The Project Manager is responsible for the execution of the overall operation of the assigned project(s), overall performance to contract requirements, and MAXIMUS quality and performance. The Project Manager will oversee all contract administrative functions including budget, financial controls and human resources. | | | Responsibilities: | •Establishes and maintains relationships with representatives of client agencies, stakeholders, and community organizations to promote and develop MAXIMUS services | •Represents MAXIMUS and the project in external meetings and forums | •Develops and maintains comprehensive knowledge of programs, MAXIMUS services, and project operations | •Oversees the development of proposals and pricing for amendments and new work | •Identifies new business opportunities | •Ensures project compliance with all applicable corporate, contract, state and federal requirements and regulations | •Provides executive management of the project's financial plan and forecast | •Develops performance goals and objectives for direct reports and monitors the achievement of those goals | •Other duties as may be assigned by corporate management | | Qualifications: | | •Preferred Masters’ degree, from an accepted and accredited college or university, in an appropriate field (i.e., MBA, MPA or MHA); | •Have at least six (6) years of management experience in healthcare administration and management; | •Demonstrate leadership ability; | •Have in-depth working knowledge of Managed Care, Medicaid, Children’s Health Insurance Program (CHIP) and low income populations; and | •Be knowledgeable of Missouri health care, social services, geographic and demographic environments. | •Excellent organizational, written, and verbal communication skills | •Excellent people management skills | •Strong client management skills | •Computer literate and information systems aptitude | •Strong communicator. Advisory, persuasive abilities, coaching and mentoring | •At least six years of experience in a senior management position in a health or human services-related field managing a large staff (250+ FTEs) | •Knowledge of Medicaid or Children’s health care, and/or human services programs preferred. Health and Human Services public sector, outreach experience, program experience, and proven manager of large complex organizations | •Proven ability with operational processes and working with community groups
Maximus is looking for experienced Siebel Developer(s) to upgrade Siebel application to latest IP17/20 version. The main objective of this effort is to upgrade, troubleshoot and resolve post-upgrade issues of current Siebel environment to latest version. This includes resolving any integration issues as well as re-designing eService module using Open UI framework. Will provide support to Siebel administrator to successfully perform code migration from one environment to other.
Required Skills & Experience: | Find and identify patterns, trends and stories in enterprise data | Solve open-ended business problems | Author database queries and modify existing queries | Knowledge of relational databases (Primary/Foreign keys, Inner/Outer joins, Indexes) | Develop self-service tools and dashboards using common visualization applications | | Required Tools, Applications & Programming Languages: | Microsoft SQL | Microsoft SQL Server Management Studio (SSMS) | Microsoft Excel (Advanced/Intermediate) | Microsoft SQL Server Reporting Services | Report Builder
This is a Bid requisition. State of Missouri. Knowledge of State of Missouri Healthcare.
As the lead executive on the ground in Missouri, the Project Director is responsible for the execution of the overall operation of the assigned project(s), overall performance to contract requirements, and MAXIMUS quality and performance. The Project Director will oversee all contract administrative functions including budget, financial controls and human resources, in addition to quality and risk management, training, and IT operations. Finally the Project Director will act as the primary contact point to the State Agency and have responsibility for developing the overall relationship with the client and other stakeholders throughout the project lifecycle. | | The operation located in or near Kansas City, MO, will consist of a call center, Medicaid eligibility processing, intake and handling (including scanning/imaging as well as data entry) of mail, and premium payment processing. | | Responsibilities: | •Establishes and maintains relationships with representatives of client agencies, stakeholders, and community organizations to promote and develop MAXIMUS services | •Represents MAXIMUS and the project in external meetings and forums | •Develops and maintains comprehensive knowledge of programs, MAXIMUS services, and project operations | •Oversees the development of proposals and pricing for amendments and new work | •Identifies new business opportunities | •Ensures project compliance with all applicable corporate, contract, state and federal requirements and regulations | •Provides executive management of the project's financial plan and forecast | •Develops performance goals and objectives for direct reports and monitors the achievement of those goals | •Other duties as may be assigned by corporate management | | Qualifications: | •Possess a Masters’ degree, from an accepted and accredited college or university, in an appropriate field (i.e., MBA, MPA or MHA); | •Have at least six (6) years of management experience in healthcare administration and extensive operations as well as client management skills; | •Demonstrate leadership ability; | • Have in-depth working knowledge of Managed Care, Medicaid, Children’s Health Insurance Program (CHIP) and low income populations; and | • Be knowledgeable of Missouri health care, social services, geographic and demographic environments. | •Excellent organizational, written, and verbal communication skills | •Excellent people management skills | •Strong client management skills | •Computer literate and information systems aptitude | •Strong communicator. Advisory, persuasive abilities, coaching and mentoring | •At least six years of experience in a senior management position in a health or human services-related field managing a large staff (150+ FTEs) | •Knowledge of Medicaid or Children’s health care, and/or human services programs preferred. Health and Human Services public sector, outreach experience, program experience, and proven manager of large complex organizations | •Proven ability with operational processes and working with community groups
The Sr. Human Resources Manager is responsible for overseeing all human resources functions to ensure high quality and effective human resources operations and administration.
SUMMARY | The Medical Director supports projects within Maximus’s Clinical Services Division, which performs a wide array of clinical assessment services for individuals with physical and/or mental disabilities seeking Medicaid-funded services and supports. The Medical Director serves as the project’s chief medical expert. The Medical Director provides consultation and training to project leadership and Registered Nurse (RN) reviewers to ensure all clinical reviews adhere to standards set forth in law and regulation and expectations set by the client and executive leadership. The Medical Director reports to the Project Director. | ESSENTIAL FUNCTIONS | 1.Provide consultation as needed to clinical review teams regarding complex cases, as well as mediation and appeals cases. | 2.Direct quality assurance oversight of nurse and physician work products. | 3.Provide advice and counsel to the client as directed. | 4.Drive innovative solutions to include automation to ensure cutting edge strategies & implementation of best practices within our industry. | 5.Direct the development of training materials for nurses and physicians. | ACCOUNTABILITY | •Maintains primary responsibility for ensuring customer satisfaction, resolving compliance issues, accountability for profit & loss and adherence to operational budgets with assigned contracts. | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Ability to demonstrate not less than two years' experience in a management role with oversight of quality assurance or medical management functions, including disability review/evaluation and evidence-based medicine research or application. | •Ability to work effectively in a “hands-on” management role, motivating staff through variety of communications vehicles to include remote working when necessary. | •Assist program staff in consistent interpretation of relevant all federal and state-specific criteria and guidelines | •Direct and control the activities of a broad functional area through several department managers within the company. | •Has overall control of planning, recommending and implementing changes to methodology and standards for performance. | •Work on complex issues where analysis of situations or data is utilized to accurately drive performance decisions and/or company NC business trajectory. | •Participate in corporate development of methods, techniques and evaluation criteria for projects, programs, and people. | •Regularly interact with executives and/or major customers. | •Excellent organizational, interpersonal, written, and verbal communication skills. | •Ability to successfully execute many complex tasks simultaneously. | Education | Doctorate of Medicine, board-certified and licensed to practice medicine in North Carolina and meet stringent credentialing standards. Expertise in North Carolina Medicaid and standards of care strongly preferred. | Experience | The job requires seven (7) years of experience managing operations, preferably in Medicaid-funded healthcare program, mental health, or a related field.
The Clinical Director oversees quality functions in Maximus’s Clinical Services Division, which performs a wide array of clinical assessment services for individuals with physical and/or mental disabilities seeking Medicaid-funded services and supports. The incumbent provides management and execution of key quality, technical, and operational processes to support program and technical operations. This role is based in Raleigh, NC; however, due to precautions related to COVID-19, this position may be temporarily remote. | | | ESSENTIAL FUNCTIONS | 1.Directs clinical operations of the company, ensuring compliance with standards. Holds formal and informal meetings and discussions with employees to offer clinical support and ensure clinical compliance in all areas of operations. Ensures clinical standards are incorporated into all project plans. Informs the Project Director about new and ongoing clinical issues. Communicates clinical updates throughout the company. | 2.Directs the management of the company Quality Improvement Plan (QIP) with the Quality Improvement Manager, ensuring compliance with standards and meeting customer expectations. Develops and monitors QIP processes and informs Project Direction about quality performance issues. | 3.Leads investigations of all clinical concerns, including formal complaints and quality of care concerns, through careful analysis of documentation and discussions with associated employees, customers, and/or stakeholders. Ensures complaints investigation and quality of care concern processes are followed and recommends course(s) of action to Project Director. | 4.Responsible for the delivery of a wide range of complete strategic program and/or business process analytics for the project. Analyzes trends and creates solutions to ensure that customer service needs are met, and the program remains in compliance. Collects reportable data and completes any reporting needs for the project. | 5.Directs the management of the quality of the program with the Project Director, ensuring compliance with standards and meeting customer expectations. Develops and monitors quality processes and informs Program Director about quality performance issues. | 6.Translates reportable data into information, interprets data, and understands the implications of data to the business. Provides recommendations to management, create and implements strategies to ensure that productivity goals are met while containing costs for the program. | 7.Documents program issues and performance measures for management review, and provides information to assist in the feedback and formal education process of employees. Develop processes to build operational policies, procedures, and/or user guides for the project. | 8.Address exceptional issues related to quality, service and compliance of the project. Analyzes operational processes, including reviewing, creating, and improving policies, procedures, systems, forms, and reports. Analyzes existing forms and methods to promote effective operations through standardization, improvement, simplification, discontinuance or other methods. | 9.Responsible for working with the IT Vendor to develop improved systems to ensure effective program operations. | 10.Performs other duties, as necessary or assigned by the Project Director. | | ACCOUNTABILITY | •Accountable for meeting all established quality and data analysis goals for the project | | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Ability to lead and drive continuous quality improvement | •Ability to work effectively in a “hands-on” management role | •Outstanding work ethic, integrity, and value system | •Excellent clinical process skills | •Ability to perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies | •Ability to analyze large and varied sets of data and draw meaningful conclusions | •Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned expeditiously | •Excellent organizational skills | •Excellent negotiation and interpersonal skills, including ability to use effective diplomacy in dealing with senior business leaders and other business parties | •Ability to work independently with minimal day-to-day supervision | •Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers | •Advanced skill with word processing, spreadsheet, presentation, and publishing software (Microsoft Word, Excel, PowerPoint, Publisher, and Visio strongly preferred) | | Education | Eligible candidates must have a Bachelor’s degree in a health and human services discipline and be a Registered Nurse or Licensed Clinical Social Worker, licensed in North Carolina. Doctorate of Nursing Practice specializing in geriatrics or adult home health is preferred. | | Experience | The job requires at least five (5) years of experience working in a clinical medical capacity, knowledge of hospital and home health care, including experience managing and/or collaborating with physicians and statistical experience associated with sampling strategies, trending and analysis, and implementation of feedback strategies. Professional training and/or certification in a formal quality program (e.g. Six Sigma, Baldrige, CQM) preferred. Knowledge of Medicaid programs strongly preferred.
Maximus’s Clinical Services Division performs a wide array of clinical assessment services for individuals with physical and/or mental disabilities seeking Medicaid-funded services and supports. The Program Manager reports to the Project Director. The Program Manager is accountable for the overall delivery of volume, quality and service level performance targets within the North Carolina Preadmission Screening and Resident Review (PASRR) contract, along with developing and monitoring their operational budgets. The Program Manager drives operational excellence for their assigned contracts and will identify, manage, and execute process improvements that yield efficiencies and meet or exceed operational metrics. The Program Manager develops and promotes talent within their assigned contracts as well as drives employee satisfaction, retention and promotions. The Program Manager also leads special projects and initiatives as assigned by the Project Director. | | ESSENTIAL FUNCTIONS | 1.Manages day to day operations and performance of assigned contracts including P&L, quality and compliance with terms and conditions along with preparing and analyzing regular performance reports. | 2.Manages the customer relationship for assigned contracts ensuring effective and efficient communication along with addressing and resolving customer complaints. | 3.Provides leadership and direct supervision to assigned employees, including setting goals, monitoring work performance, coaching and evaluating results to ensure that objectives are met. | 4.Regularly interacts with senior management or executive levels on matters concerning assigned contracts. | 5.Participates in continual process improvement by monitoring, refining, and optimizing staffing, assignments, workflow and processes. | 6.Creates an effective work environment by involvement in developing and hiring superior talent and instilling a culture of accountability, measurability and discipline. | 7.Participates in developing, modifying and executing company policies that affect operations and may also have organization-wide effects. | 8.Works collaboratively and effectively with IT to ensure that product and service applications and technologies are optimized for assigned contract compliance, productivity, and quality performance. | 9.Performs other duties, as necessary. | ACCOUNTABILITY | •Maintains primary responsibility for ensuring customer satisfaction, resolving compliance issues, accountability for profit & loss and adherence to operational budgets with assigned contracts. | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Ability to lead and manage day to day operations and drive continuous improvement | •Strong project management skills and/or aptitude | •Ability to work effectively in a “hands-on” management role, motivating staff through variety of communications vehicles | •Ability to document and re-engineer business processes | •Ability to create and direct a ‘daily management plan’ for all contracts | •Outstanding work ethic, integrity, and value system | •Excellent analytical and complex reasoning skills | •Ability to perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies | •Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned within six business hours of receipt | •Strong organizational, supervisory and interpersonal skills | •Outstanding written and verbal communication skills | •Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers | •Advanced skill with word processing, spreadsheet, presentation, and publishing software (Microsoft Word, Excel, PowerPoint, Publisher, and Visio strongly preferred) | | Education | The job requires a Bachelor’s degree, Master’s degree, or completion of an accredited nursing program. Completion of an accredited MBA program and/or PMP certification is preferred. | | Experience | The job requires five (5) years of experience managing operations, preferably in Medicaid-funded healthcare program, mental health, or a related field.
Maximus’s Clinical Services Division performs a wide array of clinical assessment services for individuals with physical and/or mental disabilities seeking Medicaid-funded services and supports. The Program Manager is accountable for the overall delivery of volume, quality and service level performance targets within the North Carolina Personal Care Services (PCS) contract, along with developing and monitoring their operational budgets. The Program Manager drives operational excellence for their assigned contracts and will identify, manage, and execute process improvements that yield efficiencies and meet or exceed operational metrics. The Program Manager develops and promotes talent within their assigned contracts as well as drives employee satisfaction, retention and promotions. The Program Manager reports to the Project Director and leads special projects and initiatives as assigned by the Project Director. | | ESSENTIAL FUNCTIONS | 1.Manages day to day operations and performance of assigned contracts including P&L, quality and compliance with terms and conditions along with preparing and analyzing regular performance reports. | 2.Manages the customer relationship for assigned contracts ensuring effective and efficient communication along with addressing and resolving customer complaints. | 3.Provides leadership and direct supervision to assigned employees, including setting goals, monitoring work performance, coaching and evaluating results to ensure that objectives are met. | 4.Regularly interacts with senior management or executive levels on matters concerning assigned contracts. | 5.Participates in continual process improvement by monitoring, refining, and optimizing staffing, assignments, workflow and processes. | 6.Creates an effective work environment by involvement in developing and hiring superior talent and instilling a culture of accountability, measurability and discipline. | 7.Participates in developing, modifying and executing company policies that affect operations and may also have organization-wide effects. | 8.Works collaboratively and effectively with IT to ensure that product and service applications and technologies are optimized for assigned contract compliance, productivity, and quality performance. | 9.Performs other duties, as necessary. | ACCOUNTABILITY | •Maintains primary responsibility for ensuring customer satisfaction, resolving compliance issues, accountability for profit & loss and adherence to operational budgets with assigned contracts. | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Ability to lead and manage day to day operations and drive continuous improvement | •Strong project management skills and/or aptitude | •Ability to work effectively in a “hands-on” management role, motivating staff through variety of communications vehicles | •Ability to document and re-engineer business processes | •Ability to create and direct a daily management plan for all contracts | •Outstanding work ethic, integrity, and value system | •Excellent analytical and complex reasoning skills | •Ability to perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies | •Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned within six business hours of receipt | •Strong organizational, supervisory and interpersonal skills | •Outstanding written and verbal communication skills | •Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers | •Advanced skill with word processing, spreadsheet, presentation, and publishing software (Microsoft Word, Excel, PowerPoint, Publisher, and Visio strongly preferred) | | Education | The job requires a Registered Nurse licensed in North Carolina. PMP certification is preferred. | | Experience | The job requires at least five (5) years of experience managing operations, preferably in Medicaid-funded healthcare programs, mental health, or a related field.
Maximus’s Clinical Services Division performs a wide array of clinical assessment services for individuals with physical and/or mental disabilities seeking Medicaid-funded services and supports. The Program Manager reports to the Project Director. The Program Manager is accountable for the overall delivery of volume, quality and service level performance targets within the North Carolina Community Alternatives Program for Disabled Adults (CAP/DA) scope, along with developing and monitoring their operational budgets. The Program Manager drives operational excellence for their assigned contracts and will identify, manage, and execute process improvements that yield efficiencies and meet or exceed operational metrics. The Program Manager develops and promotes talent within their assigned contracts as well as drives employee satisfaction, retention and promotions. The Program Manager also leads special projects and initiatives as assigned by the Project Director. | | ESSENTIAL FUNCTIONS | 1.Manages day to day operations and performance of assigned contracts including P&L, quality and compliance with terms and conditions along with preparing and analyzing regular performance reports. | 2.Manages the customer relationship for assigned contracts ensuring effective and efficient communication along with addressing and resolving customer complaints. | 3.Provides leadership and direct supervision to assigned employees, including setting goals, monitoring work performance, coaching and evaluating results to ensure that objectives are met. | 4.Regularly interacts with senior management or executive levels on matters concerning assigned contracts. | 5.Participates in continual process improvement by monitoring, refining, and optimizing staffing, assignments, workflow and processes. | 6.Creates an effective work environment by involvement in developing and hiring superior talent and instilling a culture of accountability, measurability and discipline. | 7.Participates in developing, modifying and executing company policies that affect operations and may also have organization-wide effects. | 8.Works collaboratively and effectively with IT to ensure that product and service applications and technologies are optimized for assigned contract compliance, productivity, and quality performance. | 9.Performs other duties, as necessary. | ACCOUNTABILITY | •Maintains primary responsibility for ensuring customer satisfaction, resolving compliance issues, accountability for profit & loss and adherence to operational budgets with assigned contracts. | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Ability to lead and manage day to day operations and drive continuous improvement | •Strong project management skills and/or aptitude | •Ability to work effectively in a “hands-on” management role, motivating staff through variety of communications vehicles | •Ability to document and re-engineer business processes | •Ability to create and direct a ‘daily management plan’ for all contracts | •Outstanding work ethic, integrity, and value system | •Excellent analytical and complex reasoning skills | •Ability to perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies | •Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned within six business hours of receipt | •Strong organizational, supervisory and interpersonal skills | •Outstanding written and verbal communication skills | •Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers | •Advanced skill with word processing, spreadsheet, presentation, and publishing software (Microsoft Word, Excel, PowerPoint, Publisher, and Visio strongly preferred) | | Education | The job requires a Bachelor’s degree; completion of an accredited MBA program and/or PMP certification, or Registered Nurse licensed in North Carolina preferred. | | Experience | The job requires five (5) years of experience managing operations, preferably in Medicaid-funded healthcare programs, mental health, or a related field.
Maximus’s Clinical Services Division performs a wide array of clinical assessment services for individuals with physical and/or mental disabilities seeking Medicaid-funded services and supports. The Program Manager reports to the Project Director. The Program Manager is accountable for the overall delivery of volume, quality and service level performance targets within the North Carolina Community Alternatives Program for Children (CAP/C) scope, along with developing and monitoring their operational budgets. The Program Manager drives operational excellence for their assigned contracts and will identify, manage, and execute process improvements that yield efficiencies and meet or exceed operational metrics. The Program Manager develops and promotes talent within their assigned contracts as well as drives employee satisfaction, retention and promotions. The Program Manager also leads special projects and initiatives as assigned by the Project Director. | | ESSENTIAL FUNCTIONS | 1.Manages day to day operations and performance of assigned contracts including P&L, quality and compliance with terms and conditions along with preparing and analyzing regular performance reports. | 2.Manages the customer relationship for assigned contracts ensuring effective and efficient communication along with addressing and resolving customer complaints. | 3.Provides leadership and direct supervision to assigned employees, including setting goals, monitoring work performance, coaching and evaluating results to ensure that objectives are met. | 4.Regularly interacts with senior management or executive levels on matters concerning assigned contracts. | 5.Participates in continual process improvement by monitoring, refining, and optimizing staffing, assignments, workflow and processes. | 6.Creates an effective work environment by involvement in developing and hiring superior talent and instilling a culture of accountability, measurability and discipline. | 7.Participates in developing, modifying and executing company policies that affect operations and may also have organization-wide effects. | 8.Works collaboratively and effectively with IT to ensure that product and service applications and technologies are optimized for assigned contract compliance, productivity, and quality performance. | 9.Performs other duties, as necessary. | ACCOUNTABILITY | •Maintains primary responsibility for ensuring customer satisfaction, resolving compliance issues, accountability for profit & loss and adherence to operational budgets with assigned contracts. | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Ability to lead and manage day to day operations and drive continuous improvement | •Strong project management skills and/or aptitude | •Ability to work effectively in a “hands-on” management role, motivating staff through variety of communications vehicles | •Ability to document and re-engineer business processes | •Ability to create and direct a ‘daily management plan’ for all contracts | •Outstanding work ethic, integrity, and value system | •Excellent analytical and complex reasoning skills | •Ability to perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies | •Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned within six business hours of receipt | •Strong organizational, supervisory and interpersonal skills | •Outstanding written and verbal communication skills | •Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers | •Advanced skill with word processing, spreadsheet, presentation, and publishing software (Microsoft Word, Excel, PowerPoint, Publisher, and Visio strongly preferred) | | Education | The job requires a Bachelor’s degree; completion of an accredited MBA program and/or PMP certification, or Registered Nurse licensed in North Carolina preferred. | | Experience | The job requires five (5) years of experience managing operations, preferably in Medicaid-funded healthcare programs, mental health, or a related field.
The Project Director reports to the Senior Operations Director and has direct profit and loss responsibility for a portfolio of assigned contracts which includes varying lines of Ascend business. The Project Director is accountable for the overall delivery of volume, quality and service level performance targets within their portfolio and plays a key role in facilitating resource sharing within and between portfolios to efficiently meet changes in demand. The Project Director collaborates closely as a key stakeholder of Information Technology and as a key representative of Ascend clients in the areas of application design, development, deployment and maintenance. A proven leader, he or she accomplishes results by effectively managing costs, employees, customer relationships, clinical and administrative workflows, customer support and the implementation of new contracts in the portfolio. At the senior level, the Project Director uses their leadership expertise to supervise and mentor managers under their supervision and other managers in similar roles. The Program Director also leads special projects and initiatives as assigned by the Vice President. This role is based in Raleigh, NC; however, due to precautions related to COVID-19, this position may be temporarily remote. | | ESSENTIAL FUNCTIONS | 1.Manages overall operations and performance of assigned contracts including P&L, quality and compliance with all terms and conditions along with preparing and analyzing regular performance reports. | 2.Manages all aspects of the customer relationship for assigned contracts ensuring effective and efficient communication along with addressing and resolving customer complaints. | 3.Provides leadership and direct supervision to assigned employees, including setting goals, monitoring work performance, coaching and evaluating results to ensure that objectives are met. | 4.Manages continual process improvement by monitoring, refining, and optimizing workflow and processes with the goal of continuously improving overall effectiveness (efficiency, productivity, and quality). | 5.Creates an entrepreneurial work environment by involvement in developing and hiring superior talent and instilling a culture of accountability, measurability, and discipline without undue bureaucracy. | 6.Interprets policies, procedures, and goals of the company for subordinates. | 7.Participates in the development and monitoring of the operational budget related to assigned contracts. | 8.Works collaboratively and effectively with IT to ensure that product and service applications and technologies are optimized for contract compliance, productivity, and quality performance. | 9.Performs other duties, as necessary. | ACCOUNTABILITY | •Maintains primary responsibility for ensuring customer satisfaction, resolving compliance issues, and accountability for profit & loss with assigned contracts and lines of business. | •Acts as the primary point of contact for state officials and other outside contacts for the assigned contract. | | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Ability to lead and manage complex operations and drive continuous improvement | •Ability to work effectively in a “hands-on” management role | •Outstanding work ethic, integrity, and value system | •Excellent analytical and complex reasoning skills | •Ability to effectively formulate and execute detailed operational programs and plans | •Ability to perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies | •Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned within six business hours of receipt | •Excellent organizational skills | •Ability to work independently with minimal day-to-day supervision | •Outstanding supervisory skills | •Outstanding written and verbal communication skills | •Outstanding interpersonal skills, including ability to use effective diplomacy in dealing with senior business leaders and other business parties | •Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers | •Advanced skill with word processing, spreadsheet, presentation, and publishing software (Microsoft Word, Excel, PowerPoint, Publisher, and Visio strongly preferred) | | Education | The job requires a Bachelor’s degree, Master’s degree, or completion of an accredited nursing program, as well as current licensure (as applicable), depending upon the requirements of the contract. Completion of an accredited MBA program is desirable. | | Experience | The job requires at least five (5) years of experience managing operations, preferably in healthcare, mental health, or a related field. Successful completion of an accredited MBA program is preferred.
Maximus’s Clinical Services Division performs a wide array of clinical assessment services for individuals with physical and/or mental disabilities seeking Medicaid-funded services and supports. The incumbent provides oversight of a regional network of field clinical assessors. The RN Regional Supervisor is responsible for quality assurance of clinical assessors and monitoring key quality and operational processes to ensure fidelity to assessment protocol and consistent assessment reliability and validity among and across assessors. | | ESSENTIAL FUNCTIONS | 1.Manages of the quality of regional field clinical assessors, including inter-rater reliability (IRR) activity, monitoring quality trends among assessors, and other quality activities as appropriate. | 2.Ensures assessor compliance with assessment protocols, performance standards, and meeting all customer expectations for quality. Monitors quality processes and informs Program Manager about quality performance issues. | 3.Documents quality issues and performance measures for management review, and provides information to assist in the feedback and formal education process of employees. Develop processes to build operational policies, procedures, and/or user guides for the project. | 4.Address exceptional issues related to quality, service and compliance of the project. Analyzes operational processes, including reviewing, creating, and improving policies, procedures, systems, forms, and reports. Analyzes existing forms and methods to promote effective operations through standardization, improvement, simplification, discontinuance or other methods. | 5.Responsible for working with the Program Manager to develop strategies to prevent drift and maintain adherence to quality expectations to ensure effective program operations. | 6.Performs other duties, as necessary or assigned by the Program Manager. | | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Ability to lead and drive continuous quality improvement | •Ability to work effectively manage a remote team | •Outstanding work ethic, integrity, and value system | •Excellent clinical process skills | •Ability to perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies | •Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned expeditiously | •Excellent organizational skills | •Excellent negotiation and interpersonal skills, including ability to use effective diplomacy in dealing with senior business leaders and other business parties | •Ability to work independently with minimal day-to-day supervision | •Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers | •Advanced skill with word processing, spreadsheet, presentation, and publishing software (Microsoft Word, Excel, PowerPoint, Publisher, and Visio strongly preferred) | | Education | The job requires a Registered Nurse licensed in North Carolina; specialty in geriatrics or adult home health is preferred. | | Experience | The job requires a at least three (3) years of experience in clinical medical settings, hospital and home health experience, including experience managing and/or collaborating with clinical professionals.
The Customer Support Center Manager is responsible for coordinating processes by formulating policies, managing staff, daily operations, and planning the use of materials and human resources administrative services. This position reports to the Program Director. This role is based in Raleigh, NC; however, due to precautions related to COVID-19, this position may be temporarily remote. | | | ESSENTIAL FUNCTIONS | 1.Oversee customer support center and mailroom functions and staff on a daily basis to ensure that excellent customer service is provided to customers and stakeholders | 2.Responsible for identifying and resolving issues, problems, and concerns with employees and client | 3.Ensure adequate staffing levels, staff training, and compliance to meet contractual requirements | 4.Receive assignments in the form of objectives and determine how to use resources to meet schedules and goals | 5.Provide assistance and updates to staff regarding the programs, policies, and procedures | 6.Recommend changes to policies and establishes procedures | 7.Develop individual and team goals and objectives, and monitor achievement of these goals | 8.Conduct ongoing audits and review reports to identify areas for improvement | 9.Interact with varying levels of external and internal customers | 10.Complete reports and metrics for the project and corporate office | 11.Ensure the confidentiality and security of all information | 12.Perform other duties, as necessary or assigned by the Program Director | | ACCOUNTABILITY | •Accountable for meeting all established customer support center goals for the project | | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Ability to lead and drive effective customer support center operations | •Ability to work effectively in a “hands-on” management role | •Ability to work effectively in a deadline-driven environment | •Outstanding work ethic, integrity, and value system | •Excellent written and verbal communication skills | •Ability to perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies | •Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned expeditiously | •Excellent organizational skills | •Excellent negotiation and interpersonal skills, including ability to use effective diplomacy in dealing with senior business leaders and other business parties | •Ability to work independently with minimal day-to-day supervision | •Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers | •Advanced skill with word processing, spreadsheet, presentation, and publishing software (Microsoft Word, Excel, PowerPoint, Publisher, and Visio strongly preferred) | | Education | The job requires successful completion of a Bachelor’s degree from an accredited college or university. Directly related work experience can be substituted for the required college degree on a year-for-year basis. | Experience | The job requires at least three (3) years of experience in call center or similar operations. Experience in managing a large-volume Call Center for a healthcare-related or Medicaid program preferred.
The Scheduler schedules field assessments for contract services and enters referral data into the database system, ensuring quality levels meet contract and company standards. The Scheduler also monitors Assessor onboarding and performance, offering appropriate feedback to management. | | ESSENTIAL FUNCTIONS: | •Enters referral data into the assigned database system. | •Schedules field assessments with Assessors and respondents. | •Collaborates regularly with coworkers, peer reviewers, physicians, and healthcare administrative staff. | •Responds to all inquiries consistent with confidentiality and privacy policies and refers callers to alternate sources when appropriate. | •Utilizes systems and technology to document and manage each individual call. | •Manages and routes incoming faxes and email. | •Manage print fulfillment of all required notifications. | •Attends and participates in scheduled contract, committee, and all-staff meetings | •Completes other job duties as assigned or necessary. | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies and procedures | •Excellent data entry and telephonic skills | •Experience with computers, phone systems, and headsets | •Ability to perform comfortably in a fast-paced, deadline-oriented work environment | •Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned within contract standards | •Ability to work independently with minimal day-to-day supervision | •Excellent written and verbal communication skills | •Excellent interpersonal skills | •Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers | •Ability to define problems, collect data, establish facts, and draw valid conclusions | •Intermediate skill with word processing and spreadsheet software (Microsoft Word and Excel preferred) | Education | The job requires a high school diploma or equivalent. | | Experience | The job requires at least one (1) year of experience in customer service role, preferably in a health and human services call center setting. Telephonic customer service experience preferred.
The Scheduling Coordinator schedules field assessments for contract services and enters referral data into the database system, ensuring quality levels meet contract and company standards. The Scheduler also monitors assessor onboarding and performance, offering appropriate feedback to management. This position is monitored by the Lead Scheduler, and reports to the Customer Support Center Manager. This role is based in Raleigh, NC; however, due to precautions related to COVID-19, this position may be temporarily remote. | | ESSENTIAL FUNCTIONS: | •Enters referral data into the assigned database system. | •Schedules field assessments with Assessors and respondents. | •Collaborates regularly with coworkers, peer reviewers, physicians, and healthcare administrative staff. | •Responds to all inquiries consistent with confidentiality and privacy policies and refers callers to alternate sources when appropriate. | •Utilizes systems and technology to document and manage each individual call. | •Manages and routes incoming faxes and email. | •Manage print fulfillment of all required notifications. | •Attends and participates in scheduled contract, committee, and all-staff meetings | •Completes other job duties as assigned or necessary. | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies and procedures | •Excellent data entry and telephonic skills | •Experience with computers, phone systems, and headsets | •Ability to perform comfortably in a fast-paced, deadline-oriented work environment | •Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned within contract standards | •Ability to work independently with minimal day-to-day supervision | •Excellent written and verbal communication skills | •Excellent interpersonal skills | •Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers | •Ability to define problems, collect data, establish facts, and draw valid conclusions | •Intermediate skill with word processing and spreadsheet software (Microsoft Word and Excel preferred) | Education | The job requires a high school diploma or equivalent. | | Experience | The job requires at least one (1) year of experience in customer service role, preferably in a health and human services call center setting. Telephonic customer service experience preferred.
The Customer Support Representative (CSR) is responsible for interacting with customers to provide information in response to inquiries about programs and services in a contact center. | | ESSENTIAL FUNCTIONS: | •Responds to callers' inquires and needs in accordance with all Department and Ascend performance standards, policies and procedures, and protocols. | •Facilitates the fulfillment of caller requests for information. | •Responds to all inquiries consistent with confidentiality and privacy policies and refers callers to alternate sources when appropriate. | •Utilizes systems and technology to document and manage each individual call. | •Manages and routes incoming faxes and email. | •Manage print fulfillment of all required notifications. | •Completes other job duties as assigned or necessary. | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies and procedures | •Excellent data entry and telephonic skills | •Experience with computers, phone systems, and headsets | •Ability to perform comfortably in a fast-paced, deadline-oriented work environment | •Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned within contract standards | •Ability to work independently with minimal day-to-day supervision | •Excellent written and verbal communication skills | •Excellent interpersonal skills | •Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers | •Ability to define problems, collect data, establish facts, and draw valid conclusions | •Intermediate skill with word processing and spreadsheet software (Microsoft Word and Excel preferred) | Education | The job requires a high school diploma or equivalent; Associate’s or Bachelor’s degree preferred. | | Experience | The job requires at least one (1) year of experience in call center experience or similar customer service role. Experience in a health and human services call center setting preferred.
The Customer Support Representative (CSR) is responsible for interacting with customers to provide information in response to inquiries about programs and services in a contact center. This position is monitored by the Lead CSR, and reports to the Customer Support Center Manager. This role is based in Raleigh, NC; however, due to precautions related to COVID-19, this position may be temporarily remote. | | ESSENTIAL FUNCTIONS: | •Responds to callers' inquires and needs in accordance with all contractual, departmental, and company performance standards, policies and procedures, and protocols. | •Facilitates the fulfillment of caller requests for information. | •Responds to all inquiries consistent with confidentiality and privacy policies and refers callers to alternate sources when appropriate. | •Utilizes systems and technology to document and manage each individual call. | •Manages and routes incoming faxes and email. | •Manage print fulfillment of all required notifications. | •Completes other job duties as assigned or necessary. | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies and procedures | •Excellent data entry and telephonic skills | •Experience with computers, phone systems, and headsets | •Ability to perform comfortably in a fast-paced, deadline-oriented work environment | •Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned within contract standards | •Ability to work independently with minimal day-to-day supervision | •Excellent written and verbal communication skills | •Excellent interpersonal skills | •Ability to interact professionally and collegially with referral sources (hospital & nursing home staff, physicians, social service workers, etc.), state contract officers, and coworkers | •Ability to define problems, collect data, establish facts, and draw valid conclusions | •Intermediate skill with word processing and spreadsheet software (Microsoft Word and Excel preferred) | Education | The job requires a high school diploma or equivalent; Associate’s or Bachelor’s degree preferred. | | Experience | The job requires at least one (1) year of experience in call center experience or similar customer service role. Experience in a health and human services call center setting preferred.
SUMMARY | The incumbent monitors and reports on all mediation and appeal requested by applicants and beneficiaries whose clinical assessment results in a denial or reduction in health care services. | | ESSENTIAL FUNCTIONS | 1.Processes correspondence, appeals, program reviews, reports and other requests. | 2.Serves as a content knowledge expert regarding business rules of the project; review/research mediation and appeals cases. | 3.Works closely with the Clinical Director and Program Managers in assisting with resolving difficult and complex cases. | 4.Works closely with the Clinical Director and Program Managers to investigate issues raised by clients in their correspondence, appeals and requests. | 5.Creates letter requests in response to applicant inquiries regarding case status, appeals, and other written requests. | 6.Works closely with team to accurately adjudicate appeals and determine the outcome of the case. | 7.Participate in mediation and appeals hearings as requested by | 8.Provides the Clinical Director and Program Managers with updates on all issues regarding quality, training, policy & procedures. | 9.Meets all standards established for this position as outlined in the attached performance criteria. | 10.Performs other duties, as necessary or assigned by the manager. | | JOB REQUIREMENTS | Knowledge, Skills & Abilities | •Experience handling inquires, complaints and appeals | •Experience in level of care/service eligibility determinations in health, human services or a related field | •Excellent organizational, interpersonal, written, and verbal communication skills | •Excellent analytical and complex reasoning skills | •Ability to perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies | •Ability to multitask effectively while performing job duties, including ability to prioritize tasks and ensuring all voice mail and email messages are returned within six business hours of receipt | •Ability to perform comfortably in a fast-paced, deadline-oriented work environment | •Ability to successfully execute many complex tasks simultaneously | •Ability to work as a team member, as well as independently | •Intermediate skill with word processing, spreadsheet, presentation, and publishing software (Microsoft Word, Excel, PowerPoint, Publisher, and Visio strongly preferred) | | Education | The job requires a Registered Nurse licensed in North Carolina. Experience working with individuals with chronic medical conditions and/or cognitive impairment preferred. Experience making level of care determinations also preferred. | | Experience | The job requires at least three (3) years of experience within a healthcare, mental health, or long-term care setting.