Program Manager with Medicaid Job at Ocean Blue Solutions (Columbus)

Senior Manager, Government Programs - Medicaid

The Senior Manager for Government Programs - Medicaid at Baxter will work to ens...

Location

United States , Saint Paul, Minnesota

Salary:

152000.00 - 209000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

Bachelor’s degree required
6 plus years in health policy, reimbursement, Medicaid and public health payment programs is required
3 plus years of pharmaceutical/medical device proven experience is required
Proven understanding of Medicaid systems and differences in state operations required
Detailed understanding of state programs, processes, and experience preferred
Established track record of cultivating relationships with Medicaid Administrators, specifically directors, policy managers, and medical directors, through articulate written and verbal communication.

Job Responsibility

Develop relationships with Medicaid Administrators to assist in clarification of state policies and find opportunities for coverage development
Act as the primary contact for Respiratory Health to Government Programs in communications and meetings
Supervise Government Payer requirements & policies to identify potential changes that may impact Respiratory Health’s reimbursement process
Lead resolution of Medicaid payer issues brought up from Patient & Customer Service teams
Advance questions requiring Legal or Compliance guidance related to reimbursement processes to appropriate resource
Participate in industry Trade Associations or State HME / DME Associations
Collaborate with Government Affairs on state lobbying efforts
Analyze government program trends applying internal and external data
Maintain communication with senior management regarding major reimbursement issues
Assist the Coverage Manager on Coverage Expansion strategy development

What we offer

Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan
401(k) Retirement Savings Plan
Flexible Spending Accounts
Educational assistance programs
Paid holidays
Paid time off ranging from 20 to 35 days based on length of service
Family and medical leaves of absence
Paid parental leave

Fulltime

Director Utilization Management

The Director of Utilization Management is a strategic clinical operations leader...

Location

United States , New York

Salary:

154600.00 - 236555.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

Bachelor’s degree in healthcare, business, or a related field from an accredited institution or equivalent work experience
Progressive leadership experience in healthcare management including work experience in a mid-senior management role
Work experience and deep familiarity of health plans such as Medicare, Medicaid and/or Managed Long-Term Care Plan (MLTCP)
Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care operations
Work experience interpreting and operationalizing regulatory updates and guidance from DOH and CMS
Work experience demonstrating written and verbal communication skills with the ability to influence and collaborate across all levels and functions
Demonstrated success driving high performance and quality outcomes in a fast-paced, regulated environment

Job Responsibility

Provide strategic direction and leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requests
Develop strong operational and leadership capabilities within the organization through performance improvement, career development, and coaching
Develop and implement policies and procedures that align with industry standards, payer guidelines, and regulatory requirements
Deliver on Healthfirst’s Mission by ensuring optimum quality of member care in a cost-effective manner
Ensure UM operations meet regulatory requirements set forth by CMS, New York State Department of Health (DOH), and other oversight entities
Develop and monitor appropriate metrics to maintain and improve department performance
Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement
Lead initiatives to improve efficiency, cost-effectiveness, and quality in the UM program, sometimes through the implementation of new technology
Serve as the operational subject matter expert on business development efforts related to UM programs, including the launch of new products or regulatory initiatives
Collaborate closely with other Operations leaders including but not limited to Care Management, Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions

What we offer

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions

Fulltime

Embedded Transitional Care Manager RN

Oak Street Health takes a team-based approach to providing outstanding patient c...

Location

United States , Rockford

Salary:

66575.00 - 142576.00 USD / Year

CVS Health

Expiration Date

Until further notice

Requirements

An active RN license within the state of practice in good standing
Willingness to obtain cross-state licensure, as needed
Certified Case Manager (CCM) or equivalent case management certification required, or willingness to obtain within 12 months of hire
2+ years’ experience in transitional nursing, discharge planning, nursing case management, or home health
Experience in utilization management preferred
Knowledge of Medicare/Medicaid and NCQA regulatory transitions of care criteria
Exceptional communication skills and customer service orientation
Innovative and independent problem solving skills
Ability to monitor and evaluate opportunities for cost-effective care options with high-quality outcomes
Spanish-speaking preferred but not required

Job Responsibility

Manage patients through transitions of care
Advocate for the patient throughout the care continuum
Identify opportunities for improved program workflows
Maintain real-time and accurate records of patient status
Adhere to CMS, state specific and NCQA compliance criteria
Evaluate patient status post-ED visit or observation stay
Triage to determine appropriate follow up care
Engage directly with inpatient physicians, case managers, medical directors, and hospitalists
Coordinate with the Utilization Management team
Conduct structured clinical assessment to identify post-discharge needs

What we offer

Paid vacation, sick time, and investment/retirement 401K match options
Health insurance, vision, and dental benefits
Affordable medical plan options
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access

Fulltime

New

Program Manager with Medicaid

The person in this position is responsible for engaging Program Management and B...

Location

United States , Columbus

Salary:

Not provided

Ocean Blue Solutions

Expiration Date

Until further notice

Requirements

Conduct end-to-end business analysis for SNAP/Cash, Child Care, and Medicaid eligibility and enrollment systems
Manage system integration initiatives, focusing on interface development, data conversion, and reporting solutions
Review and approve detailed system design documentation (Ohio Benefits Design Documents)
Act as strategic liaison with other Project Managers
Recommend enhancements of the Ohio Benefits Self-Service Portal (SSP)
Promote and manage Business Intelligence (BI) initiatives, utilizing tools such as Cognos and Tableau
Conduct detailed analysis and planning for the integration of IVR and EDMS with Ohio Benefits and also BOTs
Work with other technical project managers to deploy system enhancements
Manage JIRA access and provide guidance on the usage and flow of work requests
Work with Operational Change Management team

Job Responsibility

Engage Program Management and Business Analysis tasks and techniques as a liaison among stakeholders in order to understand the structure, policies, and operations of the Ohio Benefits Program (OB), to recommend solutions that enable the Program to achieve its goals, and to ensure the timely delivery of key program initiatives

New

State Gov Programs Policy Analyst

The incumbent serves as a State Government Programs Policy Analyst to research a...

Location

United States , Saint Paul

Salary:

80000.00 - 110000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

Two-year associates degree required or Bachelor's degree (B.A. or B.S.) from four-year college or university preferred
Minimum 4 years of relevant work experience in healthcare reimbursement, payer policy and/or health plan administration
Working knowledge of state government program policy including Medicaid fee-for- service, Medicaid managed care organizations, disability waivers, Children’s Health Insurance Programs (CHIP), and other state government programs preferred
General understanding of provider credentialing and enrollment requirements preferred
General knowledge of TIMS third party payer database and state and federal laws, rules, and regulations preferred
Strong knowledge of database integrity procedures and standards and ability to apply analytical findings to day-to-day business practices preferred
Ability to lead projects, meet deadlines, and prioritize workload
Superior communication, innovative, and critical thinking skills

Job Responsibility

Conduct analysis of state government programs policy impacting Respiratory Health products
Monitor and interpret state and payer documentation, including but not limited to provider manuals, guidelines, bulletins, and regulatory communications
Develop and maintain relationships with managed care organizations to ensure compliance with payer policy and regulations
Develop strategic policy summaries to inform leadership decisions
Track and analyze legislative and regulatory developments affecting Respiratory Health products within the State Government Programs space
Translate policy requirements into actionable operational guidance and workflows maintaining compliance with payer policy and regulations
Identify compliance risks associated with payer changes and recommend mitigation strategies to State Government Programs Manager

What we offer

medical and dental coverage that start on day one
insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP)
401(k) Retirement Savings Plan (RSP)
Flexible Spending Accounts
educational assistance programs
paid holidays
paid time off ranging from 20 to 35 days based on length of service
family and medical leaves of absence
paid parental leave

Fulltime

New

State Gov Programs Policy Analyst

The incumbent serves as a State Government Programs Policy Analyst to research a...

Location

United States , Saint Paul

Salary:

80000.00 - 110000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

Two-year associates degree required or Bachelor's degree (B.A. or B.S.) from four-year college or university preferred
Minimum 4 years of relevant work experience in healthcare reimbursement, payer policy and/or health plan administration
Working knowledge of state government program policy including Medicaid fee-for- service, Medicaid managed care organizations, disability waivers, Children’s Health Insurance Programs (CHIP), and other state government programs preferred
General understanding of provider credentialing and enrollment requirements preferred
General knowledge of TIMS third party payer database and state and federal laws, rules, and regulations preferred
Strong knowledge of database integrity procedures and standards and ability to apply analytical findings to day-to-day business practices preferred
Ability to lead projects, meet deadlines, and prioritize workload
Superior communication, innovative, and critical thinking skills

Job Responsibility

Conduct analysis of state government programs policy impacting Respiratory Health products
Monitor and interpret state and payer documentation, including but not limited to provider manuals, guidelines, bulletins, and regulatory communications
Develop and maintain relationships with managed care organizations to ensure compliance with payer policy and regulations
Develop strategic policy summaries to inform leadership decisions
Track and analyze legislative and regulatory developments affecting Respiratory Health products within the State Government Programs space
Translate policy requirements into actionable operational guidance and workflows maintaining compliance with payer policy and regulations
Identify compliance risks associated with payer changes and recommend mitigation strategies to State Government Programs Manager

What we offer

Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount
401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching
Flexible Spending Accounts
Educational assistance programs
Paid holidays
Paid time off ranging from 20 to 35 days based on length of service
Family and medical leaves of absence
Paid parental leave

Fulltime

New

State Gov Programs Policy Analyst

The incumbent serves as a State Government Programs Policy Analyst to research a...

Location

United States , Saint Paul

Salary:

80000.00 - 110000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

Two-year associates degree required or Bachelor's degree (B.A. or B.S.) from four-year college or university preferred
Minimum 4 years of relevant work experience in healthcare reimbursement, payer policy and/or health plan administration
Working knowledge of state government program policy including Medicaid fee-for-service, Medicaid managed care organizations, disability waivers, Children’s Health Insurance Programs (CHIP), and other state government programs preferred
General understanding of provider credentialing and enrollment requirements preferred
General knowledge of TIMS third party payer database and state and federal laws, rules, and regulations preferred
Strong knowledge of database integrity procedures and standards and ability to apply analytical findings to day-to-day business practices preferred
Ability to lead projects, meet deadlines, and prioritize workload
Superior communication, innovative, and critical thinking skills

Job Responsibility

Conduct analysis of state government programs policy impacting Respiratory Health products
Monitor and interpret state and payer documentation, including but not limited to provider manuals, guidelines, bulletins, and regulatory communications
Develop and maintain relationships with managed care organizations to ensure compliance with payer policy and regulations
Develop strategic policy summaries to inform leadership decisions
Track and analyze legislative and regulatory developments affecting Respiratory Health products within the State Government Programs space
Translate policy requirements into actionable operational guidance and workflows maintaining compliance with payer policy and regulations
Identify compliance risks associated with payer changes and recommend mitigation strategies to State Government Programs Manager

What we offer

medical and dental coverage that start on day one
insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount
401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching
Flexible Spending Accounts
educational assistance programs
paid holidays
paid time off ranging from 20 to 35 days based on length of service
family and medical leaves of absence
paid parental leave

Fulltime

New

State Gov Programs Policy Analyst

The incumbent serves as a State Government Programs Policy Analyst to research a...

Location

United States , Saint Paul

Salary:

80000.00 - 110000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

Two-year associates degree required or Bachelor's degree (B.A. or B.S.) from four-year college or university preferred
Minimum 4 years of relevant work experience in healthcare reimbursement, payer policy and/or health plan administration
Working knowledge of state government program policy including Medicaid fee-for-service, Medicaid managed care organizations, disability waivers, Children’s Health Insurance Programs (CHIP), and other state government programs preferred
General understanding of provider credentialing and enrollment requirements preferred
General knowledge of TIMS third party payer database and state and federal laws, rules, and regulations preferred
Strong knowledge of database integrity procedures and standards and ability to apply analytical findings to day-to-day business practices preferred
Ability to lead projects, meet deadlines, and prioritize workload
Superior communication, innovative, and critical thinking skills

Job Responsibility

Conduct analysis of state government programs policy impacting Respiratory Health products
Monitor and interpret state and payer documentation, including but not limited to provider manuals, guidelines, bulletins, and regulatory communications
Develop and maintain relationships with managed care organizations to ensure compliance with payer policy and regulations
Develop strategic policy summaries to inform leadership decisions
Track and analyze legislative and regulatory developments affecting Respiratory Health products within the State Government Programs space
Translate policy requirements into actionable operational guidance and workflows maintaining compliance with payer policy and regulations
Identify compliance risks associated with payer changes and recommend mitigation strategies to State Government Programs Manager

What we offer

Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP)
401(k) Retirement Savings Plan (RSP)
Flexible Spending Accounts
Educational assistance programs
Paid holidays
Paid time off ranging from 20 to 35 days based on length of service
Family and medical leaves of absence
Paid parental leave

Fulltime

Program Manager with Medicaid

Ocean Blue Solutions

Location:
United States , Columbus

Category:
Public Sector

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
January 05, 2026

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