
  
• Must have the ability to provide a high speed DSL or cable modem for a home office.
  
• 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.
  
• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
  

Preferred Qualifications

• BSN, Bachelor’s in Business, Health Administration or a related field.
  
• Experience using a wide variety of training tools to effectively facilitate to a wide audience.
  
• Experience managing projects or processes.
  

Additional Information

• Travel: Up to 10% to Humana Healthy Horizons locations in Metairie or Baton Rouge, LA for team engagement and meetings.
  
• Typical Workdays/Hours: Monday – Friday; 8:00am – 5:00pm CST.
  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

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

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

Scheduled Weekly Hours

40

Clipped from: https://jobs.smartrecruiters.com/CNSI1/743999849158791-senior-healthcare-federal-reporting-specialist-medicaid-remote-u-s-?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Company Description

CNSI delivers a broad range of health information technology enterprise solutions and customizable products to a diverse base of state and federal agencies. We align, build, and manage innovative, high-quality, cost-effective solutions that help customers achieve their mission, enhance business performance, reduce costs, and improve health for over 51 million Americans.

Job Description

Summary:

The Senior Healthcare Federal Reporting Specialist – Medicaid is responsible for analyzing business problems, identifying gaps, and developing solutions involving complex information systems under no supervision relates to CMS reporting requirements for Medicaid, Claims, Benefits Administration, Member Eligibility, Provider Enrollment, Prior Authorization, Third Party Liability (TPL) and Contracts Managed Care. This role involves managing requirement scope, determining appropriate methods on potential assignments, and serving as a bridge between information technology teams and the client through all project phases, providing day-to-day direction on State program activities.

Job Responsibilities:

• Provides Medicaid and Children’s Health Insurance Program (CHIP) expertise and guidance as it relates to Expenditures Reports, Federal Compliance Reports, Management, Analysis and Reporting Subsystem (MARS), Surveillance and Utilization Review Subsystem (SURS) reports
  
• Analyzes user requirements and client business needs, leveraging expert opinion and expertise
  
• Share use cases to data analysts for profiling, review results, and infer compliance to Medicaid / CMS processes and guidelines
  
• Acts as the requirements subject matter expert and supports requirements change management
  
• Works with customers on presenting technical solutions for complex business functionalities
  
• Understand the overall system architecture and cross-functional integration
  
• Demonstrates in-depth knowledge of business analysis to ensure high quality
  
• Communicates issues and risks to the manager or direct supervisor and assists in developing solutions
  

The selected candidate will be able to work remotely in the U.S. with up to 50% travel for client and team meetings, and trainings.  Candidate located in the Atlanta, Georgia area preferred.

Qualifications

Required Experience/Skills:

• Bachelors’ Degree with 7+ years of healthcare data analysis experience and writing business requirements OR Master’s Degree with 5+ years of healthcare data analysis experience and writing business requirements.
  
• 4+ years of experience in working with State Medicaid and CHIP agencies.
  
• 3+ years of experience working with PERM, T-MSIS, CMS Federal Reporting, or similar projects.
  
• 2+ years of experience in HEDIS, CHIPRA, or similar quality metrics.
  
• In-depth knowledge of CMS reporting requirements for Medicaid.
  
• In-depth understanding of FFS, Managed Care claim adjudication processes from enrollment to funding/finance.
  
• Knowledge of the Affordable Care Act and eligibility.
  
• Able to perform complex data analysis using SQL, Excel against data warehouses utilizing large datasets.
  

 Preferred Experience/Skills:

• Strong knowledge and proficiency in SQL.
  
• Knowledge of the Quality-of-Care program.
  
• Knowledge of data integration and software enhancements/planning.
  

Additional Information

About Us:

At CNSI, we strive to be the market leader and most trusted partner for innovative and transformative technology-enabled solutions that improve health outcomes and reduce costs. We’re passionate about helping our clients improve the health and well-being of individuals and families. We succeed when our clients succeed.

Innovation and commitment to our mission are core to our DNA. And through our shared values, we foster an environment of inclusion, empowerment, accountability, and fun! You will be offered a competitive compensation and benefits package.

CNSI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status, or any other status protected by applicable federal, state, or local law. We are proud of our diversity and encourage all qualified applicants to apply.

Kindly inquire during the interview process if this position is subject to President Biden’s Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors, requiring you to be vaccinated by December 8, 2021.

Clipped from: https://www.ziprecruiter.com/c/SeniorBridge/Job/Manager,-Care-Management-(Behavioral-Health)-Louisiana-Medicaid/-in-Many,LA?jid=c3c578e341921443&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Description

Humana Healthy Horizons in Louisiana is seeking a Manager, Care Management (Behavior Health) who will lead our behavioral health care management operations and staff to ensure timely and culturally-competent delivery of care, services, and supports in compliance with Louisiana Department of Health (LDH) contractual requirements and industry best practices.

Responsibilities

Essential Functions and Responsibilities:

• Supervise care management personnel and oversee all care management functions, including assessment, care planning, and care coordination.
  
• Lead development of care management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.
  
• Collaborate with internal departments, providers, and community partners to support the delivery of high-quality care management services, including introducing innovative approaches to care coordination.
  
• Oversee the processes for comprehensive enrollee assessments to identify their individual needs.
  
• Monitor and maintain staffing levels to meet care and service quality objectives.
  
• Support orientation and training of staff.
  
• Conduct timely evaluations of direct reports and provide regular opportunities for professional development .
  
• Influence and assist corporate leadership in strategic planning to improve effectiveness of case and disease management programs for behavioral health.
  
• Collect and analyze performance reports on care management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
  

               
 

Required Qualifications

• Licensed Mental Health Practitioner (LMHP) who is licensed to practice independently in Louisiana and is in compliance with the requirements of one of the following regulated areas: Physicians (Psychiatrists), Medical Psychologists, Licensed Psychologists, Licensed Clinical Social Workers (LCSWs), Licensed Professional Counselors (LPCs), Licensed Marriage and Family Therapists (LMFTs), Licensed Addiction Counselors (LACs) or Advanced Practice Registered Nurses (APRN) with specialization in adult psychiatric and mental health.
  
• Must reside in the state of Louisiana.
  
• Minimum Five (5) years’ experience working in the healthcare setting.
  
• Minimum two (2) years of management/supervisory experience.
  
• Minimum one (1) year of work experience in the behavior health field.
  
• Experience in case management.
  
• Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
  
• Ability to work independently under general instructions and with a team.
  
• This role is considered patient facing and is a part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
  
• This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least100,000/300,000/100,000limits.
  
• Must have the ability to provide a high speed DSL or cable modem for a home office.
  
• 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.
  
• Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.
  

Preferred Qualifications

• Certified Case Manager (CCM) or willingness to obtain within 2 years of employment.
  
• Experience serving Medicaid, TANF, and/or CHIP populations.
  

Additional Information

• Workstyle: Remote.
  
• Travel: 25% in-state travel.
  
• Direct Reports: up to 12 Associates.
  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

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

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

Scheduled Weekly Hours

40

Clipped from: https://www.careerbuilder.com/job/J3S0BW65MWQ7HH78SB9?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

List of Jobs and Events

 
 

Sr. Project Manager – Medicaid

Aetna Inc. Washington, DC Full-Time

Job Description

This role is remote and may sit anywhere in the US.

This role:

* Supports Business Development team with strong project management skills and technical knowledge of products and systems with a Medicaid background.
* Manages significant product initiatives, and cultivates relationships with internal and external constituencies.
* Leverages in-depth knowledge and understanding of products across functions and market segments in directing the development and implementation of new initiatives
* Directs, evaluates, and provides requirements/specifications for use of appropriate business processes and systems to support initiatives.
* Seeks and maintains comprehensive understanding of internal and external environmental influences and competitive pressures to develop and enhance portfolio.
* Establish and manage large (or significant) cross-functional development work groups.
* Anticipate resource needs, set priorities, establish accountabilities, define roles/responsibilities, and manage relationships to secure necessary resources not under direct control.

Pay Range

The typical pay range for this role is:

Minimum: 75,400

Maximum: 158,300

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

6+ years of related experience.

Extensive knowledge of Medicaid Managed Care.

Experience leading cross-functional project management initiatives.

Advanced communication/presentation skills.

COVID Requirements

COVID-19 Vaccination Requirement

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

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

Preferred Qualifications

Experience working in market pursuit preferred, but not required.

Education

BA/BS or equivalent experience

Business Overview

Bring your heart to CVS Health

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

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day.

CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Recommended Skills

• Business Development
  
• Business Processes
  
• Communication
  
• Market Segmentation
  
• Medicaid
  
• Medicaid Managed Care
  

Clipped from: https://www.linkedin.com/jobs/view/director-medicaid-at-regence-blueshield-3151242883/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Director of Medicaid

 
 

Oregon, Washington, Utah and Idaho (remote work available in these states)

 
 

Primary Job Purpose

 
 

The Director of Medicaid is the voice of Medicaid internally and externally reporting to the SVP, Government Programs. The Director of Medicaid is accountable for the Profit and Loss of the line of business. This leader is responsible for the strategy, business cases development and implementation of Medicaid in one or all of our four states. This includes overall performance of the market Medicaid line of business program, a focus on financial performance and membership growth. Oversees all aspects of market Medicaid programs, state contracting arrangements, product development, compliance with State and Federal Policies and requirements and partnerships with other divisions. Strategically builds, manages and sustains external business relationships, particularly with state and local regulators. Accountable for product development, administrative processes, interdepartmental communication and regulatory requirements. Develops an annual strategic plan and updates executive leadership on strategic issues/development, business performance and progress against objectives. Demonstrated passion and creativity in developing models of care serving low-income vulnerable populations.

 
 

General Functions And Outcomes

 
 

The position is responsible for the customer experience, achieving membership growth targets, overseeing & developing the Medicaid product portfolio and developing/executing market Medicaid strategy based on state and CMS requirements, national standards and alignment with overall national and market strategy. This position incorporates care delivery requirements into strategy and develops a strong partnership with the medical group and health plan delivery system.

 
 

Normally To Be Proficient In The Competencies Listed Above

 
 

Minimum 10 years of relevant experience in a Medicaid managed care organization. Minimum 7 years of management experience. Minimum 5 years in product line management to special populations. Bachelor’s degree or 4 years relevant experience.

 
 

Minimum Requirements

 
 

The Director, Medicaid must have a strong background working with Medicaid and/or Special Populations and unique health care needs. Must be a decisive, results-oriented leader of people, be able to work in a highly matrixed environment and have strong collaborative skills. Additional competencies include:

 
 

• Understanding of state and federal Medicaid framework and regulatory requirements
  
• Excellent negotiation skills, verbal/written communication skills
  
• Strong analytical and strategic planning skills
  
• Excellent public presentation skills
  
• Strong persuasive and interpersonal skills
  
• Product and Program development skills
  
• Knowledgeable of Medicaid health care delivery systems
  
• Knowledgeable of current trends in care management and industry related to care delivery to Medicaid population
  
• Demonstrated ability to build effective partnerships and influence others who may have different perspectives
  

 
 

FTE’s Supervised

 
 

1-5 direct reports

 
 

15-20 total

 
 

Work Environment

 
 

Work is primarily performed remotely

 
 

Travel may be required, locally or out of state

 
 

May be required to work outside normal hours

 
 

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We’ve been here for members for 100 years. Regence is a nonprofithealth care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largesthealth insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

 
 

If you’re seeking a career focused on making the health care experience simpler, better, and more affordable for people and their families, consider joining our team at Cambia Health Solutions. Cambia is a total health solutions company that is deeply rooted in a 100-year legacy of transforming the industry and the way people experience health care. We had our beginnings in the logging communities of the Pacific Northwest as innovators in helping workers afford health care. That pioneering spirit has kept us at the forefront as we build new avenues to improve access to and quality of health care for the future. Cambia is committed to delivering a seamless, personalized health care experience for the next 100 years.

 
 

This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.

 
 

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

 
 

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

Clipped from: https://www.governmentjobs.com/careers/utah/jobs/3539246/health-program-representative?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Job Description

 
 

Seeking candidate with excellent customer service skills AND medical program experience to join the Medicaid Bureau of Managed Health Care.  

To provide education to Medicaid and CHIP members regarding their benefits and support members with their health/dental plan enrollments.  Education is completed statewide by phone and group orientations are held throughout Davis, Salt Lake, Utah and Weber counties.  Tobacco cessation phone education and follow-up is provided for pregnant Medicaid members.  The job requires continual login to Avaya phone system to answer calls from members and providers for plan selections and changes, access to care issues, billing problems, 1095-B inquiries, MyBenefits registration and eligibility issues, and a variety of other issues.  

Preference may be given for the following.

• MMCS, MMIS, and eRep experience
  
• Software proficiency- Word, Excel, PowerPoint, Google Calendar
  
• Medicaid and Chip program knowledge
  
• Excellent Phone Skills- Avaya experience
  
• Bachelor’s Degree
  
•  
• For more information on the program, please click HERE.
  

Why work for the Utah Department of Health?  In addition to the rich benefits the State of Utah offers, the department offers:

• UTA Eco Pass, at a discounted rate
  
• On-site Fitness Center, for a minimal membership fee
  
• Teleworking opportunities
  
• On-site day care center with First Steps Day Care – contact for rates and availability, 801-538-6996.
  

If offered this position, your employment will be contingent upon passing a background check and review.  There will be no cost to you for this check.  This check will include fingerprinting, which will be available at various UDOH locations for your convenience. Fingerprinting will be completed prior to your first day of employment .  You may review the policy by clicking HERE.
(Download PDF reader)
 

Example of Duties

• Provides clients with information concerning rights, options, benefits, services, goals and expectations.
  
• Analyzes, summarizes and/or reviews data; reports findings, interprets results and/or makes recommendations.
  
• Ensures compliance with applicable federal and/or state laws, regulations, and/or agency rules, standards and guidelines, etc.
  
• Receives, researches and responds to incoming questions or complaints; provides information, explains policy and procedures, and/or facilitates a resolution.
  
• Decides upon the need for additional data, information, etc, and authorizes the means necessary to obtain the required information.
  
• Refers client/inmate/patient to other available services to meet needs where appropriate.
  
• Enters data into a computer system and retrieves, corrects, or deletes previously entered data.
  
• Counsels clients and prospective clients; screens referrals, provides community outreach.
  
• Reviews and/or inspects work for quality, accuracy, and completeness.
  

Typical Qualifications

(includes knowledge, skills, and abilities required upon entry into position and trainable after entry into position)

• Medicaid program(s) knowledge
  
• community resources and Medicaid services
  
• communicate information and ideas clearly, and concisely, in writing; read and understand information presented in writing
  
• use logic to analyze or identify underlying principles, reasons, or facts associated with information or data to draw conclusions
  
• speak clearly, concisely and effectively; listen to, and understand, information and ideas as presented verbally
  
• applicable laws, rules, regulations and/or policies and procedures
  
• research methods, techniques, and/or sources of information
  
• use automated software applications
  

Supplemental Information

Working Conditions

• Risks found in the typical office setting, which is adequately lighted, heated and ventilated, e.g., safe use of office equipment, avoiding trips and falls, observing fire regulations, etc.
  
• Standard Schedule: Monday-Friday, 8:00 am – 5:00 pm
  

Physical Requirements

• Typically, the employee may sit comfortably to perform the work; however, there may be some walking; standing; bending; carrying light items; driving an automobile, etc. Special physical demands are not required to perform the work.
  

Benefits:
The State of Utah offers eligible employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program. Please click the following link for a detailed information page: Benefits. To access a Total Compensation Calculator in Excel format click HERE.

FMLA General Notice: 
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