Clipped from: https://www.nj.gov/humanservices/involved/employment/413-20%20%20%20%20Government%20%20epresentative.pdf
Category: Uncategorized
Deputy for Data Acquisition and Management- State of Washington Job Opportunities
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Pharmaceutical Operations Manager
Long-Term Care Pharmacy Provider in Flint, MI is seeking Pharmaceutical Operations Manager: MBA; 36 months experience as pharmacy business manager. Salary $52,021/year.
- Assists CEO in development and implementation of both short and long-term plans, identify critical issues/opportunities by reviewing sales/financial analyses (i.e. cost/benefit analysis, data process modeling), utilize statistical techniques, use predictive modeling to devise practical solutions
- Develop approach to analyzing effectiveness of key processes and conduct impact assessment
- Conduct external research for improving efficiency of business operations using SWOT, PESTEL, 5 C analysis
- Assess process strengths and weaknesses, analytical procedures, transaction testing, bench marking of best practices across the business
- Assess new business opportunities; their potential impact, formulate strategic recommendations
- Define risk mitigation action plans to resolve process gaps.
- Analyzing the company’s position in the market, conduct detailed research analysis on competitors, analyzing growth and seasonal trends to predict demand.
- Oversee the marketing team in making and executing communication plans for both pharmacy team and nursing home e.g. setting up Quick Marr software.
- Analyze long term care facility needs, perceptions, and behavior through a combination of proprietary and syndicated customer research studies.
- Review and approve support documentation, work plans, and other deliverables by
- Defining the Swaps for the long-term facilities
- Managing the calendar for appropriate supply of medications to the nursing home care to minimize the inconvenience
- Synchronizing Long-term care facilities patient medications in order to deliver them on the same day, on a monthly basis by doing Medicine synchronization
- Switching of software to an upgraded version if needed and also supervise any technological advancement
- Update SOP’s for routine business operations
- Operations cost reduction by frequently providing managerial advice to enhance business, with the end desire to increase profits.
- Manage the coordination and performance of periodic physical inventories.
- Supervise department heads to allocate limited resources, efficient packaging schedules, managing the supply chain, and establish a competitive price structure.
- Supervise inventory management with the review of drug margins, ensure proper cost of goods sold is reported and make corrections for those drugs that show less than optimal margins.
- Supervise billing staff to ensure payment from insurance companies for 30,000 + claims per month through 835 upload or third-party checker (In-mar Reconciliation).
- Monitor over 60-day claims to ensure payment to reduce net aging cost for business.
- Manage the purchasing of pharmaceuticals process and buying team.
- Ensure proper research is performed to purchase the best product in terms of access, availability, supplier, price, and type of drug
- Ensuring proper minimum and maximum drug ordering limits are reviewed and maintained on a regular basis
- Monitor RX inventory levels and program efficiencies for Health and Wellness business units,
- Discontinuities of a product which is imminent due to drug back orders
- Monitor drug recalls and ensure compliance with drug supply chain security act (DSCSA)
- Minimize or eliminate DIR (Direct and Indirect Remuneration) fee by Medicaid, Blue Cross etc. to increase ASRX ratings to 5-star.
- Monitor compliance with supplier contract provisions.
- Coordinate nursing home and medical facilities client assignments, assure engagement efficiency and quality
- Maintain or develop vendor relationships. (i.e. Specialty RX items, OTC items, new/generic drug launches, flu vaccines) for inventory management.
- Act as the main point of contact for audits related to pharmacy inventory functions, billing, and ordering.
Clipped from: https://apply.recruitology.com/job/Zl8cNPzzC2HyTiSU8WDAp4agry8cSi/?cid=58168425
Contract Specialist (CMS)
Department of Health And Human Services
Office of Acquisition & Grants Management (OAGM)
- Videos
Duties
Summary
This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Office of Acquisition and Grants Management (OAGM).
As a Contract Specialist, GS-1102-11/12, you will be responsible for pre-award and post-award functions including price/cost analysis, negotiation, and administration for services for one or more organizations within Health & Human Services (HHS).
Responsibilities
- Develop strategic plans in conjunction with program officials and Contracting Officer’s Representatives (CORs).
- Prepare solicitation documents which incorporate required Federal Acquisition Regulations (FAR) and HHS policies and provisions.
- Perform cost/price analysis, including analysis of cost breakdowns to determine reasonableness and conformance to applicable regulations, directives, and policies.
- Prepare close-out documents to close contracts.
- Negotiate and prepare documents for contract modifications.
- This is a developmental position leading to the full performance duties listed above. The primary difference between the grade levels is in the areas of supervisory control and level of responsibility.
Travel Required
Not required
Supervisory status
No
Promotion Potential
12
- Job family (Series)
Requirements
Conditions of Employment
- You must be a U.S. Citizen or National to apply for this position.
- You will be subject to a background and suitability investigation.
Qualifications
ALL QUALIFICATION REQUIREMENTS MUST BE MET BY THE CLOSING DATE OF THIS ANNOUNCEMENT.
In order to qualify for the GS-11, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-09 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Preparing acquisition documents and/or reports (examples: solicitations/contracts, market research, justifications & determinations, audit reports, negotiation objectives, or award documents); AND 2) Reviewing acquisition documents to ensure adherence to terms and conditions or regulations.
– OR –
Substitution of Education for Experience: You may substitute education for specialized experience at the GS-11 level by possessing a Ph.D. or equivalent doctoral degree, or 3 full years of progressively higher level graduate education leading to such a degree. Qualifying graduate education must be in one or a combination of the following fields: accounting, business, finance, law, contracts, purchasing, economics, industrial management, marketing, quantitative methods, or organization and management.
– OR –
Combination of Experience and Education: Only graduate education in excess of the amount required for the GS-09 grade level may be used to qualify applicants for positions at grades GS-11. Therefore, only education in excess of a master’s or equivalent graduate degree or 2 full years of progressively higher level graduate education leading to such a degree, may be used to combine education and experience.
TRANSCRIPTS are required to verify satisfactory completion of the educational requirement related to substitution of education for experience and combination of experience and education. Please see “Required Documents” section below for what documentation is required at the time of application.
In order to qualify for the GS-12, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-11 grade level in the Federal government, obtained in either the private or public sector, to include: 1) Gathering and analyzing information to draw conclusions about price/cost information; 2) Providing business-related advice, guidance or direction through communication; AND 3) Conducting negotiations on pricing, performance, compliance, or technical terms.
Substitution of Education for Experience: There is no substitution of education to meet the specialized experience requirement at the GS-12 grade level.
Combination of Experience and Education: There is no combination of experience and education to meet the specialized experience requirement at the GS-12 grade level.
Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.
Education
Education Requirement: In addition to meeting the qualification requirements, all candidates must have the following educational requirements:
A. Possess a 4-year course of study leading to a bachelor’s degree with a major in any field from an accredited college or university. (Note: Unofficial or Official Transcripts must be submitted at the time of application.)
OR
B. Completed at least 24 semester hours in any combination of the following fields: accounting, business, finance, law, contracts, purchasing, economics, industrial management, marketing, quantitative methods, or organization and management. (Note: Unofficial or Official Transcripts must be submitted at the time of application.)
OR
C. On January 1, 2000, have held a position in the Federal service in the GS-1102 Contract Specialist series and I have continually held this occupational series since January 1, 2000. (Note: SF-50s must be submitted at the time of application.)
TRANSCRIPTS are required to verify satisfactory completion of the educational requirement listed above. Failure to submit a copy of your transcripts at the time of application WILL result in an ineligible rating. Please see “Required Documents” section below for what documentation is required at the time of application.
Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/10995975
Additional information
Bargaining Unit Position: Yes
Tour of Duty: Flexible
Recruitment/Relocation Incentive: Not Authorized
Financial Disclosure: Not Required
CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page.
The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one who meets the qualification standard and eligibility requirements for the position, including any medical qualifications (if applicable), minimal educational and experience requirements; meets all selective placement factors (if applicable); is physically qualified, with reasonable accommodation where appropriate, to perform the essential duties of the position; meets any special qualifying conditions that OPM has approved for the position; and is able to satisfactorily perform the duties of the position upon entry. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.
Additional Forms REQUIRED Prior to Appointment:
- Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation – A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 306.
- Form I-9, Employment Verification and the Electronic Eligibility Verification Program – CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-9.
- Standard Form 61, Appointment Affidavits – If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form 61.
If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.
How You Will Be Evaluated
You will be evaluated for this job based on how well you meet the qualifications above.
Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with any interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.
Traditional rating and ranking of applications does not apply to this vacancy. Applications will be evaluated against the basic qualifications. Qualified candidates will be referred for consideration in accordance with the Office of Personnel Management direct hire guidelines. Veterans’ Preference does not apply to direct hire recruitment procedures. Selections made under this vacancy announcement will be processed as new appointments to the civil service. Current civil service employees would, therefore, be given new appointments to the civil service; however, benefits, time served and all other Federal entitlements would remain the same.
Background checks and security clearance
Security clearance
Drug test required
No
Position sensitivity and risk
Trust determination process
Credentialing, Suitability/Fitness
Required Documents
The following documents are REQUIRED:
1. Resume
showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/59. Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/dd/yy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/
2. CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.
3. College Transcripts. Since this position requires specific education, you must submit a transcript attesting to your possession of the required education. You may submit an unofficial transcript or a list of college courses completed indicating course titles, credit hours, and grades received. An official transcript is required if you are selected for the position. If selected, you must provide an original document before the final job offer may be extended. If you do not submit a transcript indicating your possession of the required education, you will not be considered for this position.
College Transcripts and Foreign Education: Applicants who have completed part or all of their education outside of the U.S. must have their foreign education evaluated by an accredited organization to ensure that the foreign education is comparable to education received in accredited educational institutions in the U.S. For a listing of services that can perform this evaluation, visit the National Association of Credential Evaluation Services website. This list, which may not be all inclusive, is for informational purposes only and does not imply any endorsement of any specific agency.
If you are applying for a position for which a state license is issued (e.g., physician, engineer, attorney) possession of a valid and current U.S. professional license by a graduate of a foreign professional school or program is sufficient proof that the foreign education has been determined to be equivalent to the requisite U.S. professional education in that occupational field.
PLEASE NOTE: A complete application package includes the online application, resume, transcripts and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume, transcripts and CMS required documents, will result in you not being considered for employment.
If you are relying on your education to meet qualification requirements:
Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.
Benefits
A career with the U.S. Government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Learn more about federal benefits.
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time, or intermittent. Contact the hiring agency for more information on the specific benefits offered.
How to Apply
Your complete application package, as described in the “Required Documents” section, must be received by 11:59 PM ET on 01/15/2021 to receive consideration.
IN DESCRIBING YOUR WORK EXPERIENCE AND/OR EDUCATION, PLEASE BE CLEAR AND SPECIFIC REGARDING YOUR EXPERIENCE OR EDUCATION.
We strongly encourage applicants to utilize the USAJOBS resume builder in the creation of resumes. Please ensure EACH work history includes ALL of the following information:
- Official Position Title (include series and grade if Federal job)
- Duties (be specific in describing your duties)
- Employer’s name and address
- Supervisor name and phone number
- Start and end dates including month, day and year (e.g. June 18, 2007 to April 05, 2008)
- Full-time or part-time status (include hours worked per week)
- Salary
Determining length of general or specialized experience is dependent on the above information and failure to provide ALL of this information WILL result in a finding of ineligible.
- To begin, click Apply to access the online application. You will need to be logged into your USAJOBS account to apply. If you do not have a USAJOBS account, you will need to create one before beginning the application.
- Follow the prompts to select your resume and/or other supporting documents to be included with your application package. You will have the opportunity to upload additional documents to include in your application before it is submitted. Your uploaded documents may take several hours to clear the virus scan process.
- After acknowledging you have reviewed your application package, complete the Include Personal Information section as you deem appropriate and click to continue with the application process.
- You will be taken to the online application which you must complete in order to apply for the position. Complete the online application, verify the required documentation is included with your application package, and submit the application.
To verify the status of your application, log into your USAJOBS account (https://my.usajobs.gov/Account/Login), all of your applications will appear on the Welcome screen. The Application Status will appear along with the date your application was last updated. For information on what each Application Status means, visit: https://www.usajobs.gov/Help/how-to/application/status/.
This agency provides reasonable accommodation to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please send an email to Sandy.Vises@cms.hhs.gov. The decision to grant reasonable accommodation will be made on a case-by-case basis.
Commissioned Corps Officers (including Commissioned Corps applicants that are professionally boarded) who are interested in applying for this position must send their professional resume (not PHS Curriculum Vitae) and cover letter to CMSCorpsJobs@cms.hhs.gov in lieu of applying through this announcement. The cover letter should specifically explain how you are qualified for this position and draw specific attention to your resume that demonstrates these qualifications. In the subject line of your e-mail please include only the Job Announcement Number. In the body of your e-mail please include your current rank name and serial number. Failure to provide this information may impact your consideration for this position.
Agency contact information
Sandy Vises
Email
Address
Office of Acquisition and Grants Management
7500 Security Blvd
Woodlawn, MD 21244
US
Next steps
Once your online application is submitted, you will receive a confirmation notification by email. Within 30 business days of the closing date,01/15/2021, you may check your status online by logging into your USAJOBS account (https://my.usajobs.gov/Account/Login). We will update your status after each key stage in the application process has been completed.
- Fair & Transparent
The Federal hiring process is setup to be fair and transparent. Please read the following guidance.
Equal Employment Opportunity Policy
The United States Government does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.
Reasonable Accommodation Policy
Federal agencies must provide reasonable accommodation to applicants with disabilities where appropriate. Applicants requiring reasonable accommodation for any part of the application process should follow the instructions in the job opportunity announcement. For any part of the remaining hiring process, applicants should contact the hiring agency directly. Determinations on requests for reasonable accommodation will be made on a case-by-case basis.
A reasonable accommodation is any change to a job, the work environment, or the way things are usually done that enables an individual with a disability to apply for a job, perform job duties or receive equal access to job benefits.
Under the Rehabilitation Act of 1973, federal agencies must provide reasonable accommodations when:
- An applicant with a disability needs an accommodation to have an equal opportunity to apply for a job.
- An employee with a disability needs an accommodation to perform the essential job duties or to gain access to the workplace.
- An employee with a disability needs an accommodation to receive equal access to benefits, such as details, training, and office-sponsored events.
You can request a reasonable accommodation at any time during the application or hiring process or while on the job. Requests are considered on a case-by-case basis.
Learn more about disability employment and reasonable accommodations or how to contact an agency.
Legal and regulatory guidance
- Financial suitability
- Social security number request
- Privacy Act
- Signature and false statements
- Selective Service
- New employee probationary period
Clipped from: https://www.usajobs.gov/GetJob/ViewDetails/588032300
Director of Pharmacy, Health Alliance – Champaign IL 61821
Position Summary:
The Director of Pharmacy is an experienced managed care individual responsible for drug formulary design and development across government and private fully insured as well as self-funded products and rebate contracting. Integrates program implementation and risk management to improve quality, control utilization and costs, and enhance sales. Responsible for a wide variety of clinical, administrative, financial and regulatory challenges. Responsible for the direction, supervision and management of the Pharmacy Network, Pharmacy Staff, and pharmacy related contracting.
Qualifications:
EDUCATIONAL REQUIREMENTS
Bachelors Pharmacy and Masters Related Field or Doctorate Pharmacy
CERTIFICATION & LICENSURE REQUIREMENTS
Registered Pharmacist Illinois
EXPERIENCE REQUIREMENTS
Three (3) Managed Care and Two (2) Supervisory. Must have managed care pharmacy experience and have spent time in the managed care industry either with a PBM or with a health plan or health insurance carrier. Experience in developing formularies and managing drug spend for commercial and government sponsored Health Plans (Medicare/Medicaid). Experience in developing strategies to manage specialty drug spend. Experience mentoring or overseeing staff, budgeting, reporting, etc
OTHER REQUIREMENTS
Ability to organize, interpret and distill large volumes of data formats and accurately communicate issues to physicians, pharmacists, employers, administration, and Health Alliance staff. Ability to create and utilize cost benefit analysis (pharmacoeconomics).
Essential Functions:
- Communicates to all providers, changes in benefits and management which would affect their activities.
- Conducts solicitation, negotiations and contracting with pharmaceutical manufacturers.
- Develops and maintains appropriate audit systems to manage pharmaceutical discount/rebate dollar flows.
- Develops and maintains reporting required by internal staff, customers and drug manufacturers. Provides ongoing feedback to the Director of Sales regarding training and development needs, market conditions, competitive information, sales & marketing tactics, broker relationships, and metrics within the sales process.
- Direct various personnel functions including, but not limited to, hiring, performance appraisal, promotions, transfers and disciplinary issues.
- Responsible for ensuring that all pharmacy network, claims system and other related operating activities meet and support the programs of the Pharmacy Department.
Clipped from: https://careers.peopleclick.com/careerscp/client_Carle/external/gateway/viewFromLink.html?jobPostId=18125&localeCode=en-us
Executive Director (TN) – Government Programs in Nashville, TN – Anthem
Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortune Top 50 Company.
TN Executive Director – Government Programs
Responsible for designing, implementing, directing and evaluating strategic programs and external strategic relationships to support clinical, quality-related or business goals for the company and business unit. Primary duties may include, but are not limited to: Directs forecasting activities of the business unit focused on setting and achieving short and long-term strategic goals. Reports project status and progress to senior management. Ensures accuracy and timeliness of output and deliverables for assigned functional areas. Implements and ensures compliance with corporate management policies, practices, and procedures. Has fiscal responsibility for area budgets. Establishes relationships with business users. Participates with other senior management to establish strategic plans and objectives (i.e. service level targets, financial targets, development and implementation of new programs). Delivers analyses and project updates to all areas requiring information for management reporting, analysis and executive decision making.
Qualifications
- BA/BS:7 years of related experience; or any combination of education and experience, which would provide an equivalent background.
Preferences:
- Master’s degree
- Medicare and Medicaid line of business; experience delivering services to the dual population in an integrated and coordinated manner
- Managed care operations, project management or compliance background
- Demonstrated project management in a leadership role
- Ability to travel 20% in state of TN
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 careers.antheminc.com. 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.
Market Access Manager – West job | Abbott Laboratories United States job in United States – California – Los Angeles
Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 107,000 colleagues serve people in more than 160 countries
1. POSITION SUMMARY
The scope of this position includes deploying a comprehensive coverage and reimbursement strategy for the Infectious Disease (ID) portfolio in the US which includes the leading the point-of-care (POC) molecular platform ID NOW and other tests as required. During the Public Health Emergency, the Market Access Managers (MAM) is laser focused is on coverage and appropriate reimbursement Influenza Like Illness (COVID-19, Influenza, RSV and Strep) tests, and implementation of a One Abbott solution for COVID-19 testing.
The Market Access Manager, Westwill be responsible for executing on the broader coverage and reimbursement strategy by developing regional/local reimbursement initiatives in conjunction with Market Access Advocacy Manager (MAAMs), other MAMs, KOLs and the field sales team(s). Similarly, the MAM is responsible for coordinating efforts between S&L Government Affairs Directors on FFS Medicaid challenges, and working in concert with the Market Access Director on FFS Medicare related issues and opportunities as appropriate.
The ID NOW and other Abbot Point of Care testing products are used across multiple market segments including: Health Systems, Hospitals and Physician Offices, Urgent Care, Retail Health/Pharmacy with other emerging potential sites of care testing due to the COVID-19 pandemic. This individual will be the Subject Matter Expert (SME); and field based resource for their assigned Regional and National, Medicare Advantage and Managed Medicaid accounts on all coverage and reimbursement activities. They will also be responsible for having a comprehensive understanding of FFS Medicare, Medicaid and other Government entities such a VA/DoD, BIA, etc.
2. ESSENTIAL DUTIES AND RESPONSIBILITIES – (KEY ACTIVITIES)
– Compliantly engage directly with payers in assigned Region to effectively communicate value of ID portfolio to secure favorable coverage reimbursement policy decisions.
– Communicate effectively and build strong relationship with field sales teams to support complaint access and appropriate reimbursement in POL setting. Align on deliverables and needs with ASD’s, RD’s, TS’s and AE’s in the markets for both current and future needs.
– E xecute on payer advocacy efforts in coordination with MAAM, local/regional ARDx and IDDM cross-functional and Abbott cross-divisional teams in Region to support appropriate.
– Support field sales teams and MAAM in identifying clinician advocates (KOLs) to support and further IDDM initiatives impacting payers, associations and government policy.
– Work with Abbott S&L Government Affairs counterparts on Medicaid coverage and reimbursement challenges.
– Develop compliant regional Market Access reimbursement strategy by key product sector by analyzing data from various sources to inform comprehensive strategy and to build organizational alignment.
– Contribute to the broader IDDM organization and other Abbott Divisions as a Subject Matter Expert (SME) for the US reimbursement landscape across the broad continuum of sites of care. Be prepared to engage in special projects as assigned by Market Access Director.
– Participate in complaint third party support initiatives with established companies and organizations including CodeMap, leading outside reimbursement law firms, and consultants as appropriate with guidance from Market Access Director and Marketing Analyst.
– Complete all training and other administrative responsibilities in a timely fashion.
EXPERIENCE/EDUCATION
– Seven to ten (7-10) + years of relevant (Market Access/Managed Care) industry experience. History in point-of-care (POC) diagnostics and molecular platforms preferred.
– People management experience highly desirable or comparable professional experience.
– Demonstrated understanding of the varied payment methodology utilized at the sites of care for the ID NOW portfolio.
– Strong communication skills with demonstrated ability to create and deliver professional and impactful presentations.
– Strong multi-tasking and project management skills needed.
– Demonstrates understanding of the applicable industry regulations and quality management systems including approved product labeling.
– Bachelor’s degree required. MD, PhD, PharmD, MS/MHA/MBA preferred.
Department of Human Services Eligibility Benefits Program Benefits Administrator
Requisition ID:
32806
Work Location:
Human Services – Virginia Beach Blvd offices
Pay Range:
A.18, $79,393.60 – $120,369.60
Starting Salary:
Minimum of the Pay Range
Work Schedule:
Monday-Friday; 8am – 5pm
Part Time Hours/Wk:
Application Deadline:
12/28/20
Job Duties:
The City of Virginia Beach is seeking an experienced administrator to oversee the Department of Human Services Eligibility Benefits Program. Responsibilities are as follows:
- Provide supervision, consultation and leadership for the program of 161 full-time equivalent and contract positions.
- Oversee and administer eligibility benefits programs, most of which are funded by the federal and state government. Programs include the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Medicaid, Energy Assistance, Child Care, Virginia Initiative for Education and Work (VIEW) and local programs which include General Relief and the City’s Water Assistance Program. As it relates to these programs, this position oversees services and benefits to over 70,000 Virginia Beach residents and a total budget of over $15 million dollars.
- Ensure state and federal goals are met and program is in compliance with federal, state, and local policies; develop corrective action plans as needed and interpret agency policies and programs for other agencies and the public; analyze and monitor the effectiveness of service delivery within the department and ensure timely responses to clients’ needs, achieving state and federal mandates.
- Directly supervise two (2) Eligibility Coordinators, two (2) Human Services specialists I’s and one (1) Administrative Assistant.
- Work closely with state and federal officials; elected officials, citizens and other community and state organizations and partners.
- Interpret agency policies and programs for other agencies and the public.
- Receive and respond to community inquires, concerns, and complaints and continuously monitor and analyze the effectiveness of service delivery within the department.
- Participate in the development of new initiatives, business process improvements and resources; receive and make appropriate referrals, and develop new resources to enhance the departments services to clients.
- Serve on the department’s Senior Leadership team as well as other task force groups and collaborate with other agencies to bridge the gaps in services and programs.
- Prepare regular reports for the Deputy Director on divisional activities and collaborate with the administrative team to ensure total agency effectiveness.
Working Conditions:
Minimum Requirements:
Minimum Qualifications: Requires a Bachelor’s degree or higher and eight (8) years of experience associated with positions such as director or assistant director of a small social services agency or supervisor of a social services program unit OR any combination of education (above the high school level) and/or experience equivalent to twelve (12) years in fields providing the required knowledge, skills, and abilities.
Special Requirements: All employees may be expected to work hours in excess of their normally scheduled hours in response to short-term department needs and/or City-wide emergencies.
Additional Requirements:
DMV Transcript: Required
CDL: Not Required
DOT History: Not Required
CPS Check: Not Required
Physical: Not Required
Respirator: Not Required
Polygraph Review: Not Required
Psychological Screening: Not Required
Attachments Required:
Preferences:
Bachelor’s degree in or higher in a related field.
Ten (10) or more years of experience in positions such as director or assistant director of a small social services agency or as supervisor of a social services program or unit.
Fourteen (14) or more years of experience in working in public benefit programs to interpreting polices as well as federal, state and local regulations related to eligibility programs.
Experience working with eligibility benefits case management systems.
Five (5) or more years of experience with strategic planning, process improvement, quality improvement tools and methods, and use of results-based accountability in a human service agency.
Five (5) or more years of experience working with performance management systems, using evaluation tools and metrics, and applying data driven decision making.
Three (3) or more years of experience leading multiple teams and managing multiple projects, budgets and funding streams.
Three (3) or more years of experience facilitating presentations to groups varying in size, including staff, leaders, elected officials and/or other organizations and or providers.
Special Instructions:
- Please complete the application in its entirety. The application is the primary required document used to screen qualifications and years of experience. A resume does not replace a completed application. Fields on the application left blank, including but not limited to job duties, dates of employment, and hours worked, may cause your application to be incomplete.
- You will not be able to access the details of this job ad once the closing date has passed. If you would like to retain this information, please take a screen shot or print using your browser’s printing capability.
- Your responses to any “Supplemental Questions”, if attached to this requisition, must be supported by the information you give us in the work experience section of this application. Be sure you are thorough in describing your skills and duties as you complete the work experience section. If the information cannot be verified you will not receive credit.
- Please provide a copy of any certifications or related professional licenses.
VRS Contribution: All full-time employees are required to contribute 5% of annual salary toward their retirement account; in accordance with VRS retirement provisions. This will be handled through a pre-tax payroll deduction.
NV Medicaid State Ops Dir in Las Vegas, NV – Anthem
Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health care companies and a Fortune Top 50 Company.
This is an office based position and will be required to report to 9133 West Russell Road Las Vegas, NV post Covid. Remote work within the state of NV will be allowed until Anthem is cleared to return to the office.
The selected candidate will be supporting the NV Medicaid market, including implementation of new products, supporting the plan President and operations lead. This associate will be the go to person for the state on a daily basis.
Responsible for operations functions, including coordination between internal departments, ensuring the appropriate strategy, tactics and processes are in place to affect solid organizational operations and oversight.
Primary duties may include, but are not limited to:
Champions initiatives by developing and managing key relationships with state agencies, regulatory, Medicaid/SCHIP and other stakeholders as appropriate.
Resolves programmatic challenges related to operations including member issues, provider claims issues, provider network/contract configuration issues, etc.
Serves as liaison to Health Plan support services, which could include: Claims, Enrollment, NCC, PDM/PDQ, configuration; Quality, Regulatory Compliance, IT, Reimbursement policy, etc.
Identifies opportunities for Operational Excellence and works to create seamless processes between shared services and the Health Plan.
Develops and implements key operational indicators to be used for monitoring and analysis of the Health Plan operations.
Serves as a liaison with state regulatory agencies when appropriate.
Resolves programmatic challenges related to program operations including member issues, provider claims and provider network.
Represents business unit on national/state/regional boards, task forces, and work groups that impact the health care delivery system and other key health care issues.
Collaborates with senior management to develop and implement new programs to enhance relationships with key stakeholders and to promote programs and services.
Ensures all policies and procedures related to Field Operations are compliant with all applicable laws and regulations governing the State Sponsored Business.
Qualifications
- Requires a BA/BS in Business, Healthcare Administration or related field
- 10 years of relevant experience including 8 years of in-depth experience in managed care operations
- Or any combination of education and experience, which would provide an equivalent background
- Masters degree preferred
- Six Sigma Black Belt preferred
This is a Director level position, operating as an individual contributor without direct reports.
Additional skills:
OPERATIONS EXPERIENCE / PROVIDER CONTRACTING EXPERIENCE A PLUS
FACETS KNOWLEDGE A PLUS
MS OFFICE
STRONG COMMUNICATION SKILLS
PEOPLE MANAGEMENT A PLUS
MEDICAID EXPERIENCE A PLUS
ABILITY TO MEET WITH PROVIDERS WHEN NECESSARY
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 careers.antheminc.com. 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.
Job Details – Jobs and Careers | Gainwell
Job Description:
- Processing Provider Enrollment applications submitted by Medicaid enrolled providers.
- Working on complex Provider Enrollment applications that are under strict deadlines.
- Ensuring Provider Enrollment applications are following Medicaid policy and procedures.
- Working with both Gainwell and State employees.
- Providing outreaches to providers if needed.
- Processing 377+ applications through analyst review within a week, with 0 errors identified.
- Processing 213+ applications through quality review within a week, with 0 errors identified.
Education and Experience:
- High School Diploma or equivalent; may hold 2 year post- high school Degree; may hold Bachelor’s degree.
Knowledge and Skills:
- Ability to follow written policies, procedures and guidelines.
- Self-motivated with good time management and organizational skills.
- Ability to read and interpret basic to moderately complex documents such as operating and maintenance instructions, procedure manuals, and government/healthcare guidelines.
- Excellent written and verbal communication skills and customer service skills.
- Insurance background preferred.
- Provider Enrollment background preferred.
- Experience with Medicaid policy preferred.
- Experience with Medicaid Provider Enrollment submissions preferred.
- Knowledge of Medicaid systems desired.
- Ability to access and retrieve information using a PC and basic understanding of Microsoft office products.
- Ability to work on assignments with limited instruction from leadership.
- Ability to work under pressure with strict deadlines.
- Multitasking and detail oriented.
Being flexible to learn another provider type/application in order to help the department succeed
Clipped from: https://jobs.gainwelltechnologies.com/job/12020070/