Hipaa Security Malware Analysis Migration Healthcare Consultant (Jobs in Bismarck   Requirement id 109879 Job title Consultant Job location in Bismarck, ND Skills required Medicaid Program Operations, Hipaa, Security, Malware Analysis Migration Healthcare Open Date 09-Sep-2020 Close Date Job type Contract Duration 9 Months Compensation DOE Status requirement --- Job interview type ---    Email Recruiter: coolsoft Job Description Consultant: Medicaid Program Operations, Hipaa, Security, Malware Analysis Migration Healthcare Start Date :10/01/2020 End Date :June 30, 2021 Submission Deadline :September 18, 2020, 4:00 P.M., CT Client Info : Department of Human Services Description: To procure the services of a Contractor certified by Centers for Medicare and Medicaid Services (CMS) as a Quality Improvement Organization (QIO) or QIO-like entity. Client has serves in excess of 75,000 North Dakotans with comprehensive health care services funded through a combination of state and federal funds. As part of its mission, the Medicaid program must ensure the integrity of payments made to participating providers. The purpose of the clients contract is to attain measurable improvement in the appropriate utilization of Medicaid services. STATE expects the successful offeror to exceed compliance standards as dictated by federal QIO regulations. STATE expects the successful offeror to take on a very active role in shaping the Medicaid program to be more cost effective and have improved outcomes of members. STATE seeks a thought leader who is aware of national trends and innovative initiatives. The successful offeror will help shape the future of the state of North Dakotas Medicaid program. The successful offeror will be tasked with five goals: 1) Meeting federal Medicaid requirements for QIO services. These include activities, such as attaining measurable improvement in the appropriate utilization (or, measurable true reduction in inappropriate utilization) of Medicaid services, specifically inpatient and outpatient hospital services, including emergency department visits, for the Fee for Service (FFS) population; 2) Other than hospital inpatient and outpatient services, recommend services that STATE should focus on for targeted utilization review and how that will add value to the Medicaid program by improving cost effectiveness or health outcomes; 3) As a result of utilization reviews, offer education to providers and provide over payment report on inappropriate Medicaid services; 4) Ability to lead data driven, quality improvement projects as requested by STATE; and 5) Ability to offer clinical expertise to STATE, as needed, for the purposes of utilization review done by STATE staff. Items 1-3 listed above will be annual contracted functions. It is expected that the demand for items 4 and 5 listed above will be as needed. STATE will provide claims data to the successful offeror for use in achieving the tasks outlined above. To enable STATE to qualify for 75 percent federal financial participation as established in Section 1903(a)(3)(C) of the Social Security Act, the successful offeror must be a contractor certified by the CMS as a QIO or QIO-like entity. The goal of the QIO is to improve the effectiveness, efficiency, economy, and quality of services delivered to Persons/Individuals. At its core, the QIO functions to: (a) Improve quality of care for Persons/Individuals; (b) Protect the integrity of the Medicaid funds by ensuring that Medicaid pays only for services and goods that are reasonable and necessary and that are provided in the most appropriate setting; and (c) Increase the overall Person/Individuals satisfaction. The successful offeror shall develop a project plan that provides a comprehensive timeline for, and implementation of the following tasks to be completed by the successful offeror: (a) Performance of Utilization Reviews as required by federal regulations and as agreed upon between STATE and successful offeror for targeted improvement; (b) Provider education and over payment reporting as indicated by results of utilization reviews; (c) Performance of Prior Authorization Services for clinical areas where STATE does not have the expertise to conduct internally; (d) Quality Reporting as needed and development and implementation of qualit   Call 502-379-4456 Ext 100 for more details. Please provide Requirement id: 109879 while calling.   Other jobs in ND: Medicaid Program Operations job openings in Bismarck, ND Jobs List Implementation And Advance Planning Document Preparation Create date: 12-Aug-2016 Start Date : 08/25/2016 Submitted Deadline: 08/19/2016 Description : The ITD working with the Department of Human Services (DHS), through its current contract for services with CedarBridge Group, seeks assistance to update North Dakotas SMHP, including the I-APD, per the specifications outlined by the Centers for Medicare and.... (This job is for - CMS Jobs in ND Bismarck Developer - (in Bismarck, ND))    Medicaid Program Operations job openings in other states Jobs List DHHS MES IT Product Manager (735711) Create date: 02-May-2024 Remote No of Submissions : 1 start date :05/06/2024 End date :08/17/2024 submission deadline :05/08/2024 client info : NCDHHS-ITSM Description : NOTE: This position is 100% remote and candidates located anywhere in the US are.... 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