Medicare-Medicaid Integration Specialist

4 weeks ago


Richmond, California, United States Commonwealth of Virginia Full time

Job Summary

The Department of Medical Assistance Services (DMAS) is seeking a highly skilled and experienced professional to serve as a Medicare-Medicaid Integration Specialist. This position will provide operational oversight of Medicare-Medicaid integration activities for programs that enroll our dual eligible population.

Key Responsibilities

  • Monitor, review, and analyze the activities of our contracted managed care entities to ensure they are operating within the guidelines prescribed by the Department.
  • Work closely with Integrated Care Contract Monitoring, Data, Systems and Encounters and Policy Unit staff, as well as staff across the Department, to create and implement operational oversight and monitoring plans.
  • Provide reports to management and technical expertise to stakeholders as needed.
  • May require limited travel for meetings, conferences, and/or trainings.

Requirements

  • Experience with Medicaid and/or Medicare Managed Care programs to include contract management and compliance of contracts.
  • Knowledge of legislative practices, research, and evaluative techniques.
  • Experience analyzing issues and data and applying solutions.
  • Experience in contract management/oversight.
  • Experience with Microsoft Office Suite.
  • Experience analyzing, interpreting, and applying state and/or federal regulations and laws.
  • Experience demonstrating organizational skills and meeting deadlines.
  • Experience communicating and collaborating with diverse internal and external stakeholders.

About the Department

The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high-quality healthcare coverage. We are committed to providing exceptional service and promoting a culture of collaboration, trust, problem-solving, and adaptability.

What We Offer

  • A competitive salary and benefits package.
  • The opportunity to work with a talented and dedicated team.
  • The chance to make a meaningful difference in the lives of Virginians.

How to Apply

To be considered for this opportunity, please submit your application and/or resume through our website. We are an equal opportunity employer and encourage individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process.



  • Richmond, California, United States UHS Full time

    The highly respected Universal Health Services, Inc. (UHS) is a Fortune 500 corporation with a storied history of delivering exceptional healthcare services.With a global presence spanning the United States, Washington D.C., Puerto Rico, and the United Kingdom, UHS operates a diverse network of acute care hospitals, behavioral health facilities, outpatient...


  • Richmond, California, United States WallStJobs Full time

    Medicare Sales Specialist RoleA leading provider of Medicare solutions, dedicated to offering tailored healthcare products that address the unique needs of each client, is seeking a passionate and knowledgeable Medicare Sales Specialist to support their team in delivering exceptional client experiences.In this position, you will play a key role in educating...


  • Richmond, California, United States VCU Health Full time

    Job SummaryThe Care Integration Liaison plays a vital role in facilitating discharge placements and streamlining the referral process for post-acute care at VCU Health. This position is responsible for coordinating with the care coordination team, physicians, and other disciplines to ensure a timely and safe discharge for patients.Key...


  • Richmond, California, United States Commonwealth of Virginia Full time

    Job Summary:We are seeking a highly skilled Paralegal to join our Medicaid Fraud Control Unit. The successful candidate will be responsible for assisting in the investigation and prosecution of Medicaid fraud cases.Key Responsibilities: Assist in the compilation of logs and documents for discovery purposes Draft motions and assist with drafting indictments...


  • Richmond, California, United States Omni Inclusive Full time

    Job Title: B2B EDI Integration SpecialistAbout the Role:We are seeking a highly skilled B2B EDI Integration Specialist to join our team at Omni Inclusive. As a key member of our EDI team, you will be responsible for the day-to-day production support, enhancement, administration, and operations of our EDI environment.Key Responsibilities:- Assist in the...


  • Richmond, California, United States Syntricate Technologies Full time

    Job Title: Senior Data Integration SpecialistJob Summary:We are seeking a highly skilled Senior Data Integration Specialist to join our team at Syntricate Technologies. The ideal candidate will have expertise in IBM DataStage and a strong background in data warehousing, Oracle PL/SQL, and MS SQL server development.Key Responsibilities:Design and implement...


  • Richmond, California, United States Experis Full time

    Job Title: Senior Data Integration SpecialistAs a Senior Data Integration Specialist at Experis, you will be part of a dynamic team focused on delivering cutting-edge data solutions. Your primary responsibility will be to design and develop data virtualization solutions, ensuring seamless data flow between upstream and downstream systems. Key...


  • Richmond, California, United States Manpower Group Inc. Full time

    Job Title: Senior Data Integration SpecialistWe are seeking a highly skilled Senior Data Integration Specialist to join our team at Manpower Group Inc. The ideal candidate will have strong technical skills, excellent communication abilities, and a proven track record in data integration.### Key Responsibilities* Design and develop data virtualization...


  • Richmond, California, United States Omni Inclusive Full time

    Job Title: B2B EDI Integration SpecialistAbout the Role:We are seeking a talented and team-oriented individual to join our EDI team as a B2B EDI Integration Specialist. In this role, you will be responsible for supporting the day-to-day operations of our EDI environment, including production support, enhancement, administration, and operations of the EDI...


  • Richmond, California, United States inSync Staffing Full time

    DAS Installation and Integration Specialist Job SummaryAs a DAS Installation and Integration Specialist at inSync Staffing, you will be responsible for the installation of portions of WiFi, Cellular, and Public Safety In-Building DAS, BDA, DRAN, Private LTE, and Rooftop Small Cell systems. You will work with a variety of DAS platforms, including JMA, Solid,...


  • Richmond, California, United States Gateway Integrated Solutions, LLC Full time

    Job DescriptionGateway Integrated Solutions, LLC is seeking a highly skilled Integration Lead to join our team. As an Integration Lead, you will be responsible for managing the development of integrations and interfaces using APIs, ETL, middleware, or custom code.Key Responsibilities:Manage the development of (20+) integrations and interfacesExpertise in...


  • Richmond, California, United States Innova Solutions Full time

    Job Title: AV Commissioning SpecialistInnova Solutions is seeking a highly skilled AV Commissioning Specialist to join our team. This role will be responsible for the final testing and commissioning of complex Audio-Visual systems during and post-build.Key Responsibilities:Test point-to-point functionality of systems.Review project Scope of Work (SOW) to...


  • Richmond, California, United States Hargrove Oliver & Parker Enterprises Inc. Full time

    Job DescriptionJob Title: Clinical Assessment Specialist/Program SupervisorJob Summary:We are seeking a highly skilled Clinical Assessment Specialist/Program Supervisor to join our team at Hargrove Oliver & Parker Enterprises Inc. The successful candidate will be responsible for providing direct services to clients and families, conducting quality assurance...


  • Richmond, California, United States Elevance Health Full time

    Job SummaryWe are seeking a highly skilled Medical Management Specialist I to provide non-clinical support to our Medical Management and/or Operations areas. This role is responsible for gathering clinical information, determining appropriate areas to refer or assign cases, and providing information regarding network providers or general program information...

  • Registered Dietitian

    4 weeks ago


    Richmond, California, United States Option Care Enterprises, Inc. Full time

    Job Title: Registered Dietitian - Clinical Nutrition SpecialistJob Summary:Option Care Health is seeking a Registered Dietitian - Clinical Nutrition Specialist to join our team. As a key member of our clinical staff, you will be responsible for developing and implementing clinical and operational strategies to promote home nutrition support across multiple...


  • Richmond, California, United States Aloden, Inc. Full time

    Data Quality Specialist is responsible for ensuring the integrity of data used for business operations and decision-making processes. This role will analyze, monitor, and improve data quality across various systems and databases.Key responsibilities include:Collaborating with business partners to understand data quality standards, policies, and procedures to...


  • Richmond, California, United States Commonwealth of Virginia Full time

    Transforming Lives through EmploymentWe are seeking a highly motivated Reentry Supported Employment Specialist to join our team at the Virginia Commonwealth University Rehabilitation Research and Training Center (RRTC). The ideal candidate will have a strong passion for empowering individuals with disabilities to achieve competitive, integrated...


  • Richmond, California, United States Reid Hospital & Health Care Services Full time

    Job SummaryWe are seeking a skilled Unified Communications Specialist to manage and monitor our Cisco Call Manager Systems and integrations. The ideal candidate should have a deep understanding of Cisco Call Manager and experience in managing and monitoring it.Key Responsibilities:Manage and monitor the company's Cisco Call Manager Systems and...


  • Richmond, California, United States Integrated Resources Full time

    Job Title: Business Systems Documentation SpecialistLocation: Hybrid (at least 3 days onsite per week)Duration: 9+ monthsInterview: In-personJob Description:At Integrated Resources, we are seeking a skilled Business Systems Documentation Specialist to join our team. The ideal candidate will have 6+ years of experience in systems documentation, including...


  • Richmond, California, United States ASCENDING LLC Full time

    Job Title: Power Platform Automation SpecialistAbout the Role:We are seeking a skilled Power Platform Automation Specialist to join our team at ASCENDING LLC.Key Responsibilities:- Troubleshoot and resolve issues with Power Automate scripts to ensure smooth operations.- Design, develop, and test new Power Automate flows based on evolving business needs.-...