Senior Medicaid Project Manager - Telecommute

Company: UnitedHealth Group ( Learn More )

General Information
US-MN-Eden Prairie
Not Specified
Not Specified
Not Specified
Job Description Optum CCM-Network has responsibility for developing and managing SNF networks for all United lines of business.  As a result, our department is tasked this year with building and maintaining networks for several Community and State migrations and expansions.  Due to this high level of Medicaid and federal expansions, Optum CCM-Network is in need of a full time project manager position to ensure timely and accurate completion of the tasks identified below to meet state and federal regulatory and United business requirements.

The project manager will be responsible for ensuring the tasks identified below are tracked, completed according to plan, and are regulatory compliant and meet the business needs of United.  The tasks to be managed by the project manager include (but are not limited to):

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Candidate should have exceptional organizational skills and be able to drive the implementations and keep all parties on task so that deliverables are met and hold all parties accountable.

  • Identification of Medicaid SNF benefits and regulatory requirements on an ongoing basis through extensive research on state Medicaid websites
  • Thorough understanding of RFP for all C&S Implementations
  • Identifying compliant coding for those benefits to include in our contract documents
  • Work with markets in Identifying state rates for covered SNF benefits via research state website and or RFP
  • Completing reimbursement summary based on market input and analysis
  • Manage and submit claim platform testing of all payment appendices created to ensure system compatibility and accurate claim payments to providers
  • Responsible for all Reporting needs for C&S as well as required state reporting
  • Coordinate with market /Contract Admin team mailing projects for contract paper and retrieval of signed documents
  • Maintain accurate work plan and tracking log of contract and contract loading status
  • Liaison with C&S health plan, represent Optum CCM at all internal and external meetings pertaining to network development
  • Coordinate all cross function work with other Optum and C&S internal departments and workgroups
  • Continued maintenance, research and review of all state files and websites to ensure accurate pricing and benefits are compliant and deliverables are met for all Medicaid lines of business during implementations, migrations, post implementations and post migrations to ensure accurate claims adjudication
  • Facilitating and coordinating all projects relating to C&S lob on an ongoing basis
  • Review and resolve claims issues as they relate to post implementations – Attend post implementation meetings
  • Ownership of Medicaid FTE interstate agreements review and confirmation and chargebacks ( monthly reconciliation )
  • Ownership of review and analysis of FTE calculation and management of FTE calculations for C&S support for market (PRA) OIT and contract admin teams
  • Evaluate Intersegment agreements to determine appropriate allocation of support and resources for all Medicaid lob

  • Required Qualifications:

  • 3+ years of project management experience using data and information to make business decisions
  • Proficiency with Excel, PowerPoint and SharePoint
  • 3+ years Medicaid related experience
  • Organizational skills

  • Preferred Qualifications:

  • PMP Certification
  • Visio
  • Undergraduate degree or equivalent work experience
  • Moderate experience with Facets Claims System

  • Optum is a diversified health services and innovation company where data, technology, people and action combine to make great things happen every day. Join us. Learn more about how you can start doing your life's best work.(sm)UnitedHealth Group is working to create the health care system of tomorrow. Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

    *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

    Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

    UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

    Job Keywords: Medicaid, Facets, PMI, Claims, Contracts, SNF, Telecommute, Telecommuter
    Job Requirements