Senior Manager, Government Programs - Medicaid Job at Baxter (Saint Paul, Minnesota)

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

New

Senior Manager, Medicaid Compliance

We’re building a world of health around every individual — shaping a more connec...

Location

United States , New Albany, Ohio

Salary:

75400.00 - 165954.00 USD / Year

CVS Health

Expiration Date

March 13, 2026

Requirements

Minimum of 7 years regulatory compliance experience in managed care, health care, or insurance
Minimum of 1 year project management experience
Bachelor’s Degree preferably in Public Policy, Government Affairs, Health Care Administration, or Public Administration
equivalent years of related professional work experience may substitute

Job Responsibility

Acts as the primary liaison to the state Medicaid agency, facilitating compliance and contract-related communications and activities
Maintain the systems and tools to track, monitor, review, and submit required regulatory and compliance related deliverables and responses to state Medicaid agencies on or before required due dates
independently prepares and oversees the submission of complex regulatory reports and deliverables as needed on behalf of the Medicaid compliance team
Facilitates the preparation for and management of external audits conducted by state Medicaid and related agencies or partners in conjunction with health plan leadership through final report and corrective action plan closure
Lead and execute all elements of the Medicaid compliance program for Aetna’s OH Medicaid health plan
Conduct research and develop recommendations to help develop compliant business operations, processes, and policies in accordance with state specific Medicaid program requirements
Develop compelling, strategic, and appropriate compliance related communications on behalf of the health plan in response to state Medicaid agency inquiries or requests
Maintain an in-depth working knowledge of the health plan’s contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to health plan and growth partner staff for education, training, and business decision making purposes
Ensure that current resource tools and other internal deliverables such as current contract library, regulatory reporting assignments, risk assessments, risk tracking lists, internal reporting systems and summaries, and other department wide tools are current and accessible to business partners to ensure the appropriate monitoring and oversight of health plan compliance processes
Identify key areas of risk or concern and proactively conduct oversight and monitoring to evaluate levels of compliance with Medicaid managed care organization requirements across the business

What we offer

Affordable medical plan options
a 401(k) plan (including matching company contributions)
an employee stock purchase plan
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 and many other benefits depending on eligibility

Fulltime

!

Health Policy & Reimbursement Executive Director

In this vital role the Health Policy & Reimbursement Executive Director will lea...

Location

United States , Washington D.C.

Salary:

281425.00 - 325550.00 USD / Year

Amgen

Expiration Date

Until further notice

Requirements

Doctorate degree & 6 years of health policy or reimbursement experience
Master’s degree & 10 years of health policy or reimbursement experience
Bachelor’s degree & 12 years of health policy or reimbursement experience
6 years of managerial experience directly managing people and/or leadership experience leading teams, projects, programs or directing the allocation of resources

Job Responsibility

Lead development and implementation of reimbursement strategies for federal (US) payer issues across multiple therapeutic areas and the company’s biosimilar portfolio
Work cross-functionally to help identify and resolve barriers to entry for pipeline products/ therapies and provide broad reimbursement-related advice for inline products, including mitigation strategies in response to proposals that would negatively affect access of Amgen therapies for patients
Manage broader health policy efforts including reviewing and analyzing complex policy proposals including regulatory proposals and legislative text, and promptly and concisely communicating impact of these proposals to key internal audiences (government affairs, commercial, regulatory, clinical, and senior executives)
Collaborate with government affairs staff to ensure alignment of strategy, talking points and messaging to constituents (elected officials/leaders, agencies, third parties, etc.)
Play a key role in health policy engagement with major trade associations on corporate policy priorities which include Amgen specific priorities as well as industry-wide priorities including, but not limited to, Federal drug pricing policy
Conduct research and integrate clinical, market and payer data to inform engagement on reimbursement objectives
Regularly update via written and oral communications to senior executives and other key partners on various reimbursement and US health policy topics

What we offer

Comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts
A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
Stock-based long-term incentives
Award-winning time-off plans and bi-annual company-wide shutdowns
Flexible work models, including remote work arrangements, where possible

Fulltime

Senior Reimbursement Analyst

Senior Reimbursement Analyst role focusing on government payor programs, revenue...

Location

United States , Milwaukee

Salary:

41.10 - 61.65 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Bachelor's Degree in Finance or related field
Typically requires 5 years of experience in reimbursement that includes experiences in preparation of Medicare/Medicaid cost reports, regulations and the analysis, modeling and reporting of third party payers
Demonstrated expertise with Medicare and Medicaid regulations in a health care or federal intermediary setting
Knowledge and understanding of third party regulations and the interrelationship of financial statements
Strong accounting background with experience in preparing and/or reviewing health care financial statements
Strong proficiency in the use of the Microsoft Office (Excel, PowerPoint, Word, Access), software systems, data management tools or similar products
Proficiency in data mining and analysis
Excellent written and verbal communication skills

Job Responsibility

Plans and prepares revenue analysis for system wide programs, projects and services, and monitors revenue budgets and benchmarking activities
Identifies and researches opportunities to enhance revenue and improve administrative efficiency of governmental payor programs
Reviews government agency bulletins, publications, and the Federal Register to understand proposed and actual state and federal government statutory and regulatory changes
Serves as one of the Aurora representatives on the state Medicaid Hospital Rate Advisory Group, Health Care Quality Coalition, and Wisconsin Hospital Association Medicaid Advisory Group
Provides support as needed to Finance and Operations on reimbursement related matters
Prepares and/or provides necessary information required for the completion of the annual Medicare and Medicaid interim and year-end cost reports
Develops and provides coordination for the system-wide monthly closing process with respect to Medicare/Medicaid liabilities
Monitors processes to ensure accurate payment for Medicare/Medicaid and monitors interim payments
Works with Graduate Medical Education programs to ensure proper Medicare and Medicaid reimbursement

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Senior Reimbursement Analyst

Senior Reimbursement Analyst role focusing on government payor programs, revenue...

Location

United States , Milwaukee

Salary:

41.10 - 61.65 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Bachelor's Degree in Finance or related field
Typically requires 5 years of experience in reimbursement that includes experiences in preparation of Medicare/Medicaid cost reports, regulations and the analysis, modeling and reporting of third party payers
Demonstrated expertise with Medicare and Medicaid regulations in a health care or federal intermediary setting
Knowledge and understanding of third party regulations and the interrelationship of financial statements
Strong accounting background with experience in preparing and/or reviewing health care financial statements
Strong proficiency in the use of the Microsoft Office (Excel, PowerPoint, Word, Access), software systems, data management tools or similar products
Proficiency in data mining and analysis
Excellent written and verbal communication skills

Job Responsibility

Plans and prepares revenue analysis for system wide programs, projects and services, and monitors revenue budgets and benchmarking activities
Identifies and researches opportunities to enhance revenue and improve administrative efficiency of governmental payor programs
Reviews government agency bulletins, publications, and the Federal Register to understand proposed and actual state and federal government statutory and regulatory changes
Serves as one of the Aurora representatives on the state Medicaid Hospital Rate Advisory Group, Health Care Quality Coalition, and Wisconsin Hospital Association Medicaid Advisory Group
Provides support as needed to Finance and Operations on reimbursement related matters
Prepares and/or provides necessary information required for the completion of the annual Medicare and Medicaid interim and year-end cost reports
Develops and provides coordination for the system-wide monthly closing process with respect to Medicare/Medicaid liabilities
Monitors processes to ensure accurate payment for Medicare/Medicaid and monitors interim payments
Works with Graduate Medical Education programs to ensure proper Medicare and Medicaid reimbursement

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Director, Market Access Strategy

The Director of Market Access Strategy is responsible for developing and executi...

Location

United States , San Mateo

Salary:

235000.00 - 260000.00 USD / Year

Dompé

Expiration Date

Until further notice

Requirements

10+ years of progressive experience in Market Access, Pricing, Payer Strategy, Government Affairs, or related functions within biopharma, med-tech, diagnostics, or healthcare services
Deep understanding of U.S. reimbursement systems, including commercial payer structures, Medicare/Medicaid regulations, formulary dynamics, and value-based contracting
Previous experience overseeing market access related market research including but not limited to qualitative and quantitative pricing research, qualitative payer research for pipeline and marketed products, and physician/office staff research to assist in crafting access strategies for sales team
Demonstrated success in designing and executing market access strategies for new product launches and/or marketed products
Experience collaborating with HEOR, Medical Affairs, Policy, and Commercial teams
Experience conducting market analyses, formulating and presentation strategy recommendations, including to C-level executives
Strategic Thinker: Able to translate complex policy and payer trends into actionable business strategies
Analytical Mindset: Skilled in financial modeling, scenario planning, and contract impact analysis
Strong Communicator: Capable of crafting compelling value propositions and presenting to executive leadership
Relationship Builder: Demonstrated ability to cultivate productive partnerships with payers and external stakeholders

Job Responsibility

Develop and lead the overarching U.S. market access strategy for both marketed and pipeline assets
Conduct landscape analyses of payer trends, competitive dynamics, regulatory policies, and reimbursement pathways to guide strategic decision-making
Establish pricing frameworks that align with product value, market conditions, and payer expectations
Lead the process of research and analysis to inform annual price increases for marketed products
Lead pricing research, scenario testing, and sensitivity modeling to inform optimal list, net, and contract pricing decisions
Ensure pricing governance compliance, documentation, and alignment with corporate policies
Assist in the determination and implementation of contracting strategy as appropriate
Oversee development of contract terms, value-based agreements, and rebate structures to support access and profitability targets
Work with Legal and Finance to manage contract negotiations, risk assessments, and financial impact analyses
Lead pricing and reimbursement strategy development for pipeline assets, including early value assessments, US access landscape evaluations, and identification of optimal reimbursement pathways

What we offer

Comprehensive medical benefits
Generous vacation / holiday time off
Competitive 401(K) matching
Bay Area office with great views, located in vibrant downtown San Mateo and within walking distance to restaurants, coffee shops, and the Cal Train
A super cool team who’s excited to transform lives through innovative therapies

Fulltime

New

Seasonal team member

Longleat is seeking enthusiastic and customer focused Seasonal Team Members to j...

Location

United Kingdom , Longleat

Salary:

10.30 - 12.21 GBP / Hour

Longleat Enterprises Limited

Expiration Date

March 08, 2026

Requirements

A passion for delivering a great guest experience and willing to go out of your way to do so
Good team player with excellent interpersonal skills
Ability to remain calm and efficient under pressure
Excellent communication skills with a confident and friendly nature
Be honest, reliable and committed, and enjoy responsibility and exceeding expectations
You must be aged 16 or over, and above school leaving age to apply for this role
For Attractions Team Member role: applicants must be aged 18 or over
For Guest Experience Team Member role: Experience in a customer service environment is required

Job Responsibility

Food and Beverage Team Member: Delivering outstanding service at varied food outlets
Attractions Team Member: Supporting animal team with giraffe feeding, marshalling seasonal events, ensuring guest safety on rides
Retail Team Member: Engaging with guests, helping pick souvenirs, serving on till
Cleansing Team Member: Ensuring the park remains clean and presentable, focusing on guest toilet blocks
Ranger: Providing a clean and presentable environment, waste disposal, traffic management
Guest Experience Team Member: Welcoming guests at arrivals booths, resolving enquiries, meeting VIP guests, responding to questions via email, social media, or telephone

What we offer

29 days holiday inclusive of bank holidays, rising to 31 days at 5 years’ service
Unlimited free entry to Longleat for our employees
Complimentary tickets to Longleat and Cheddar Gorge and Caves, 18 per annum pro rata
50% off Membership for Friends and Family
Discounts on food and beverages and retail merchandise
Discounts on VIP Experiences and Accommodation
Discretionary bonus scheme
Employee Assistance Programme
Employer contributory pension scheme
Life assurance scheme

Fulltime

!

New

Planermill Supervisor

You are a natural leader with the proven ability to adapt and remain flexible in...

Location

United States , El Dorado

Salary:

Not provided

Canfor

Expiration Date

Until further notice

Requirements

Minimum 3-5 years of supervisory experience in an industrial environment
Working knowledge of web-based computer applications and Microsoft Office
Grade 12 or equivalent
Valid driver's license

Job Responsibility

Maintain the highest safety standards, ensuring compliance with all policies, procedures, practices, and OSHA regulations
Address unsafe conditions promptly and proactively
Identify opportunities to improve processes and reduce costs while safely meeting production targets
Coach, train, and support team members to maximize performance
Foster open communication and engage employees for input into work processes and systems
Ensure timely implementation of key corporate and operational initiatives, and assist in equipment troubleshooting
Maintain and monitor production goals
Work with other departments to achieve operational goals

Fulltime

Senior Manager, Government Programs - Medicaid

Baxter

Location:
United States , Saint Paul, Minnesota

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
March 21, 2025

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