15 Healthcare jobs in Oro Valley
Medical Necessity Analyst - Pre Services- Healthcare Documentation Specialist
85718 Tucson, Arizona
Tucson Medical Center
Posted 1 day ago
Job Viewed
Job Description
SUMMARY :
Incumbent responsible for timely pre-services evaluation of physician-submitted clinical documentation supporting planned or elective procedures. Goal of evaluation: To ensure that patients' planned healthcare services meet current published insurance payor guidelines yielding payment without claim denial. After prior authorization is obtained per current facility protocol, incumbent reviews surgical cases in established work queues then analyzes relevant healthcare documentation against current published payor guidelines to ensure it supports the meeting of medical necessity for the proposed procedure(s). If the healthcare documentation available in the EHR is insufficient, incumbent coordinates with involved healthcare providers and/or their designated associates to ensure the specific, required criteria have been fully documented prior to the delivery of planned healthcare service(s).
ESSENTIAL FUNCTIONS :
Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors, providers, peers, and other staff. Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.
Collaborates with providers and their office staff and other appropriate delegates to ensure documentation that establishes medical necessity is present and meets current published payor guidelines prior to planned healthcare services.
Analyzes and gathers clinical documentation prior to prospective healthcare delivery to patients utilizing EHRs.
Utilizes a variety of electronic verification tools and web-based resources to verify Common Procedural Terminology (CPT) codes and numerous current published insurance payor guidelines.
Identifies unmet medical necessity criteria within provided healthcare documentation which increases risk of non-payment to TMCH. Generates and issues targeted patient-and-case-specific addendum requests to the provider with recommendations for remediation, so documentation meets stated payor medical necessity requirements.
Documents clinical review summaries/findings in EHR.
Documents all other activity undertaken in the process of attempting to obtain/obtaining medical necessity documentation from providers in the EHR and/or any other appropriate locations.
Escalates concerns to department leadership as indicated (i.e., supervisor and manager).
Maintains appropriate organized confidential filing systems, records, and reports to ensure rapid retrieval of information by all team members and leadership.
May refer questions of a clinical nature to department leadership as well as Utilization Management RNs to ensure accuracy.
May attend meetings as a representative of the Pre-Services Medical Necessity team.
Coordinates with the Authorization team and other pre-services patient access entities within TMCH to confirm accuracy of supplied CPT codes and as otherwise needed.
Escalates questions or concerns regarding patient admission status related to proposed healthcare service(s) to appropriate individual or entity.
May train new peer analysts as well as assist less-experienced analysts in daily work.
Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards.
Performs other related duties as assigned.
MINIMUM QUALIFICATIONS
EDUCATION: High school diploma or general education degree (GED) required.
EXPERIENCE : Minimum of three (3) years of hospital and/or medical-surgical office experience. Must have documented experience working with either clinical healthcare documentation, medical coding, and/or billing systems. Healthcare Documentation Specialist/Professional, Medical Assistant, or comparable experience preferred.
LICENSURE OR CERTIFICATION : Certified Healthcare Documentation Specialist (CHDS), Certified Healthcare Documentation Professional (CHDP), or Certified Medical Assistant (CMA/MA) preferred but not required.
KNOWLEDGE, SKILLS, AND ABILITIES :
•Excellent critical thinking skills; strong ability to apply common sense understanding to all aspects of daily duties.
•Effective interpersonal skills utilizing proper communication etiquette when interacting in person, virtually, via email, and over the telephone.
•Strong skill in reading and listening to ensure comprehension.
•Excellent skill in both oral and written communication, including understanding and providing instructions as well as reading and writing correspondence in an appropriate and businesslike manner.
•Ability to effectively and accurately present information to, as well as respond to, inquiries and complaints from all customers, which include providers, their representatives, and all employees of this organization.
•Ability to effectively and accurately present information in one-on-one and small group situations.
•Ability to read and analyze documents such as clinical healthcare documentation, current published payor guidelines, and government regulations.
•Intermediate to advanced knowledge of medical terminology, surgical procedures, and imaging, as well as anatomic systems and medical-surgical specialties.
•Ability to use an extensive array of professional reference materials in both printed and electronic format for research and reference.
•Ability to understand and compare information entered into the medical record by various sources, and ability to accurately determine that the information is consistent and appropriate to meet current published payor guidelines.
•Ability to maintain composure while multi-tasking (performing more than one task at a time and/or quickly switching back and forth between tasks) as well as endure frequent interruptions at the same as working under pressure of time constraints.
•Ability to work independently with minimal supervision.
•Ability to concentrate and pay attention to detail, yielding results with a high degree of accuracy.
•Ability to understand and apply relevant medicolegal concepts such as confidentiality.
•Ability to assist other staff effectively and patiently when needed.
•Ability to "triage" competing tasks while meeting department, facility, and personal productivity and quality benchmarks.
•Knowledge and use of Microsoft applications, EHR software, the internet, and various other applications as well as general computer, keyboard, and mouse usage. Must have basic ability to troubleshoot computer, internet, and software issues.
•Knowledge of CPT codes is helpful.
•Knowledge of regulations relating to commercial insurance programs as well as Federal healthcare programs such as Medicare and Medicaid (AHCCCS) preferred.
Incumbent responsible for timely pre-services evaluation of physician-submitted clinical documentation supporting planned or elective procedures. Goal of evaluation: To ensure that patients' planned healthcare services meet current published insurance payor guidelines yielding payment without claim denial. After prior authorization is obtained per current facility protocol, incumbent reviews surgical cases in established work queues then analyzes relevant healthcare documentation against current published payor guidelines to ensure it supports the meeting of medical necessity for the proposed procedure(s). If the healthcare documentation available in the EHR is insufficient, incumbent coordinates with involved healthcare providers and/or their designated associates to ensure the specific, required criteria have been fully documented prior to the delivery of planned healthcare service(s).
ESSENTIAL FUNCTIONS :
Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors, providers, peers, and other staff. Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.
Collaborates with providers and their office staff and other appropriate delegates to ensure documentation that establishes medical necessity is present and meets current published payor guidelines prior to planned healthcare services.
Analyzes and gathers clinical documentation prior to prospective healthcare delivery to patients utilizing EHRs.
Utilizes a variety of electronic verification tools and web-based resources to verify Common Procedural Terminology (CPT) codes and numerous current published insurance payor guidelines.
Identifies unmet medical necessity criteria within provided healthcare documentation which increases risk of non-payment to TMCH. Generates and issues targeted patient-and-case-specific addendum requests to the provider with recommendations for remediation, so documentation meets stated payor medical necessity requirements.
Documents clinical review summaries/findings in EHR.
Documents all other activity undertaken in the process of attempting to obtain/obtaining medical necessity documentation from providers in the EHR and/or any other appropriate locations.
Escalates concerns to department leadership as indicated (i.e., supervisor and manager).
Maintains appropriate organized confidential filing systems, records, and reports to ensure rapid retrieval of information by all team members and leadership.
May refer questions of a clinical nature to department leadership as well as Utilization Management RNs to ensure accuracy.
May attend meetings as a representative of the Pre-Services Medical Necessity team.
Coordinates with the Authorization team and other pre-services patient access entities within TMCH to confirm accuracy of supplied CPT codes and as otherwise needed.
Escalates questions or concerns regarding patient admission status related to proposed healthcare service(s) to appropriate individual or entity.
May train new peer analysts as well as assist less-experienced analysts in daily work.
Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards.
Performs other related duties as assigned.
MINIMUM QUALIFICATIONS
EDUCATION: High school diploma or general education degree (GED) required.
EXPERIENCE : Minimum of three (3) years of hospital and/or medical-surgical office experience. Must have documented experience working with either clinical healthcare documentation, medical coding, and/or billing systems. Healthcare Documentation Specialist/Professional, Medical Assistant, or comparable experience preferred.
LICENSURE OR CERTIFICATION : Certified Healthcare Documentation Specialist (CHDS), Certified Healthcare Documentation Professional (CHDP), or Certified Medical Assistant (CMA/MA) preferred but not required.
KNOWLEDGE, SKILLS, AND ABILITIES :
•Excellent critical thinking skills; strong ability to apply common sense understanding to all aspects of daily duties.
•Effective interpersonal skills utilizing proper communication etiquette when interacting in person, virtually, via email, and over the telephone.
•Strong skill in reading and listening to ensure comprehension.
•Excellent skill in both oral and written communication, including understanding and providing instructions as well as reading and writing correspondence in an appropriate and businesslike manner.
•Ability to effectively and accurately present information to, as well as respond to, inquiries and complaints from all customers, which include providers, their representatives, and all employees of this organization.
•Ability to effectively and accurately present information in one-on-one and small group situations.
•Ability to read and analyze documents such as clinical healthcare documentation, current published payor guidelines, and government regulations.
•Intermediate to advanced knowledge of medical terminology, surgical procedures, and imaging, as well as anatomic systems and medical-surgical specialties.
•Ability to use an extensive array of professional reference materials in both printed and electronic format for research and reference.
•Ability to understand and compare information entered into the medical record by various sources, and ability to accurately determine that the information is consistent and appropriate to meet current published payor guidelines.
•Ability to maintain composure while multi-tasking (performing more than one task at a time and/or quickly switching back and forth between tasks) as well as endure frequent interruptions at the same as working under pressure of time constraints.
•Ability to work independently with minimal supervision.
•Ability to concentrate and pay attention to detail, yielding results with a high degree of accuracy.
•Ability to understand and apply relevant medicolegal concepts such as confidentiality.
•Ability to assist other staff effectively and patiently when needed.
•Ability to "triage" competing tasks while meeting department, facility, and personal productivity and quality benchmarks.
•Knowledge and use of Microsoft applications, EHR software, the internet, and various other applications as well as general computer, keyboard, and mouse usage. Must have basic ability to troubleshoot computer, internet, and software issues.
•Knowledge of CPT codes is helpful.
•Knowledge of regulations relating to commercial insurance programs as well as Federal healthcare programs such as Medicare and Medicaid (AHCCCS) preferred.
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0
Healthcare Services Pharmacist
85702 Tucson, Arizona
Walgreens
Posted today
Job Viewed
Job Description
**Job Description:**
**Job Summary:**
Provides clinical services to patients, such as immunizations or MTM interventions, ensuring the compliance with regulatory guidelines, company policies and procedures.
**Job Responsibilities:**
Patient Experience
+ Engages patients by greeting them and offering assistance with products and services. Resolves patient issues in a timely manner and answers questions to ensure a positive patient experience.
+ Models and shares patient service best practices with all team members to deliver a distinctive and joyful experience, including interpersonal habits that show care (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., demonstrating curiosity to identify needs and proactively helping, servicing until satisfied, championing empathy and inclusivity, etc.).
+ Connects with patients by anticipating needs and proactively offering services. Supports efforts on enhancing patient experience by increasing awareness of healthcare services offered through Walgreens (e.g., patient consultation, medication management, drug therapy reviews, and perform clinical, or wellness services such as immunizations, diagnostic testing, and patient outcomes services) thereby promoting the shift of the Walgreens pharmacy role from transactional to interpersonal.
Operations
+ Provides clinical services to patients, such as immunizations or MTM interventions, ensuring compliance with regulatory guidelines, company policies and procedures.
+ Ensures the use of all elements of the Good Faith Dispensing policy in conjunction with state and federal controlled substance laws when filling prescriptions. The Product Review/Retail Fill Process Pharmacist is responsible for ensuring that elements of Good Faith are present.
Training & Personal Development
+ Maintains current knowledge and required licensing/credentialing/certification as established by federal and state regulations to provide such clinical services.
+ Maintains current knowledge and skills related to pharmacy and healthcare by reading pharmacy related journals, company publications, and communications. Maintains awareness of developments in retail and management and pursues best practices that would enhance performance.
+ Obtains necessary certifications, education credits and training, including learning modules, as required by the Company.
About Walgreens
Founded in 1901, Walgreens ( ) has a storied heritage of caring for communities for generations, and proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico, and leading omni-channel platforms. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for retail pharmacy and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.
Walgreens is the flagship U.S. brand of Walgreens Boots Alliance, Inc. (Nasdaq: WBA), an integrated healthcare, pharmacy and retail leader. Its retail locations are a critical point of access and convenience in thousands of communities, with Walgreens pharmacists playing a greater role as part of the healthcare system and patients' care teams than ever before. Walgreens Specialty Pharmacy provides critical care and pharmacy services to millions of patients with rare disease states and complex, chronic conditions.
**Job ID:** 1633762BR
**Title:** Healthcare Services Pharmacist
**Company Indicator:** Walgreens
**Employment Type:** Part-time
**Job Function:** Retail
**Full Store Address:** 2929 W VALENCIA RD,TUCSON,AZ,85746-08036-05532-S
**Full District Office Address:** 2929 W VALENCIA RD,TUCSON,AZ,85746-08036-05532-S
**External Basic Qualifications:**
+ BS in Pharmacy or Pharmacist Degree from an accredited educational institution.
+ Current pharmacist licensure in the states within the district.
+ Certified Immunizer or willing to become an immunizer within 90 days of hire.
**Preferred Qualifications:** The Salary below is being provided to promote pay transparency and equal employment opportunities at Walgreens. The actual hourly salary within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits ( . If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits
We will consider employment of qualified applicants with arrest and conviction records.
**Shift:**
**Store:**
**Job Summary:**
Provides clinical services to patients, such as immunizations or MTM interventions, ensuring the compliance with regulatory guidelines, company policies and procedures.
**Job Responsibilities:**
Patient Experience
+ Engages patients by greeting them and offering assistance with products and services. Resolves patient issues in a timely manner and answers questions to ensure a positive patient experience.
+ Models and shares patient service best practices with all team members to deliver a distinctive and joyful experience, including interpersonal habits that show care (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., demonstrating curiosity to identify needs and proactively helping, servicing until satisfied, championing empathy and inclusivity, etc.).
+ Connects with patients by anticipating needs and proactively offering services. Supports efforts on enhancing patient experience by increasing awareness of healthcare services offered through Walgreens (e.g., patient consultation, medication management, drug therapy reviews, and perform clinical, or wellness services such as immunizations, diagnostic testing, and patient outcomes services) thereby promoting the shift of the Walgreens pharmacy role from transactional to interpersonal.
Operations
+ Provides clinical services to patients, such as immunizations or MTM interventions, ensuring compliance with regulatory guidelines, company policies and procedures.
+ Ensures the use of all elements of the Good Faith Dispensing policy in conjunction with state and federal controlled substance laws when filling prescriptions. The Product Review/Retail Fill Process Pharmacist is responsible for ensuring that elements of Good Faith are present.
Training & Personal Development
+ Maintains current knowledge and required licensing/credentialing/certification as established by federal and state regulations to provide such clinical services.
+ Maintains current knowledge and skills related to pharmacy and healthcare by reading pharmacy related journals, company publications, and communications. Maintains awareness of developments in retail and management and pursues best practices that would enhance performance.
+ Obtains necessary certifications, education credits and training, including learning modules, as required by the Company.
About Walgreens
Founded in 1901, Walgreens ( ) has a storied heritage of caring for communities for generations, and proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico, and leading omni-channel platforms. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for retail pharmacy and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.
Walgreens is the flagship U.S. brand of Walgreens Boots Alliance, Inc. (Nasdaq: WBA), an integrated healthcare, pharmacy and retail leader. Its retail locations are a critical point of access and convenience in thousands of communities, with Walgreens pharmacists playing a greater role as part of the healthcare system and patients' care teams than ever before. Walgreens Specialty Pharmacy provides critical care and pharmacy services to millions of patients with rare disease states and complex, chronic conditions.
**Job ID:** 1633762BR
**Title:** Healthcare Services Pharmacist
**Company Indicator:** Walgreens
**Employment Type:** Part-time
**Job Function:** Retail
**Full Store Address:** 2929 W VALENCIA RD,TUCSON,AZ,85746-08036-05532-S
**Full District Office Address:** 2929 W VALENCIA RD,TUCSON,AZ,85746-08036-05532-S
**External Basic Qualifications:**
+ BS in Pharmacy or Pharmacist Degree from an accredited educational institution.
+ Current pharmacist licensure in the states within the district.
+ Certified Immunizer or willing to become an immunizer within 90 days of hire.
**Preferred Qualifications:** The Salary below is being provided to promote pay transparency and equal employment opportunities at Walgreens. The actual hourly salary within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits ( . If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits
We will consider employment of qualified applicants with arrest and conviction records.
**Shift:**
**Store:**
View Now
1
Freelance Healthcare Interpreter
85702 Tucson, Arizona
SOS International LLC
Posted today
Job Viewed
Job Description
Overview SOSi is actively seeking qualified, professional, and experienced healthcare interpreters. Our job is to provide in person, over the phone, and video remote interpretation (VRI) interpretation services for scheduled and on-demand service requests within the state of Washington, and bordering zip codes. The government contractor requires interpretation services for injured workers and crime victims during medical and vocational appointments. All languages are encouraged to apply across the country. Essential Job Duties Provides scheduled and on-demand in-person, over-the-phone, and VRI consecutive interpretation between Multiple Languages and English and vice versa between medical/vocational providers and injured workers and crime victims with low English proficiency as required. Minimum Requirements High School Diploma. Ability to obtain and provide a valid driver's license, U.S. passport, or other government issued photo ID. Ability to obtain a background check through Washington Access To Criminal History (WATCH) website. Highly proficient in both English and Target Language, ILR scale of 2+. Ability to speak English and Target Language fluently, including high to low levels of language register, regional colloquialisms, and slang expressions, and do so with clear and intelligible pronunciation. Ability to preserve the tone and emotional level of the speaker, as well as manage the delivery, speed, and length of the statement (projection, pace and pausing) of the speaker. Ability to maintain appropriate speed and projection while rendering interpretation, and request and incorporate clarification of speaker's statements only when justified. Ability to obtain one of the following certifications: Washington State Department of Social and Health Services Federal Court Interpreter Certification Examination Washington State Administrative Office for the Courts National Board of Certification for Medical Interpreter Certification Commission for Healthcare Interpreters (CCHI) US State Department Office of Language Services Ability to obtain a National Provider Identifier (NPI) Number Ability to obtain a Unified Business Identifier (UBI) with the Washington State Department of Revenue. Work Environment In-person appointments throughout the state of Washington and surrounding zip codes. Remote work available for telephonic and video remote appointments. Working at SOSi All interested individuals will receive consideration and will not be discriminated against for any reason.
SOSi is an equal employment opportunity employer and affirmative action employer. All interested individuals will receive consideration and will not be discriminated against on the basis of race, color, religion, sex, national origin, disability, age, sexual orientation, gender identity, genetic information, or protected veteran status. SOSi takes affirmative action in support of its policy to advance diversity and inclusion of individuals who are minorities, women, protected veterans, and individuals with disabilities.
SOSi is an equal employment opportunity employer and affirmative action employer. All interested individuals will receive consideration and will not be discriminated against on the basis of race, color, religion, sex, national origin, disability, age, sexual orientation, gender identity, genetic information, or protected veteran status. SOSi takes affirmative action in support of its policy to advance diversity and inclusion of individuals who are minorities, women, protected veterans, and individuals with disabilities.
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2
Business Transformation - Sr Manager - Healthcare Provider - Acute Care
85702 Tucson, Arizona
EY
Posted today
Job Viewed
Job Description
Location: Anywhere in Country
At EY, we're all in to shape your future with confidence.
We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world.
? **Business Transformation - Sr Manager - Healthcare Provider - Acute Care**
Today's healthcare environment is undergoing rapid change and transformation. The market is being impacted by changing regulations, new payment structures, increasing reliance on technology, and a move towards population health. As a senior manager within our Health consulting practice, you'll work with clients across the healthcare industry, from hospitals and integrated delivery networks to commercial and governmental insurers. You'll use your industry knowledge and relationship skillsets to assist our clients in delivering services efficiently and effectively.
**The opportunity**
As part of EY's Health consulting practice, you will work with these clients across the country in solving complex problems in today's rapidly changing healthcare environment? We currently are seeking a highly motivated Senior Manager, with a focus on provider operations, to manage client engagement teams, work with a wide variety of clients to deliver professional services and manage business development activities on strategic and global priority accounts.
**Your key responsibilities**
As a Senior Manager in our Health consulting group focused on Clinical Operations, you'll spend most of your time teaming with our provider team working with a broad spectrum of not-for-profit and for-profit healthcare clients, including hospitals, healthcare systems, physician practices and academic medical centers, to assess and redesign clinical processes across the following areas:
+ Operational improvement
+ Benchmarking and financial quantification
+ Cost reduction/revenue enhancement
+ Workflow redesign
Our current hiring priorities are focused on engagements related to acute care. Candidates with experience leading work in the following areas are strongly preferred:
+ Acute care labor/ productivity
+ ED throughput
+ OR optimization
+ Length of stay and patient throughput
+ Care management redesign
+ Acute care organization design/ span of control
**Skills and attributes for success**
+ Effectively manage and motivate client engagement teams with diverse skills and backgrounds
+ Foster an innovative and inclusive team -oriented work environment. Play an active role in counselling and mentoring junior consultants within the organization
+ Foster relationships with client personnel at appropriate levels. Consistently deliver quality client services. Drive high-quality work products within expected timeframes and on budget. Monitor progress, manage risk and ensure key stakeholders are kept informed about progress and expected outcomes
+ Cultivate and manage business development opportunities. Understand EY and its service lines and actively assess/present ways to serve clients. Develop and maintain long-term client relationships and networks
+ Demonstrate in-depth technical capabilities and professional knowledge
**To qualify for the role, you must have**
+ A bachelor's degree and approximately 10 years of related work experience; or a graduate degree and approximately 7 years of related work experience.
+ Approximately 7 years of healthcare consulting experience in provider operations; acute care experience is preferred.
+ Prior experience as a senior manager (or above), in a consulting firm or in a senior management role within industry
+ Ability to read and interpret hospital financial statements and contract terms, utilize complex financial models, experience with operational process mapping and experience with healthcare cost reduction planning and implementation
+ Experience with healthcare organization M&A, physician alignment, or financial margin improvement initiatives
+ Experience in selling and delivering projects that cover the full life cycle of assessment, design and implementation support; demonstrated record of driving revenue within existing healthcare clients and in developing new prospects at the "C" level of large healthcare companies
+ Ability to manage a team of staff/senior/manager consulting professionals
+ Ability to work collaboratively in a team environment
+ Strong analytical and problem-solving skills, as well as excellent oral and written communication skills
+ A willingness to travel to meet client needs; travel is estimated at 80%.
**Ideally, you'll also have**
+ A degree with an emphasis in Finance, Accounting, and/or Business; CPA, MBA, MHA and/or MPH
+ Clinical background is preferred but not required.
**What we look for**
We're interested in passionate leaders with strong vision and a desire to stay on top of trends in the healthcare industry. If you have a genuine passion for healthcare, this role is for you.
**What we offer you**
At EY, we'll develop you with future-focused skills and equip you with world-class experiences. We'll empower you in a flexible environment, and fuel you and your extraordinary talents in a diverse and inclusive culture of globally connected teams. Learn more .
+ We offer a comprehensive compensation and benefits package where you'll be rewarded based on your performance and recognized for the value you bring to the business. The base salary range for this job in all geographic locations in the US is $150,400 to $43,600. The base salary range for New York City Metro Area, Washington State and California (excluding Sacramento) is 180,500 to 390,500. Individual salaries within those ranges are determined through a wide variety of factors including but not limited to education, experience, knowledge, skills and geography. In addition, our Total Rewards package includes medical and dental coverage, pension and 401(k) plans, and a wide range of paid time off options.
+ Join us in our team-led and leader-enabled hybrid model. Our expectation is for most people in external, client serving roles to work together in person 40-60% of the time over the course of an engagement, project or year.
+ Under our flexible vacation policy, you'll decide how much vacation time you need based on your own personal circumstances. You'll also be granted time off for designated EY Paid Holidays, Winter/Summer breaks, Personal/Family Care, and other leaves of absence when needed to support your physical, financial, and emotional well-being.
**Are you ready to shape your future with confidence? Apply today.**
EY accepts applications for this position on an on-going basis.
For those living in California, please click here for additional information.
EY focuses on high-ethical standards and integrity among its employees and expects all candidates to demonstrate these qualities.
**EY | Building a better working world**
EY is building a better working world by creating new value for clients, people, society and the planet, while building trust in capital markets.
Enabled by data, AI and advanced technology, EY teams help clients shape the future with confidence and develop answers for the most pressing issues of today and tomorrow.
EY teams work across a full spectrum of services in assurance, consulting, tax, strategy and transactions. Fueled by sector insights, a globally connected, multi-disciplinary network and diverse ecosystem partners, EY teams can provide services in more than 150 countries and territories.
EY provides equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, pregnancy, genetic information, national origin, protected veteran status, disability status, or any other legally protected basis, including arrest and conviction records, in accordance with applicable law?
EY is committed to providing reasonable accommodation to qualified individuals with disabilities including veterans with disabilities. If you have a disability and either need assistance applying online or need to request an accommodation during any part of the application process, please call 1-800-EY-HELP3, select Option 2 for candidate related inquiries, then select Option 1 for candidate queries and finally select Option 2 for candidates with an inquiry which will route you to EY's Talent Shared Services Team (TSS) or email the TSS at .
At EY, we're all in to shape your future with confidence.
We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world.
? **Business Transformation - Sr Manager - Healthcare Provider - Acute Care**
Today's healthcare environment is undergoing rapid change and transformation. The market is being impacted by changing regulations, new payment structures, increasing reliance on technology, and a move towards population health. As a senior manager within our Health consulting practice, you'll work with clients across the healthcare industry, from hospitals and integrated delivery networks to commercial and governmental insurers. You'll use your industry knowledge and relationship skillsets to assist our clients in delivering services efficiently and effectively.
**The opportunity**
As part of EY's Health consulting practice, you will work with these clients across the country in solving complex problems in today's rapidly changing healthcare environment? We currently are seeking a highly motivated Senior Manager, with a focus on provider operations, to manage client engagement teams, work with a wide variety of clients to deliver professional services and manage business development activities on strategic and global priority accounts.
**Your key responsibilities**
As a Senior Manager in our Health consulting group focused on Clinical Operations, you'll spend most of your time teaming with our provider team working with a broad spectrum of not-for-profit and for-profit healthcare clients, including hospitals, healthcare systems, physician practices and academic medical centers, to assess and redesign clinical processes across the following areas:
+ Operational improvement
+ Benchmarking and financial quantification
+ Cost reduction/revenue enhancement
+ Workflow redesign
Our current hiring priorities are focused on engagements related to acute care. Candidates with experience leading work in the following areas are strongly preferred:
+ Acute care labor/ productivity
+ ED throughput
+ OR optimization
+ Length of stay and patient throughput
+ Care management redesign
+ Acute care organization design/ span of control
**Skills and attributes for success**
+ Effectively manage and motivate client engagement teams with diverse skills and backgrounds
+ Foster an innovative and inclusive team -oriented work environment. Play an active role in counselling and mentoring junior consultants within the organization
+ Foster relationships with client personnel at appropriate levels. Consistently deliver quality client services. Drive high-quality work products within expected timeframes and on budget. Monitor progress, manage risk and ensure key stakeholders are kept informed about progress and expected outcomes
+ Cultivate and manage business development opportunities. Understand EY and its service lines and actively assess/present ways to serve clients. Develop and maintain long-term client relationships and networks
+ Demonstrate in-depth technical capabilities and professional knowledge
**To qualify for the role, you must have**
+ A bachelor's degree and approximately 10 years of related work experience; or a graduate degree and approximately 7 years of related work experience.
+ Approximately 7 years of healthcare consulting experience in provider operations; acute care experience is preferred.
+ Prior experience as a senior manager (or above), in a consulting firm or in a senior management role within industry
+ Ability to read and interpret hospital financial statements and contract terms, utilize complex financial models, experience with operational process mapping and experience with healthcare cost reduction planning and implementation
+ Experience with healthcare organization M&A, physician alignment, or financial margin improvement initiatives
+ Experience in selling and delivering projects that cover the full life cycle of assessment, design and implementation support; demonstrated record of driving revenue within existing healthcare clients and in developing new prospects at the "C" level of large healthcare companies
+ Ability to manage a team of staff/senior/manager consulting professionals
+ Ability to work collaboratively in a team environment
+ Strong analytical and problem-solving skills, as well as excellent oral and written communication skills
+ A willingness to travel to meet client needs; travel is estimated at 80%.
**Ideally, you'll also have**
+ A degree with an emphasis in Finance, Accounting, and/or Business; CPA, MBA, MHA and/or MPH
+ Clinical background is preferred but not required.
**What we look for**
We're interested in passionate leaders with strong vision and a desire to stay on top of trends in the healthcare industry. If you have a genuine passion for healthcare, this role is for you.
**What we offer you**
At EY, we'll develop you with future-focused skills and equip you with world-class experiences. We'll empower you in a flexible environment, and fuel you and your extraordinary talents in a diverse and inclusive culture of globally connected teams. Learn more .
+ We offer a comprehensive compensation and benefits package where you'll be rewarded based on your performance and recognized for the value you bring to the business. The base salary range for this job in all geographic locations in the US is $150,400 to $43,600. The base salary range for New York City Metro Area, Washington State and California (excluding Sacramento) is 180,500 to 390,500. Individual salaries within those ranges are determined through a wide variety of factors including but not limited to education, experience, knowledge, skills and geography. In addition, our Total Rewards package includes medical and dental coverage, pension and 401(k) plans, and a wide range of paid time off options.
+ Join us in our team-led and leader-enabled hybrid model. Our expectation is for most people in external, client serving roles to work together in person 40-60% of the time over the course of an engagement, project or year.
+ Under our flexible vacation policy, you'll decide how much vacation time you need based on your own personal circumstances. You'll also be granted time off for designated EY Paid Holidays, Winter/Summer breaks, Personal/Family Care, and other leaves of absence when needed to support your physical, financial, and emotional well-being.
**Are you ready to shape your future with confidence? Apply today.**
EY accepts applications for this position on an on-going basis.
For those living in California, please click here for additional information.
EY focuses on high-ethical standards and integrity among its employees and expects all candidates to demonstrate these qualities.
**EY | Building a better working world**
EY is building a better working world by creating new value for clients, people, society and the planet, while building trust in capital markets.
Enabled by data, AI and advanced technology, EY teams help clients shape the future with confidence and develop answers for the most pressing issues of today and tomorrow.
EY teams work across a full spectrum of services in assurance, consulting, tax, strategy and transactions. Fueled by sector insights, a globally connected, multi-disciplinary network and diverse ecosystem partners, EY teams can provide services in more than 150 countries and territories.
EY provides equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, pregnancy, genetic information, national origin, protected veteran status, disability status, or any other legally protected basis, including arrest and conviction records, in accordance with applicable law?
EY is committed to providing reasonable accommodation to qualified individuals with disabilities including veterans with disabilities. If you have a disability and either need assistance applying online or need to request an accommodation during any part of the application process, please call 1-800-EY-HELP3, select Option 2 for candidate related inquiries, then select Option 1 for candidate queries and finally select Option 2 for candidates with an inquiry which will route you to EY's Talent Shared Services Team (TSS) or email the TSS at .
View Now
3
Business Transformation, Healthcare Provider Operations Consulting_Manager
85702 Tucson, Arizona
EY
Posted today
Job Viewed
Job Description
Location: Anywhere in Country
At EY, we're all in to shape your future with confidence.
We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world.
**Business Transformation, Healthcare Provider Operations Consulting_Manager**
**#Healthconsulting**
Today's healthcare environment in the post-COVID era is undergoing rapid change and transformation. As healthcare organizations seek to stabilize operations and plan for a financially sustainable future, they are challenged to integrate transformative technology (Artificial intelligence, automation, etc.), adjust to patient-focused operations, and maintain operational discipline to withstand increasing financial pressures. As a manager within our Health consulting practice, you'll work with clients across the healthcare industry, from hospitals and integrated delivery networks to commercial and governmental insurers. You'll use your industry knowledge and relationship skillsets to assist our clients in transforming operations to meet the evolving demands of today's healthcare market.
**The opportunity**
As part of EY's Health consulting practice, you will work with these clients across the country in solving complex problems in today's rapidly changing healthcare environment? We currently are seeking a highly motivated Manager, with a focus on provider operations, to manage client engagement teams, work with a wide variety of clients to deliver professional services and manage business development activities on strategic and global priority accounts.
**Your key responsibilities**
You'll spend most of your time teaming with our provider team working with a broad spectrum of not-for-profit and for-profit healthcare clients, including hospitals, healthcare systems, physician practices and academic medical centers, to assess and redesign clinical processes.
As a Manager in our Health consulting group focused on Provider Operations, you'll work with clients across the following areas:
+ Operational improvement
+ Benchmarking and financial quantification
+ Cost reduction/revenue enhancement
+ Workflow redesign
**Skills and attributes for success**
+ Effectively manage and motivate client engagement teams with diverse skills and backgrounds Foster an innovative and inclusive team -oriented work environment. Play an active role in counselling and mentoring junior consultants within the organization
+ Foster relationships with client personnel at appropriate levels. Consistently deliver quality client services. Drive high-quality work products within expected timeframes and on budget. Monitor progress, manage risk and ensure key stakeholders are kept informed about progress and expected outcomes
+ Cultivate and manage business development opportunities. Understand EY and its service lines and actively assess/present ways to serve clients. Develop and maintain long-term client relationships and networks
+ Demonstrate in-depth technical capabilities and professional knowledge
**To qualify for the role you must have**
+ A bachelor's degree and approximately 5 years of related work experience; or a master's degree and approximately 4 years of related work experience
+ Approximately 4 years of healthcare consulting experience, preferably with prior experience as a manager (or above), in a consulting firm or in a management role within industry
+ Ability to read and interpret hospital financial statements and contract terms, utilize complex financial models, experience with operational process mapping and experience with healthcare cost reduction planning and implementation
+ Experience with healthcare organization M&A, physician alignment, or financial margin improvement initiatives
+ Experience in selling and delivering projects that cover the full life cycle of assessment, design and implementation support
+ Assist in generating revenue within existing healthcare clients and in developing new prospects at the "C" level of large healthcare companies
+ Ability to manage a team of staff/senior consulting professionals
+ Ability to work collaboratively in a team environment (knows when to lead and when to follow)
+ Strong analytical and problem-solving skills, as well as excellent oral and written communication skills
+ A willingness to travel to meet client needs; travel is required as neede by the client.
**Ideally you'll also have**
+ A degree with an emphasis in Finance, Accounting, and/or Business; CPA, MBA, MHA and/or MPH
**What we look for**
We're interested in passionate leaders with strong vision and a desire to stay on top of trends in the healthcare industry. If you have a genuine passion for healthcare, this role is for you
**What we offer you**
At EY, we'll develop you with future-focused skills and equip you with world-class experiences. We'll empower you in a flexible environment, and fuel you and your extraordinary talents in a diverse and inclusive culture of globally connected teams. Learn more .
+ We offer a comprehensive compensation and benefits package where you'll be rewarded based on your performance and recognized for the value you bring to the business. The base salary range for this job in all geographic locations in the US is $127,100 to $33,000. The base salary range for New York City Metro Area, Washington State and California (excluding Sacramento) is 152,500 to 264,800 Individual salaries within those ranges are determined through a wide variety of factors including but not limited to education, experience, knowledge, skills and geography. In addition, our Total Rewards package includes medical and dental coverage, pension and 401(k) plans, and a wide range of paid time off options.
+ Join us in our team-led and leader-enabled hybrid model. Our expectation is for most people in external, client serving roles to work together in person 40-60% of the time over the course of an engagement, project or year.
+ Under our flexible vacation policy, you'll decide how much vacation time you need based on your own personal circumstances. You'll also be granted time off for designated EY Paid Holidays, Winter/Summer breaks, Personal/Family Care, and other leaves of absence when needed to support your physical, financial, and emotional well-being.
**Are you ready to shape your future with confidence? Apply today.**
EY accepts applications for this position on an on-going basis.
For those living in California, please click here for additional information.
EY focuses on high-ethical standards and integrity among its employees and expects all candidates to demonstrate these qualities.
**EY | Building a better working world**
EY is building a better working world by creating new value for clients, people, society and the planet, while building trust in capital markets.
Enabled by data, AI and advanced technology, EY teams help clients shape the future with confidence and develop answers for the most pressing issues of today and tomorrow.
EY teams work across a full spectrum of services in assurance, consulting, tax, strategy and transactions. Fueled by sector insights, a globally connected, multi-disciplinary network and diverse ecosystem partners, EY teams can provide services in more than 150 countries and territories.
EY provides equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, pregnancy, genetic information, national origin, protected veteran status, disability status, or any other legally protected basis, including arrest and conviction records, in accordance with applicable law?
EY is committed to providing reasonable accommodation to qualified individuals with disabilities including veterans with disabilities. If you have a disability and either need assistance applying online or need to request an accommodation during any part of the application process, please call 1-800-EY-HELP3, select Option 2 for candidate related inquiries, then select Option 1 for candidate queries and finally select Option 2 for candidates with an inquiry which will route you to EY's Talent Shared Services Team (TSS) or email the TSS at .
At EY, we're all in to shape your future with confidence.
We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world.
**Business Transformation, Healthcare Provider Operations Consulting_Manager**
**#Healthconsulting**
Today's healthcare environment in the post-COVID era is undergoing rapid change and transformation. As healthcare organizations seek to stabilize operations and plan for a financially sustainable future, they are challenged to integrate transformative technology (Artificial intelligence, automation, etc.), adjust to patient-focused operations, and maintain operational discipline to withstand increasing financial pressures. As a manager within our Health consulting practice, you'll work with clients across the healthcare industry, from hospitals and integrated delivery networks to commercial and governmental insurers. You'll use your industry knowledge and relationship skillsets to assist our clients in transforming operations to meet the evolving demands of today's healthcare market.
**The opportunity**
As part of EY's Health consulting practice, you will work with these clients across the country in solving complex problems in today's rapidly changing healthcare environment? We currently are seeking a highly motivated Manager, with a focus on provider operations, to manage client engagement teams, work with a wide variety of clients to deliver professional services and manage business development activities on strategic and global priority accounts.
**Your key responsibilities**
You'll spend most of your time teaming with our provider team working with a broad spectrum of not-for-profit and for-profit healthcare clients, including hospitals, healthcare systems, physician practices and academic medical centers, to assess and redesign clinical processes.
As a Manager in our Health consulting group focused on Provider Operations, you'll work with clients across the following areas:
+ Operational improvement
+ Benchmarking and financial quantification
+ Cost reduction/revenue enhancement
+ Workflow redesign
**Skills and attributes for success**
+ Effectively manage and motivate client engagement teams with diverse skills and backgrounds Foster an innovative and inclusive team -oriented work environment. Play an active role in counselling and mentoring junior consultants within the organization
+ Foster relationships with client personnel at appropriate levels. Consistently deliver quality client services. Drive high-quality work products within expected timeframes and on budget. Monitor progress, manage risk and ensure key stakeholders are kept informed about progress and expected outcomes
+ Cultivate and manage business development opportunities. Understand EY and its service lines and actively assess/present ways to serve clients. Develop and maintain long-term client relationships and networks
+ Demonstrate in-depth technical capabilities and professional knowledge
**To qualify for the role you must have**
+ A bachelor's degree and approximately 5 years of related work experience; or a master's degree and approximately 4 years of related work experience
+ Approximately 4 years of healthcare consulting experience, preferably with prior experience as a manager (or above), in a consulting firm or in a management role within industry
+ Ability to read and interpret hospital financial statements and contract terms, utilize complex financial models, experience with operational process mapping and experience with healthcare cost reduction planning and implementation
+ Experience with healthcare organization M&A, physician alignment, or financial margin improvement initiatives
+ Experience in selling and delivering projects that cover the full life cycle of assessment, design and implementation support
+ Assist in generating revenue within existing healthcare clients and in developing new prospects at the "C" level of large healthcare companies
+ Ability to manage a team of staff/senior consulting professionals
+ Ability to work collaboratively in a team environment (knows when to lead and when to follow)
+ Strong analytical and problem-solving skills, as well as excellent oral and written communication skills
+ A willingness to travel to meet client needs; travel is required as neede by the client.
**Ideally you'll also have**
+ A degree with an emphasis in Finance, Accounting, and/or Business; CPA, MBA, MHA and/or MPH
**What we look for**
We're interested in passionate leaders with strong vision and a desire to stay on top of trends in the healthcare industry. If you have a genuine passion for healthcare, this role is for you
**What we offer you**
At EY, we'll develop you with future-focused skills and equip you with world-class experiences. We'll empower you in a flexible environment, and fuel you and your extraordinary talents in a diverse and inclusive culture of globally connected teams. Learn more .
+ We offer a comprehensive compensation and benefits package where you'll be rewarded based on your performance and recognized for the value you bring to the business. The base salary range for this job in all geographic locations in the US is $127,100 to $33,000. The base salary range for New York City Metro Area, Washington State and California (excluding Sacramento) is 152,500 to 264,800 Individual salaries within those ranges are determined through a wide variety of factors including but not limited to education, experience, knowledge, skills and geography. In addition, our Total Rewards package includes medical and dental coverage, pension and 401(k) plans, and a wide range of paid time off options.
+ Join us in our team-led and leader-enabled hybrid model. Our expectation is for most people in external, client serving roles to work together in person 40-60% of the time over the course of an engagement, project or year.
+ Under our flexible vacation policy, you'll decide how much vacation time you need based on your own personal circumstances. You'll also be granted time off for designated EY Paid Holidays, Winter/Summer breaks, Personal/Family Care, and other leaves of absence when needed to support your physical, financial, and emotional well-being.
**Are you ready to shape your future with confidence? Apply today.**
EY accepts applications for this position on an on-going basis.
For those living in California, please click here for additional information.
EY focuses on high-ethical standards and integrity among its employees and expects all candidates to demonstrate these qualities.
**EY | Building a better working world**
EY is building a better working world by creating new value for clients, people, society and the planet, while building trust in capital markets.
Enabled by data, AI and advanced technology, EY teams help clients shape the future with confidence and develop answers for the most pressing issues of today and tomorrow.
EY teams work across a full spectrum of services in assurance, consulting, tax, strategy and transactions. Fueled by sector insights, a globally connected, multi-disciplinary network and diverse ecosystem partners, EY teams can provide services in more than 150 countries and territories.
EY provides equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, pregnancy, genetic information, national origin, protected veteran status, disability status, or any other legally protected basis, including arrest and conviction records, in accordance with applicable law?
EY is committed to providing reasonable accommodation to qualified individuals with disabilities including veterans with disabilities. If you have a disability and either need assistance applying online or need to request an accommodation during any part of the application process, please call 1-800-EY-HELP3, select Option 2 for candidate related inquiries, then select Option 1 for candidate queries and finally select Option 2 for candidates with an inquiry which will route you to EY's Talent Shared Services Team (TSS) or email the TSS at .
View Now
4
Senior Analyst, Healthcare Analytics (Risk Adjustment) - REMOTE
85702 Tucson, Arizona
Molina Healthcare
Posted today
Job Viewed
Job Description
**JOB DESCRIPTION**
**Job Summary**
This Sr. Analyst, Healthcare Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare intervention program performance. Develops and presents Risk Adjustment intervention ROI, incremental conditions captured, and other program performance reports including forecasts and makes recommendations based on relevant findings. Performs Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items (SAIs) to meet business needs. Performs analysis across multiple states and lines of business (Medicare, Medicaid, Marketplace ACA).
**KNOWLEDGE/SKILLS/ABILITIES**
+ Compiling and organizing health care data using Databricks and Spark SQL, Notebooks, Workflows, Repositories, SQL Server Stored Procedures, SQL Server Integration Services (SSIS), and other analytic / programming tools as needed
+ Reporting includes Risk Adjustment program performance metrics, risk score and revenue impact, tracking of strategic/scorable action items, annual and quarterly forecasts, and regular deep dives to drive improvement in financial results
+ Take ownership with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps
+ Create databases and reporting dashboards for monitoring, tracking and trending based on project specifications and applies automation as appropriate
+ Complete analysis and forecasting of risk adjustment intervention program values
+ Develop and demonstrate proficiency in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS model for Medicaid members, and others as needed
+ Must have a strong attention to detail and knowledge of data structure and programming
+ Performing financial analysis to assist in delivering optimal health care management and decision making
+ Understanding and applying data storage and data sharing best practices
+ Converting data into usable information that is easy to understand and provides insights needed to support strategic investment decisions
+ Research and develop reports and analyses for senior management and effectively and concisely communicate results and key takeaways
+ Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce errors and rework
+ Practice strong judgement in carrying out work independently, consult with experts as needed and use available resources and reports to critique results
+ Manage multiple projects and consistently deliver results on time in a fast-paced environment with changing priorities
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Computer Science
**Required Experience**
+ 5-7 years increasingly complex database and data management responsibilities
+ 5-7 years of increasingly complex experience in quantifying, measuring, analyzing, and reporting financial/performance management metrics
+ Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare
+ Advanced knowledge of SQL
+ Proficient in Excel and visualization tools such as Power BI, Tableau, or similar
**Preferred Experience**
Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:
+ Proactively identify and investigate complex suspect areas regarding risk adjustment initiatives, risk score lift, conditions captured, and program value
+ Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan
+ Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.
+ Analysis and forecasting of program value and underlying population trends in risk adjustment to provide analytic support for finance, pricing and actuarial functions
+ Healthcare Analyst I or Financial/Accounting Analyst I experience desired
+ Multiple data systems and models
+ Data modelling and BI tools
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**Job Summary**
This Sr. Analyst, Healthcare Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare intervention program performance. Develops and presents Risk Adjustment intervention ROI, incremental conditions captured, and other program performance reports including forecasts and makes recommendations based on relevant findings. Performs Health Plan strategic analysis and planning and coordinates across business units on Risk Adjustment Program Valuation and Strategic/Scoreable Action Items (SAIs) to meet business needs. Performs analysis across multiple states and lines of business (Medicare, Medicaid, Marketplace ACA).
**KNOWLEDGE/SKILLS/ABILITIES**
+ Compiling and organizing health care data using Databricks and Spark SQL, Notebooks, Workflows, Repositories, SQL Server Stored Procedures, SQL Server Integration Services (SSIS), and other analytic / programming tools as needed
+ Reporting includes Risk Adjustment program performance metrics, risk score and revenue impact, tracking of strategic/scorable action items, annual and quarterly forecasts, and regular deep dives to drive improvement in financial results
+ Take ownership with root cause analysis to maintain high integrity data and processes to minimize discrepancies and gaps
+ Create databases and reporting dashboards for monitoring, tracking and trending based on project specifications and applies automation as appropriate
+ Complete analysis and forecasting of risk adjustment intervention program values
+ Develop and demonstrate proficiency in running all applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA members, the CDPS model for Medicaid members, and others as needed
+ Must have a strong attention to detail and knowledge of data structure and programming
+ Performing financial analysis to assist in delivering optimal health care management and decision making
+ Understanding and applying data storage and data sharing best practices
+ Converting data into usable information that is easy to understand and provides insights needed to support strategic investment decisions
+ Research and develop reports and analyses for senior management and effectively and concisely communicate results and key takeaways
+ Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce errors and rework
+ Practice strong judgement in carrying out work independently, consult with experts as needed and use available resources and reports to critique results
+ Manage multiple projects and consistently deliver results on time in a fast-paced environment with changing priorities
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree in Finance, Economics, Computer Science
**Required Experience**
+ 5-7 years increasingly complex database and data management responsibilities
+ 5-7 years of increasingly complex experience in quantifying, measuring, analyzing, and reporting financial/performance management metrics
+ Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare
+ Advanced knowledge of SQL
+ Proficient in Excel and visualization tools such as Power BI, Tableau, or similar
**Preferred Experience**
Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators:
+ Proactively identify and investigate complex suspect areas regarding risk adjustment initiatives, risk score lift, conditions captured, and program value
+ Initiate in-depth analysis of the suspect/problem areas and suggest a corrective action plan
+ Apply investigative skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc.
+ Analysis and forecasting of program value and underlying population trends in risk adjustment to provide analytic support for finance, pricing and actuarial functions
+ Healthcare Analyst I or Financial/Accounting Analyst I experience desired
+ Multiple data systems and models
+ Data modelling and BI tools
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
View Now
5
Project Manager, PMO - Healthcare
85702 Tucson, Arizona
Molina Healthcare
Posted today
Job Viewed
Job Description
**JOB DESCRIPTION**
**Job Summary**
Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, planning, and issue/risk management.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Proven depth of understanding and demonstrable results for effective management of intermediate to large-scale projects, using prescribed approach(as). Solid knowledge of methods and techniques involved in project management initiatives.
+ Work with IT and business teams to set up/ amend new/ existing healthplans and new lines of business.
+ Must have experience in merger and acquisitions
+ Familiarity with SDLC.
+ Must have strong experience in Jira and smartsheets is preferred
+ Knowledge in Medicare, Medicaid and Marketplace is highly preferred.
+ Able to develop detailed project plans, communication plans, schedules, role definition, risk management and assumptions.
+ Complete mastery of standard applications and project specific software. Able to learn new software with little to no instruction within a short timeframe and instruct others on its functionality.
+ Identifies problems and anticipates potential problems. Ability to present alternatives to manage/overcome obstacles.
+ May consultant with higher level project management staff and may refer to established procedures and/or prior experience to determine appropriate and timely action. Projects may have moderate cross functional impact and team organization.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's degree or equivalent combination of education and experience and at least 1 PM course required
**Required Experience**
2-4 years of relevant work experience in business, engineering, or a related field in lieu of degree acceptable.
**Preferred Education**
Additional formal training in PM preferred.
**Preferred License, Certification, Association**
PMP or Six Sigma Green Belt Certification desired.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $115,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
**Job Summary**
Focuses on process improvement, organizational change management, project management and other processes relative to the business. Project management includes estimating, scheduling, costing, planning, and issue/risk management.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Proven depth of understanding and demonstrable results for effective management of intermediate to large-scale projects, using prescribed approach(as). Solid knowledge of methods and techniques involved in project management initiatives.
+ Work with IT and business teams to set up/ amend new/ existing healthplans and new lines of business.
+ Must have experience in merger and acquisitions
+ Familiarity with SDLC.
+ Must have strong experience in Jira and smartsheets is preferred
+ Knowledge in Medicare, Medicaid and Marketplace is highly preferred.
+ Able to develop detailed project plans, communication plans, schedules, role definition, risk management and assumptions.
+ Complete mastery of standard applications and project specific software. Able to learn new software with little to no instruction within a short timeframe and instruct others on its functionality.
+ Identifies problems and anticipates potential problems. Ability to present alternatives to manage/overcome obstacles.
+ May consultant with higher level project management staff and may refer to established procedures and/or prior experience to determine appropriate and timely action. Projects may have moderate cross functional impact and team organization.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's degree or equivalent combination of education and experience and at least 1 PM course required
**Required Experience**
2-4 years of relevant work experience in business, engineering, or a related field in lieu of degree acceptable.
**Preferred Education**
Additional formal training in PM preferred.
**Preferred License, Certification, Association**
PMP or Six Sigma Green Belt Certification desired.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $115,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
View Now
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6
Sr. Program Manager - Healthcare Enrollment (Remote)
85702 Tucson, Arizona
Molina Healthcare
Posted today
Job Viewed
Job Description
**Job Summary**
Responsible for multiple Enrollment internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as review enhancement ROI. Candidate must have strong analytic, organizational skills and the ability to independently resolve issues and remove hurdles. This is a hybrid role that requires Program Management, System Analyst and Sr. Business Analyst skills. Responsibilities include troubleshooting, analyzing, managing assignments, assisting team members, oversight of vendor projects, reviewing team outputs, review of deployment request and post deployment monitoring.
Building and maintaining strong relationships and proactive processes are key to the success of this team. The selected candidate would act as the liaison between the business, vendors , IT, and support Program Managers and Business Analyst in a subject matter expert capacity. May engage and oversee the work of external vendors. Coordinates with business analyst, IT and business areas, provides and reviews requirements and test results.
Knowledge/Skills/Abilities
+ Independently manage and deliver Enrollment Enterprise wide project initiatives from inception through delivery
+ Subject matter expert of enrollment to Program Managers and Analyst and in functional areas (Inbound and Outbound)
+ Communicate and collaborate with Operations, Health Plans and Leadership to analyze and transform needs and goals into functional requirements
+ Develops, defines, and executes plans, schedules, and deliverables. Monitors programs from initiation through delivery
+ Identify root cause, function and process improvement opportunities that are critical to effective outcome
+ Leads programs to meet critical needs. Including but not limited to BRD reviews, logic changes, root cause analysis, etc.
+ Works with operational leaders within the business to provide recommendations on opportunities for process improvements
+ Collaborate with Other Teams within Molina to deliver End to End for any process within Enrollment Accounting Team
+ Active collaborator responsible for operation projects and programs involving enrollment and eligibility
+ Works with cross-functional teams and IT and business subject matter expert and to deliver products from design to completion
+ Subject matter expert of enrollment and provides knowledge and feedback to ensure regulatory and Addresses health plan concerns within Enrollment Operations
+ Researches, interpret, define and summarize enhancement recommendations
+ Provides health plan requirement recommendations
+ Responsible for managing deliverables, improving performance, training needs, support to other business units
+ Strong business knowledge related to Medicaid and Medicare lines of business
+ Reviews enrollment issue trends and provides long term solutions as needed
+ Manages, creates and communicates status reports
+ Ensures compliant with regulatory and company guidelines, including HIPAA compliance
+ This position primarily focuses on project/program management related to the business projects, rather than the technical application projects
+ Focuses on process improvement, organizational change management, program management and other processes relative to the business
+ Participate and lead brainstorming sessions to develop new concepts to build efficiencies
+ Ideally possess minimum of 5 years' experience with eligibility processing, including; eligibility Applications and Files
+ Extensive knowledge in health insurance
+ Knowledge of enrollment files, including extracts
+ Program Manager experience
+ Sr. Business or System Analyst experience
+ Process Improvement Experience.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
7-9 years
**Required License, Certification, Association**
PMP Certification (and/or comparable coursework)
**Preferred Education**
Graduate Degree or equivalent combination of education and experience
**Preferred Experience**
10+ years
**Preferred License, Certification, Association**
Six Sigma Black Belt Certification, ITIL Certification desired
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Responsible for multiple Enrollment internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as review enhancement ROI. Candidate must have strong analytic, organizational skills and the ability to independently resolve issues and remove hurdles. This is a hybrid role that requires Program Management, System Analyst and Sr. Business Analyst skills. Responsibilities include troubleshooting, analyzing, managing assignments, assisting team members, oversight of vendor projects, reviewing team outputs, review of deployment request and post deployment monitoring.
Building and maintaining strong relationships and proactive processes are key to the success of this team. The selected candidate would act as the liaison between the business, vendors , IT, and support Program Managers and Business Analyst in a subject matter expert capacity. May engage and oversee the work of external vendors. Coordinates with business analyst, IT and business areas, provides and reviews requirements and test results.
Knowledge/Skills/Abilities
+ Independently manage and deliver Enrollment Enterprise wide project initiatives from inception through delivery
+ Subject matter expert of enrollment to Program Managers and Analyst and in functional areas (Inbound and Outbound)
+ Communicate and collaborate with Operations, Health Plans and Leadership to analyze and transform needs and goals into functional requirements
+ Develops, defines, and executes plans, schedules, and deliverables. Monitors programs from initiation through delivery
+ Identify root cause, function and process improvement opportunities that are critical to effective outcome
+ Leads programs to meet critical needs. Including but not limited to BRD reviews, logic changes, root cause analysis, etc.
+ Works with operational leaders within the business to provide recommendations on opportunities for process improvements
+ Collaborate with Other Teams within Molina to deliver End to End for any process within Enrollment Accounting Team
+ Active collaborator responsible for operation projects and programs involving enrollment and eligibility
+ Works with cross-functional teams and IT and business subject matter expert and to deliver products from design to completion
+ Subject matter expert of enrollment and provides knowledge and feedback to ensure regulatory and Addresses health plan concerns within Enrollment Operations
+ Researches, interpret, define and summarize enhancement recommendations
+ Provides health plan requirement recommendations
+ Responsible for managing deliverables, improving performance, training needs, support to other business units
+ Strong business knowledge related to Medicaid and Medicare lines of business
+ Reviews enrollment issue trends and provides long term solutions as needed
+ Manages, creates and communicates status reports
+ Ensures compliant with regulatory and company guidelines, including HIPAA compliance
+ This position primarily focuses on project/program management related to the business projects, rather than the technical application projects
+ Focuses on process improvement, organizational change management, program management and other processes relative to the business
+ Participate and lead brainstorming sessions to develop new concepts to build efficiencies
+ Ideally possess minimum of 5 years' experience with eligibility processing, including; eligibility Applications and Files
+ Extensive knowledge in health insurance
+ Knowledge of enrollment files, including extracts
+ Program Manager experience
+ Sr. Business or System Analyst experience
+ Process Improvement Experience.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
7-9 years
**Required License, Certification, Association**
PMP Certification (and/or comparable coursework)
**Preferred Education**
Graduate Degree or equivalent combination of education and experience
**Preferred Experience**
10+ years
**Preferred License, Certification, Association**
Six Sigma Black Belt Certification, ITIL Certification desired
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $171,058 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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7
Account Manager II - Honeywell Building Solutions - Healthcare
85702 Tucson, Arizona
Honeywell
Posted today
Job Viewed
Job Description
Manage all aspects of engagements with existing and new customers for our Honeywell Building Solutions organization. You will build relationships and understand customer business in order to provide appropriate products and solutions. You will define sales and growth strategy toward key customers while aligning with critical sales business objectives. You will identify opportunities and build credibility with customers and utilize your product knowledge to deliver the value proposition to the customers. This is a Solutions based sales role, crafting both hardware and software solutions to meet the needs of our customers in the Healthcare sector.
You will work under our Sales Manager. This is a remote role but requires travel within the territory. The expected territory for this role is Arizona, New Mexico, and West Texas.
**Key Responsibilities**
+ Develop and execute strategic account plans
+ Build and maintain strong relationships with key customers
+ Identify new business opportunities and deliver value-added solutions
+ Drive revenue growth and achieve sales targets
+ Provide strategic guidance and mentorship to the team
+ Develop and implement strategies to expand market presence
+ Travel up to 60%
BENEFITS OF WORKING FOR HONEYWELL
In addition to a performance-driven salary, cutting-edge work, and developing solutions side-by-side with dedicated experts in their fields, Honeywell employees are eligible for a comprehensive benefits package. This package includes employer-subsidized Medical, Dental, Vision, and Life Insurance; Short-Term and Long-Term Disability; 401(k) match, Flexible Spending Accounts, Health Savings Accounts, EAP, and Educational Assistance; Parental Leave, Paid Time Off (for vacation, personal business, sick time, and parental leave), and 12 Paid Holidays.
The application period for the job is estimated to be 40 days from the job posting date; however, this may be shortened or extended depending on business needs and the availability of qualified candidates.
Key Responsibilities
+ Develop and execute account management strategies to drive sales growth and achieve targets
+ Build and maintain strong relationships with key accounts, serving as the primary point of contact
+ Identify new business opportunities and collaborate with customers to deliver valueadded solutions
+ Conduct regular business reviews with customers to ensure customer satisfaction and identify areas for improvement
+ Monitor market trends, competitor activities, and customer feedback to identify opportunities for growth
**MUST HAVE**
+ 2+ years experience in a Sales/Account Management related field - specifically Enterprise software solutions, Fire Alarm systems, Cybersecurity, DDC Controls Automation, etc
**WE VALUE**
+ Experience selling in the healthcare sector
+ Experience working with contractors
+ Excellent communication skills
+ Ability to influence at varying levels across the organization
+ Ability to handle multiple priorities and navigate in a highly matrixed environment
+ Solution-based sales experience
+ Salesforce experience
ABOUT HONEYWELL
Honeywell International Inc. (NYSE: HON) invents and commercializes technologies that address some of the world's most critical challenges around energy, safety, security, air travel, productivity, and global urbanization. We are a leading software-industrial company committed to introducing state-of-the-art technology solutions to improve efficiency, productivity, sustainability, and safety in high growth businesses in broad-based, attractive industrial end markets. Our products and solutions enable a safer, more comfortable, and more productive world, enhancing the quality of life of people around the globe.
Honeywell helps organizations solve the world's most complex challenges in automation, the future of aviation and energy transition. As a trusted partner, we provide actionable solutions and innovation through our Aerospace Technologies, Building Automation, Energy and Sustainability Solutions, and Industrial Automation business segments - powered by our Honeywell Forge software - that help make the world smarter, safer and more sustainable.
Honeywell is an equal opportunity employer. Qualified applicants will be considered without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality, sex, religion, or veteran status.
You will work under our Sales Manager. This is a remote role but requires travel within the territory. The expected territory for this role is Arizona, New Mexico, and West Texas.
**Key Responsibilities**
+ Develop and execute strategic account plans
+ Build and maintain strong relationships with key customers
+ Identify new business opportunities and deliver value-added solutions
+ Drive revenue growth and achieve sales targets
+ Provide strategic guidance and mentorship to the team
+ Develop and implement strategies to expand market presence
+ Travel up to 60%
BENEFITS OF WORKING FOR HONEYWELL
In addition to a performance-driven salary, cutting-edge work, and developing solutions side-by-side with dedicated experts in their fields, Honeywell employees are eligible for a comprehensive benefits package. This package includes employer-subsidized Medical, Dental, Vision, and Life Insurance; Short-Term and Long-Term Disability; 401(k) match, Flexible Spending Accounts, Health Savings Accounts, EAP, and Educational Assistance; Parental Leave, Paid Time Off (for vacation, personal business, sick time, and parental leave), and 12 Paid Holidays.
The application period for the job is estimated to be 40 days from the job posting date; however, this may be shortened or extended depending on business needs and the availability of qualified candidates.
Key Responsibilities
+ Develop and execute account management strategies to drive sales growth and achieve targets
+ Build and maintain strong relationships with key accounts, serving as the primary point of contact
+ Identify new business opportunities and collaborate with customers to deliver valueadded solutions
+ Conduct regular business reviews with customers to ensure customer satisfaction and identify areas for improvement
+ Monitor market trends, competitor activities, and customer feedback to identify opportunities for growth
**MUST HAVE**
+ 2+ years experience in a Sales/Account Management related field - specifically Enterprise software solutions, Fire Alarm systems, Cybersecurity, DDC Controls Automation, etc
**WE VALUE**
+ Experience selling in the healthcare sector
+ Experience working with contractors
+ Excellent communication skills
+ Ability to influence at varying levels across the organization
+ Ability to handle multiple priorities and navigate in a highly matrixed environment
+ Solution-based sales experience
+ Salesforce experience
ABOUT HONEYWELL
Honeywell International Inc. (NYSE: HON) invents and commercializes technologies that address some of the world's most critical challenges around energy, safety, security, air travel, productivity, and global urbanization. We are a leading software-industrial company committed to introducing state-of-the-art technology solutions to improve efficiency, productivity, sustainability, and safety in high growth businesses in broad-based, attractive industrial end markets. Our products and solutions enable a safer, more comfortable, and more productive world, enhancing the quality of life of people around the globe.
Honeywell helps organizations solve the world's most complex challenges in automation, the future of aviation and energy transition. As a trusted partner, we provide actionable solutions and innovation through our Aerospace Technologies, Building Automation, Energy and Sustainability Solutions, and Industrial Automation business segments - powered by our Honeywell Forge software - that help make the world smarter, safer and more sustainable.
Honeywell is an equal opportunity employer. Qualified applicants will be considered without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality, sex, religion, or veteran status.
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8
Healthcare Admin Secretary
85701 Tucson, Arizona
Fresenius Medical Care Holdings, Inc.
Posted 14 days ago
Job Viewed
Job Description
PURPOSE AND SCOPE:
The Secretary/ Receptionist performs general clerical support and office duties for the department and its Management.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Performs basic administrative functions including preparation of business correspondence, memorandums, informational packages, training materials and reports.
- Assists with scheduling.
- Maintains calendar and daily schedules.
- Maintains departmental tracking logs.
- Greets visitors and directs them to the appropriate location or person as needed.
- Establishes and maintains filing systems and basic databases as applicable.
- Performs routine general office duties such as filing, copying, and scanning.
- Provides general clerical support to management staff including scheduling meetings, routing phone calls and taking messages.
- Records minutes of meetings and providing the resulting documents as necessary.
- Sorts and distributes mail.
- Maintains inventory of the necessary office forms and supplies.
- Escalates issues to supervisor for resolution, as deemed necessary.
- Assist with various projects as assigned by direct supervisor.
- Other duties as assigned.
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION:
High School Diploma required
EXPERIENCE AND REQUIRED SKILLS:
- 1 – 2 years’ related experience.
- Knowledge of office procedures required.
- Proficient in Microsoft office applications.
- Good interpersonal and communication skills required.
- Pleasant telephone manner.
EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity
Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.
EOE, disability/veterans
Apply Now
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