The primary role and responsibility of the Advance Planning Writer (APW) is to develop Advance Planning Documents, and other documentation required for planning, implementation, and operations activities in support of the NC Medicaid Program. This role will also review and provide feedback on APDs, draft CMS submittal letters and tie together all associated areas including business engagement, stakeholder management, project management, and technical liaising.
Additionally, the APW will collaborate with internal and external stakeholders, project teams, technical teams, vendors, contract and budget offices, and other key stakeholders to develop APDs required by Centers of Medicaid and Medicare Services (CMS). The APW must be able to take complex concepts and convert them into easily understood written documentation such that the content ensures successful system certification and compliance consistent with program management guidelines and processes and CMS expectations.
Responsibilities:
Develop, collect, and compile data from the business and technology teams to develop a solid, viable, meaningful APD (similar to grants) and planning documents within required timelines.
Develop and maintain strong relationships with stakeholders to ensure seamless communication, data, analysis, and development plans remain on schedule.
Coordinate and meet with various teams, suppliers legal, and key stakeholders to support the gathering, analysis, and finalization of information to obtain final sign-off on APDs.
Work alongside the DHB business units, Medicaid Enterprise System (MES) project teams, technology teams, and subject matter experts to gain an understanding of project and related requirements to develop an appropriate APD.
Facilitate and coordinate APD review meetings with key stakeholders.
Review contract and amendment submittal letters for accuracy and relevancy.
Interface with mid-level executive management and project teams to clearly articulate current APD activities and translate the information provided into concise updates.
Maintain awareness of CMS policy updates, organization, and communications as applicable.
Independently review and prepare APD documents for review and approval.
Review, support and provide feedback on APDs.
Review all relevant regulations and standards for APDs and to ensure other documentation is in alignment.
Utilize tools, templates, and developed methods to keep abreast of project activities across the program.
Ability to exercise communication skills in both written and verbal means to take complex concepts and convert into easily understood written documentation.
Organize material and complete writing assignments according to agency standards regarding order, clarity, conciseness, style, and terminology.
Attend DHB meetings to stay informed of current activities in NC Medicaid.
Required Skills/Experience:
Expert working knowledge in Medicaid, NC FAST and/or Health and Human Services Projects. Required 4 Years
Expert experience executing against multiple priorities/projects. Required 7 Years
Proficient use of project collaboration and tracking tools (Microsoft Project Suite, MS Teams, Zoom, etc.) Required 5 Years
Ability to interpret Medicaid, NC FAST and/or Health and Human Services policies to ensure compliance with CMS regulations. Required 4 Years
Expert level communication skills, both verbal and written. Required 8 Years
Demonstrated project management, training and facilitation experience. Required 5 Years
Demonstrated stakeholder engagement and collaboration experience. Required 5 Years
Prior APD development, RFP, RFI, grant or contract writing experience. Highly desired 3 Years
Ability to create and deliver PowerPoint presentations, and standard operating procedures (SOPs). Highly desired 5 Years
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The Azure Cloud Architect will be a support person to Infrastructure to assist with setting up Azure in a way that will benefit the client agency.
The client works with the Department of Information and Technology and Microsoft Azure Support Teams for the design and implementation of groups, virtual machines, data bases, firewall rules and VPN tunnels from an operations and security standpoint for our Permit Transformation Project.
Responsibilities:
Setup of our Customer Owned environment, Create Images, Create VNet and VPN gateways, Create VDI machines based on Custom Images.
Setup Intune for management of VDI machines, assign to resources and resource groups in high, medium and low zones.
Document DevOps environment and setup proper rights.
Knowledge share and training with my team during any down time.
Required Skills/Experience:
*Azure Cloud Architect, to include Custom Imaging and VDI/Hypervisor, InTune, and MDM management, VNet and Resource Groups and Azure VPN gateways. Required 5 Years
Demonstrated knowledge of directory services (Azure AD and AD) Required 5 Years
Must have great Interpersonal and leadership skills – leadership, collaboration, facilitation, negotiation, and documentation skills. Required 5 Years
Demonstrated knowledge of cloud computing and management (groups, users, virtual machines, etc.) Required 5 Years
*Require a thorough knowledge of firewalls (access groups, rules, ports, and specific pinhole connections), and interoperations between technologies Required 5 Years
Require a thorough knowledge of implementing secure, best practices, access for the confidential data and availability between all infrastructures. Required 5 Years
Strong written and oral communication skills. Required 5 Years
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration!
The primary purpose of this position in the Enforcement Section, within the client’s Systems Unit, is to provide software support to the North Carolina State Highway Patrol Motor Carrier Enforcement Section (NCSHP MCES) and the DMV License and Theft Bureau.
The Fuel Tax Compliance System (FuelTaCS) provides NCSHP MCES personnel the ability to issue citations to commercial trucks that are in violation of NC General Statues.
This application allows NCSHP Officers to wirelessly access pertinent information from their laptop located in the patrol car or from a local Weigh Station across the State of North Carolina.
The application is used to assist in collecting outstanding taxes and penalties that are owed to the State of North Carolina.
The License and Theft Bureau Motor Vehicle Inspection Law Enforcement System (MILES) allows L&T personnel to oversee the Inspection Program for the citizens of North Carolina.
The application tracks all inspections conducted at stations across the State by ensuring Technicians and Station Owners to follow the General Statues for inspecting cars to ensure they are safely on the road. With the proper inspections, citizens are permitted to register their vehicles to operate on the roads in the State.
This position also supports other applications such as LECMS, the Scrap Yard System, Trip Permits, CVIEW, and Notice Storage & Theft.
Required Skills/Experience:
SQL and DB/2 Required 20 Years
.Net C# Required 10 Years
MQ middleware Required 20 Years
C++ Required 20 Years
MS Office Required 20 Years
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration!
The client is seeking a Project Manager specialist contractor for a 12 month engagement working for the Department’s Engineering Application Services with the Engineering Design and CADD Services Team.
The specialist will be responsible for providing project management tasks on multiple ongoing technical projects as well as providing assistance in writing several technical guidelines and workflows.
These administration tasks are in support of Preconstruction Engineering Design and CADD business processes that are critical to the project development workflows in the transportation lifecycle.
Responsibilities:
Break down and work tasks into clearly defined, manageable work items for multiple ongoing technical projects.
Prioritize and track progress on work items and deliverables
Ensure work items and deliverables are scheduled, completed, and delivered to the clients on time and with high quality & excellent, usable documentation
Develop and maintain CADD guidelines and workflows for the Department wide administration and utilization of Bentley and other CADD Systems.
Document the program and project deliverables as assigned
Coordinate with clients to ensure coordinated business processes
Draft and deliver training materials as needed
Provide maintenance and quality control for overall Team register of project tasks and project deliverables
Required Skills/Experience:
Experience in project management of IT related initiatives and programs Required 3 Years
Proven experience writing clear and concise technical training materials and other user documentation Required 3 Years
Strong analytical and conceptual skills Required 3 Years
Positive interpersonal skills Required 3 Years
Strong written and verbal communication skills, including ability to explain business processes to IT users and IT applications to business users Required 3 Years
Excellent organizational and presentation skills Required 3 Years
Strong Microsoft Suite experience (e.g., Outlook, Word, Excel, PowerPoint, Teams) Required 3 Years
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration!
We are actively seeking a dedicated Intensive Care Manager with an active RN or LCSW license to join our expanding team on a full-time basis. In this role, you will play a crucial part in our mission to provide exceptional care to our clients. As a key member, you will assume a pivotal role in supporting the Provider Community and working with at-risk youth to prevent residential placement. If you are passionate about ensuring quality healthcare outcomes and skilled at working with at risk people we encourage you to apply for this opportunity!
Accountabilities
Conducting initial and concurrent reviews for individuals at risk of residential placement, ensuring alignment with their needs and expertise.
Overseeing mental health and substance abuse treatment services, verifying their medical necessity and effectiveness.
Participating in interdisciplinary team meetings to develop customized care plans and discharge strategies for each youth’s therapeutic journey.
Providing educational support and implementing interventions to enhance member care throughout the treatment process.
Collaborating with diverse stakeholders, including local departments of Social Services, Community Services Boards, schools, and service providers to ensure comprehensive support.
Actively engaging in quality improvement initiatives, including data collection, monitoring, and analysis, to enhance service delivery.
Contributing to network growth by identifying and recruiting high-quality providers as necessary.
Fulfilling other duties as assigned to support the overall objectives of the organization.
The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.
Knowledge, Skills, Abilities
Proficiency in InterQual or ASAM guidelines, ensuring adherence to industry standards.
Ability to effectively prioritize tasks, assign responsibilities, and meet required deadlines.
Strong problem-solving skills, capable of addressing complex issue and finding viable solutions.
Aptitude for providing technical consultation and interpreting policies accurately.
Exceptional customer service skills, committed to delivering high-quality support and assistance,
Excellent written and verbal communication abilities, facilitating clear and effective communication with stakeholders.
Basic proficiency in Microsoft Office applications to support administrative tasks and documentation needs.
Required Qualifications
Active unrestricted Licensed Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) in the State of Virginia.
Proficient clinical assessment and critical thinking skills.
A minimum of 2 years of hands-on experience in Intensive Care Management and post-degree in healthcare; behavioral health, psychiatric, and/or substance abuse healthcare settings.
Attention Applicants: Please be advised that proper email communication will only be sent from email addresses ending in @astyra.com. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. It is important to communicate within our guidelines and proper channels to expedite possible interview considerations.
The IT Product Manager will serve as a member of the client’s Medicaid Enterprise System (MES) Program providing IT product management within the MES portfolio.
This position will champion our departments key strategies with the goal of creating the opportunity for healthier outcomes for our citizens through clinical and technological innovation.
This position is responsible for providing independent product oversight for the client’s Medicaid products.
This oversight may include development and monitoring of the Medicaid Managed Care product strategies, while collaborating with other divisions and external stakeholders to develop and implement targeted strategies to streamline processes.
This position will create user stories, technology roadmaps and customer research in relation to Medicaid initiatives and strategic goals.
The IT Product Manager represents the client’s business functions within NC Medicaid and partners with IT to ensure delivery of relevant and impactful software and solutions. This position will interact with the NC Medicaid Business Information Analytics Office, Data Office, Information Technology Division, Privacy and Security Office, Policy Office, General Counsel, Office of Procurement, Contracts and Grants, among others.
Responsibilities:
Leads and direct cross-functional activities that provide effective oversight of Medicaid Programs.
Manages direct and hybrid reporting relationships and staff, sets priorities, establishes accountabilities, and defines roles/responsibilities to secure necessary resources not under direct supervision, while maintaining peak levels of performance and compliance.
Collaborates and develops workgroups around product deliverables with Product Owners, Business Leads, Technical Leads and Management.
In-depth knowledge and understanding of products across functions and business segments in healthcare that meet departmental goals.
Directing the conception, development and implementation of new product initiatives, including current product enhancements.
Provides feedback and input to senior level decision-makers to develop long-range strategic alternatives for product solutions.
Communicate project goals and timelines, next steps and results to team members, project managers and the executive team.
Through a variety of communication/meeting methods, determines the customer’s needs, leads product discovery and translates these into detailed and actionable requirements for the MES PMU.
Able to assess emerging products and partners to measure and address their potential value or risk to the department, as well as make recommendations on which new technologies to invest in or leverage.
Provide in-person, conference calls, or virtual trainings on product knowledge, usage and implementation.
Use database queries to analyze performance indicators, evaluate survey data, define successful criteria for testing and product acceptance.
Fluently discuss the financial and/or operational benefits associated with proposed product capabilities.
Ensures compliance with all applicable policies and procedures.
Manages the product lifecycle from conception through implementation.
Performs other duties as assigned.
In addition the IT Product Manager (ITPDM) is responsible for the successful development of IT systems in support of the Medicaid program.
The ITPDM will expressly engage with the business owners to develop the strategy behind how each MES module will support the business requirements definition and will own the translation and specification of all functional requirements.
The ITPDM will work integrally with MES IT Program Managers and the MES Systems Integrator to manage the launch of features and systems.
The ITPDM will evaluate and analyze work done by Medicaid SMEs, Business and Technical Leads, Data Leads, Engineers, and Architects to ensure the business requested capability, implemented design, and delivered functionality is successful and useful to the stakeholders.
Medicaid/Health Care and or Managed Care experience is highly desired and will be preferred.
This is a remote position and candidates are welcome anywhere in the US. Equipment will be provided and VPN access and collaboration tools are available.
Required Skills/Experience:
Knowledge of Enterprise IT Systems, system integration principles, and associated change management best practices. Required 7 Years
Has an understanding of CMS Seven Standards and Conditions and the Medicaid program Required 7 Years
Demonstrated ability to manage multiple priorities and projects, function in a fast-paced moving constantly changing, deadline driven environment Required 7 Years
Proficient use of Microsoft Project, Word, Excel, PowerPoint, Access, and Adobe software Required 7 Years
Skills in persuasion, negotiation, relationship management, conflict resolution, and effective oral and written communication at all levels Required 7 Years
Proven track record of launching successful user-focused products preferably in the enterprise, analytics or healthcare space. Required 7 Years
Previous experience creating business use cases, requirements, and process maps/data flows. Required 7 Years
Experience working in a combination of business analysis, product management, project management and/or software application development. Required 7 Years
Excellent communication skills and attention to detail with specific experience developing, editing, and presenting summaries, reports, and complex in Required 7 Years
Proven experience and working knowledge of agile development methodologies, environment and tools. Highly desired 7 Years
Experience using or implementing Cloud technologies IaaS, PaaS, SaaS. Highly desired 7 Years
Experience handling HIPAA and PII data. Required 7 Years
7+ years of experience in product management in a healthcare or government setting Highly desired 7 Years
Managed Care knowledge or experience Highly desired 7 Years
MITA knowledge or experience Highly desired 7 Years
Medicaid Program knowledge or related HealthCare Information System experience Required 7 Years
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration!
Monitors inpatient and/or outpatient level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.
Provides telephone triage, crisis intervention, and emergency authorizations as assigned.
Performs concurrent reviews for inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience.
In conjunction with providers and facilities, develop discharge plans and oversee their implementation.
Performs quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment.
Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.
Participates in quality improvement activities, including data collection, tracking, and analysis.
Maintains an active workload in accordance with National Care Manager performance standards.
Works with community agencies as appropriate.
Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria.
Participates in network development including identification and recruitment of quality providers as needed.
Advocates for the patient to ensure treatment needs are met.
Interacts with providers in a professional, respectful manner that facilitates the treatment process.
Responsibilities:
Licensure is required for this position, specifically, a current license that meets State, Commonwealth, or customer-specific requirements.
One or more of the following licensure is required for this role with the necessary degrees: CEAP, LMSW, LCSW, LPC, RN, or LPN.
Minimum 2 years experience post degree in healthcare, behavioral health, psychiatric, and/or substance abuse healthcare setting. Strong organization, time management, and communication skills.
Knowledge of utilization management procedures, mental health, and substance abuse community resources and providers. Knowledge and experience in inpatient and/or outpatient settings.
Knowledge of DSM V or the most current diagnostic edition.
Ability to analyze specific utilization problems, and plan and implement solutions that directly influence quality of care.
Work Experience:
Clinical 2+ years
Certification:
Must be Independently licensed in the State of California.
Must have one of the following: CEAP – Certified Employee Assistance Professional, LCSW – Licensed Clinical Social Worker, LMFT – Licensed Marriage and Family Therapist, LMSW – Licensed Master Social Worker, LPC – Licensed Professional Counselor, LPN – Licensed Practical Nurse, RN – Registered Nurse, State and/or Compact State Licensure
Top 3 Must-Haves (Hard Skills):
Business management experience
Computer knowledge
Stable hard-wired fast internet
Private workspace that abides by HIPPA standards
Nice-To-Haves (Hard Skills):
Hospital/ Healthcare background
Education:
Dependent on Certification–Associates: Nursing, Bachelors: Social Work, Masters: Social Work (Required)
Standard Hours: 8:30 AM – 5 PM (PST) Monday – Friday (Lunches and Breaks are scheduled) Must have some flexibility
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Summary: The Registered Nurse will utilize standard criteria to review post-service and prepayment reviews of Outpatient Behavioral Health claims. The nurse will utilize HCPC Codes to ensure claims are being charted for correct processing of Arizona Medicaid requirements.
Responsibilities:
Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which an appeal has been submitted, to ensure medical necessity and appropriate/accurate billing and claims processing.
Identifies and reports quality of care issues.
Assists with Complex Claim review including DRG Validation, Itemized Bill Review, Appropriate Level of Care, Inpatient Readmission, and any opportunity identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience
Documents clinical review summaries, bill audit findings and audit details in the database
Provides supporting documentation for denial and modification of payment decisions
Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of client policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care.
Identify problems or needed changes, recommends resolution, and participates in quality improvement efforts.
Provide accurate documentation.
Maintain and enhance relationships between the business and the provider community.
Required Qualifications:
Active Registered Nurse (RN) license to practice in the state of Arizona or a Compact License.
2+ years of clinical Behavioral Health experience (acute care hospital or Outpatient Clinic setting)
2+ years chart review experience (UM/UR, clinical review, quality review)
Minimum 1 year of experience working remotely.
Behavioral Health Claims review (post-payment and prepayment)
Working knowledge of outpatient BH HCPCs codes (ex. H0004, H2017, S9480, etc.)
Strong computer skills using tools like MS Teams, Sharepoint, Office, EMR, etc…
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration!
Note: This position is fully remote. However, candidates will be required to work within the Pacific Time Zone.
Responsibilities:
Provides non-clinical support to workflows involving utilization management, case management, disease management, and health promotion.
Troubleshoots when an appropriate provider, type of service, or appropriate level of care cannot be readily found.
Has current knowledge or researches availability of community resources and services and link members to appropriate services.
May assist in transitions in care for hospitalized patients and makes appropriate placements, if needed.
Assumes responsibility for self-development and career progression.
Proactively seeks and participates in ongoing training (formal and informal) in all aspects of the Care Worker role.
Assists in the mentoring and training of new Care Workers.
Remains responsible for updating self on ever changing information to ensure accuracy when dealing with members and providers.
Coordinates and manages distribution of correspondence and materials to enrollees and providers.
Participates in operational activities, including data collection, tracking, and analysis.
Required Skills:
Proficient in Microsoft (Word, Excel, Outlook, Excel)
Public Outreach experience
Required Soft Skills:
Must have excellent written /verbal skills
Organized, time management
Nice to Have Soft Skills:
Independent worker
Required Experience:
Experience in a managed care environment, integrated medical and behavioral health care and/or training in chronic pain management.
Understanding of plan benefit structures, psychiatric/medical terminology, and local communication resources.
For roles supporting the Chronic Pain Management SBU, understanding of Chronic Pain Management guidelines and workflows is also required.
Education:
Associate’s (Preferred)
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Independently participate in requirements documentation, business systems configuration and defining/execution of acceptance criteria.
Document issues and participate in their resolution.
Work closely with development and business teams to understand business requirements.
Translate business needs into high-level technical specifications and design.
Identify gaps and ensure deployment of solutions.
Support business-critical systems using mature IT and software engineering practices.
Develop, deploy, and execute test strategies.
Work with team to ensure the highest quality product delivery.
Work closely with cross functional teams and across boundary organizations to gather requirements, define solutions, implement new tools and process, and provide ongoing support to these teams.
Test applications and products at the user level, both manually and with automated tools.
Develop deep understanding of the applications that he/she/they support.
Communicating cross-functionally and across management levels in formal and informal settings.
Track multiple test executions simultaneously and synthesize the results.
Required Skills:
3+ years related experience including developing requirements, designing and executing test cases in IT.
Experience with QA methodology and problem solving techniques/tools.
Detail-oriented person who is passionate about quality and is enthusiastic about the new technology offered to customers.
Demonstrated software testing experience.
Excellent written and oral communication skills.
Meticulous attention to detail; the ability to juggle several tasks in parallel without lowering your quality bar.
Experience with analytical programming languages such as SQL.
Ability to thrive in ambiguity and rapid change.
Experience with process flow diagrams.
Experience with applying Agile Methods.
Experience with Problem Solving Techniques.
Hands-on experience running queries and creating reports.
Ability to understand technical specifications and analyze log files.
Experience working with industry standard claims, billing or EHR systems.
Preferred Skills:
Edifecs Experience
Experience with gathering business requirements
Experience:
IT
Education:
Bachelor’s
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration!
Analyzes problems and program in two or more programming language/platforms.
Understands and develops functional and non-functional requirements for a system.
Works with multiple programming frameworks.
Develops, tests, and maintains code using software development methodology and appropriate technologies for the system being used.
Integrates systems to databases and other applications using middleware such as SnapLogic and consume or produce SOAP or REST based services, etc. Agile, DevOPS and Cloud.
Possesses proficiency in automated testing strategies, including TDD.
Understands advanced concepts of Containers, Micro-Services, Continuous Integration.
Understands Cloud computing concepts and how to build Cloud deployable application.
Performs load and performance testing on the application and do regular performance tuning.
Required Skills:
3+ years of programming experience.
Strong working knowledge of modern programming languages including JavaScript, Java, Swift etc.
Critical thinker.
Demonstrated problem solving techniques.
Strong verbal and written communication skills.
Required Experience:
IT Programming 3+ Years
Education:
Bachelor’s: Computer and Information Science (Preferred)
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration!
