Eligibility Review Manager

Overview

Empower AI is AI for government. Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions. Our proven Empower AI Platform® provides a practical, sustainable path for clients to achieve transformation that is true to who they are, what they do, how they work, with the resources they have. The result is a government workforce that is exponentially more creative and productive. For more information, visit www.Empower.ai.

Empower AI is proud to be recognized as a 2024 Military Friendly Employer by Viqtory, the publisher of G.I. Jobs. This designation reflects the company’s commitment to hiring and supporting active-duty and veteran employees.

Responsibilities

We are seeking a highly motivated and detail-oriented individual to join our team as a Eligibility ReviewManager. As an integral part of our PERM program, the Eligibility Review Manager will play a crucial role in ensuring the accuracy and compliance of eligibility reviews. This remote position offers the flexibility to work independently while contributing to the success of our program.

Responsibilities:

• Independently manage and oversee eligibility reviews for our Medicaid program.
• Collaborate with the project director to ensure alignment with project goals and objectives.
• Provide quality assurance by meticulously reviewing eligibility assessments and documentation.
• Offer technical assistance and guidance to state staff regarding eligibility review processes.
• Direct and supervise eligibility policy analysts and reviewers, fostering a cohesive and efficient team.
• Maintain open lines of communication with all levels of the Performance and Results Management (PERM) team.
• Adhere to departmental policies, procedures, and guidelines to uphold the integrity of the program.
• Ensure compliance with the Statement of Work (SOW) guidelines and CMS directives and regulations.
• Participate in departmental meetings and engage in required education and training programs.

Qualifications

• A minimum of three (3) years project management experience;
• A minimum of six (6) years related experience;
• Bachelor's degree or equivalent;
• Ability to establish and maintain effective working relationships;
• Strong working knowledge of state eligibility systems, state eligibility determination processes, and state eligibility policies;
• Considerable program knowledge of the principles and practices of Medicaid and CHIP eligibility
• Considerable knowledge of the Affordable Care Act with specific understanding of eligibility;
• Ability to interpret Medicaid, CHIP, and state eligibility regulations and to analyze their impact on current and proposed programs;
• A minimum of five (5) years of experience conducting Medicaid/CHIP eligibility reviews;
• Experience conducting quality assurance activities related to program integrity reviews; and
• Experience conducting eligibility reviews for the PERM program.
• Strong organizational skills and a keen attention to detail.
• Excellent customer service skills, with the ability to address inquiries and concerns effectively.
• Proficiency in managing routine activities and prioritizing tasks to meet deadlines.
• Self-motivated and able to work independently in a remote setting.
• Exceptional communication skills, both written and verbal.
• Demonstrated ability to work collaboratively within a team-oriented environment.
• Thorough understanding of Medicaid eligibility and related processes (preferred).
• Familiarity with CMS directives and regulations pertaining to eligibility reviews (preferred).
• This is a remote position that offers a unique opportunity to contribute to the success of our Medicaid program while enjoying the benefits of a flexible work environment. If you possess the necessary skills and are committed to maintaining the highest standards of accuracy and compliance, we encourage you to apply.

About Empower AI

All hiring and promotion decisions at Empower AI are based on merit to bring the best talent available to contribute to our firm’s overall success. It is the policy of Empower AI not to discriminate against any applicant for employment, or employee because of age, color, sex, disability, national origin, race, religion, or veteran status. Empower AI is a VEVRAA Federal Contractor.