Claims Unit Manager Jobs in Reno, NV (NOW HIRING)

***THIS RECRUITMENT MAY CLOSE WITHOUT FURTHER NOTICE DEPENDING ON THE NUMBER OF APPLICATIONS RECEIVED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE*** Job Summary Nevada Health Authority is hiring for multiple Management Analyst 2 positions in different units under the division of Medicaid. Office of Analytics This position serves as an analyst in the Nevada Health Authority's (NVHA) Office of Analytics - Medicaid Unit and operates under the technical guidance of a Management Analyst IV and the Chief Biostatistician.

The analyst will join a team responsible for producing various analytical products such as research reports, recurring reports, dashboards, and population health studies that support NVHA and Nevada Medicaid leadership priorities, primarily using agency data such as the All Payer Claims Database (APCD), Medicaid claims, hospital billing, and other key datasets. The Medicaid Data Analytics unit is tasked with collecting and analyzing health program data-including claims, utilization, enrollment, and cost-while preparing analytical reports, conducting special studies, and responding to both recurring and ad hoc data requests to inform policy, improve health outcomes, and guide strategic initiatives. This position will use technical skills to collect and perform statistical analysis, maintains data quality, follow procedures, and grow to use complex analytic and predictive modeling tools across the full data science lifecycle.

To be successful, candidates should have experience using analytic software such as SAS, Python, or similar tools, demonstrate expertise in analyzing medical claims or health data, writing analytic reports, and working on analytical teams in a fast-paced, data-driven environment. Procurement and Contracts Unit This position is a Certified Contracts Manager, under Procurement and Contracts Unit. This position is responsible for contract manager functions within federal law, Nevada Revised Statutes, Administrative Code and Nevada Medicaid requirements.

The essential functions of this position reviews solicitations, contracts, modifications, extensions, renewals, Competitive Bidding Exceptions, Purchase Orders and items for accuracy. They review items for accuracy and compliance with Nevada Revised Statutes (NRS), purchasing policies, and federal requirements. Provide interpretation on federal regulations and procurement processes.

Review and make recommendations to issues in NRS interpretation, procurement procedures, and contract administration. Prepare procurement reports to senior management highlighting performance metrics and improvement opportunities. Must have some knowledge in procurement rules, contract negotiation and administration expertise, budget and financial oversite, leadership and team management.

This role is critical for ensuring that NVHA procures goods and services efficiently, legally, and in compliance with state and federal laws. Supplemental Reimbursement Unit (SRU) This position is under the direction of the Management Analyst IV is responsible for fiscal oversight, data reporting, stakeholder coordination, and administration of several Medicaid reimbursement programs. Key duties include managing the VLBW, SOBRA, and Stop Loss programs by ensuring accurate documentation, verification, and timely payment processing; overseeing MCO electronic files; and administering the Indigent Free Care Obligations and County Match programs, including calculations, notifications, revenue tracking, and annual summaries.

The position extracts and analyzes DSS claims data, conducts regulatory and technical research, manages workloads, supports process improvements, and oversees assigned projects. Additional responsibilities include participating in work program preparation, biennial budget development, and monitoring related funding; supporting contract drafting and compliance; tracking and interpreting state and federal regulatory changes; communicating findings to providers, contractors, and leadership; and updating manuals, procedures, and the Nevada Medicaid State Plan, including developing and submitting State Plan Amendments. The Management Analyst II also serves as a liaison with NVHA administration, state and federal agencies, CMS, contractors, and stakeholders, represents the Division in public forums, and performs other duties as assigned, including additional analysis, research, and participation in trainings and conferences.

Rate Analysis and Development Unit of Nevada Medicaid. This position will be responsible for managing the rates for a number of Provider Types within the Nevada Medicaid system. This will require interfacing with providers, provider associations, Managed Care Organizations, other government agencies, and the Centers for Medicare and Medicaid Services.

Major processes included performing fiscal impact analysis for policy and legislative changes, managing amendments to the Nevada Medicaid State Plan and Medicaid Services Manual, and building a high-level understanding of Medicaid finance. Management Analysts conduct studies, research, and examination of management and administrative areas such as agency operations, forms, policies and procedures, workflow, legislative analysis, management research, and statistical and informational analysis. Essential Qualifications Two or more years of applicable experience as described in the job duties and graduation from high school or equivalent education.

Job Duties Conduct research and analyze legislative implications. Determine software application program needs or requirements. Review and monitor contracts.

Make recommendations on policy and procedure improvements. Provide recommendations to management regarding programs and/or work unit activities. Prepare reports and correspondence.

Review, write, revise, and recommend administrative policies or procedures for the work unit and/or assigned programs. Conduct statistical or investigative studies, compile and analyze data, and prepare and present reports summarizing study results and conclusions. Develop, manage, review, and make recommendations on contracts and the contracting process.

Review, monitor, and research bills submitted to the Legislature impacting the work unit, inform management of possible implications, and recommend an appropriate course of action. Perform related duties as assigned. Knowledge, Skills, and Abilities This job specification lists the major knowledge, skills and abilities of the job and is not all inclusive.

Incumbent(s) will be expected to have knowledge, skills and abilities from a previous level. Knowledge of: Statistical and research methodology; contract development and oversight. Skill in: Organizing, planning, implementing, and overseeing multiple programs or areas of responsibility.

Ability to: Analyze organizational and administrative programs, policies, and procedures, prepare plans for revision, and make recommendations; perform statistical computations such as correlation studies, variance analysis, averages, and trends; analyze user needs and develop appropriate solutions and requirements; organize materials, information, and resources systematically to optimize efficiency; organize, plan, implement, and oversee multiple programs. Establish and maintain effective working relationships with coworkers, other agencies, and the public; negotiate and exchange ideas, information, and opinions with others to formulate policies, programs, and reach consensus; define problems, identify trends, analyze issues, solve problems, and communicate solutions; produce clear, concise and valid operational manuals, reports, and other presentation materials. Recruiter Contact Information: Victoria Sheehan - Torisheehan@admin.nv.gov The State of Nevada is an equal opportunity employer dedicated to building diverse, inclusive, and innovative work environments with employees who reflect our communities and enthusiastically serve them

All applicants are considered without regard to race, color, national origin, religion or belief, age, disability, sex, sexual orientation, gender identity or expression, pregnancy, domestic partnership, genetic information (GINA), or compensation and/or wages. Please send direct Inquiries or correspondence to the recruiter listed on this announcement.