Explore AMERIGROUP Healthcare Jobs. Are you a healthcare professional looking for a non-traditional healthcare job? Explore nurse jobs. social work jobs, healthcare administration jobs, and more, with AMERIGROUP.en-us/view/client/amerigroup/images/banner.gifwww.amerigroup-jobs.com720Job Title:
Call Center Workforce Planner TN, FL, VA
Job ID:
10771
Location: Nashville, TN;Tampa, FL;Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
Grade: 19 Recruiter: J. Mays
NCC
JOB SUMMARY:
Under the general direction of the Director of National Contact Center (NCC) Operations, the Resource Planner supports the workforce management team by preparing accurate and timely variable forecasts for the NCC. The incumbent is responsible for accurately matching staffing to workload arrival patterns, planning schedules, maintaining accurate staffing data, assisting with long-range staffing plans and handling multiple tasks aimed at meeting/exceeding ongoing service level and occupancy. The responsibilities of this analyst are focused on improving the customer experience and maximizing operational efficiencies.

PRIMARY RESPONSIBILITIES:
1.Responsible for supporting the workforce management program by forecasting call volume and work demand by creating and analyzing staffing and predictive models to determine resource needs.

2.Conducts real time monitoring to manage service levels for the National Contact Center. Makes adjustments to ensure the NCC is meeting service levels in all markets.

3.Defines both long-term strategies and ever-changing, short-term and immediate workforce needs.

4.Responsible for allocating call volume to appropriate sites and queues based on real time call arrival and real time staffing levels across all sites.

5.Collaborates with Director, Call Center Planning to develop appropriate staffing models and ensure that the models are aligned with the customer expectation and with the goals of the NCC.

6.Maximizes technology and workforce management methodology to build forecasting assumptions and determine staffing needs.

7.Responsible for assuring integrity and accuracy of operational data produced including daily updates, event logs commentary and all reports regarding staffing models.

8.Identifies increased call volume trends that go above and beyond forecasted volumes and analyzes and communicates the reasons for the increased volume. Analyzes key performance metrics against forecast and reconciles variances monthly.

9.Works with other departments to communicate trends to facilitate resolution to real time customer issues.

10.Manages and develops assigned staff by providing ongoing feedback and support. Responsible for recruitment and selection of team members.

11.Other Duties as Assigned

EDUCATION AND EXPERIENCE:
Education
Required:
•Bachelor's degree or equivalent experience in Business Administration, Management Information Systems, Mathematics, Statistics or related discipline.
Preferred:
•Master's degree in Business or related field
Years and Type of Experience Required:
Required:
•5+ years call center workforce management experience (forecasting, scheduling)
Preferred:
•Experience in a Virtual Call Center
•One year experience in a management or supervisory role in a call center environment.
•Managed care experience with a Medicaid/Medicare plan administration
Specific Technical Skills
Required:
•Proficient knowledge of call center forecasting applications
•Scheduling software
•Advanced proficiency with Microsoft Office including Excel & Access
Preferred: Impact 360/Blue Pumpkin experience

Certifications or Licensure
Required:
Preferred: Six Sigma Green Belt certification

Other
Required:
•Demonstrated success in workforce planning.
•Ability to design databases, create complex spreadsheets, and import/export data between applications
•Service focused.
•Sense of urgency and proven ability to work independently.
•Excellent understanding of call center operations and back-office practices and processes.
•Proven ability to effectively analyze workforce data, determine appropriate operational needs, and drive change and improvement.
•Knowledge of leading edge technology deployed in call centers and back-office operations.
•Outstanding analytical, reasoning and problem solving skills; ability to determine root causes driving problems and solutions.
•Strong leadership skills with the ability to interact and communicate at all levels with excellent verbal and written communication skills.
•Proven ability to establish effective relationships with internal staff and clients.
•Organized with ability to handle multiple projects and establish priorities appropriately.
•Appreciation of cultural diversity and sensitivity towards target population.
Preferred:

SCOPE INFORMATION
Item Measure
•# Direct Reports May have direct reports based on assignment
•# Indirect Reports 0

PHYSICAL REQUIREMENTS
•Must be able to operate a computer, telephone and other commonly used business-related items.
•Must be able to conduct and participate in meetings.
•Must be able to travel on common carriers and adhere to AGP's travel policy.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/NASHVILLE-Call-Center-Resource-Planner-TN-Job-TN-37201/679126/6791266791262010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSMultiple Locations, USJob Title:
Coordinator Quality MgtRN-Plan
Job ID:
10917
Location: Nevada
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY: The Coordinator Quality Management RN - Plan is responsible in conjunction with management for developing, coordinating, implementing, and evaluating the continuous quality improvement activities throughout the company according to the established Quality Management program. In collaboration with and under the direction management, the Coordinator Quality Management RN - Plan establishes indicators for monitoring and evaluating the full spectrum of care and services provided to members for quality, appropriateness, continuous improvement and satisfaction. The Coordinator Quality Management RN - Plan provides education in the area of quality management to all departments and assists in ensuring compliance with regulatory and accrediting organizations.

PRIMARY RESPONSIBILITIES:
1. Designs and implements quality improvement studies including selection of valid and reliable indicators and coordinates monitoring and evaluation activities

2. Analyzes data and prepares concise, accurate and meaningful quality management reports in accordance with Company procedures.

3. Actively participates in intradepartmental quality management improvement teams as appointed.

4. Coordinates resolution of high level complaints.

5. Educates AMERIGROUP associates about the QM process.

6. Assists in defining opportunities for improvement identified through analysis of trends and communicates these appropriately.

7. Assists in the preparation for the Quality Improvement Council and other QM related committee meetings.

8. Implements, analyzes and evaluates the Company-wide inter-rater reliability program.

9. Prepares QM department responses for RFIs and RFPs.

10. Responsible for maintaining quality management documents, case files and correspondence in an organized, confidential and secure manner.

11. Conducts, as appropriate, oversight audits for all nationally delegated vendors.

12. Develops and maintains ancillary vendor audit tools.

13. Communicates significant findings, including potential risk management issues to the AVP Quality Management as indicated in a timely manner.

14. Assists with coordinating HEDIS Improvement Activities.

15. Assists with coordinating Member Satisfaction Improvement activities.

16. Other duties as requested or assigned.

JOB REQUIREMENTS:
EDUCATION AND EXPERIENCE:
• Bachelor's degree or equivalent experience required
• Associates degree in nursing or related field
• 2-3 years experience in quality improvement, risk management and/or utilization review in a managed care setting.
• Knowledge of local and national QM and regulatory standards preferred, including NCQA and HEDIS reporting.

CERTIFICATION AND LICENSURE:
• Current professional licensure – RN required
• CPHQ preferred

Knowledge and Skills:
• Computer literate including word processing, spreadsheets and database management skills.
• Excellent verbal and written communication skills.
• Strong decision making skills.
• Demonstrates organizational skills.
• Ability to work self directed and in work groups.
• Ability to interact with all relevant components of the health care system.
• Appreciation of cultural diversity and sensitivity towards target population.

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate a telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/Coordinator-Quality-MgtRN-Plan-Job-NEVA/706217/7062177062172010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSNevada, USJob Title:
Case Manager RN - located in Dallas/Fort Worth
Job ID:
10975
Location: Nevada
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY: The Case Manager RN is responsible for managing members experiencing complex or catastrophic illness, injury and/or specialty illnesses such as diabetes, HIV, transplant, etc, to insure cost effective and efficient utilization of health services. She/he acts as a member advocate, seeking and coordinating creative solutions to member's health care needs without compromising quality of outcomes.

PRIMARY RESPONSIBILITIES:
1. Obtains an accurate member history.

2. Assesses clinical information to develop care plans including a member support system.

3. Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements.

4. Establishes working relationships with referral sources and community resources.

5. Communicates care objectives to appropriate individuals/departments/referral sources.

6. Assessment of biopsychosocial factors.

7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.

8. Collaborates with the member's PCP and specialists in the development of the plan of care to ensure that members' physical needs are addressed

9. Provide case management and/or disease management services to members, as identified by the health plan's CI3 list

10. May be required to conduct field visits.

11. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan

12. Acts as an advocate for an individual's health care needs.

13. Reviews benefit systems and cost benefit analysis.

14. Evaluates the quality of necessary medical services.

15. Utilizes criteria for authorizing appropriate clinical services.

16. Identifies members that would benefit from an alternative level of care.

17. Acquires data and evaluates necessary health services for cost containment.

18. Documents effectiveness of case management services.

19. Identifies the need for assistive devices/adaptive equipment needed for members.

20. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.

21. Requests direction from appropriate supervisor(s) on complex issues.

22. Utilizes leadership skills for non-clinical team members.

23. Collaboratively works with other departments.

24. Participates in Quality Improvement processes.

25. Serves on internal and external committees.

26. Maintains member confidentiality.

27. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Current RN state license required.
Preferred:
• Bachelors or Masters Degree.
Years and Type of Experience Required:
Required:
• Four years experience in health care, case management, discharge planning or behavioral health.

Preferred:
• Experience working on the community level and with community agencies preferred.

Specific Technical Skills
Required:
Preferred:

Certifications or Licensure
Required:
• Must possess a valid driver's license and access to a motor vehicle.

Preferred:
• Certified case managers preferred.
Other
Required:
• Computer literate.
• Excellent verbal and written communications skills.
• Strong decision making skills.
• Ability to provide services in an environment that involves multiple health care systems.
• Ability to interact with all relevant components of the health care system.
• Ability to provide services that deal with the individual's broad spectrum of needs.
• Self-starter with ability to handle multiple projects at one time.
• Appreciation of cultural diversity and sensitivity towards target population.
• Bilingual a plus.
Preferred:

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate (and communicate via) a telephone.
• Must be able to sit for long periods of time
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/Case-Manager-RN-located-in-Dallas-Fort-Worth-Job-NEVA/716024/7160247160242010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSNevada, USJob Title:
Case Manager RN - Plan
Job ID:
10979
Location: Nevada
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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------------

Responsibilities
JOB SUMMARY: The Case Manager RN is responsible for managing members experiencing complex or catastrophic illness, injury and/or specialty illnesses such as diabetes, HIV, transplant, etc, to insure cost effective and efficient utilization of health services. She/he acts as a member advocate, seeking and coordinating creative solutions to member's health care needs without compromising quality of outcomes.

PRIMARY RESPONSIBILITIES:
1. Obtains an accurate member history.

2. Assesses clinical information to develop care plans including a member support system.

3. Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements.

4. Establishes working relationships with referral sources and community resources.

5. Communicates care objectives to appropriate individuals/departments/referral sources.

6. Assessment of biopsychosocial factors.

7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.

8. Collaborates with the member's PCP and specialists in the development of the plan of care to ensure that members' physical needs are addressed

9. Provide case management and/or disease management services to members, as identified by the health plan's CI3 list

10. May be required to conduct field visits.

11. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan

12. Acts as an advocate for an individual's health care needs.

13. Reviews benefit systems and cost benefit analysis.

14. Evaluates the quality of necessary medical services.

15. Utilizes criteria for authorizing appropriate clinical services.

16. Identifies members that would benefit from an alternative level of care.

17. Acquires data and evaluates necessary health services for cost containment.

18. Documents effectiveness of case management services.

19. Identifies the need for assistive devices/adaptive equipment needed for members.

20. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.

21. Requests direction from appropriate supervisor(s) on complex issues.

22. Utilizes leadership skills for non-clinical team members.

23. Collaboratively works with other departments.

24. Participates in Quality Improvement processes.

25. Serves on internal and external committees.

26. Maintains member confidentiality.

27. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Current RN state license required.
Preferred:
• Bachelors or Masters Degree.
Years and Type of Experience Required:
Required:
• Four years experience in health care, case management, discharge planning or behavioral health.

Preferred:
• Experience working on the community level and with community agencies preferred.

Specific Technical Skills
Required:
Preferred:

Certifications or Licensure
Required:
• Must possess a valid driver's license and access to a motor vehicle.

Preferred:
• Certified case managers preferred.
Other
Required:
• Computer literate.
• Excellent verbal and written communications skills.
• Strong decision making skills.
• Ability to provide services in an environment that involves multiple health care systems.
• Ability to interact with all relevant components of the health care system.
• Ability to provide services that deal with the individual's broad spectrum of needs.
• Self-starter with ability to handle multiple projects at one time.
• Appreciation of cultural diversity and sensitivity towards target population.
• Bilingual a plus.
Preferred:

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate (and communicate via) a telephone.
• Must be able to sit for long periods of time
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/Case-Manager-RN-Plan-Job-NEVA/717729/7177297177292010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSNevada, USJob Title:
VP Provider Relations - Plan
Job ID:
10981
Location: Edison, NJ
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:
Lead all aspects of Provider Network Management to include provider network strategy, provider contracting, provider relations and operations to support provider service, network development, provider education, and product and market expansions. Responsibilities include the strategic analysis and negotiations for network management, including organizational management, complex contracting, and contracting efforts to support MEIs. Provider Network Management includes all aspects of interaction with claim centers, Business Solutions, HCMS, QI and Service Center Operations. The Provider Relations VP may also work closely with our client or regulatory partners to achieve high level of compliance and customer satisfaction. It is further expected this leadership position is a key part of the health plan leadership team supporting important operational and leadership aspects of the health plan.

PRIMARY RESPONSIBILITIES:
1. Responsible for managing and improving network management operations to achieve or exceed performance standards/budgets.

2. Leads the development of provider network business plans, strategies and goals.

3. Responsible for hiring, developing, training and retaining high-quality, productive employees.

4. Develops and manages provider contracting efforts and partnerships to achieve quality, cost management, and strategic business development objectives.

5. Assists the CEO/COO with aspects of local and state government relationships, including dealing with regulators as necessary to establish and continue effective working relationships.

6. Effectively represent AGP in interaction and negotiation with the provider network.

7. Collaborate with health plan senior management to identify and align provider contracting efforts with the goals and objectives of the plan and AGP.

8. Lead or assist in the development of Provider network related earnings improvement initiatives.

9. Lead the execution of provider network business plans, strategies and goals.

10. Monitor local market trends relative to Provider contracting, reimbursement and service, make recommendations to modify current processes and lead or assist with implementing changes when necessary.

11. Responsible for managing required regulatory compliance for provider networks.

12. Liaison to home office personnel to ensure that provider credentialing, maintenance and reimbursement is properly maintained.

EDUCATION AND EXPERIENCE:
Education
Required: College degree required.
Preferred: Advanced degree preferred

Years and Type of Experience Required:
Required: Minimum ten (10) years experience in managed care, with minimum eight (8) years in managed care administration, and two (2) years in executive management.

Specific Technical Skills
Required:
•Demonstrated experience with team management and performance improvement.
•Strong understanding of the healthcare industry, managed care and health plan operations
Preferred:
•Experience leading a company or division with a distinct P and L is considered a positive.
•Experience with government programs preferred.
•Knowledge of Medicaid reimbursement methodologies is desired.
•Experience in large, complex negotiations and contracting efforts.
•Documented success in operational management.
•Ability to successfully interact with senior executives of the AGP organization as well as community Healthcare clinical professionals and business executives nationwide.
•Self starter and goal oriented.
•Computational and analytical skills related to Provider contracting and healthcare cost management.
•Ability to establish a strategic vision, set expectations and provide clear direction to individuals or departments being managed.
•Respect for and ability to work well with all levels within the organization and within the Provider community.
•Appreciation of cultural diversity and strong sensitivity towards target member population.
•Excellent communication, organizational and project management skills.
•Ability to prioritize and execute multiple complex projects in various markets simultaneously.
•Ability to complete projects/assignments accurately, on-time, on-budget and with a minimum amount of supervision.
•Understanding and appreciation of legal and regulatory environment relative to Provider Relations.
•Respect for and ability to work well with all levels within the organization and within the Provider community.

Licensure Required: Current driver's license, and at minimum, state required amount of automobile insurance for state where automobile is licensed.

PHYSICAL REQUIREMENTS
•Must be able to travel on common carriers, drive an automobile and adhere to AGP's travel policy.
•Must be able to operate a computer, telephone and other commonly used business-related items.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/EDISON-VP-Provider-Relations-Plan-Job-NJ-08817/717731/7177317177312010-04-09AmerigroupHealth Care Operationsfull-timeUSDstarting0BSEdison, NJ, USJob Title:
Account Rep-Medicare Advantage
Job ID:
10978
Location: Edison, NJ
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:
The Medicare Account Representative is responsible educating seniors and the community about Medicare products; generating enrollment leads and referrals; enrolling seniors in the AMERGROUP Medicare Advantage plan; and presenting plan information at community-based seminars. This position is responsible for developing and maintaining leads which includes timely reporting and documentation of results for use by management.
At all times, this position must conduct themselves in full compliance with state and federal regulatory requirements.

PRIMARY RESPONSIBILITIES:
1. Meets sales and sales development goals as assigned by management.

2. Submits enrollment applications in a complete and timely manner.

3. Conducts telemarketing activities, both inbound and outbound to respond to inquiries, generate appointments, and follow-up on leads, referrals, and re-marketing opportunities.

4. Responds and follows-up on leads which include entry of data into AMERIGROUP's Sales Tracking System.

5. Coordinates and implements strategies in an assigned territory and growing membership through face-to-face sales enrollment meetings, presentations, community and provider education sessions and social service outreach to existing and potential members.

6. Develops and maintains new contacts and/or partnerships in the community.

7. Conducts in-home presentations and community-based presentations and performs other activities in an effort to gain members and maintain and/or established positive relationships with providers, community and faith based organizations.

8. Develops and maintains new and existing provider and community-based organization relationships.

9. Participates in marketing events and exhibits as needed.

10. Identifies and enlists the cooperation of individuals, groups, social service agencies and other community organizations in educational and outreach activities.

11. Supports health and wellness education activities; referral of members to health education programs.

12. Acts as a viable resource to the membership and the community as needed.

13. Identifies cultural issues regarding current and potential members; communicates those issues and concerns to management immediately.

14. All other professional duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Preferred: BS/BA degree

Type of Experience
Required: 3 yrs direct consumer services sales experience, if highest education level is High School.
Preferred: Direct experience selling Medicare insurance products to seniors.

Specific Technical Skills
Preferred: Experience working with Microsoft office - Excel and Word

Certifications/Licensure:
Required:
•Health Producer's license, as required and issued by the state (must have a valid license prior to the first day of employment);
•Must possess a valid driver's license, motor vehicle insurance and have access to a motor vehicle

Knowledge and Skills:
•Self-starter with the ability to work with limited supervision;
•Medicare, Medicaid and CHIP program knowledge desired;
•Excellent verbal and written communications skills; bilingual a plus (Spanish-English);
•Strong time management, organizational and follow up skills required;
•Must exhibit sensitivity towards the target population including experiences selling or caring for seniors;
•Must be creative, innovative and have excellent interpersonal skills; and
•Must be self-oriented, flexible, enthusiastic and energetic.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/EDISON-Account-Rep-Medicare-Advantage-Job-NJ-08817/717728/7177287177282010-04-09AmerigroupSales & Marketingfull-timeUSDstarting0BSEdison, NJ, USJob Title:
Case Specialist - Plan
Job ID:
10848
Location: Edison, NJ
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:
The Case Specialist - Plan is responsible for managing care and services to members. Case Specialists works in conjunction with Case Managers to coordinate health care services by facilitating, scheduling, and arranging a variety of treatment and health care plans.

PRIMARY RESPONSIBILITIES:
1. Coordination, authorization, fulfillment, monitoring and tracking of health care services.

2. Establish working relationships with referral sources

3. Initiates and maintains contact with assigned individuals/significant others and providers to determine members response to services.

4. Coordinate home visits for Case Managers.

5. Review of benefit systems.

6. Identifies cases in consultation with Case Manager that would benefit from alternative care.

7. Coordinates assignments for Case Managers to facilitate timely member evaluation.

8. Arranges for services as identified by the case manager such as home health resources, alternative long-term care placements etc.

9. Knowledge of care-coordination and case management concepts.

10. Identifies potential liability issues for services provided.

11. Utilizes knowledge of community resources.

12. Refers members to case management as indicated.

13. Ensures that health care services are received as authorized by the provider.

14. Collaboratively works with other departments.

15. Utilizes excellent customer service principles to assist internal and external customers.

16. Maintains member confidentiality.

17. Other duties as requested or assigned.

JOB REQUIREMENTS:
Education
Required: Associate Degree required (or equivalent experience)
Preferred: Bachelors degree preferred

Years and Type of Experience Required:
Required:
•Minimum of (2) years working in Health Services field
•Knowledge of DME and Medical terminology
•Bilingual a plus

Specific Technical Skills
Required: Knowledge of Microsoft Office suite
Preferred: Experience working with data base applications

Other Skills:
•Excellent verbal and written communication skills.
•Strong decision making skills.
•Ability to provide services in an environment that involves multiple health care systems.
•Ability to interact with all relevant components of the health care system.
•Ability to provide services that deal with the individuals broad spectrum of needs
•Self-starter with ability to handle multiple projects at one time.
•Appreciation of cultural diversity and sensitivity towards target population.

PHYSICAL REQUIREMENTS:
•Must be able to operate a computer.
•Must be able to operate a telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/EDISON-Case-Specialist-Plan-Job-NJ-08817/695691/6956916956912010-04-09AmerigroupHealth Care Operationsfull-timeUSDstarting0BSEdison, NJ, USJob Title:
Case Manager RN - Plan
Job ID:
10849
Location: Edison, NJ
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
We currently have 3 Case Manager RN positions. Two positions are on the SSI team and require experience working with people with disabilities (ABD population). One position is on the Acute Team, working with our level 3 members.

JOB SUMMARY: The Case Manager RN is responsible for managing members experiencing complex or catastrophic illness, injury and/or specialty illnesses such as diabetes, HIV, transplant, etc, to insure cost effective and efficient utilization of health services. She/he acts as a member advocate, seeking and coordinating creative solutions to member's health care needs without compromising quality of outcomes.

PRIMARY RESPONSIBILITIES:
1. Obtains an accurate member history.

2. Assesses clinical information to develop care plans including a member support system.

3. Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements.

4. Establishes working relationships with referral sources and community resources.

5. Communicates care objectives to appropriate individuals/departments/referral sources.

6. Assessment of biopsychosocial factors.

7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.

8. Collaborates with the member's PCP and specialists in the development of the plan of care to ensure that members' physical needs are addressed

9. Provide case management and/or disease management services to members, as identified by the health plan's CI3 list

10. May be required to conduct field visits.

11. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan

12. Acts as an advocate for an individual's health care needs.

13. Reviews benefit systems and cost benefit analysis.

14. Evaluates the quality of necessary medical services.

15. Utilizes criteria for authorizing appropriate clinical services.

16. Identifies members that would benefit from an alternative level of care.

17. Acquires data and evaluates necessary health services for cost containment.

18. Documents effectiveness of case management services.

19. Identifies the need for assistive devices/adaptive equipment needed for members.

20. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.

21. Requests direction from appropriate supervisor(s) on complex issues.

22. Utilizes leadership skills for non-clinical team members.

23. Collaboratively works with other departments.

24. Participates in Quality Improvement processes.

25. Serves on internal and external committees.

26. Maintains member confidentiality.

27. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Preferred: Bachelors or Masters Degree.

Years and Type of Experience Required:
Required: Four years experience in health care, case management, discharge planning or behavioral health.

Preferred: Experience working on the community level and with community agencies preferred.

Specific Technical Skills
Required: Knowledge of Microsoft Office
Preferred: Experience with data base applications

Certifications or Licensure
-Active NJ State RN license required.
-Certified Case Managers preferred.

Other Skills:
•Excellent verbal and written communications skills.
•Strong decision making skills.
•Ability to provide services in an environment that involves multiple health care systems.
•Ability to interact with all relevant components of the health care system.
•Ability to provide services that deal with the individual's broad spectrum of needs.
•Self-starter with ability to handle multiple projects at one time.
•Appreciation of cultural diversity and sensitivity towards target population.
•Bilingual a plus.

PHYSICAL REQUIREMENTS:
•Must be able to operate a computer.
•Must be able to operate (and communicate via) a telephone.
•Must be able to sit for long periods of time
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/EDISON-Case-Manager-RN-Plan-Job-NJ-08817/689632/6896326896322010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSEdison, NJ, USJob Title:
Utilization Manager RN
Job ID:
11073
Location: Edison, NJ
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY: Performs technical and administrative work required to evaluate the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Licensed RN responsible for clinical review of all acute and subacute services for appropriateness based on medical criteria. This individual is responsible for the management of healthcare resources necessary and appropriate for achievement of desired acute and subacute outcomes and the coordination of alternative levels of care for membership.

PRIMARY RESPONSIBILITIES:
1. Performs on-site and/or telephonic review of acute and subacute services.

2. Predicts and plans for patient's needs from pre-admission, through acute and subacute care and post-discharge, in collaboration with the member.

3. Utilizes pre-approved criteria and guidelines to validate medical necessity of continued stay and appropriateness of treatment and discharge planning.

4. Acts in conjunction with the appropriate manager(s) on a daily basis to assess the inpatient census for appropriate alternative health care service needs.

5. Coordinates with appropriate discharge planning team members, facility utilization management department, physicians and members to coordinate timely discharges.

6. Strives to maintain quality care while effectively utilizing resources.

7. Identifies and reports any quality or utilization issues to the Medical Director.

8. Acts in conjunction with the clinical team related to discharge planning e.g., home care, hospice care, rehabilitation care, special program care, transitional care, occupational therapy, speech, respiratory and physical therapy, durable equipment and disposable supplies.

9. Documents all activities in the appropriate system(s) on a timely basis.

10. Participates in rounds with the Medical Director.

11. Review Plan appeal items for concurrent and retrospective reviews as required and requested.

12. Monitors and facilities appropriate utilization of resources utilizing clinical criteria.

13. Tracks and reports trends of inappropriate utilization of resources to the Medical Director.

14. Participates in a multi-disciplinary clinical team to achieve positive member outcomes.

15. Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

16. Utilizes effective communication, conflict management and negotiation skills.

17. Utilizes excellent customer service principles to assist internal and external customers.

18. Participates in Quality Improvement Process.

19. Maintains member confidentiality.

20. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education: BA/BS degree preferred.

Years and Type of Experience Required:
•Two years of Utilization Management or Hospital/Acute care experience required.
•Currently licensed RN with three years experience in health care, case management, discharge planning, utilization management, or behavioral health.
•Experience working on the community level and with community agencies preferred.

Specific Technical Skills
Knowledge of Microsoft Office suite.
Experience with data base applications preferred.

Certifications or Licensure
•Current State RN license required
•Certified Case Manager a plus.
•Must possess a valid driver's license and access to a motor vehicle.

Other Skills:
•Excellent verbal and written communications skills.
•Strong decision making skills.
•Ability to provide services in an environment that involves multiple health care systems.
•Ability to interact with all relevant components of the health care system.
•Ability to provide services that deal with the individual's broad spectrum of needs.
•Self-starter with ability to handle multiple projects at one time.
•Appreciation of cultural diversity and sensitivity towards target population.
•Bilingual a plus.

PHYSICAL REQUIREMENTS:
•Must be able to operate a computer.
•Must be able to operate a telephone.
•Must be able to sit for long periods of time.
•Must be able to operate a motor vehicle and travel locally.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/EDISON-Utilization-Manager-RN-Job-NJ-08817/740111/7401117401112010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSEdison, NJ, USJob Title:
Provider Relations Rep I - NJ
Job ID:
11155
Location: Edison, NJ
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Serves as liaison to providers and is responsible for performing activities designed to establish and maintain positive and productive relationships with AMERIGROUP network providers. These activities include responding to inquiries from providers to clarify issues related to member benefits, claim resolution, appeal status, provider recruitment, and authorization or referral information. May perform position requirements in the field or telephonically, as appropriate.

PRIMARY RESPONSIBILITIES:
1. Responds to telephonic and written inquiries from providers.

2. Ensures that provider relationships with the Plan are positive and productive for both parties.

3. Participates in problem solving with providers. Identifies and monitors provider issues and concerns, recommends solutions, and works with local and corporate staff to resolve the issues.

4. Collaborates with local and corporate staff as necessary to ensure that appropriate contracts are executed and implemented and that all providers are credentialed in a timely manner.

5. Analyzes provider network for adequacy in addressing members' medical needs and assists in the identification and recruitment of key providers where network gaps or needs exist.

6. Creates and maintains information required to support the network development process.

7. Conducts onsite provider education forums, orientations, and provider servicing visits to ensure providers are well-acquainted with AMERIGROUP benefits, policies, and procedures.

8. Provides expertise and assistance with guidelines relative to provider billing and payment.

9. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled.

10. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities.

11. Participates in earnings improvement opportunities, as appropriate and achieving strategic objectives relating to the Provider network.

EDUCATION AND EXPERIENCE:
Education
- BA/BS degree preferred or equivalent experience

Years and Type of Experience Required:
Required: Minimum of 3 years of managed care experience, preferably in a Medicaid/Medicare environment

Technical Skills
Required:
•Experience with computer software applications including Excel
•Claims experience/knowledge of medical coding

Licensure
Required: Must have access to a vehicle with current drivers license and insurance

Other Skills
•Excellent verbal and written communication skills
•Detail-oriented
•Ability to handle multiple tasks

PHYSICAL REQUIREMENTS
•Must be able to operate a computer, telephone and fax machine
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/EDISON-Provider-Relations-Rep-I-NJ-Job-NJ-08817/756746/7567467567462010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSEdison, NJ, USJob Title:
Case Manager RN Plan - NY
Job ID:
11014
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:

The Case Manager RN is responsible for managing members experiencing complex or catastrophic illness, injury and/or specialty illnesses such as diabetes, HIV, transplant, etc, to insure cost effective and efficient utilization of health services. She/he acts as a member advocate, seeking and coordinating creative solutions to member's health care needs without compromising quality of outcomes.

PRIMARY RESPONSIBILITIES:
1. Obtains an accurate member history.

2. Assesses clinical information to develop care plans including a member support system.

3. Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements.

4. Establishes working relationships with referral sources and community resources.

5. Communicates care objectives to appropriate individuals/departments/referral sources.

6. Assessment of biopsychosocial factors.

7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.

8. Collaborates with the member's PCP and specialists in the development of the plan of care to ensure that members' physical needs are addressed

9. Provide case management and/or disease management services to members, as identified by the health plan's CI3 list

10. May be required to conduct field visits.

11. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan

12. Acts as an advocate for an individual's health care needs.

13. Reviews benefit systems and cost benefit analysis.

14. Evaluates the quality of necessary medical services.

15. Utilizes criteria for authorizing appropriate clinical services.

16. Identifies members that would benefit from an alternative level of care.

17. Acquires data and evaluates necessary health services for cost containment.

18. Documents effectiveness of case management services.

19. Identifies the need for assistive devices/adaptive equipment needed for members.

20. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.

21. Requests direction from appropriate supervisor(s) on complex issues.

22. Utilizes leadership skills for non-clinical team members.

23. Collaboratively works with other departments.

24. Participates in Quality Improvement processes.

25. Serves on internal and external committees.

26. Maintains member confidentiality.

27. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Current RN state license required.
Preferred:
• Bachelors or Masters Degree.
Years and Type of Experience Required:
Required:
• Four years experience in health care, case management, discharge planning or behavioral health.

Preferred:
• Experience working on the community level and with community agencies preferred.

Specific Technical Skills
Required:
Preferred:

Certifications or Licensure
Required:
• Must possess a valid driver's license and access to a motor vehicle.

Preferred:
• Certified case managers preferred.
Other
Required:
• Computer literate.
• Excellent verbal and written communications skills.
• Strong decision making skills.
• Ability to provide services in an environment that involves multiple health care systems.
• Ability to interact with all relevant components of the health care system.
• Ability to provide services that deal with the individual's broad spectrum of needs.
• Self-starter with ability to handle multiple projects at one time.
• Appreciation of cultural diversity and sensitivity towards target population.
• Bilingual a plus.
Preferred:

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate (and communicate via) a telephone.
• Must be able to sit for long periods of time
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-Case-Manager-RN-Plan-NY-Job-NY-10001/727864/7278647278642010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSNew York City, NY, USJob Title:
Manager - Operations
Job ID:
11035
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Responsible for the collection, review, and analysis of data from key operational processes: financial, production, configuration and staffing data. Develop and disseminate key management metrics used to track and improve core processes. Develop and recommend process improvements that reduce medical and administrative costs and improve efficiency. Provide technical support for the testing of new systems. Perform ad hoc analysis of contract, productivity and claims issues.

PRIMARY RESPONSIBILITIES:
1. Analyze the more significant and complex cross-functional problems presented to Management Analysis and Recovery.

2. Perform root-cause analysis and develop/propose systematic or process solutions to the problems' origin.

3.Develop solutions that resolve the problem and can be supported by the applicable business owners and systems.

4.Lead the development and implementation of systems that reduce defects and provide more efficient production.

5.Coordinate efforts of other Management Analysis and Recovery associates to successfully meet project requirements and results.

6.Gain team support and motivate team to action in order to implement solutions.

7.Supervise department Recovery Analysts and/or Management Analysts.

8.Serves as the ‘go-to' person for Management Analysis and Recovery's greatest operational challenges.

9.Develop and implement Quality Assurance processes in Management Analysis and Recovery.

10.Perform other Duties as Assigned.

EDUCATION AND EXPERIENCE:
Education
Required: Bachelors Degree in Information Technology, Health Information Systems, Business, Healthcare Management or equivalent experience
Preferred: MBA

Years and Type of Experience Required:
Required: 5+ years of management analysis experience
Preferred:

Specific Technical Skills
Required: 5+ years experience with Information systems including SQL and Microsoft Office suite and Oracle (preferred).
Preferred:

Certifications or Licensure
Required:
Preferred:

Other
Required: Excellent analytical and organizational skills. Excellent verbal and written communication skills. Excellent interpersonal skills, including the ability to work closely with Senior Management. Knowledge of managed care, process improvement, and root cause analysis.

Preferred:

SCOPE INFORMATION

Item Measure
•# Direct Reports 4 direct reports
•# Indirect Reports Varies according to project; 1 to 10 typical
•Budgetary $ Responsibility Projects impacting millions of dollars in operating costs

PHYSICAL REQUIREMENTS
•Must be able to operate a computer
•Must be able to operate a telephone.
•Travel required - must be able to travel on common carriers and adhere to AMERIGROUP's travel policies
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-Mgr-Mgmt-Analysis-&-Recov-Job-NY-10001/730386/7303867303862010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSNew York City, NY, USJob Title:
Maternity Case Manager RN Plan - NY
Job ID:
11102
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:

The Case Manager RN is responsible for managing members experiencing complex or catastrophic illness, injury and/or specialty illnesses such as diabetes, HIV, transplant, etc, to insure cost effective and efficient utilization of health services. She/he acts as a member advocate, seeking and coordinating creative solutions to member's health care needs without compromising quality of outcomes.

PRIMARY RESPONSIBILITIES:
1. Obtains an accurate member history.

2. Assesses clinical information to develop care plans including a member support system.

3. Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements.

4. Establishes working relationships with referral sources and community resources.

5. Communicates care objectives to appropriate individuals/departments/referral sources.

6. Assessment of biopsychosocial factors.

7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.

8. Collaborates with the member's PCP and specialists in the development of the plan of care to ensure that members' physical needs are addressed

9. Provide case management and/or disease management services to members, as identified by the health plan's CI3 list

10. May be required to conduct field visits.

11. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan

12. Acts as an advocate for an individual's health care needs.

13. Reviews benefit systems and cost benefit analysis.

14. Evaluates the quality of necessary medical services.

15. Utilizes criteria for authorizing appropriate clinical services.

16. Identifies members that would benefit from an alternative level of care.

17. Acquires data and evaluates necessary health services for cost containment.

18. Documents effectiveness of case management services.

19. Identifies the need for assistive devices/adaptive equipment needed for members.

20. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.

21. Requests direction from appropriate supervisor(s) on complex issues.

22. Utilizes leadership skills for non-clinical team members.

23. Collaboratively works with other departments.

24. Participates in Quality Improvement processes.

25. Serves on internal and external committees.

26. Maintains member confidentiality.

27. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Current RN state license required.
Preferred:
• Bachelors or Masters Degree.
Years and Type of Experience Required:
Required:
• Four years experience in health care, case management, discharge planning or behavioral health.

Preferred:
• Experience working on the community level and with community agencies preferred.

Specific Technical Skills
Required:
Preferred:

Certifications or Licensure
Required:
• Must possess a valid driver's license and access to a motor vehicle.

Preferred:
• Certified case managers preferred.
Other
Required:
• Computer literate.
• Excellent verbal and written communications skills.
• Strong decision making skills.
• Ability to provide services in an environment that involves multiple health care systems.
• Ability to interact with all relevant components of the health care system.
• Ability to provide services that deal with the individual's broad spectrum of needs.
• Self-starter with ability to handle multiple projects at one time.
• Appreciation of cultural diversity and sensitivity towards target population.
• Bilingual a plus.
Preferred:

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate (and communicate via) a telephone.
• Must be able to sit for long periods of time
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-Case-Manager-RN-Plan-NY-Job-NY-10001/744119/7441197441192010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSNew York City, NY, USJob Title:
Medicare Provider Relations Rep II - NY
Job ID:
11070
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:

Serves as liaison to providers (including physicians, hospitals, and/or ancillary providers) and internal departments at the health plan. Responsible for performing activities designed to establish and maintain positive and productive relationships with AMERIGROUP network providers for Medicaid and Medicare products. These activities include responding to inquiries from providers regarding benefits, claim resolution, appeal status, and authorization or referral information. Also may be responsible for recruiting providers to ensure network access and service adequacy. Provides training, guidance and assistance to Provider Relations Representatives I to support their skill development and successful completion of assignments. May perform position requirements in the field or telephonically, as appropriate. More emphasis is placed on field work at the rep level II.

PRIMARY RESPONSIBILITIES:
1. Track and respond to in-person, telephonic, and written inquiries from providers and document all contacts in appropriate system per Plan (i.e. Sales force).

2. Ensures that provider relationships with the Plan are positive and productive for both parties.

3. Works with Providers to understand issues/concerns. Identifies root cause of problems and trends and participates in developing solutions. . Works with Provider's staff and AMERIGROUP staff (local and/or corporate) to resolve the issue and monitor recurrence.

4. Assists with training and mentoring of the Provider Relations Representatives as needed to ensure departmental success and effective team work. In the absence of management, acts as the lead or senior associate in the department or for the assigned team.

5. Collaborates with local and corporate staff as necessary to ensure that appropriate applications are processed, contracts are executed and all providers are credentialed in a timely manner.

6. Analyzes provider network for adequacy in addressing members' medical needs and assists in the identification and recruitment of key providers where network gaps or needs exist.

7. Creates and maintains information required to support the network development process.

8. Develops training materials and conducts on-site provider education, orientations, and provider servicing visits to ensure providers are well-acquainted with AMERIGROUP benefits, policies, and procedures.

9. Provides expertise and assistance relative to provider billing and payment guidelines consistent with AMERIGROUP policies and procedures.

10. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled within established time frames.

11. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities.

12. Performs other duties and special projects as assigned

EDUCATION AND EXPERIENCE:

Education
Required:
• BA/BS degree or equivalent experience

Preferred:

Years and Type of Experience Required:
Required:
• 5+ years of managed care experience, preferably in a Medicare environment

Preferred:

Specific Technical Skills
Required:
• Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
• Claims experience/knowledge of medical coding
• Strong telephonic and customer service skills.
• Effective presentation skills.
Preferred:
• Experience using Sales force CRM
• Experience using Facets.

Certifications or Licensures
Required:
Preferred:
•

Other:
Required:
• Excellent verbal and written communication skills.
• Detail-oriented.
• Ability to handle multiple tasks in a fast-paced environment.
• Must be service oriented and able to identify and resolve problems.
• Appreciation of cultural diversity and sensitivity toward target population.
•
Preferred:
•

SCOPE INFORMATION
# Direct Reports:
# Indirect Reports:
Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS
• Must be able to operate a computer, telephone and fax machine.
• Must be able to travel locally and regionally.
• Must be able to operate a motor vehicle.
• Must be able to conduct and participate in meetings.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-Medicare-Provider-Relations-Rep-II-NY-Job-NY-10001/745822/7458227458222010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSNew York City, NY, USJob Title:
Business Dev Consultant - NY
Job ID:
10806
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:

Responsible for developing marketing venues, mentoring Marketing Representatives and outreaching potential members in designated service areas.

PRIMARY RESPONSIBILITIES:

1. Develop strategy for identifying community organizations that will help the company achieve targeted membership goals.
2. Identify and develop relationships with community organizations, businesses, faith based organizations and schools. Relationships should allow for entry of Marketing Reps to market to employees or clientele or develop a referral network.
3. Track and Maintain positive relationships with community organizations. Execute regular reviews of relationships and determine effectiveness.
4. Identify Network Providers that AMERIGROUP can grow with. Identify new providers that will improve our ability to market the network. Work with Network Development to contract these providers.
5. Develop potential client leads for Marketing Reps.
6. Mentor Marketing Reps on site development, sales presentations and staff exhibits. Responsible for improvement of Rep's ability to operate independently, quality of submissions and productivity.
7. Perform quality review of submitted applications, including periodic audits of Marketing Rep applications
8. Act as a resource to the community and membership as needed
9. Support health education activities and referral of members to health education programs.
10. Identify and develop community events such as health education events and enrollment events (when approved by the State).
11. Identify cultural issues regarding current and potential members and present resolutions for those issues to senior management in a timely manner
12. When appropriate and approved by the State, assist potential and existing members with the enrollment or recertification process.
13. Meet and/or exceed department service standards.
14. All other professional duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required: High School
Preferred: Associates Degree or BS/BA degree
Years and Type of Experience Required:
Required: 2 years of marketing/business development experience
Preferred: management experience, particularly with an MCO organization
Specific Technical Skills
Required:
Preferred: Experience working with excel and word
Certifications or Licensure
Required:
Preferred: Possess a valid driver's license and have access to a motor vehicle and must possess valid motor vehicle insurance
Other
Required:
Preferred: Bi-Lingual a Plus

SCOPE INFORMATION

Item Measure
• # Direct Reports No Direct Reports
• # Indirect Reports Up to 4 Indirect Reports
• Budgetary $ Responsibility Yes

PHYSICAL REQUIREMENTS

• Must be able to operate a computer
• Must be able to operate a telephone

JOB SUMMARY:

Responsible for developing marketing venues, mentoring Marketing Representatives and outreaching potential members in designated service areas.

PRIMARY RESPONSIBILITIES:

1. Develop strategy for identifying community organizations that will help the company achieve targeted membership goals.
2. Identify and develop relationships with community organizations, businesses, faith based organizations and schools. Relationships should allow for entry of Marketing Reps to market to employees or clientele or develop a referral network.
3. Track and Maintain positive relationships with community organizations. Execute regular reviews of relationships and determine effectiveness.
4. Identify Network Providers that AMERIGROUP can grow with. Identify new providers that will improve our ability to market the network. Work with Network Development to contract these providers.
5. Develop potential client leads for Marketing Reps.
6. Mentor Marketing Reps on site development, sales presentations and staff exhibits. Responsible for improvement of Rep's ability to operate independently, quality of submissions and productivity.
7. Perform quality review of submitted applications, including periodic audits of Marketing Rep applications
8. Act as a resource to the community and membership as needed
9. Support health education activities and referral of members to health education programs.
10. Identify and develop community events such as health education events and enrollment events (when approved by the State).
11. Identify cultural issues regarding current and potential members and present resolutions for those issues to senior management in a timely manner
12. When appropriate and approved by the State, assist potential and existing members with the enrollment or recertification process.
13. Meet and/or exceed department service standards.
14. All other professional duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required: High School
Preferred: Associates Degree or BS/BA degree
Years and Type of Experience
Required: 2 years of marketing/business development experience
Preferred: management experience, particularly with an MCO organization
Specific Technical Skills
Required:
Preferred: Experience working with excel and word
Certifications or Licensure
Required:
Preferred: Possess a valid driver's license and have access to a motor vehicle and must possess valid motor vehicle insurance
Other
Required:
Preferred: Bi-Lingual a Plus

SCOPE INFORMATION

Item Measure
• # Direct Reports No Direct Reports
• # Indirect Reports Up to 4 Indirect Reports
• Budgetary $ Responsibility Yes

PHYSICAL REQUIREMENTS

• Must be able to operate a computer
• Must be able to operate a telephone
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-Business-Dev-Consultant-NY-Job-NY-10001/684161/6841616841612010-04-09AmerigroupSales & Marketingfull-timeUSDstarting0BSNew York City, NY, USJob Title:
Quality Improvement RN-NY
Job ID:
10807
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
Grade: 19

JOB SUMMARY: The Coordinator Quality Management RN - NY is responsible in conjunction with management for developing, coordinating, implementing, and evaluating the continuous quality improvement activities throughout the company according to the established Quality Management program. In collaboration with and under the direction management, the Coordinator Quality Management RN - NY establishes indicators for monitoring and evaluating the full spectrum of care and services provided to members for quality, appropriateness, continuous improvement and satisfaction. The Coordinator Quality Management RN - NY provides education in the area of quality management to all departments and assists in ensuring compliance with regulatory and accrediting organizations.

PRIMARY RESPONSIBILITIES:
1. Designs and implements quality improvement studies including selection of valid and reliable indicators and coordinates monitoring and evaluation activities

2. Analyzes data and prepares concise, accurate and meaningful quality management reports in accordance with Company procedures.

3. Actively participates in intradepartmental quality management improvement teams as appointed.

4. Coordinates resolution of high level complaints.

5. Educates AMERIGROUP associates about the QM process.

6. Assists in defining opportunities for improvement identified through analysis of trends and communicates these appropriately.

7. Assists in the preparation for the Quality Improvement Council and other QM related committee meetings.

8. Implements, analyzes and evaluates the Company-wide inter-rater reliability program.

9. Prepares QM department responses for RFIs and RFPs.

10. Responsible for maintaining quality management documents, case files and correspondence in an organized, confidential and secure manner.

11. Conducts, as appropriate, oversight audits for all nationally delegated vendors.

12. Develops and maintains ancillary vendor audit tools.

13. Communicates significant findings, including potential risk management issues to the AVP Quality Management as indicated in a timely manner.

14. Assists with coordinating HEDIS Improvement Activities.

15. Assists with coordinating Member Satisfaction Improvement activities.

16. Other duties as requested or assigned.

JOB REQUIREMENTS:
EDUCATION AND EXPERIENCE:
• Bachelor's degree or equivalent experience required
• Associates degree in nursing or related field
• 2-3 years experience in quality improvement, risk management and/or utilization review in a managed care setting.
• Knowledge of local and national QM and regulatory standards preferred, including NCQA and HEDIS reporting.

CERTIFICATION AND LICENSURE:
• Current professional licensure RN
• CPHQ preferred

Knowledge and Skills:
• Computer literate including word processing, spreadsheets and database management skills.
• Excellent verbal and written communication skills.
• Strong decision making skills.
• Demonstrates organizational skills.
• Ability to work self directed and in work groups.
• Ability to interact with all relevant components of the health care system.
• Appreciation of cultural diversity and sensitivity towards target population.

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate a telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-Coordinator-Quality-Mgt-RN-NY-Job-NY-10001/684162/6841626841622010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSNew York City, NY, USJob Title:
Enrollment QA Specialist - NY
Job ID:
10882
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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Responsibilities
JOB SUMMARY:

Review enrollment applications or renewals of existing or potential members to ensure that all information has been obtained, is legible and accurate. Renewals or applications that are incomplete or incorrect are forwarded to a specialized area for completion and processing. Once the renewal or application is returned to the Enrollment Quality Assurance Specialist , complete and accurate, the application must be submitted to the Data entry and Membership Auditor team for further processing timely to ensure that the member does not experience a lapse in coverage.

PRIMARY RESPONSIBILITIES:

1. Review new applications renewals and all supporting documents to ensure that the applicant is eligible for the benefit coverage selected on the application or renewal. And determine prospective member status/product

2. Ensure that the correct membership protocol (e.g. Medicaid Recertification, CHP, FHP, or MED) has been followed.

3. Track membership applications to ensure that applications or renewals are processed timely whether submitted by the Marketing Department or through the renewal process.

4. Review and complete the marketing reps submission checklist and send back to manager with feedback

5. Log status of applications on Marketing Tracking Database

6. Complete and sign Appendix X checklist

7. Update marketing tracking database with application status

8. Forward inaccurate, incomplete, applications to the Completion to obtain the needed information.

9. Forward complete and presumptive application to Data entry for further processing

10. Meet or exceed quality and productivity standards.

11. Other duties as assigned

EDUCATION AND EXPERIENCE:
Education
Required: High School Education or equivalent
Preferred: Some College
Years and Type of Experience Required:
Required: Must have at least 1 year of medical insurance experience
Preferred: Knowledge of Medicaid Insurance Program
Specific Technical Skills
Required: Must have organizational skills / Multi tasked
Preferred:
Certifications or Licensure
Required:
Preferred:
Other
Required:
Preferred:

SCOPE INFORMATION

Item Measure
• # Direct Reports 0
• # Indirect Reports 0
• Budgetary $ Responsibility 0
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-Enrollment-QA-Specialist-NY-Job-NY-10001/695692/6956926956922010-04-09AmerigroupAdministrative Supportfull-timeUSDstarting0BSNew York City, NY, USJob Title:
Director Long Term Care RN
Job ID:
10873
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:

The Director, Health Care Management Services is responsible for the development, implementation and coordination of a comprehensive health care program that will assist Health Care Management Services, Medical Management, and/or Health Plans, resulting in improved health outcomes for members.

PRIMARY RESPONSIBILITIES:
1. Assists in development and implementation of clinical programs in accordance with the goals of AMERIGROUP Corporation's mission, vision and values, the needs of the health plans, federal and state regulatory requirements and NCQA standards.

2. Serves as a clinical leader to HCMS / Medical Management associates.

3. Manages and evaluates team's performance and ensures adherence to department's standards.

4. Provides departments with updates as needed to ensure continued compliance with specific medical management standards

5. Assists in the development of medical management policy, procedures and guidelines that relate to specific programs.

6. Assists in evaluating and implementing contracts in coordination with Network Development as needed to implement specific programs.

7. Assists Member Services and Provider Inquiry Department with timely response to issues including complaint resolution.

8. Assists in developing clinical management guidelines including:
• Conducting literature search to identify “evidenced-based” management
• Identifying changes in practice which may require updating of guidelines
• Developing DRAFT guidelines as directed
• Identifying national providers experienced in treating patients within these areas
• Coordinating physician advisory groups

9. Assists in managing the information requirements of HCMS / Medical Management programs.

10. Acquires data and evaluates necessary medical, mental health and substance abuse services for cost containment.

11. Identification and implementation of HCMS/ Medical Management “best practices.”

12. Ensures that delegated medical management activities are contracted, reviewed and reported according to established criteria.

13. Evaluates programs quarterly.

14. Supports and participates in quality initiatives and activities including clinical indicators reporting, focus studies and HEDIS reporting.

15. Ensures compliance with state reporting on utilization management activities for accuracy.

16. May assist in developing the annual operating and capital budgets to sufficiently meet departmental needs.

17. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required: Bachelors Degree
Preferred: MSN, MPH, MPA, or MSW or related or MBA with Health Care Concentration

Years and Type of Experience Required:
Required:
• Must have five years management experience.
• Must have at least five years of current experience in utilization management in a managed care setting.

Knowledge and Technical Skills
Required:
• Demonstrated medical management experience in health care.
• Knowledge of Utilization Management targets
• Self-directed with strong organizational skills.
• Excellent verbal and written communication skills.
• Ability to foster inter and intradepartmental communication and team building.
• Strong analytical capabilities.
• Attention to detail.
• Mastery of computer software.
• Statistical reporting experience preferred.
• Multi-task oriented with ability to follow-up on numerous complex problems.
• Strong customer focus.
Certifications or Licensure
Required: RN or LCSW , LPC
Preferred: Certified Case Manager

SCOPE INFORMATION
Item Measure
• # Direct Reports 2-10
• # Indirect Reports 2-20
• Budgetary $ Responsibility As assigned

PHYSICAL REQUIREMENTS
• Able to operate a computer
• Able to operate a telephone
• Must be able to travel on common carriers and to adhere to AMERIGROUP's travel policies.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-Director-Long-Term-Care-RN-Job-NY-10001/692313/6923136923132010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSNew York City, NY, USJob Title:
RN Case Manager
Job ID:
10663
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:

The Case Manager RN is responsible for managing members experiencing complex or catastrophic illness, injury and/or specialty illnesses such as diabetes, HIV, transplant, etc, to insure cost effective and efficient utilization of health services. She/he acts as a member advocate, seeking and coordinating creative solutions to member's health care needs without compromising quality of outcomes.

PRIMARY RESPONSIBILITIES:

1. Obtains an accurate member history.

2. Assesses clinical information to develop care plans including a member support system.

3. Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements.

4. Establishes working relationships with referral sources and community resources.

5. Communicates care objectives to appropriate individuals/departments/referral sources.

6. Assessment of biopsychosocial factors.

7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.

8. May be required to conduct field visits.

9. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan

10. Acts as an advocate for an individual's health care needs.

11. Reviews benefit systems and cost benefit analysis.

12. Evaluates the quality of necessary medical services.

13. Utilizes criteria for authorizing appropriate clinical services.

14. Identifies members that would benefit from an alternative level of care.

15. Acquires data and evaluates necessary health services for cost containment.

16. Documents effectiveness of case management services.

17. Identifies the need for assistive devices/adaptive equipment needed for members.

18. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.

19. Requests direction from appropriate supervisor(s) on complex issues.

20. Utilizes leadership skills for non-clinical team members.

21. Collaboratively works with other departments.

22. Participates in Quality Improvement processes.

23. Serves on internal and external committees.

24. Maintains member confidentiality.

EDUCATION AND EXPERIENCE:
Education
Required:
• RN required with four years experience in health care, case management, discharge planning or behavioral health.
• Current State RN license to practice Nursing.
• Bachelors or Masters Degree
Years and Type of Experience Required:

Preferred:
• Experience working on the community level and with community agencies preferred.

Certifications or Licensure
Required:
• Current State RN license to practice Nursing.
• Must possess a valid driver's license and access to a motor vehicle.
Preferred:
• Certified case managers preferred.
Other
Required:
• Computer literate.
• Excellent verbal and written communications skills.
• Strong decision making skills.
• Ability to provide services in an environment that involves multiple health care systems.
• Ability to interact with all relevant components of the health care system.
• Ability to provide services that deal with the individual's broad spectrum of needs.
• Self-starter with ability to handle multiple projects at one time.
• Appreciation of cultural diversity and sensitivity towards target population.
• Bilingual a plus.

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate (and communicate via) a telephone.
• Must be able to sit for long periods of time
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-Case-Manager-RN-Plan-NY-Job-NY-10001/640797/6407976407972010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSNew York City, NY, USJob Title:
VP Govt Relations - Albany, New York
Job ID:
10753
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
Grade: 23

JOB SUMMARY: Responsible for establishing a variance in the perception of regulators and elected officials of AMERIGROUP's mission and values as contrasted with the HMO industry today by forming alliances and coalitions with community-based organizations, local, state and federal officials and industry groups. Responsible for promoting sound public policy that is in concert with AMERIGROUP's mission and values. Serve as the lead business owner for the rate setting process with state regulators.

PRIMARY RESPONSIBILITIES:

1. Coordinate company-wide responses to national and state legislation or anticipated legislative initiatives.

2. Establish and implement proactive strategies to bring new products or extensions of current products to market.

3. Establishes, fosters, and manages relationship with state regulators, legislators and key stakeholders that will have impact on AMERIGROUP's business or the managed care industry.

4. Establish and implement proactive strategies to promote AMERIGROUP's legislative agenda including hiring contract lobbyists, PR firms, building coalitions necessary to pass legislation, rules or changes to policy that are in concert with the internal agenda.

5. Serve as a member of the state leadership executive team. Participate decisions as well as provide advice and counsel regarding the government relations impact that operational decisions may have.

6. Establish local relationships with elected officials and regulators that will support membership growth, reinforce our market position, mission, values and calls to action.

7. Create a company presence in both political parties all elections.

8. Represent AMERIGROUP when performing lobbyist activities.

9. Continually monitor market databases and product review to analyze select opportunities.

10. Other duties as assigned or requested.

EDUCATION AND EXPERIENCE:
Education:
Required:
• Bachelor's Degree
Preferred:
• Master's Degree

Years and Type of Experience Required::
Required:
• 12 + years experience in government relations, marketing, public relations or related field.
• Previous HMO/managed care industry experience.
Preferred:
Specific Technical Skills:
Required:
• Excellent writing, communications, presentation, interpersonal, problem-solving, analytical and organizational skills.
• Excellent understanding of word processing, graphics and spreadsheet applications.
• Strong knowledge of managed care operations.
• Familiarity with state managed care regulatory environment.
• In-depth knowledge of the Medicaid business, including products and regulatory issues.
• Understanding and knowledge of the health care industry, specifically as it relates to contemporary and future trends in the delivery and financing of health care services in the public sector managed care environment.
Preferred:
Certifications or Licensure:
Required:
Preferred:
Other:
Required:
• Able to handle multiple priorities.
• Able to work well and produce high quality results under the pressure of deadlines and multiple deliverables.
• Able to work well with all levels of the organization with little supervision or direction.
• Excellent problem solving and negotiating skills.
• Excellent verbal and written communication skills.
• Strong leadership skills with the ability to influence and manage change.
• Ability to effectively set priorities and meet commitments.
• Demonstration of resilience, passion towards AMERIGROUP's agenda and commitment to partnering with stakeholders.
• Appreciation of cultural diversity and sensitivity towards target population.
Preferred:

PHYSICAL REQUIREMENTS
• Must be able to operate a computer.
• Must be able to operate a telephone.
• Must be able to conduct and participate in meetings
• Must be able to travel on common carriers and to adhere to AMERIGROUP's travel policies.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-VP-Govt-Relations-Job-NY-10001/671395/6713956713952010-04-09AmerigroupLegalfull-timeUSDstarting0BSNew York City, NY, USJob Title:
Behavioral & Physical Health Case Manager Plan - NY
Job ID:
10964
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
Grade: 18

JOB SUMMARY: The Case Manager is responsible for managing members experiencing complex or catastrophic illness, injury and/or specialty illnesses such as diabetes, HIV, transplant, etc, to insure cost effective and efficient utilization of health services. She/he acts as a member advocate, seeking and coordinating creative solutions to member's health care needs without compromising quality of outcomes.

PRIMARY RESPONSIBILITIES:
1. Obtains an accurate member history.

2. Assesses clinical information to develop care plans including a member support system.

3. Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements.

4. Establishes working relationships with referral sources and community resources.

5. Communicates care objectives to appropriate individuals/departments/referral sources.

6. Assessment of biopsychosocial factors.

7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.

8. Collaborates with the member's PCP and specialists in the development of the plan of care to ensure that members' physical needs are addressed

9. Provide case management and/or disease management services to members, as identified by the health plan's CI3 list

10. May be required to conduct field visits.

11. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan

12. Acts as an advocate for an individual's health care needs.

13. Reviews benefit systems and cost benefit analysis.

14. Evaluates the quality of necessary medical services.

15. Utilizes criteria for authorizing appropriate clinical services.

16. Identifies members that would benefit from an alternative level of care.

17. Acquires data and evaluates necessary health services for cost containment.

18. Documents effectiveness of case management services.

19. Identifies the need for assistive devices/adaptive equipment needed for members.

20. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.

21. Requests direction from appropriate supervisor(s) on complex issues.

22. Utilizes leadership skills for non-clinical team members.

23. Collaboratively works with other departments.

24. Participates in Quality Improvement processes.

25. Serves on internal and external committees.

26. Maintains member confidentiality.

27. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Current state license required: LVN, LPN, LPC, LSW, or LMHC (CMSW for TN Plan).

Preferred:
Bachelors or Masters Degree

Years and Type of Experience Required:
Required:
• Four years experience in health care, case management, discharge planning or behavioral health.

Specific Technical Skills
Required:
Preferred:

Certifications or Licensure
Required:
• Must possess a valid driver's license and access to a motor vehicle.

Preferred:
• Certified case managers preferred.
Other
Required:
• Computer literate.
• Excellent verbal and written communications skills.
• Strong decision making skills.
• Ability to provide services in an environment that involves multiple health care systems.
• Ability to interact with all relevant components of the health care system.
• Ability to provide services that deal with the individual's broad spectrum of needs.
• Self-starter with ability to handle multiple projects at one time.
• Appreciation of cultural diversity and sensitivity towards target population.
• Bilingual a plus.
Preferred:

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate (and communicate via) a telephone.
• Must be able to sit for long periods of time
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-Case-Manager-Plan-NY-Job-NY-10001/713390/7133907133902010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSNew York City, NY, USJob Title:
Claims Research Spec - Plan
Job ID:
10965
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
Grade: 14

JOB SUMMARY: To review and analyze inquiries related to authorizations that negatively impact the accurate processing claims and to be able to formulate reports and recommend steps that may be taken to improve disconnects that will promote superior customer service.

PRIMARY RESPONSIBILITIES:
1. Responsible for the management of pended claim workflow that requires medical review, i.e. claims with modifiers, multiple surgical procedures, unlisted codes, code review and durable or home medical equipment this includes:
a. understanding of and ability to interpret contract terms and provisions
b. Understanding of system configuration for benefits, pricing, provider set up, et al.
c. knowledge of the applicable policies and procedures related to claims reimbursement
d. Knowledge of medical coding, ICD-9, CPT4, HCPCS, and provider billing practices.
e. Ability to do root cause analysis and make recommendations for process and policy improvements.

2. Ensure that all research is worked and documented in an accurate and timely manner.

3. Responsible for preparing and communicating research documentation.

4. Analyze and produce daily inventory management via ActionGrams reports to ensure appropriate
Resource balancing to meet goals and objectives .

5. Maintain self proficiency in all aspects of claims vs authorization relationships and processing.

6. Participate in special projects & Plan and Corporate initiatives.

7. Track, review, and maintain departmental responsibility in either a Project Log or an Access Data Base.

8. Perform complex analysis of missing OB authorizations that impact the financial payments to the
Plan because of the lack of an OB Kick payment by the State. Research duplicate reporting of OB
Authorizations to prevent duplicate OB Kick payment

9. Identifies new born assessments that have not been completed

10. Orders and tracks requests for medical documentation (medical records, operative reports, anesthesia reports, etc) submitted for aberrant billing and coding patterns.

11. Identify authorization entry patterns and trends that may interfere with the seamless processing of clean claims within 30 days

12. Actively participates in monthly meeting with other Plans initiated by the Corporate Office

13. Serves as a resource to medical and non-medical staff members in expediting the resolution of outstanding claims issues as they relate to incomplete authorizations

14. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required: High school diploma or GED
Preferred: College Degree

Years and Type of Experience Required:
Required: Minimum of 2 years managed care experience or medical claims research experience.

Specific Technical Skills
Required:
• Intermediate to advanced level Microsoft Office skills.
• Advanced understanding of medical terminology, claims coding, and standard claims forms used for physician and hospital billings.
• Strong Analytical/Problem Solving Skills.
• Knowledge of state guidelines and regulations applicable to Medicaid.

Certifications or Licensure
Preferred: Certified Professional or Medical Coder within six months of hiring

Other
Required:
• Strong interpersonal skills
• Demonstrates initiative; is proactive in problem resolution; ability to multitask
• Able to work independently and use reference material to resolve claims related questions.
Preferred: Project management experience

PHYSICAL REQUIREMENTS
• Must be able to operate a computer, telephone and fax & scanning machine
• Data entry using repetitive motion
• Must be able to participate in meetings
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-Claims-Research-Spec-Plan-Job-NY-10001/713391/7133917133912010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSNew York City, NY, USJob Title:
Provider Relations Rep II - NY
Job ID:
10989
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Serves as liaison to providers (including physicians, hospitals, and/or ancillary providers) and internal departments at the health plan. Responsible for performing activities designed to establish and maintain positive and productive relationships with AMERIGROUP network providers for Medicaid and Medicare products. These activities include responding to inquiries from providers regarding benefits, claim resolution, appeal status, and authorization or referral information. Also may be responsible for recruiting providers to ensure network access and service adequacy. Provides training, guidance and assistance to Provider Relations Representatives I to support their skill development and successful completion of assignments. May perform position requirements in the field or telephonically, as appropriate. More emphasis is placed on field work at the rep level II.

PRIMARY RESPONSIBILITIES:
1. Track and respond to in-person, telephonic, and written inquiries from providers and document all contacts in appropriate system per Plan (i.e. Sales force).

2. Ensures that provider relationships with the Plan are positive and productive for both parties.

3. Works with Providers to understand issues/concerns. Identifies root cause of problems and trends and participates in developing solutions. . Works with Provider's staff and AMERIGROUP staff (local and/or corporate) to resolve the issue and monitor recurrence.

4. Assists with training and mentoring of the Provider Relations Representatives as needed to ensure departmental success and effective team work. In the absence of management, acts as the lead or senior associate in the department or for the assigned team.

5. Collaborates with local and corporate staff as necessary to ensure that appropriate applications are processed, contracts are executed and all providers are credentialed in a timely manner.

6. Analyzes provider network for adequacy in addressing members' medical needs and assists in the identification and recruitment of key providers where network gaps or needs exist.

7. Creates and maintains information required to support the network development process.

8. Develops training materials and conducts on-site provider education, orientations, and provider servicing visits to ensure providers are well-acquainted with AMERIGROUP benefits, policies, and procedures.

9. Provides expertise and assistance relative to provider billing and payment guidelines consistent with AMERIGROUP policies and procedures.

10. Provides follow up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled within established time frames.

11. Participates in standing meetings, as necessary, regarding provider reimbursement issues and network development activities.

12. Performs other duties and special projects as assigned

EDUCATION AND EXPERIENCE:

Education
Required:
• BA/BS degree or equivalent experience

Years and Type of Experience Required:
Required:
• 5+ years of managed care experience, preferably in a Medicaid environment

Specific Technical Skills
Required:
• Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
• Claims experience/knowledge of medical coding
• Strong telephonic and customer service skills.
• Effective presentation skills.
Preferred:
• Experience using Sales force CRM
• Experience using Facets.

Other:
Required:
• Excellent verbal and written communication skills.
• Detail-oriented.
• Ability to handle multiple tasks in a fast-paced environment.
• Must be service oriented and able to identify and resolve problems.
• Appreciation of cultural diversity and sensitivity toward target population.

PHYSICAL REQUIREMENTS
• Must be able to operate a computer, telephone and fax machine.
• Must be able to travel locally.
• Must be able to operate a motor vehicle.
• Must be able to conduct and participate in meetings.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-Provider-Relations-Rep-II-NY-Job-NY-10001/719176/7191767191762010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSNew York City, NY, USJob Title:
Outreach Associate
Job ID:
10925
Location: New York City, NY
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:

The Member Outreach Associate is responsible for providing support for clinical quality initiatives and regulatory/contractual requirements. Support includes telephonic and in-person outreach to members who are identified as requiring outreach services. May provide assistance to clinical compliance staff with member education classes, quality management, and Health Promotion initiatives and performance data collection and recording.

PRIMARY RESPONSIBILITIES:
1. Provide members with information on how to access preventive and health maintenance services while identifying barriers to care.

2. Arrange transportation for members as needed, if applicable.

3. Conducts telephonic and/or home visit education with members (e.g., compliance with state required programs such as the EPSDT program, appropriate ER utilization).

4. Collect member encounter data and medical records.

5. Review medical records for completeness.

6. Promote and distribute educational materials and program information to members.

7. Assists members in making follow-up appointments with his/her Primary Care Physician (PCP) and/or Specialist as indicated by the guidelines of the disease management or large case management program in which they participate.

8. Provides telephone follow-up to ensure members have seen their PCP and completed or are in process of completing their treatment plan or preventive care services as defined by the PCP or guidelines

9. Promotes and supports the PCP relationship.

10. Refers issues and concerns about members to the Case Manager or Member Advocate as soon as identified.

11. Serve as a referral agent to internal services and external CBO's.

12. Educates members and providers about Plan policies, programs and services when contacts result in questions, concerns or identified learning needs.

13. Assists members in identifying community resources for the management of their disease as directed by the Case Manager.

14. Assists members in obtaining appropriate health education materials, classes and programs for the required level of care.

15. Documents member participation of member outreach activities as appropriate.

16. Records and reports all member outreach activity.

1. Performs other duties as assigned or requested.

EDUCATION AND EXPERIENCE:
Education
Required: High School diploma required with at least one year of experience in healthcare or managed care industry
Preferred: College degree or equivalent preferred.

Years and Type of Experience Required:
Required: Some understanding of medical terminology.
Preferred: Experience in a health related service such as community outreach worker, home health aide, etc.

Specific Technical Skills
Required: Computer literacy in excel and word.
Preferred:

Certifications or Licensure
Required: Valid Driver's License and clean driving record
Preferred:

Other
Required:
• Good verbal communication skills.
• Professional telephone skills.
• Community awareness and knowledge.
• Appreciation of cultural diversity and sensitivity towards targeted populations.
• Must be organized and able to multi-task.
• Must be able to work independently.
• Must have excellent communication skills and the ability to communicate effectively with internal and external customers.

Preferred: Bilingual skills in Spanish a plus.

PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.
• Must be able to collect medical records
• Willing to work in community.

• For NY Plan Outreach only:
• Must be able to work weekends, off shifts and/or evenings as directed.
• Must be able to travel by MTA (Bronx, Brooklyn, Manhattan, Staten Island and Queens).
• Must be able to conduct home/provider visits as directed.
• Must be able to work outreach/Health promotions events (Bronx, Brooklyn, Manhattan, Staten Island and Queens).
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/NEW-YORK-CITY-Outreach-Associate-Job-NY-10001/707192/7071927071922010-04-09AmerigroupHealth Care Operationsfull-timeUSDstarting0BSNew York City, NY, USJob Title:
Case Specialist - Plan
Job ID:
10970
Location: Baltimore, MD
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
The Case Specialist is responsible for managing care and services for Medicare members. Case Specialists works in conjunction with Case Managers to coordinate health care services by facilitating, scheduling, and arranging a variety of treatment and health care plans.

PRIMARY RESPONSIBILITIES:
1. Coordination, authorization, fulfillment, monitoring and tracking of health care services.

2. Establish working relationships with referral sources

3. Initiates and maintains contact with assigned individuals/significant others and providers to determine members response to services.

4. Coordinate home visits for Case Managers.

5. Review of benefit systems.

6. Identifies cases in consultation with Case Manager that would benefit from alternative care.

7. Coordinates assignments for Case Managers to facilitate timely member evaluation.

8. Arranges for services as identified by the case manager such as home health resources, alternative long-term care placements etc.

9. Knowledge of care-coordination and case management concepts.

10. Identifies potential liability issues for services provided.

11. Utilizes knowledge of community resources.

12. Refers members to case management as indicated.

13. Ensures that health care services are received as authorized by the provider.

14. Collaboratively works with other departments.

15. Utilizes excellent customer service principles to assist internal and external customers.

16. Maintains member confidentiality.

17. Other duties as requested or assigned.

JOB REQUIREMENTS:
Education
Required: Associate Degree required (or equivalent experience)
Preferred:
• Bachelors degree preferred
• Medical Terminology preferred
Years and Type of Experience Required:
Required:
• Minimum of (2) years working in Health Services field
• Bilingual an asset.

Other
Required:
• Computer literate
• Excellent verbal and written communication skills.
• Strong decision making skills.
• Ability to provide services in an environment that involves multiple health care systems.
• Ability to interact with all relevant components of the health care system.
• Ability to provide services that deal with the individuals broad spectrum of needs
• High energy level.
• Self-starter with ability to handle multiple projects at one time.
• Appreciation of cultural diversity and sensitivity towards target population.
• Bilingual a plus.
Preferred:

SCOPE INFORMATION
Item Measure
• # Direct Reports 0
• # Indirect Reports 0
• Budgetary $ Responsibility N/A

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate a telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/BALTIMORE-Case-Specialist-Plan-Job-MD-21201/716021/7160217160212010-04-09AmerigroupHealth Care Operationsfull-timeUSDstarting0BSBaltimore, MD, USJob Title:
Utilization Manager RN
Job ID:
10697
Location: Baltimore, MD
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY: Performs technical and administrative work required to evaluate the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Licensed RN responsible for clinical review of all acute and subacute services for appropriateness based on medical criteria. This individual is responsible for the management of healthcare resources necessary and appropriate for achievement of desired acute and subacute outcomes and the coordination of alternative levels of care for membership.

PRIMARY RESPONSIBILITIES:
1. Performs on-site and/or telephonic review of acute and subacute services.

2. Predicts and plans for patient's needs from pre-admission, through acute and subacute care and post-discharge, in collaboration with the member.

3. Utilizes pre-approved criteria and guidelines to validate medical necessity of continued stay and appropriateness of treatment and discharge planning.

4. Acts in conjunction with the appropriate manager(s) on a daily basis to assess the inpatient census for appropriate alternative health care service needs.

5. Coordinates with appropriate discharge planning team members, facility utilization management department, physicians and members to coordinate timely discharges.

6. Strives to maintain quality care while effectively utilizing resources.

7. Identifies and reports any quality or utilization issues to the Medical Director.

8. Acts in conjunction with the clinical team related to discharge planning e.g., home care, hospice care, rehabilitation care, special program care, transitional care, occupational therapy, speech, respiratory and physical therapy, durable equipment and disposable supplies.

9. Documents all activities in the appropriate system(s) on a timely basis.

10. Participates in rounds with the Medical Director.

11. Review Plan appeal items for concurrent and retrospective reviews as required and requested.

12. Monitors and facilities appropriate utilization of resources utilizing clinical criteria.

13. Tracks and reports trends of inappropriate utilization of resources to the Medical Director.

14. Participates in a multi-disciplinary clinical team to achieve positive member outcomes.

15. Functions as a resource to the clinical team regarding approved criteria, practice guidelines and alternative treatment options.

16. Utilizes effective communication, conflict management and negotiation skills.

17. Utilizes excellent customer service principles to assist internal and external customers.

18. Participates in Quality Improvement Process.

19. Maintains member confidentiality.

20. Other duties as requested or assigned.

Years and Type of Experience Required:
Required:
• Two years of Utilization Management or Hospital/Acute care experience required.
• Currently licensed RN with three years experience in health care, case management, discharge planning, utilization management, or behavioral health.
• Experience working on the community level and with community agencies preferred.

Certifications or Licensure
Required:
• Current State RN license
• Certified Professional Utilization Review (as required by Plan)
• Certified Case Managers a plus.
• Must possess a valid driver's license and access to a motor vehicle.

Other
Required:
• Computer literate.
• Excellent verbal and written communications skills.
• Strong decision making skills.
• Ability to provide services in an environment that involves multiple health care systems.
• Ability to interact with all relevant components of the health care system.
• Ability to provide services that deal with the individual's broad spectrum of needs.
• Self-starter with ability to handle multiple projects at one time.
• Appreciation of cultural diversity and sensitivity towards target population.
• Bilingual a plus.

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate a telephone.
• Must be able to sit for long periods of time.
• Must be able to operate a motor vehicle and travel locally (as required by Plan).
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/BALTIMORE-Utilization-Manager-RN-Job-MD-21201/649563/6495636495632010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSBaltimore, MD, USJob Title:
Director Health Care Management RN
Job ID:
10489
Location: Baltimore, MD
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
The Director, Health Care Management Services is responsible for the development, implementation and coordination of a comprehensive health care program that will assist Health Care Management Services, Medical Management, and/or Health Plans, resulting in improved health outcomes for members.

PRIMARY RESPONSIBILITIES:
1. Assists in development and implementation of clinical programs in accordance with the goals of AMERIGROUP Corporation's mission, vision and values, the needs of the health plans, federal and state regulatory requirements and NCQA standards.

2. Serves as a clinical leader to HCMS / Medical Management associates.

3. Manages and evaluates team's performance and ensures adherence to department's standards.

4. Provides departments with updates as needed to ensure continued compliance with specific medical management standards

5. Assists in the development of medical management policy, procedures and guidelines that relate to specific programs.

6. Assists in evaluating and implementing contracts in coordination with Network Development as needed to implement specific programs.

7. Assists Member Services and Provider Inquiry Department with timely response to issues including complaint resolution.

8. Assists in developing clinical management guidelines including:
• Conducting literature search to identify “evidenced-based” management
• Identifying changes in practice which may require updating of guidelines
• Developing DRAFT guidelines as directed
• Identifying national providers experienced in treating patients within these areas
• Coordinating physician advisory groups

9. Assists in managing the information requirements of HCMS / Medical Management programs.

10. Acquires data and evaluates necessary medical, mental health and substance abuse services for cost containment.

11. Identification and implementation of HCMS/ Medical Management “best practices.”

12. Ensures that delegated medical management activities are contracted, reviewed and reported according to established criteria.

13. Evaluates programs quarterly.

14. Supports and participates in quality initiatives and activities including clinical indicators reporting, focus studies and HEDIS reporting.

15. Ensures compliance with state reporting on utilization management activities for accuracy.

16. May assist in developing the annual operating and capital budgets to sufficiently meet departmental needs.

17. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required: Bachelors Degree, or equivalent work experience
Preferred: MSN, MPH, MPA, or MSW or related or MBA with Health Care Concentration

Years and Type of Experience Required:
Required:
• Must have five years management experience.
• Must have at least five years of current experience in utilization management in a managed care setting.

Knowledge and Technical Skills
Required:
• Demonstrated medical management experience in health care.
• Knowledge of Utilization Management targets
• Self-directed with strong organizational skills.
• Excellent verbal and written communication skills.
• Ability to foster inter and intradepartmental communication and team building.
• Strong analytical capabilities.
• Attention to detail.
• Mastery of computer software.
• Statistical reporting experience preferred.
• Multi-task oriented with ability to follow-up on numerous complex problems.
• Strong customer focus.
Certifications or Licensure
Required: RN or LCSW , LPC
Preferred: Certified Case Manager

SCOPE INFORMATION
Item Measure
• # Direct Reports 2-10 (or individual contributor in a coaching/training capacity within the department)
• # Indirect Reports 2-20
• Budgetary $ Responsibility As assigned

PHYSICAL REQUIREMENTS
• Able to operate a computer
• Able to operate a telephone
• Must be able to travel on common carriers and to adhere to AMERIGROUP's travel policies.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/BALTIMORE-Director-Health-Care-Management-Job-MD-21201/610172/6101726101722010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSBaltimore, MD, USJob Title:
Behavioral Health Case Manager RN
Job ID:
11122
Location: Baltimore, MD
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY: Behavioral health/mental health/substance abuse management experience needed. The Case Manager RN is responsible for managing members experiencing complex or catastrophic illness, injury and/or specialty illnesses such as diabetes, HIV, transplant, etc, to insure cost effective and efficient utilization of health services. She/he acts as a member advocate, seeking and coordinating creative solutions to member's health care needs without compromising quality of outcomes.

PRIMARY RESPONSIBILITIES:
1. Obtains an accurate member history.

2. Assesses clinical information to develop care plans including a member support system.

3. Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements.

4. Establishes working relationships with referral sources and community resources.

5. Communicates care objectives to appropriate individuals/departments/referral sources.

6. Assessment of biopsychosocial factors.

7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.

8. Collaborates with the member's PCP and specialists in the development of the plan of care to ensure that members' physical needs are addressed

9. Provide case management and/or disease management services to members, as identified by the health plan's CI3 list

10. May be required to conduct field visits.

11. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan

12. Acts as an advocate for an individual's health care needs.

13. Reviews benefit systems and cost benefit analysis.

14. Evaluates the quality of necessary medical services.

15. Utilizes criteria for authorizing appropriate clinical services.

16. Identifies members that would benefit from an alternative level of care.

17. Acquires data and evaluates necessary health services for cost containment.

18. Documents effectiveness of case management services.

19. Identifies the need for assistive devices/adaptive equipment needed for members.

20. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.

21. Requests direction from appropriate supervisor(s) on complex issues.

22. Utilizes leadership skills for non-clinical team members.

23. Collaboratively works with other departments.

24. Participates in Quality Improvement processes.

25. Serves on internal and external committees.

26. Maintains member confidentiality.

27. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Current RN state license required.
Preferred:
• Bachelors or Masters Degree.
Years and Type of Experience Required:
Required:
• Four years experience in health care, case management, discharge planning or behavioral health.

Preferred:
• Experience working on the community level and with community agencies preferred.

Certifications or Licensure
Required:
• Must possess a valid driver's license and access to a motor vehicle.

Preferred:
• Certified case managers preferred.
Other
Required:
• Computer literate.
• Excellent verbal and written communications skills.
• Strong decision making skills.
• Ability to provide services in an environment that involves multiple health care systems.
• Ability to interact with all relevant components of the health care system.
• Ability to provide services that deal with the individual's broad spectrum of needs.
• Self-starter with ability to handle multiple projects at one time.
• Appreciation of cultural diversity and sensitivity towards target population.
• Bilingual a plus.
Preferred:

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate (and communicate via) a telephone.
• Must be able to sit for long periods of time
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/BALTIMORE-Behavioral-Health-Case-Manager-RN-Job-MD-21201/748568/7485687485682010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSBaltimore, MD, USJob Title:
Case Manager RN - Plan
Job ID:
11133
Location: Merrifield, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY: The Case Manager RN is responsible for managing members experiencing complex or catastrophic illness, injury and/or specialty illnesses such as diabetes, HIV, transplant, etc, to insure cost effective and efficient utilization of health services. She/he acts as a member advocate, seeking and coordinating creative solutions to member's health care needs without compromising quality of outcomes.

PRIMARY RESPONSIBILITIES:
1. Obtains an accurate member history.

2. Assesses clinical information to develop care plans including a member support system.

3. Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements.

4. Establishes working relationships with referral sources and community resources.

5. Communicates care objectives to appropriate individuals/departments/referral sources.

6. Assessment of biopsychosocial factors.

7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.

8. Collaborates with the member's PCP and specialists in the development of the plan of care to ensure that members' physical needs are addressed

9. Provide case management and/or disease management services to members, as identified by the health plan's CI3 list

10. May be required to conduct field visits.

11. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan

12. Acts as an advocate for an individual's health care needs.

13. Reviews benefit systems and cost benefit analysis.

14. Evaluates the quality of necessary medical services.

15. Utilizes criteria for authorizing appropriate clinical services.

16. Identifies members that would benefit from an alternative level of care.

17. Acquires data and evaluates necessary health services for cost containment.

18. Documents effectiveness of case management services.

19. Identifies the need for assistive devices/adaptive equipment needed for members.

20. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.

21. Requests direction from appropriate supervisor(s) on complex issues.

22. Utilizes leadership skills for non-clinical team members.

23. Collaboratively works with other departments.

24. Participates in Quality Improvement processes.

25. Serves on internal and external committees.

26. Maintains member confidentiality.

27. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Current RN state license required.
Preferred:
• Bachelors or Masters Degree.
Years and Type of Experience Required:
Required:
• Four years experience in health care, case management, discharge planning or behavioral health.

Preferred:
• Experience working on the community level and with community agencies preferred.

Certifications or Licensure
Required:
• Must possess a valid driver's license and access to a motor vehicle.

Preferred:
• Certified case managers preferred.
Other
Required:
• Computer literate.
• Excellent verbal and written communications skills.
• Strong decision making skills.
• Ability to provide services in an environment that involves multiple health care systems.
• Ability to interact with all relevant components of the health care system.
• Ability to provide services that deal with the individual's broad spectrum of needs.
• Self-starter with ability to handle multiple projects at one time.
• Appreciation of cultural diversity and sensitivity towards target population.
• Bilingual a plus.
Preferred:

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate (and communicate via) a telephone.
• Must be able to sit for long periods of time

------------

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------------]]>http://www.amerigroup-jobs.com/job/MERRIFIELD-Case-Manager-RN-Plan-Job-VA-22081/751837/7518377518372010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSMerrifield, VA, USJob Title:
Intern (Summer)
Job ID:
11088
Location: Merrifield, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Temporary

------------

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------------

Responsibilities
JOB SUMMARY:
The Summer Internship Program is a ten week program consisting of various assignments through corporate departments combined with leadership development. Each internship will be assigned to one department for the entire program, in this case it is the Provider Relations department in northern Virginia. Internships will focus on building general business knowledge, while receiving mentoring and leadership opportunities.

PRIMARY RESPONSIBILITIES:

Based on assignment primary responsibilities may include 1 or more of the following:
1. Research and Analysis
a. Assists with research, analytics and support efforts related to new markets, new products, mergers and acquisitions.
2. Process Improvement and Documentation
a. Assists with analysis (operational, analytical and financial) for projects aimed at maximizing revenue and efficiencies while reducing medical, administrative and other costs.
b. Contributes to the development of and documentation of policies, procedures and processes.
3. Project Management
a. Assists with the development and monitoring of project schedules, budgets and resources.
b. Communicates key areas of concern or risk toward progress and goals.
4. System Development, Testing and Implementation
a. Assists in the development, testing and implementation of systems to improve performance, service and/or management of key areas.
5. Reporting
a. Assists with monthly reporting to include budget variances, compliance review, and performance metrics analysis.
b. Maintains reports and tracking systems using database applications, such as MS Access and Excel.
6. Program Management
a. Supports Healthcare Management Services programs for the prevention/maintenance of physical, developmental, emotional and addictive diseases.
7. Supervision and Workforce Management
a. Supports the business operations of the National Contact Center and management of call center staff.
b. Reviews metrics, productivity and service levels needed for workforce management, quality assurance and improvement initiatives.
8. Overall Business / Market / Healthcare Knowledge
a. Acquires an understanding of the business processes in operational areas.
b. Acquires an understanding of the relationship and interdependencies between departments.
9. Other duties as assigned.

EDUCATION AND EXPERIENCE:

Education
Required:
• Must have completed 2 years of college with a GPA Average of 3.0 or better.
• Must be currently enrolled in an accredited college or university actively pursuing a Bachelor's degree, preferably in Business.

Preferred:
• General Business Knowledge
• Project management experience and/or project life cycle knowledge.

Specific Technical Skills
Required:
• Strong PC skills to include the MS Office Suite.
Preferred:
• Visio and Project Management Software.
• Knowledge of process improvement and project management including tools and techniques, critical path method, program evaluation and review technique, resource balancing, and cost estimating.

Other
Required:
• Understands and Resolves Issues Effectively
• Thinks broadly
• Seeks Customer Satisfaction
• Creates Effective Plans
• Manages Work Effectively
• Shows Initiative and Commitment
• Improves Processes
• Collaborates and works effectively within and across teams.
• Shares Information
• Relates Well to Others
• Demonstrates Credibility
• Adapts Readily

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/MERRIFIELD-Intern-(Summer)-Job-VA-22081/742599/7425997425992010-04-09AmerigroupTemporary/Consultantfull-timeUSDstarting0BSMerrifield, VA, USJob Title:
Intern (Summer)
Job ID:
11090
Location: Merrifield, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Temporary

------------

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------------

Responsibilities
JOB SUMMARY:
The Summer Internship Program is a ten week program consisting of various assignments through corporate departments combined with leadership development. Each internship will be assigned to one department for the entire program, (in this case, Marketing). Internships will focus on building general business knowledge, while receiving mentoring and leadership opportunities.

PRIMARY RESPONSIBILITIES:

Based on assignment primary responsibilities may include 1 or more of the following:
1. Research and Analysis
a. Assists with research, analytics and support efforts related to new markets, new products, mergers and acquisitions.
2. Process Improvement and Documentation
a. Assists with analysis (operational, analytical and financial) for projects aimed at maximizing revenue and efficiencies while reducing medical, administrative and other costs.
b. Contributes to the development of and documentation of policies, procedures and processes.
3. Project Management
a. Assists with the development and monitoring of project schedules, budgets and resources.
b. Communicates key areas of concern or risk toward progress and goals.
4. System Development, Testing and Implementation
a. Assists in the development, testing and implementation of systems to improve performance, service and/or management of key areas.
5. Reporting
a. Assists with monthly reporting to include budget variances, compliance review, and performance metrics analysis.
b. Maintains reports and tracking systems using database applications, such as MS Access and Excel.
6. Program Management
a. Supports Healthcare Management Services programs for the prevention/maintenance of physical, developmental, emotional and addictive diseases.
7. Supervision and Workforce Management
a. Supports the business operations of the National Contact Center and management of call center staff.
b. Reviews metrics, productivity and service levels needed for workforce management, quality assurance and improvement initiatives.
8. Overall Business / Market / Healthcare Knowledge
a. Acquires an understanding of the business processes in operational areas.
b. Acquires an understanding of the relationship and interdependencies between departments.
9. Other duties as assigned.

EDUCATION AND EXPERIENCE:

Education
Required:
• Must have completed 2 years of college with a GPA Average of 3.0 or better.
• Must be currently enrolled in an accredited college or university actively pursuing a Bachelor's degree, preferably in Communications or Marketing.

Years and Type of Experience Required:
Required:

Preferred:
• General Business Knowledge
• Project management experience and/or project life cycle knowledge.

Specific Technical Skills
Required:
• Strong PC skills to include the MS Office Suite.
Preferred:
• Visio and Project Management Software.
• Knowledge of process improvement and project management including tools and techniques, critical path method, program evaluation and review technique, resource balancing, and cost estimating.

Other:
Required:
• Understands and Resolves Issues Effectively
• Thinks broadly
• Seeks Customer Satisfaction
• Creates Effective Plans
• Manages Work Effectively
• Shows Initiative and Commitment
• Improves Processes
• Collaborates and works effectively within and across teams.
• Shares Information
• Relates Well to Others
• Demonstrates Credibility
• Adapts Readily
•

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/MERRIFIELD-Intern-(Summer)-Job-VA-22081/742601/7426017426012010-04-09AmerigroupTemporary/Consultantfull-timeUSDstarting0BSMerrifield, VA, USJob Title:
Case Manager RN
Job ID:
11019
Location: Merrifield, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

Email to Friend Save Job Apply Now

------------

Responsibilities
JOB SUMMARY: The Case Manager RN is responsible for managing members experiencing complex or catastrophic illness, injury and/or specialty illnesses such as diabetes, HIV, transplant, etc, to insure cost effective and efficient utilization of health services. This position will work with adults, pediatric and special needs members. She/he acts as a member advocate, seeking and coordinating creative solutions to member's health care needs without compromising quality of outcomes.

PRIMARY RESPONSIBILITIES:
1. Obtains an accurate member history.

2. Assesses clinical information to develop care plans including a member support system.

3. Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements.

4. Establishes working relationships with referral sources and community resources.

5. Communicates care objectives to appropriate individuals/departments/referral sources.

6. Assessment of biopsychosocial factors.

7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.

8. Collaborates with the member's PCP and specialists in the development of the plan of care to ensure that members' physical needs are addressed

9. Provide case management and/or disease management services to members, as identified by the health plan's CI3 list

10. May be required to conduct field visits.

11. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan

12. Acts as an advocate for an individual's health care needs.

13. Reviews benefit systems and cost benefit analysis.

14. Evaluates the quality of necessary medical services.

15. Utilizes criteria for authorizing appropriate clinical services.

16. Identifies members that would benefit from an alternative level of care.

17. Acquires data and evaluates necessary health services for cost containment.

18. Documents effectiveness of case management services.

19. Identifies the need for assistive devices/adaptive equipment needed for members.

20. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.

21. Requests direction from appropriate supervisor(s) on complex issues.

22. Utilizes leadership skills for non-clinical team members.

23. Collaboratively works with other departments.

24. Participates in Quality Improvement processes.

25. Serves on internal and external committees.

26. Maintains member confidentiality.

27. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Current RN state license required.
Preferred:
• Bachelors or Masters Degree.
Years and Type of Experience Required:
Required:
• Four years experience in health care, case management, discharge planning or behavioral health.

Preferred:
• Experience working on the community level and with community agencies preferred.

Specific Technical Skills
Required:
Preferred:

Certifications or Licensure
Required:
• Must possess a valid driver's license and access to a motor vehicle.

Preferred:
• Certified case managers preferred.
Other
Required:
• Computer literate.
• Excellent verbal and written communications skills.
• Strong decision making skills.
• Ability to provide services in an environment that involves multiple health care systems.
• Ability to interact with all relevant components of the health care system.
• Ability to provide services that deal with the individual's broad spectrum of needs.
• Self-starter with ability to handle multiple projects at one time.
• Appreciation of cultural diversity and sensitivity towards target population.
• Bilingual a plus.
Preferred:

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate (and communicate via) a telephone.
• Must be able to sit for long periods of time
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/MERRIFIELD-Case-Manager-RN-Job-VA-22081/727867/7278677278672010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSMerrifield, VA, USJob Title:
Director Health Care Mgmt Services
Job ID:
11027
Location: Merrifield, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
Grade: 21

JOB SUMMARY:
The Director, Health Care Management Services is responsible for the development, implementation and coordination of a comprehensive health care program that will assist Health Care Management Services, Medical Management, and/or Health Plans, resulting in improved health outcomes for members. Responsible for case management and utilization management functions.

PRIMARY RESPONSIBILITIES:
1. Assists in development and implementation of clinical programs in accordance with the goals of AMERIGROUP Corporation's mission, vision and values, the needs of the health plans, federal and state regulatory requirements and NCQA standards.

2. Serves as a clinical leader to HCMS / Medical Management associates.

3. Manages and evaluates team's performance and ensures adherence to department's standards.

4. Provides departments with updates as needed to ensure continued compliance with specific medical management standards

5. Assists in the development of medical management policy, procedures and guidelines that relate to specific programs.

6. Assists in evaluating and implementing contracts in coordination with Network Development as needed to implement specific programs.

7. Assists Member Services and Provider Inquiry Department with timely response to issues including complaint resolution.

8. Assists in developing clinical management guidelines including:
• Conducting literature search to identify “evidenced-based” management
• Identifying changes in practice which may require updating of guidelines
• Developing DRAFT guidelines as directed
• Identifying national providers experienced in treating patients within these areas
• Coordinating physician advisory groups

9. Assists in managing the information requirements of HCMS / Medical Management programs.

10. Acquires data and evaluates necessary medical, mental health and substance abuse services for cost containment.

11. Identification and implementation of HCMS/ Medical Management “best practices.”

12. Ensures that delegated medical management activities are contracted, reviewed and reported according to established criteria.

13. Evaluates programs quarterly.

14. Supports and participates in quality initiatives and activities including clinical indicators reporting, focus studies and HEDIS reporting.

15. Ensures compliance with state reporting on utilization management activities for accuracy.

16. May assist in developing the annual operating and capital budgets to sufficiently meet departmental needs.

17. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required: Bachelors Degree, or equivalent work experience
Preferred: MSN, MPH, MPA, or MSW or related or MBA with Health Care Concentration

Years and Type of Experience Required:
Required:
• Must have five years management experience.
• Must have at least five years of current experience in utilization management in a managed care setting.

Knowledge and Technical Skills
Required:
• Demonstrated medical management experience in health care.
• Knowledge of Utilization Management targets
• Self-directed with strong organizational skills.
• Excellent verbal and written communication skills.
• Ability to foster inter and intradepartmental communication and team building.
• Strong analytical capabilities.
• Attention to detail.
• Mastery of computer software.
• Statistical reporting experience preferred.
• Multi-task oriented with ability to follow-up on numerous complex problems.
• Strong customer focus.
Certifications or Licensure
Required: RN or LCSW , LPC
Preferred: Certified Case Manager

SCOPE INFORMATION
Item Measure
• # Direct Reports 2-10 (or individual contributor in a coaching/training capacity within the department)
• # Indirect Reports 2-20
• Budgetary $ Responsibility As assigned

PHYSICAL REQUIREMENTS
• Able to operate a computer
• Able to operate a telephone
• Must be able to travel on common carriers and to adhere to AMERIGROUP's travel policies.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/MERRIFIELD-Director-Health-Care-Mgmt-Services-Job-VA-22081/728660/7286607286602010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSMerrifield, VA, USJob Title:
Case Manager RN
Job ID:
9526
Location: Merrifield, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY: The Case Manager RN is responsible for managing members experiencing complex or catastrophic illness, injury and/or specialty illnesses such as diabetes, HIV, transplant, etc, to insure cost effective and efficient utilization of health services. She/he acts as a member advocate, seeking and coordinating creative solutions to member's health care needs without compromising quality of outcomes.

PRIMARY RESPONSIBILITIES:
1. Obtains an accurate member history.

2. Assesses clinical information to develop care plans including a member support system.

3. Establishes short and long term goals in collaboration with the member that meet the member's needs and the referral source's requirements.

4. Establishes working relationships with referral sources and community resources.

5. Communicates care objectives to appropriate individuals/departments/referral sources.

6. Assessment of biopsychosocial factors.

7. Identifies members with potential for high risk complications and coordinates the appropriate treatment in conjunction with the member and the health care team.

8. May be required to conduct field visits.

9. May be required to perform Pre Certification duties and responsibilities as assigned and required by the Plan

10. Acts as an advocate for an individual's health care needs.

11. Reviews benefit systems and cost benefit analysis.

12. Evaluates the quality of necessary medical services.

13. Utilizes criteria for authorizing appropriate clinical services.

14. Identifies members that would benefit from an alternative level of care.

15. Acquires data and evaluates necessary health services for cost containment.

16. Documents effectiveness of case management services.

17. Identifies the need for assistive devices/adaptive equipment needed for members.

18. Conducts skills assessment, planning, implementation, coordination, monitoring and evaluation.

19. Requests direction from appropriate supervisor(s) on complex issues.

20. Utilizes leadership skills for non-clinical team members.

21. Collaboratively works with other departments.

22. Participates in Quality Improvement processes.

23. Serves on internal and external committees.

24. Maintains member confidentiality.

25. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• RN required with four years experience in health care, case management, discharge planning or behavioral health.
• Current State RN license to practice Nursing.
• Florida Long Term Care Community Diversion Waiver Project requirements: Must attend and complete four hours of in-service training annually and the Abuse and Neglect Exploitation training approved by the Department of Elder Affairs.
Preferred:
• Bachelors or Masters Degree
Years and Type of Experience Required:
Required: Experience working on the community level and with community agencies preferred.

Preferred:

Specific Technical Skills
Required:
Certifications or Licensure
Required:
• Certified case managers preferred.
• Must possess a valid driver's license and access to a motor vehicle.

Other
Required:
• Computer literate.
• Excellent verbal and written communications skills.
• Strong decision making skills.
• Ability to provide services in an environment that involves multiple health care systems.
• Ability to interact with all relevant components of the health care system.
• Ability to provide services that deal with the individual's broad spectrum of needs.
• Self-starter with ability to handle multiple projects at one time.
• Appreciation of cultural diversity and sensitivity towards target population.
• Bilingual a plus.

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate (and communicate via) a telephone.
• Must be able to sit for long periods of time
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/MERRIFIELD-Case-Manager-RN-Job-VA-22081/610190/6101906101902010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSMerrifield, VA, USJob Title:
HEDIS Nurse Reviewer
Job ID:
10141
Location: Merrifield, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY: Responsible for performing and collecting data collection and medical record activities to support the Health Plan's Quality Management Work Plan

PRIMARY RESPONSIBILITIES:
1. Integrates data collected from a variety of sources including to but not limited to: medical records, immunization registries, member documents and provider office

2. Requests and review appropriate medical records.

3. Participates in medical record collection and validation review process for HEDIS and other projects as indicated.

4. Educate providers and office staff about medical records and clinical standard guidelines.

5. Assists in defining opportunities for improvement through analysis of patterns and trends and communicates these appropriately.

6. Communicates significant findings, including potential risk management issues to the Quality Management lead in a timely manner.

7. Performs on-site medical record reviews. Follows appropriate procedures for scheduling, requesting, and reviewing records while on-site at provider offices and hospitals.
Prepare additional reports as needed.

8. Collaboratively works with other departments.

9. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required: Licensed Practical Nurse (LPN)/Registered Nurse (RN) in Plan state
Preferred: Bachelors degree

Years and Type of Experience Required:
Required: Minimum of two (2) years of clinical experience
Preferred: Experience with medical record abstraction processes

Specific Technical Skills
Required:
• Excellent interpersonal, organizational, problem solving, analytic and communication skills
• Appreciation of cultural diversity and sensitivity towards target population
• Professional phone etiquette
• Ability to work calmly and effectively under adverse conditions
• Computer keyboard and work processing proficiency
Preferred: Bi-lingual preferred

Certifications or Licensure
Required:
• Current LPN/RN licensure in Plan state
• Must possess a valid driver's license, required insurance, and vehicle
Preferred: None

Other
Required: Ability to work evening and weekends as needed
Preferred: Established working relationship with community providers

SCOPE INFORMATION
Item Measure
• # Direct Reports None
• # Indirect Reports None
• Budgetary $ Responsibility Complete expense reports monthly

PHYSICAL REQUIREMENTS
• Must be able to operate a computer
• Must be able to operate a telephone
• Must be able to operate a motor vehicle
• Must be able to operate a fax machine
• Must be able to operate a copying machine
• Local travel- must be able to travel locally to providers offices and members homes
• Must be able to communicate verbally
• Must be able to tolerate standing and sitting for long periods of time
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/MERRIFIELD-HEDIS-Nurse-Reviewer-Job-VA-22081/610095/6100956100952010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSMerrifield, VA, USJob Title:
Credentialing Specialist III
Job ID:
10146
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Coordinates completion of provider credentialing process for identified segment of health plan credentialing needs. Performs provider credentialing and recredentialing, and delegated provider credentialing for assigned Health Plan(s). Obtains necessary information to credential and recredential providers utilizing all applicable National Committee for Quality Assurance (NCQA), Accreditation Association for Ambulatory Health Care (AAAHC), and Centers for Medicare and Medicaid Services (CMS) standards. Responsible for daily business operations, including resolution of non-responsive providers, coordination of site visits with Health Plan Provider Relations staff, and works with various group administrators and hospital medical staff offices to ensure successful and timely completion of the delegated credentialing, credentialing and recredentialing process. May provide guidance to Credentialing Specialists I and II on more complex credentialing issues.

PRIMARY RESPONSIBILITIES:
1. Manages provider or delegated provider credentialing process to meet time-sensitive deliverables, including notification and follow up of other departments directly involved in oversight. Reviews provider's policies and procedures; performs on-site review of physical plant, and review of program in its entirety including adherence to AMERIGROUP's delegation program requirements; audits credentialing and recredentialing files.

2. Evaluates and analyzes provider's credentialing program to ensure compliance with AMERIGROUP, federal, state, NCQA, AAAHC requirements; determines delegate's opportunities for improvement and recommends denial or revocation of the decision to delegate when compliance issues arise that compromise AMERIGROUP's ability to maintain contractual or state requirements.

3. Works independently with internal and external customers to research and resolve credentialing-related issues.

4. Communicates with physicians and their office staff, IPA's, hospitals and other provider organizations to provide primary source verification. Maintains relationships with delegate, delegate's office personnel, Legal, Regulatory and Health Plan's Provider Relations department to provide and/or obtain documentation pertinent to timely and accurate completion of the delegated credentialing process.

5. Provides process oversight of daily business operations as it relates to resolution of non-responsive providers to credentialing and recredentialing to ensure all efforts are made to keep providers in compliance according to NCQA/AAAHC standards and regulatory requirements.

6. Coordinates annual delegation assessment and onsite visit, on-going monitoring, audit preparation, and credentialing committee preparation and reporting.

7. Tracks progress of working files to ensure submission to Credentialing Committee in a timely manner, to meet department Service Level Agreements. Coordinates the transfer of files ready for Committee review to the Health Plan on a weekly basis.

8. Maintains delegation/credentialing standards and business requirements (policy review) - NCQA, AAAHC. Researches and resolves delegated credentialing-related issues, including review of draft delegation addenda's from the Legal department to determine whether draft revisions may create compliance issues for AMERIGROUP. Provides recommendations to committee on process administration.
9. Maintains repository of delegated entities information, including audit results, narratives, credentialing committee notification, corrective action plan and any pertinent documents gathered in the ongoing monitoring process.

10. Coordinates with Health Plan and Provider Data Management regarding staff roster submission of new practitioners, changes to existing practitioners or provider terminations/dismissals.

11. Coordinates with Health Plan regarding termination process of any delegate who fails to maintain the delegation requirements set forth by AMERIGROUP to credentialing and recredentialing in compliance according to NCQA, AAAHC and CMS standards and regulatory requirements.

12. Leads biweekly Credentialing Department/Health Plan conference calls.

13. Reviews all licensing agency and Medicare/Medicaid sanction sites and communications on a monthly basis, reporting any findings to department management and Health Plan.

14. Supports the credentialing portion of annual state audits and ensures the submission of review materials as requested.

15. Reviews assigned Health Plan elements in Credentialing Manual and provides updates as appropriate regarding new or improved documentation resources and business rules.

16. Monitors progress of delegation activity to ensure timely submission and recommendation to Credentialing Committee and/or Vendor Selection Oversight Committee (VSOC) in a timely manner, to meet department Service Level Agreements and to maintain compliance requirements.

17. Generates basic and ad hoc reports of providers required for review by Medical Director and Credentialing Committee, for participation with AMERIGROUP.

18. Conducts credentialing training for new associates, and refresher training for existing associates. Provides input for training materials and job aids.

19. Maintains current knowledge of state guidelines and regulatory requirements, and all business rules pertaining to assigned Health Plan. Maintains current knowledge of the credentialing process and applicable database system (Amisys, Facets, and CACTUS) changes.

20. Maintains thorough knowledge of AMERIGROUP policies & procedures, NCQA, AAAHC, CMS and other related accreditation standards, state guidelines, regulatory requirements and any/all Health Plan specific requirements.

21. Assist in development of “best practice” department policies and procedures and workflows to create and maintain replicable processes within the department.

22. Assists with the applicant review and interview process.

23. Leads special projects.

24. Other duties as assigned.

EDUCATION AND EXPERIENCE:

Education Required:
• High School
Preferred:
• Bachelor's degree

Years and Type of Experience Required: Required:
• Minimum 4 years' experience using computer systems in an administrative setting
• Minimum 3 years' credentialing experience in another environment, or 2 years' progressive credentialing experience with AMERIGROUP
Preferred:
• Experience leading a team to meet quality and productivity goals.

Specific Technical Skills Required:
• Proficient in MS Office, including but not limited to Word, Excel
• Must be able to pass Credentialing Proficiency Test prior to expiration of initial 90 day period and on an annual basis.
• Must have strong analytical skills to analyze complex situations, ability to formulate decisions and execute a plan of action.
Preferred:
• Experience using Amisys, Cactus, MS Access, Facets

Certifications or Licensures Required:
• None
Preferred:
• CPCS – Certified Provider Credentialing Specialist or CMSC – Certified Medical Staff Coordinator

Other Required:
• Excellent verbal and written communication skills
• Strong attention to detail
• Strong organizational skills
• Appreciation of cultural diversity
• Maintains a positive demeanor, actively participate in team/department meetings and assist the department in identifying areas of opportunity while assisting in driving solutions
• Ability to interact with all levels of management
• Ability to set priorities and manage multiple demands effectively minimal direction and oversight.

SCOPE INFORMATION
# Direct Reports: 0
# Indirect Reports: Typically 3 or more
Budgetary $ Responsibility: N/A

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Must be able to travel up to 60% of the time and adhere to AMERIGROUP travel policies and procedures
• Occasional lifting up to 25 lbs.
• Must be available for overtime as needed.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Credentialing-Specialist-III-Job-VA-23450/610097/6100976100972010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
SVP Quality Management - Corporate
Job ID:
10662
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:

The Senior Vice President of Clinical Quality Management (SVP CQM) is responsible, in conjunction with the Chief Medical Officer, for shaping the company's Clinical Quality vision and accountability as well as fulfilling its external value proposition to shareholders and state/federal regulatory agency programs. The SVP, CQM does so by leading internal and external customer and stakeholder initiatives to include state-specific quality program proposals, cross-functional strategy development and execution and global communication of initiatives and outcomes. Responsible for developing, coordinating and implementing clinical quality strategies and initiatives within all health plans and departments of AMERIGROUP Corporation. This corporate umbrella-type oversight includes establishing indicators for monitoring and evaluating the quality and appropriateness of care/service, assessing for continuous improvement in monitored indicator activities, monitoring member satisfaction, and directing initiatives for improvement and evaluating the effectiveness of interventions across the continuum of care to members. Maintains liaison for clinical quality initiatives with all the market's state/federal regulatory agencies and collaborates with Government Relations leaders to meet external quality strategy and information needs. The SVP CQM oversees operational leadership for companywide HEDIS reporting and member satisfaction surveying, NCQA/AAAHC accreditation readiness and collaboration for accreditation with the Health Plans, and QM new business development. The SVP Clinical Quality Management works to establish and promote a culture of operational excellence.

PRIMARY RESPONSIBILITIES:
Provides leadership for implementation of the comprehensive Clinical Quality Management Program for AMERIGROUP Corporation

1. Participates with other senior managers to establish strategic plans, annual goals, and objectives in conjunction with the Chief Medical Officer or designee.

2. Executes on administrative or operational matters and ensures effective achievement of objectives.

3. Promotes organization--wide understanding, communication, and coordination of the Clinical Quality Management Program and strategies.

4. Develops corporate and/or organizational policies and authorizes their implementation.

5. Provides supervision and leadership to QM representation in new business activities (RFP responses, new market/product development, and state contract changes etc.)

6. Provides organizational leadership to comply with National Committee for Quality Assurance (NCQA) standards, or other accrediting bodies such as URAC and AAAHC.

7. Oversees the company-wide QM Scorecard reporting including analyzing validity of Clinical Quality management data/reports from a clinical perspective.

8. Provides leadership and accountability management for the development, implementation, and evaluation of Clinical Quality improvement action plans for clinical quality improvement activities.

9. Interacts internally and externally with executive level management.

10. Directs and controls the activities of one or more functional areas, products or service operations through senior managers, who have overall responsibility for the successful operation of those assigned areas.

11. Oversees the member complaint process across the company and ensures contractual compliance and performance standards are met.

12. Oversees the centralized appeal process across the company and reports on the contractual compliance and performance of medical necessity appeal handling and turnaround.

13. Provides leadership for and supervises the member/provider satisfaction survey process.

14. Oversees Health Employer Data Information Sets (HEDIS) reporting and provides leadership to the development and realization of action plans to achieve target improvement goals.

15. Supports the health plans' External Quality Review Organization (EQRO) state audit processes

16. Oversees and provides leadership for the company-wide Quality Improvement Council (QIC)

17. Provides leadership and makes recommendations for provider recredentialing in the areas of medical record reviews, Clinical Quality indicators, performance and quality of care actions.

18. Collaborates with Government Relations and External Communication leaders to develop and execute strategic positioning of AMERIGROUP's impact on quality of care and the health outcomes of the members served.

19. Oversees delegated services QM auditing including ensuing evaluations/recommendations for improvement

20. Develops the annual operating and capital budgets to sufficiently meet departmental needs and ensures that department stays within budget and accounts for variances.

21. Interviews, manages, evaluates, and develops new and existing departmental staff.

EDUCATION AND EXPERIENCE:
Education Required:
• Bachelor's Degree
Education Preferred:
• Master's Degree (MSN, MPH, MPA) preferred

Years and Type of Experience Required: Required:
• Must have 14 years relevant work experience in quality improvement, risk management, and/or utilization management in a managed care setting.
• At least 10 years of leadership/management experience.
• Development and execution of large scale, cross-functional clinical quality improvement strategies
• Optimization of data management and behavioral change quality improvement efforts
• Creating linkages between standard clinical quality measures and population-focused healthcare outcomes
• Championing corporate clinical quality strategy and culture (to include socialization)
• Leading quality strategies satisfying external customer requirements and market growth opportunities
• Previous NCQA accreditation and HEDIS reporting experience required.
Years and Type of Experience Preferred:
• Experience with the Medicaid population required.
• In-depth knowledge of the functional area and AMERIGROUP's goals.

Specific Technical Skills Required:
• Intermediate level Microsoft Office Suite skills, specifically Word, Excel and PowerPoint

Certifications or Licensure Preferred:
• CPHQ Certification or other Clinical Quality certification(s)
• Registered nurse with current license preferred

OTHER REQUIRED SKILLS:
• Strong knowledge base in areas of quality improvement and risk management.
• Strong analytical skills and business acumen.
• Entrepreneurial spirit, a passion for building business, and the ability to work across a matrix environment.
• Demonstrated ability to consistently work with abstract ideas or situations across functional areas of the business.
• Excellent oral and written presentation/persuasion skills.
• Influences policymaking requiring negotiation of extremely critical matters.
• Ability to work effectively with physicians and other health care providers
• Demonstrated ability to be a team builder and work in a team environment with self-directed work groups.
• Excellent project and people management/interpersonal skills including conflict resolution
• Proven ability to identify and integrate organizational strategies to achieve and sustain competitive advantage.
• A track record of effective interaction and influence at the Senior Executive Level
• Excellent problem solving skills.
• Strong organizational skills.
• Ability to handle multiple tasks.
• Appreciation of cultural diversity and sensitivity towards target population.

SCOPE INFORMATION
Item Measure
• # Direct Reports 1-5
• # Indirect Reports 10+
• Budgetary $ Responsibility $2+ million

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.
• Must be able to access/operate filing systems.
• Must be able to conduct, facilitate, and actively participate in meetings.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-SVP-Quality-Management-Corporate-Job-VA-23450/640796/6407966407962010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
ITS Programmer Analyst Princ I - .net
Job ID:
10703
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Acts independently under general direction, designs, develops, modifies, debugs and evaluates programs for functional and operational areas. Functions as a technical expert team member to implement and support various development, design and analysis initiatives employing prescribed methodologies, and follows the AMERIGROUP Quality Assurance process in the creation of work products. Uses a full technical knowledge of all phases of applications programming.

PRIMARY RESPONSIBILITIES:
1. Develops program logic for new applications or analyzes and modifies logic in existing applications. Specializes in one or more phases of applications programming.

2. Independently modifies complex application programs from specifications. Provides technical consulting on complex projects.

3. Recommends changes in development, maintenance and system standards.

4. Independently codes, tests, debugs, documents, implements and maintains software applications.
- Creates a highly complex design document through the assessment of requirements. Assesses alternatives to different designs and selects best solution to fit business needs. Reads, interprets, creates and maintains complex conceptual, logical and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

5. Ensures that system improvements are successfully implemented. Resolves highly complex design issues utilizing software development lifecycle and development methods.

6. Serves as a contributor in development of IT architecture strategies for small to medium sized application infrastructures. For small to medium sized applications, evaluates recommends and exploits evolving technologies in the design and implementation of application infrastructure for scalability reliability availability and serviceability and identify the tradeoffs and risks associated with each.

7. Develops multiple, modular objects and the messaging interface between objects to create a highly complex software package. Reuses objects and creates object inventories.

8. Creates and guides definition of good database design practices. Designs highly complex data models and databases with minimal assistance.

9. Performs analysis on new and complex release features and analyze impact on the application and customer's business process. Coordinates potential vendor product/service evaluations to ensure technical requirements and performance measures are met. Participates in RFP activities which include but are not limited to: understanding business requirements; assess baseline/marketplace; construct, issue, and receive completed RFP's; evaluate potential vendors based on selected scoring model; evaluate cost benefit, and recommend vendor

10. Performs complex application administration and support.

11. Services subject matter expert providing assistance and training to less experience team members.

12. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelor's degree in Computer Science or related field. Equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required:
Required:
• Requires a minimum of 8 years relevant work experience.

Specific Technical Skills
Required:
• Demonstrates comprehensive knowledge of core IT applications and systems.
• Demonstrates advanced proficiency with all applicable company supported software applications.
• Demonstrates knowledge of the strategic alignment of IT solutions with business objectives.
• Extremely high level of understanding and experience with all data modeling concepts and practices, database design, database performance and optimization. Extremely high level of handling software development issues related to databases for relational, object-oriented, and other database and software technologies. Experience with multiple database technologies and products.
• Demonstrates thought leadership in a development discipline or toolset.
• Able to identify root causes of problems. Demonstrates the ability to develop and implement solutions for the causes identified.
• Able to develop and manage a project.
• Demonstrates a moderate to comprehensive understanding of supported applications and all interdependencies (OS, network, server, workstations, etc).

Other:
Required:
• Able to present information verbally, and in writing, in a concise and effective manner at all levels within the organization.
• Able to create and deliver presentations tailored to an audience.
• Able to motivate others, provide innovative ideas and solutions, and promote the department vision for improvement within the department.
• Able to develop creative strategies to problems.
• Able to manage customer expectations.
• Able to demonstrate leadership in a team environment.
• Demonstrates knowledge of the inter-relationship among various managed care operational areas.
• Demonstrates understanding of how each department/health plan relates to the organization as a whole.

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-ITS-Programmer-Analyst-Princ-I-.net-Job-VA-23450/652828/6528286528282010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Data Analyst Coding Validation Analytics (CVI)
Job ID:
10709
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY: Responsible for the analytical analyses which support the claims coding validation initiatives. Develops and programs data queries to support the investigation and validation of hypotheses related to claims coding issues in support of the department's savings goals. Works in conjunction with the Coding Validation Initiative (CVI) Team, supporting the identification, investigation and implementation of operational and system improvements aimed at improving the accuracy of provider claim submissions and claims payment. Responsible for understanding business processes and data in a range of operational areas.

PRIMARY RESPONSIBILITIES:
1. Analyzes and queries multiple, complex databases and systems to produce reports and databases
2. Develops, investigates and validates hypotheses (root cause analysis), examining and evaluating claim submission patterns of providers to determine whether the patterns indicate possible abuse or waste
3. Identifies potential savings opportunity through detailed claims data analysis.
4. Develops processes and reports to support detection of claims coding issues causing overpayments
5. Works closely with subject matter experts in specific root cause analyses and solution development
6. Investigates/analyzes the effect of changes in the business environment/potential causes of future overpayments (changes in authorization requirements, upgrades, systems conversions)
7. Developing queries and with a demonstrated knowledge of medical reimbursement policies and coding, determine billing patterns of providers and possible irregularities for more thorough review and provider education
8. Works to establish and maintain effective working relationships with management and associates throughout corporate and the health plans
9. Interprets and understands Medicaid and Medicare contracts
10. Supports development, maintenance and management of departmental database to track leads and savings in an automated fashion

EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelors degree, or equivalent years of work experience
Preferred:

Years and Type of Experience Required:
Required:
• Minimum of 1 year programming/analytical analysis experience, including experience working with relational databases (and data warehouses) to include proven query and report development expertise.
• Experience in medical claims processing or auditing
Preferred:
• CPC, Medical Terminology Certificate

Specific Technical Skills
Required:
• Skilled in query techniques and understand the underlying data and implications as they relate to the business.
• Proficiency in the use of common software packages, including Microsoft office, to develop analyses, graphics, reports and meeting documents
Preferred:

Certifications or Licensures
Required:
• Certified Coder
Preferred:
• RN or LCSW, LPC

Other:
Required:
• Knowledge of managed healthcare industry, its products, services and major business processes (e.g. enrollment, claims payment)
• Excellent interpersonal and communication skills and the ability to work effectively with peers, management and subordinates, proven expertise in fostering teams
• Knowledge of medical reimbursement policies, procedures and standards
• Strong analytical/problem solving skills
• Proven assessment and analytical skills, especially the ability to synthesize, distill concepts, draw conclusions and identify implications
Preferred:

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Data-Analyst-Coding-Validation-Analytics-(CVI)-Job-VA-23450/655634/6556346556342010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Clinical Pharmacist - SSO
Job ID:
10710
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
Grade: 21
JOB SUMMARY:

This position will report directly to the National Medical Director of the Senior and Special Services Organization (SSO) with a dotted line to corporate Pharmacy department. The individual will be the pharmacotherapy subject matter expert on the Medicare Advantage Special Needs Plan Model of Care (MoC) Interdisciplinary Care Team (IDCT). The individual will work closely with other health care professionals on the IDCT, staff in the Amerigroup Pharmacy department, and with providers to ensure that each members' medication therapy is optimized and that the program goals for SNP MoC are met.

PRIMARY RESPONSIBILITIES:
1.Performs initial comprehensive medication review and develops pharmacotherapy plan of care.

2.Engages with members, caregivers, and providers to optimize drug treatment plans.

3.Monitors members for adverse drug reactions and pharmacotherapy adherence.

4.Manages a priority group of members who need special intervention and continuous monitoring.

5.Serves as pharmacotherapy subject matter expert for Special Needs Plan Model of Care Interdisciplinary Care Team.

6.Regularly participates in clinical team meetings and rounds.

7.Conducts pharmacotherapy training for case managers, physicians, and other IDCT members.

8.Collaborates with corporate Pharmacy department including MTM programs, utilization management, Part D compliance, quality assurance, drug utilization review, Pharmacy and Therapeutics Committee, and other clinical pharmacist meetings in order to keep current with corporate pharmacy initiatives and provide input to meet the program and outcome goals.

9.Works collaboratively with Amerivantage departments, including HCMS, marketing, finance, quality management, claims payment, and member and provider services to achieve goals.

10.Develops and manages the review of strategies to improve the quality of prescribing to improve adherence.

11.Other duties as assigned

EDUCATION AND EXPERIENCE:
Education
Required: Pharm. D. or BS in Pharmacy
Preferred: Pharm. D.

Years and Type of Experience Required:
Required: Minimum of five (5) years Clinical Pharmacy practice or equivalent experience of two (2) years clinical Pharmacy plus completion of one (1) year accredited LTC or geriatric residency program.
Preferred:
oMedicare and/or managed care experience
oWork with an interdisciplinary team and nurse case managers.

Specific Technical Skills
Required: MS Office: MS Outlook, Word, Excel

Certifications or Licensure
Required: Active Pharmacist License

Other
Required:
•Excellent verbal and written communications skills.
•Strong decision making skills.
•Ability to provide services in an environment that involves multiple health care systems.
•Interest in all business aspects of Managed Care Pharmacy
•Ability to provide services that deal with the individual's broad spectrum of needs.
•Self-starter with ability to handle multiple projects at one time.

PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Clinical-Pharmacist-SSO-Job-VA-23450/655635/6556356556352010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Credentialing Specialist II
Job ID:
10694
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:
Performs various duties in support of the provider credentialing and recredentialing process. Obtains necessary information to credential provider files using automated on-line and hard copy sources. Assist senior credentialing team members in daily business operations including, but not limited to, resolution of non-responsive providers, coordination of site visits with Health Plan Provider Relations staff or independent contractor and working with various group administrators and hospital medical staff offices to ensure the successful completion of the credentialing process for AMERIGROUP Providers.

PRIMARY RESPONSIBILITIES:
1. Meets or exceeds individual productivity metrics, quality and timeliness standards as defined by department guidelines.

2. Perform primary source verifications of licensure, board certification, DEA/CDS Certificates, Education and Training, Medicare/Medicaid Sanctions, hospital privileges, malpractice history, insurance coverage, and NPDB and FSMB queries.

3. Performs and documents licensure updates as applicable.

4. Updates provider information and enters malpractice coverage limits into applicable database system (Amisys, Facets, CredTracker, Cactus), as appropriate.

5. Documents completion of physician/practitioner office site visits, as appropriate.

6. Documents provider credentialing verifications in checklist format; tracking expiration dates to
ensure currency at time of Credentialing Committee decision.

7. Obtains documentation pertinent to timely completion of credentialing process from provider offices, IPAs, hospitals, and other provider organizations.

8. Maintains current knowledge of the Credentialing Manual and applicable database system (Amisys, Facets, CredTracker, Cactus) changes.

9. Coordinates with Plan staff to obtain missing credentialing information from non-compliant providers.

10. Assists senior credentialing team members as required to meet department standards. Examples include tracking information for provider site visits, processing Credentialing Committee Meeting Minutes, and training new associates.

11. Reviews and evaluates changes in processing procedures.

12. Other duties as assigned.

EDUCATION AND EXPERIENCE:

Education
Required:
• High School diploma or equivalent
Preferred:
• Some college preferred

Years and Type of Experience Required:
Required:
• One year successful credentialing experience with AMERIGROUP; or
• Minimum 2 years' credentialing experience in another environment.
Preferred:
• Minimum 3 years' experience in a healthcare or other related environment requiring administrative and detail-oriented responsibilities.

Specific Technical Skills
Required:
• Proficient in MS Office, including but not limited to Word, Excel.
Preferred:
• Experience using Amisys, Cactus, MS Access, Facets.

Certifications or Licensures
Required:
• None
Preferred:
• CPCS – Certified Provider Credentialing Specialist or CMSC – Certified Medical Staff Coordinator.

Other:
Required:
• Excellent verbal and written communication skills
• Strong attention to detail
• Strong organizational skills
• Appreciation of cultural diversity

SCOPE INFORMATION

# Direct Reports: 0
# Indirect Reports: 0
Budgetary $ Responsibility: N/A

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Occasional lifting up to 25 lbs.
• Must be available for overtime as needed.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Credentialing-Specialist-II-Job-VA-23450/649560/6495606495602010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Director Clinical Call Center Operations RN
Job ID:
10876
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
Grade: 21
NCC Clinical Recruiter: J. Mays
JOB SUMMARY: Incumbent will provide leadership, direction, operational and administrative procedures including Contact Center Administration, and organizational development initiatives. Incumbent will also develop and implement policies and procedures that ensure service level achievement and precertification turnaround times in accordance with company, contractual, State and Federal requirements. This key resource is accountable for the tactical management and coordination of departmental staff to ensure consistent customer satisfaction and quality of service. The role will manage the achievement and maintenance of all performance goals for the teams in their span of control, and contribute toward the attainment of the National Contact Center and Precertification goals and objectives.

PRIMARY RESPONSIBILITIES:
1.Responsible for the ongoing coordination and management of key operational resources assigned to contact center operations resolving issues related to members and providers for clinical services.

2.Creates an atmosphere of learning and improving clinical decision making skills

3.Develops policies, programs, and procedures to ensure the successful communication and education of members and providers relating to telephonic (inbound and outbound), web based and fax inquiries.

4.Responsible for contact center operations for NCC Clinical Services. Responsible for planning, organizing and managing all contact center activities including policies and procedures, organization structure, staffing, technology, training, Quality and adherence scores, HIPAA and OIG/EPLS compliance, facilities, reporting and related activities.

5.Serves as the department liaison for the Health Plan in the areas of all operational issues/errors.

6.Generates and submits statistical reports on performance for designated tasks.

7.Responsible for monitoring and assessing performance of Phone, Fax, ECF, NICU, and project teams.

8.Evaluates statistics to identify areas of concerns; identifies trends and issues across entities that are impeding the ability to provide high quality service and collaborates with the Director, NCC Performance Improvement to develop initiatives to reduce defects and improve overall operating efficiencies.

9.Promotes the use of best practice initiatives and other customer service enhancing initiatives.

10.Develops strong relationships with primary internal partners, practicing excellent customer relations and attention to customer needs
11.implements new processes as developed by the Director, NCC Process Improvement.

12.Provides proactive and on-going communication to designated internal customers regarding policies, procedures and systems through regularly scheduled meetings, ad hoc meetings, and telephone calls arranged and/or presented by the incumbent or assigned resources.

13.Ensures action plans are in place and shared across internal partners to address corrective actions and preventative measures for all service issues to enhance operational efficiency.

14.Leads the clinical management team and works with other contact center operations leaders. Ensures resolution of issues and provides long-term solutions to other functional areas.

15.Communicates changes and impacts to functional areas and aligned Health Plans on operational matters.

16.Develops and mentors a high performance team with high levels of productivity, adherence, attendance and quality. Maintains a focus on associate satisfaction and morale.

17.Actively contributes to assembly and operation of a strong, diverse and customer-focused team through effective recruiting, training, coaching and team building. Works with direct reports to build and execute individual development action plans providing coaching for individual development needs. Selects, develops and evaluates staff to ensure the efficient operation of the function. Provides leadership and direction to department staff as appropriate to ensure the quality of departmental work outcomes and deliverables.

18.Responsible for administering Human Resources policies; conducts performance evaluations and maintains and appropriately updates all information in direct report files.

19.Other duties as assigned.

EDUCATION AND EXPERIENCE:

Education
Required:
•Bachelor's degree in nursing or equivalent clinical field

Years and Type of Experience Required:
Required:
•Minimum of 7 years of relevant work experience and at least 3 years management experience in a UM Managed care environment
•(Internal) Demonstrated proficiency as a Clinical NCC Manager.
Preferred:
•Managed care experience with a Medicaid/Medicare plan administration.

Specific Technical Skills
Required:
•Advanced understanding of contact center technology and terminology.
•Advanced level MS Office skills.
.
Certifications or Licensures
Required:
•Registered Nurse

Other:
Required:
•Management skills for all levels of staff (exempt and non-exempt).
•Ability to interact and communicate to and at all levels.
•Ability to set and execute a strategy.
•Excellent verbal and written communication skills.
•Strong working knowledge/experience in the areas of expense management and cost controls.
•Strong analytical and problem solving skills.
•Conflict management skills.
•Strong interpersonal skills.
•Demonstrates initiative, is proactive in problem resolution, has the ability to multitask successfully.

SCOPE INFORMATION

# Direct Reports: 3
# Indirect Reports: ~150
Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

•Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
•Ability to communicate both in person and/or by telephone.
•Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/TAMPA-Director-Call-Center-Clinical-Operations-Job-FL-33601/692316/6923166923162010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
FACETS Pricing Configuration Analyst with NetworX
Job ID:
10782
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
This is a senior technical position. Performs complex configuration activities. The incumbent for this position possesses a high degree of expertise in the configuration of business rules that support reimbursement policies and methodologies in a large managed care organization. This position plays a key role in the configuration and implementation of new markets and products.

PRIMARY RESPONSIBILITIES:
1. Works with Lead Configuration Analysts to define and prioritize projects.

2. Considers interdepartmental impact when recommending solutions and identifies opportunities for interdepartmental utilization of recommended solutions.

3. Works with peers in department to develop realistic project scope estimates, detailed project plans, and timelines.

4. Analyzes business requirements and objectives towards determining the optimal configuration of the requirements.

5. Configures, tests and documents configuration solutions for the following functions:

Provider reimbursement configuration set-up and maintenance
Benefit package configuration setup and maintenance
Membership/divisions configuration set-up and maintenance
Group/member premium configuration set-up and maintenance
Medical management configuration set-up and maintenance
Employer and state group/billing configuration setup and maintenance
Setup and maintenance of financial management risk pools in relation to healthcare software
Setup of code sets used for configuration in benefits & pricing and other sub-systems

6. Exercises good judgment in the use of configuration standards. Can propose business beneficial changes to coding standards and development procedures.

7. Adheres to existing configuration management procedures. Recommends improvements to existing procedures. Assesses work of team members to ensure compliance with procedures.

8. Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit business needs.

9. Performs complex data modeling and database design with minimal oversight.

10. Adheres to departmental and corporate policies and procedures.

11. Attends improvement training programs when available and offered.

12. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
Bachelor's degree in business administration, information science, computer science, industrial engineering or a relevant area, or equivalent technical skills and experience.

Years and Type of Experience Required:
Required:
• A minimum of five years of configuration experience providing pricing and/or benefits configuration support on Amisys, Facets, MHS, Metavance, Diamond, or a similar payer system, preferably in a medium to large health care or related organization.
• Possess problem solving and project management skills. Must be able to take charge, manage numerous projects and successfully coordinate projects with internal areas and external vendors.
• Project team member oversight management and/or supervisory experience required.
Preferred:
• Experience using a software development life-cycle methodology like the Software Development Life Cycle (SDLC).
• Broad operational managed care background.
Specific Technical Skills
Required:
• A minimum of two years of experience:
• Using MS Office.
• Using the Windows operating system and its utilities.
• Using the internet to conduct research and to download information.
• Using a relational database management system or SQL to retrieve and analyze data.
• Familiarity with data structures and data types.
Preferred:
• Formal coursework using a 3-GL or a 4-GL programming language (e.g., C+, Visual Basic).

Other
Required:
• Ability to work with integrated data using a relational database management system or SQL.
• Excellent analytical and organization skills.
• Excellent verbal and written communication skills.
• Excellent interpersonal skills, including the ability to work with all levels of personnel.

SCOPE INFORMATION
Item Measure
• # Direct Reports None
• # Indirect Reports Configuration Analysts I and II as needed
• Budgetary $ Responsibility None
• KPI – Department Standards Yes - as determined

PHYSICAL REQUIREMENTS
• Must be able to participate in meetings.
• Must be able to operate a PC for extended periods of time.
• Must be able to operate and effectively utilize office telephone equipment.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-FACETS-Pricing-Configuration-Analyst-with-NetworX-Job-VA-23450/680602/6806026806022010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Care Services Technician I CPHT 11:30am - 8:00pm
Job ID:
10857
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Responsible for responding to inquiries from Members and Providers, clarifying benefits, providing member education as well as member's health referrals for Pharmacy or Behavioral Health. As a member of the HCMS Call center team, will act as a front line advocate and be dedicated to supporting and administering the AMERIGROUP Pharmacy or Behavioral Health programs.

PRIMARY RESPONSIBILITIES:
1. Responsible for telephonic outreach efforts related to Medicaid population. This includes calls to members, providers or pharmacies related to AMERIGROUP Pharmacy or Behavioral Health program.

2. Function as a referral source for Members or Providers. Have the ability to access system provider lists and give appropriate network referrals.

3. Work closely with members, providers or community agencies to proactively coordinate access to services utilizing their knowledge of community resources.

4. Coordination, authorization, fulfillment, monitoring or tracking of health care services.

5. Ensure that health care services are received as authorized by completing outbound discharge calls.

6. Utilize excellent customer service principles with all internal or external customers.

7. Adhere to all state accreditation standards or regulatory guidelines, which include HIPAA guidelines, while maintaining member confidentiality.

8. Document all pre-certification or authorization requests as well as member encounters utilizing the appropriate systems or resources and in accordance with documentation standards.

9. Adhere to key performance measures including average speed of answer, abandon rate and average talk time as well as productivity and quality measures.

10. Complete/follow up on failed faxes to providers or pharmacies

11. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required: High School or GED
Preferred: Associate or Bachelor Degree
Years and Type of Experience Required:
Required:
• 5 years customer service with a minimum of one (1) year call center experience.
• One (1) year of healthcare
Preferred: 2 years of Health Services, Call Center
Specific Technical Skills
Required:
• Working knowledge of PCs and PC software packages is required.
• Ability to demonstrate working knowledge of MS Office Suite applications, such as Word and Outlook.
• Computer keyboarding skills
Preferred:
• Bilingual desired – Spanish is a plus
CERTIFICATION AND LICENSURE:
Required:
Preferred:

Other:
Required:
• Excellent verbal and written communication skills.
• Proven problem identification and solving abilities.
• Ability to organize, prioritize, complete multiple tasks and meet deadlines.
• Ability to manage several concurrent activities, while frequently changing activity priorities.
• Professional demeanor and strong interpersonal skills.
• Self-starter; must work well independently with little direction. Ability to exercise good, sound judgment and to maintain confidentiality.
• Strong personal management skills to plan, organize, schedule, and complete own work and work that is coordinated with others.
• Appreciation of cultural diversity and sensitivity towards target population.
• Ability to communicate with people at all levels
Preferred:
• Medical transcription experience is a plus.

SCOPE INFORMATION

Item Measure
• # Direct Reports 0
• # Indirect Reports 0
• Budgetary $ Responsibility 0

•

PHYSICAL REQUIREMENTS
• Must be able to operate a computer.
• Must be able to operate a telephone.
• Must be able to participate in meetings.
• Must be able to adhere to AMERIGROUP's various policies and procedures.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Care-Services-Technician-I-11-30am-8-00pm-Job-VA-23450/696569/6965696965692010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
PEGA Programmer Analyst Princ I
Job ID:
10831
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Acts independently under general direction, designs, develops, modifies, debugs and evaluates programs for functional and operational areas. Functions as a technical expert team member to implement and support various development, design and analysis initiatives employing prescribed methodologies, and follows the AMERIGROUP Quality Assurance process in the creation of work products. Uses a full technical knowledge of all phases of applications programming.

PRIMARY RESPONSIBILITIES:
1. Develops program logic for new applications or analyzes and modifies logic in existing applications. Specializes in one or more phases of applications programming.

2. Independently modifies complex application programs from specifications. Provides technical consulting on complex projects.

3. Recommends changes in development, maintenance and system standards.

4. Independently codes, tests, debugs, documents, implements and maintains software applications.
- Creates a highly complex design document through the assessment of requirements. Assesses alternatives to different designs and selects best solution to fit business needs. Reads, interprets, creates and maintains complex conceptual, logical and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

5. Ensures that system improvements are successfully implemented. Resolves highly complex design issues utilizing software development lifecycle and development methods.

6. Serves as a contributor in development of IT architecture strategies for small to medium sized application infrastructures. For small to medium sized applications, evaluates recommends and exploits evolving technologies in the design and implementation of application infrastructure for scalability reliability availability and serviceability and identify the tradeoffs and risks associated with each.

7. Develops multiple, modular objects and the messaging interface between objects to create a highly complex software package. Reuses objects and creates object inventories.

8. Creates and guides definition of good database design practices. Designs highly complex data models and databases with minimal assistance.

9. Performs analysis on new and complex release features and analyze impact on the application and customer's business process. Coordinates potential vendor product/service evaluations to ensure technical requirements and performance measures are met. Participates in RFP activities which include but are not limited to: understanding business requirements; assess baseline/marketplace; construct, issue, and receive completed RFP's; evaluate potential vendors based on selected scoring model; evaluate cost benefit, and recommend vendor

10. Performs complex application administration and support.

11. Services subject matter expert providing assistance and training to less experience team members.

12. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelor's degree in Computer Science or related field. Equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required:
Required:
• Requires a minimum of 8 years relevant work experience.

Specific Technical Skills
Required:
• Demonstrates comprehensive knowledge of core IT applications and systems.
• Demonstrates advanced proficiency with all applicable company supported software applications.
• Demonstrates knowledge of the strategic alignment of IT solutions with business objectives.
• Extremely high level of understanding and experience with all data modeling concepts and practices, database design, database performance and optimization. Extremely high level of handling software development issues related to databases for relational, object-oriented, and other database and software technologies. Experience with multiple database technologies and products.
• Demonstrates thought leadership in a development discipline or toolset.
• Able to identify root causes of problems. Demonstrates the ability to develop and implement solutions for the causes identified.
• Able to develop and manage a project.
• Demonstrates a moderate to comprehensive understanding of supported applications and all interdependencies (OS, network, server, workstations, etc).

Other:
Required:
• Able to present information verbally, and in writing, in a concise and effective manner at all levels within the organization.
• Able to create and deliver presentations tailored to an audience.
• Able to motivate others, provide innovative ideas and solutions, and promote the department vision for improvement within the department.
• Able to develop creative strategies to problems.
• Able to manage customer expectations.
• Able to demonstrate leadership in a team environment.
• Demonstrates knowledge of the inter-relationship among various managed care operational areas.
• Demonstrates understanding of how each department/health plan relates to the organization as a whole.

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-PEGA-Programmer-Analyst-Princ-I-Job-VA-23450/687106/6871066871062010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Change Management Analyst with Subversion and ITIL knowledge
Job ID:
10835
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:
Responsible for analysis, design, development and testing of custom software, third-party application software, interface development and operational reporting development. The Application Analyst III will support one of the following company-wide operational and administrative functions: General and Administrative Applications - Finance, Human Resources, Payroll, Legal, Sales/Marketing, Purchasing; Business Information and Regulatory – Encounters and Regulatory Reporting; Claims operations – Claims and EDI; Financial Operations – Enrollment, Billing, Business Controls, Provider Network Support, Distribution Services and Cost Containment; Call Center and Medical Services – Customer Service, Clinical and National Call Center Operations and Medical Management; and Enterprise IT Operations – Acquisitions, State and Health Plan IT representation. He/she will support license and contract agreements, amendments, renewal and terminations and will act in a leadership role in a team environment and work under regular supervision

PRIMARY RESPONSIBILITIES:
1. Contributes to budget development and manages designated components of operating budgets in support of department budget management.

2. Develops moderately complex web applications, which utilize SQL data sources. Exercises good judgment in the use of coding standards.

3. Uses a client server development language to develop moderately complex packages.

4. Develops multiple, modular objects and the messaging interface between objects to create moderately complex software packages.

5. Adheres to existing configuration management procedures and recommends improvements to existing procedures. Influences others to follow existing procedures.

6. Develops complex test plans, which include regression testing and packaging tests into consecutive steps based on logical dependencies.

7. Applies configuration knowledge to resolve moderate to complex business issues, identifies alternatives, determine impact and recommend optimal configuration solutions.

8. Moderate to comprehensive understanding of supported applications and all interdependencies (OS, network, server, workstations, etc). Serves as a contributor in development of IT architecture strategies for small to medium sized application infrastructures. Evaluates technology, performance, scalability, interoperability, reliability, availability, and serviceability in small to medium sized applications.

9. Utilizes appropriate methods to resolve moderately complex design issues. Basic understanding of the strategic alignment of IT solutions with business objectives.

10. Performs complex SQL queries and updates tables. Performs moderately complex data modeling and database design with small amount of oversight.

11. Understands data modeling concepts and their application including entities, tables, relations, constraints, attribute data types and column data types. Understands referential integrity, locking and transaction processing. Understands impact of data modeling decision on system performance and resource usage.

12. Writes, revises and verifies functional test plans for complex systems in a software application.

13. Evaluate and tests complex new/modified programs, applications and/or operating systems. Monitors system functionality and performance to ensure standards are met. Documents and tracks product defect and coordinates problem resolution with development and/or product vendors.

14. Actively participates in the initiation, amendment, renewal and termination of contracts. Participates in the coordination between AMERIGROUP's Legal department, ITS Program Management and vendor's Legal department.

15. Participates in potential vendor product/service evaluations to ensure technical requirements and performance measures are met.

16. Evaluates, recommends and exploits evolving technologies in the design and implementation of application infrastructure for scalability, reliability, availability and serviceability and identifies the trade-offs and risks associated with each.

17. Basic knowledge of the inter-relationship among various managed care operational areas.

18. Ability to deliver by managing through others.

19. Other Duties as Assigned

EDUCATION AND EXPERIENCE:
Education:
Required:
• Bachelor's degree. Equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required::
Required:
• Requires a minimum of 6 years ITS related work experience with 4 years software analysis experience.

Specific Technical Skills:
Required:
• Advanced proficiency with all applicable company support software applications.
• Understanding of the inter-relationship among various IT applications and systems.
• Identifies root causes of problems, develops, and implements solutions for the causes identified.
• Develops and manages a project with direction and supervision.
• Creates moderately complex design documents through the assessment of requirements. Assess alternatives to different designs and chooses best solutions to fit business needs.
• Reads, interprets, creates and maintains moderately complex Conceptual, Logical and Physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.
• Reads entity relationship diagrams. Understands and codes complex software package to suite a complex data model. Read, interpret, create and maintain moderately complex data flow diagrams and data dictionaries.

Other:
Required:
• Provides professional and appropriate written information to internal and external customers.
• Deliver planned presentations to an audience.
• Develop creative strategies and tap the creative potential of individuals and groups
• Manages customer expectations.
• Motivates others and provides innovative solutions for unit/team improvement.
• Understands how unit/team relates to the department.
• Able to demonstrate leadership in a team environment.

SCOPE INFORMATION
Item Measure
• # Direct Reports 0
• # Indirect Reports 0 - 10
• Budgetary $ Responsibility $0 - $500k

PHYSICAL REQUIREMENTS
• Must be able to operate a computer.
• Must be able to operate other information appliances.
• Must be able to operate a telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.
Key Word Search
ITIL and Subversion is a PLUS!

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-TeamTrack-Application-Analyst-Job-VA-23450/687895/6878956878952010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
ITS Network Administrator II
Job ID:
10850
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Under general supervision responsible for administrative tasks and projects relating to equipment buildout, network monitoring, and maintenance of routers, switches, and related network connectivity devices. Works with project teams to deploy hardware and software. Responsible for problem identification, research, resolution, and follow-up for complex network administration issues. Functions as a technical contributor working in a group of engineers, analysts, and technicians. Provides technical guidance for the Network Administrator I position. This position is considered essential to operations and will be required to be available during an emergency. Additionally, the incumbent will be required to maintain an on-call status.

PRIMARY RESPONSIBILITIES:
1. Responsible for executing the enterprise system strategy as it applies to the installation, maintenance, and management of the corporate network.

2. Contributes technical knowledge and experience in the area of local area networking, communications, and related hardware/software.

3. Develops and implements basic project plans with minimal direction and supervision

4. Performs system analysis, installation and support.

5. Performs server software and hardware upgrades as needed.

6. Performs implementations and configuration of software and hardware.

7. Provides resolutions for systems level problems in relation to the corporate network.

8. Provides network operations support to include configuration management, performance analysis, and product evaluations.

9. Provides integrated team support and maintenance of network hardware and software.

10. Ensures network security is maintained and strengthened through implementation of current policies.

11. Assists engineering staff as assigned, in the evaluation of vendor products for future purchase.

12. Monitors network level functions, capacity, and utilization; provides detailed reports to senior engineers.

13. Assists with product testing and integration.

14. Maintains accurate documentation of network infrastructure devices.

15. Provides technical guidance for the following positions: Network Administrator I.

16. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Associate Degree. Equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required:
Required:
• A minimum of 2 years of relevant network administration work experience.

Specific Technical Skills
Required:
• Must meet all skill-set requirements for Network Administrator I.
• Exhibits motivation to maintain and advance proficiency in field.
• Expert knowledge of HP desktop hardware and Microsoft desktop software.
• Basic knowledge of HP server hardware and administration of Microsoft server software.
• Working knowledge of Cisco network hardware and software administration.

Preferred:
• CCNA
• Net Qos
Other:
Required:
• Excellent verbal and written communication skills.
• Good analytical, organizational, and time management skills.
• Customer focused.
• Self motivated.
• Ability to react quickly and positively to changes while exercising sound judgment.
• Ability to work effectively and professionally with coworkers.
• Appreciation of cultural diversity.

SCOPE INFORMATION

# Direct Reports: 0
# Indirect Reports: 0
Budgetary $ Responsibility: $0

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Must be able to lift 50lbs.
• Must be able to operate network maintenance tools.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-ITS-Network-Administrator-II-Job-VA-23450/689633/6896336896332010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Medicare Marketng Analyst - Corp
Job ID:
10968
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
Grade: 18
SSO Dept Recruiter: J. Mays
JOB SUMMARY:
Responsible for supporting the data and research needs of the Sales and Marketing Department. This includes maintenance and optimization of the Customer Relationship Management (CRM) system, business process improvement, training, sales activity tracking, competitor analysis, and marketing operations. The position will be responsible for comprehensive analysis (operational, analytical and strategic), scoping of resources, documentation, problem solving, project management and implementation of key sales and marketing initiatives related to the expansion the company's Medicare Advantage products.

PRIMARY RESPONSIBILITIES:
1.Provide data management support utilizing Salesforce.com (CRM System) as needed
a.Import leads into Salesforce.com
b.Update Salesforce.com with disenrollment data
c.Track advertising and direct mail results:
d.Sales activity tracking: productivity metrics, sales statistics, and enrollment forecasts
e.Produce reports as needed

2.Assist in the development, tracking, and implementation of Medicare Sales training program.

3.Work on special projects to identify internal and external trends that may influence and/or predict unusual marketing and enrollment activity.

4.Work closely with the Sales and Marketing management team to continually identify opportunities to strengthen marketing programs.

5.Assist in the development, administration, and coordination of advertising and direct mail campaigns.

6.Perform best practices research on Medicare marketing strategies, products, technologies and competitors.

7.Handle special projects including market research, marketing plan development, competitive analysis, and SWOT analysis.

8.Identify opportunities for sales operations process enhancements

9.Create and analyze reports and results related to sales, membership, broker commissions and sales incentives.

10.Work with health plans to ensure data in Salesforce.com is current and accurate for reporting and tracking purposes.

11.Act as SalesForce.com liaison for plan staff to ensure accuracy of data for reporting and tracking purposes.

12.Enhance and refine core ongoing projects

13.Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required: Bachelors Degree required in related field (i.e., Business Administration, Marketing, Finance…etc.) or equivalent experience.
Preferred:

Years and Type of Experience Required:
Required: Minimum of three years related marketing and analysis experience
Preferred: Experience working in a Medicare environment

Specific Technical Skills
Required: Proficiency in Microsoft Office including Excel, PowerPoint, Word, and Outlook
Preferred:
•Proficiency in any of the following: SharePoint, SalesForce.com, Microsoft Access
•Experience developing and maintaining database systems that track sales activity.

Other:
Required:
•Detail Oriented; ability to organize and maintain a system of records.
•Ability to identify and weigh potential risks; seek ways to continuously improve existing processes
•Able to work closely with other departments or units as necessary; support group decisions and solicit opinions from coworkers; exceptional interpersonal skills
•Able to clearly interpret and present complex information through the spoken or written word.
•Excellent root cause analysis and problem solving skills; ability to evaluate and present alternative solutions.
•Work independently under tight timelines
Preferred:

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

•Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
•Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Medicare-Marketng-Analyst-Corp-Job-VA-23450/716019/7160197160192010-04-09AmerigroupSales & Marketingfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
ITS Business Analyst III - Vendor Data (EDI x12 and SQL exp needed)
Job ID:
10934
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Under limited supervision, responsible for functional area of responsibility and how the functional areas interrelate, gathering requirements, performing analysis, supporting the development and testing processes, and incorporating the applications, data, and associated technologies for supported areas. Acts as a resource for associates with less experience.

PRIMARY RESPONSIBILITIES:
1. Perform detailed requirements gathering, analysis, and process and data flow diagramming for processes of moderate complexity, considering the relationship between processes and implement using simple ERDs. Identify risks and multiple solutions. Contribute to analysis standards.

2. Evaluate and test complex new/modified programs, applications and/or operating systems. Monitor system functionality and performance to ensure standards are met. Document and track product defects. Coordinate problem resolution with development and/or product vendors.

3. Adhere to existing configuration management procedures. Recommend improvements to existing procedures. Influence others to follow existing procedures.

4. Read and interpret a design document.

5. Read and interpret conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

6. Use appropriate methods to resolve moderately complex design issues.

7. Perform complex queries. Perform simple database updates.

8. Write, revise, and verify test plans for moderately complex systems in a software application.

9. Ensure compliance of current license and support agreements and requirements are met.

10. Manage multiple priorities at the same time.

11. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelor's degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required:
Required:
• A minimum of 5 years experience in business or systems analysis.
Preferred:
• A minimum of 4 years experience in healthcare or financial/hr analysis.

Specific Technical Skills
Required:
• Demonstrate an understanding of the inter-relationship among various IT applications and systems.
• Demonstrate advanced proficiency with all applicable company supported software applications.
• Demonstrate basic understanding of how each department/health plan relates to the organization as a whole.
• Create and deliver a planned presentation to an audience.
• Develop creative solutions to problems. Demonstrate the ability to seek alternatives, new ideas, and/or approaches to problems.
• Demonstrate basic knowledge of the inter-relationship among various managed care operational areas.
• Demonstrate basic understanding of the strategic alignment of IT solutions with business objectives.
• Understand data modeling concepts (e.g., the entity-relation model) and their application: entities and tables, relations and constraints, attribute data types and column data types.
• Demonstrate a basic knowledge of current technology trends.
• Experience working with the HIPAA EDI X12 transaction set (837, 835, 997, 277)
• Ability to review and troubleshoot data issues in raw X12 files
• Strong relational database SQL skills

Other:
Required:
• Manage customer expectations.
• Identify root causes of problems. Demonstrate the ability to develop and implement solutions for the causes identified.
• Demonstrate leadership in a team environment.
• Develop and manage a project with direction and supervision.
• Manage small project related budgets.
• Motivate others and provide innovative solutions for unit/team improvement.

SCOPE INFORMATION
# Direct Reports: 0
# Indirect Reports: 0 - 10
Budgetary $ Responsibility: $0 - $500k

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-ITS-Business-Analyst-III-Vendor-Data-(EDI-x12-and-SQL-exp-needed)-Job-VA-23450/716016/7160167160162010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
AVP Senior Counsel
Job ID:
10991
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Serve as Counsel for assigned AMERIGROUP subsidiary health plan(s). Handle intake and resolution of legal issues related to regulatory compliance, provider network development and maintenance, provider disputes, regulatory agency disputes, product development and plan expansion, risk management, and regulatory agency contracts for assigned markets. Participate in merger and acquisition activity and new market development activity to support subsidiary plan growth into new state markets, including conducting legal due diligence review of acquisition targets, developing model provider contracts for new markets, participating on new market implementation teams, and handling legal issues related to the assimilation of acquisition targets in to AMERIGROUP, including target provider network assimilation issues. Participate with Plan and Healthcare Delivery Systems (HCDS) business owners, upon request, in contract negotiations, process improvement and other contracting issues. Manage assigned paralegal and administrative staff.

PRIMARY RESPONSIBILITIES:
1. Interact with Regional CEOs, Plan CEOs, COOs and management staff to handle intake and resolution of legal issues identified by assigned Health Plans.

2. Provide support to Health Plans related to regulatory compliance, including interacting with Regulatory Department managers to resolve legal issues identified by the Regulatory Department. Provide support to the Plan regarding regulatory agency disputes.

3. Provide support to assigned health plan(s) and corporate departments focusing on provider network development and maintenance regarding network-wide contracting issues and initiative as well as specific provider contracting initiatives and contract disputes.

4. Support product development and plan expansion initiatives for assigned health plan(s).

5. Review and advise on risk management issues identified by assigned health plan(s).

6. Upon request by Regulatory Department, Government Markets or Health Plan business owners, provide advice regarding agency contracts and amendments to agency contracts, and/or participate in negotiations with agencies to complete agency contracts or amendments.

7. Manage provider contracting request workflow, assign paralegal provider contracting projects to market managers, review and revise paralegal provider contracting work product and supervise paralegal interaction with business owners and business owner requests for project work.

8. Maintain provider contracting tools for assigned existing markets and develop new tools for new markets.

9. Foster and maintain strong working relationships with assigned Health Plans and corporate departments.

10. Participate directly in contract and settlement negotiations with providers and provider counsel, upon the request of Health Plan business owners.

11. Manage litigation related to disputes arising at the Health Plan level. Work directly with outside counsel and the Health Plan to facilitate optimal outcomes to pending or threatened litigation.

12. Assist in maintaining and updating Legal Department policies and procedures related to provider contracting. Identify and assist in effecting provider contracting process improvements.

13. Assist in maintaining paralegal provider contracting quality control and production standards.

14. Conduct ongoing training for provider contracting paralegals and evaluate paralegal performance for assigned markets.

15. Participate in business owner training related to provider contracting initiatives.

16. Develop and draft model contracts, network-wide amendment documents and other contracting projects upon request for assigned markets.

17. Perform contract work related to product development initiatives, service area expansions, new state market expansions and acquisition projects.

18. Conduct and/or supervise, as appropriate, contract due diligence activity related to acquisition projects.

19. Serve on new market implementation teams and address issues related to the assimilation of acquisition targets, including target's provider network, in to AMERIGROUP.

20. Perform other duties as assigned/requested.

EDUCATION AND EXPERIENCE:

Education
Required:
• Juris Doctor (JD) or Legum Baccalaureus (LLB)

Years and Type of Experience Required:
Required:
• Minimum of 8 years of legal experience including provider contracting experience with at least 3 years of leadership/management experience

Specific Technical Skills
Required:
• Proficient with various computer programs including Microsoft Word, Outlook, Excel and Access.
Preferred:
• Experience with contract database software

Certifications or Licensures
Required:
• Member in Good Standing with the Bar Associations of the States that they support.

Other:
Required:
• Excellent analytical, writing and communication skills
• Exceptional negotiations skills
• Ability to function effectively with senior operational and functional management.
• Strong leadership, management, mentoring, communication, and interpersonal skills
• Ability to deal with multiple issues and prioritize them
• Commitment to high standards of quality and ethical behavior
• Ability to exercise sound business judgment
• Previous experience in working within a highly-matrixed environment. Ability to deliver by managing through others.
• Ability to work well independently or in a team setting, as well as the ability to identify and resolve legal issues quickly and effectively.
• Ability to actively promote and contribute to teamwork within the Legal Department and the Company
• Demonstrated commitment to continuous process improvements
• Thorough appreciation of cultural diversity and sensitivity towards providers and the target populations

SCOPE INFORMATION

# Direct Reports: 1+
# Indirect Reports: 1+
Budgetary $ Responsibility: 0

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-AVP-Senior-Counsel-Job-VA-23450/719876/7198767198762010-04-09AmerigroupLegalfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
ITS Programmer Analyst III
Job ID:
10980
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Under limited supervision, designs, develops, modifies, debugs and evaluates programs for functional and operational areas. Functions as an active team member to implement and support various development, design and analysis initiatives employing prescribed methodologies, and follows the AMERIGROUP Quality Assurance process in the creation of work products. Competent to work at the highest technical level of all phases of applications programming activities.

PRIMARY RESPONSIBILITIES:
1. Develops program logic for new applications or analyzes and modifies logic in existing applications.

2. Under limited supervision, modifies moderate to complex application programs from detail specifications.

3. Under limited supervision, codes, tests, debugs, documents, implements and maintains software applications.

- Creates a complex design document through the assessment of requirements. Assesses alternatives to different designs and selects best solution to fit business needs. Reads, interprets, creates and maintains complex conceptual, logical and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

4. Assists in ensuring that system improvements are successfully implemented. Resolves complex design issues utilizing software development lifecycle and development methods.

5. Develops multiple, modular objects and the messaging interface between objects to create a complex software package. Reuses objects and creates object inventories.

6. Performs complex queries and updates of tables. Performs complex data modeling and database design with minimal oversight.

7. Defines requirements for application infrastructure including scalability, reliability, availability and serviceability and the trade-offs of each.

8. Performs analysis on new release features and analyze impact on the application and customer's business process. Participates in potential vendor product/service evaluations to ensure technical requirements and performance measures are met.

9. Performs moderate to complex application administration and support.

10. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelor's degree in Computer Science or related field. Equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required:
Required:
• Requires a minimum of 5 years relevant work experience.

Specific Technical Skills
Required:
• Demonstrates understanding of the inter-relationship among various IT applications and systems.
• Demonstrates advanced proficiency with all applicable company supported software applications.
• Able to develop and manage a project with direction and supervision.
• Demonstrates a thorough understanding of infrastructure associated with supported applications.
• Understands the strategic alignment of IT solutions with business objectives.
• Understands impact of data modeling decisions on system performance and resource usage.
• Demonstrates knowledge of current and evolving application architecture trends to include infrastructure, software, database, networks and their interdependencies.

Other:
Required:
• Able to present information verbally, and in writing, in a concise and effective manner at all levels within the organization.
• Demonstrate ownership skills when handling internal or external customer concerns or issues.
• Able to develop creative solutions to problems. Demonstrates the ability to seek alternatives, new ideas, and/or approaches to problems.
• Able to demonstrate leadership in a team environment.
• Able to motivate others and provide innovative solutions for unit/team improvement.
• Demonstrates basic knowledge of specific components of managed care operations.
• Demonstrates understanding of how unit/team relates to department

SCOPE INFORMATION
# Direct Reports: 0
# Indirect Reports: 0
Budgetary $ Responsibility: $0

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-ITS-Programmer-Analyst-III-Job-VA-23450/717730/7177307177302010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Lead FACETS Configuration Analyst - Legacy Team
Job ID:
10931
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
This position is the lead configuration analyst for the department. Performs complex configuration activities. The incumbent for this position possesses a high degree of expertise in the configuration of business rules that support reimbursement policies and methodologies in a large managed care organization. This position plays a key role in the implementation of new market business, in market growth, issue resolution, and in the configuration of provider and state contracts and benefits. The incumbent is responsible for managing configuration projects, coaching more junior analysts and for preparing performance reports for the department.

PRIMARY RESPONSIBILITIES:
1. Works with operational areas in the definition of projects to enable prioritization for analysis and solution recommendation.

2. Considers interdepartmental impact when recommending solutions and identifies opportunities for interdepartmental utilization of recommended solutions.

3. Works with peers in Business Configuration to develop realistic project scope estimates, detailed project plans, and timelines.

4. Works with project managers and coordinators from the assigned operational areas on planning and execution of Business Configuration WBS.

5. Participates in the quality assurance of all Business Configuration projects.

6. Leads requirements development sessions with business owners and other team members.

7. Conducts gap analysis discovery between business requirements and system functionality.

8. Analyzes business requirements and objectives towards determining the optimal configuration of the requirements.

9. Develops requirements documentation and obtains approval of the requirements from the business owner and other stakeholders.

10. Documents key business decisions and processes, and validates them with the business owner.

11. Acts as the point person between Business Configuration and business owners to ensure that all application and technically-oriented issues relating to the configuration project are appropriately addressed.

12. Acts as business subject-matter expert to other implementation initiatives, including conversion, report and interface development.

13. Configures implements and maintains pricing and benefits configuration.

14. Exercises good judgment in the use of configuration standards. Can propose business beneficial changes to coding standards and development procedures.

15. Adheres to existing configuration management procedures. Recommends improvements to existing procedures. Assesses work of team members to ensure compliance with procedures.

16. Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit business needs.

17. Performs complex data modeling and database design with minimal oversight.

18. Provides technical support for new development projects and market expansions.

19. Manages Business Configuration projects.

20. Mentors junior configuration analysts.

21. Adheres to departmental and corporate Policies and Procedures as outlined by Management.

22. Participates in relevant training programs when available and offered.

23. Develops and maintains departmental performance reports.

24. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelor's degree in business administration, information science, computer science, industrial engineering or a relevant area, or equivalent technical skills and experience.
Preferred:
• Masters degree in business administration, information science, computer science, industrial engineering or a relevant area.

Years and Type of Experience Required:
Required:
• Seven or more years of configuration experience providing pricing and/or benefits configuration support on Amisys, Facets, MHS, Metavance, Diamond, or a similar payer system, preferably in a medium to large health care or related organization
• Possess problem solving and project management skills. Must be able to take charge, manage numerous projects and successfully coordinate projects with internal areas and external vendors..
• Project team member oversight management and/or supervisory experience required.
Preferred:
• Experience using a software development life-cycle methodology like the Software Development Life Cycle (SDLC).
• Broad operational managed care background.
Specific Technical Skills
Required:
• A minimum of two years of experience:
• Using MS Office.
• Using the Windows operating system and its utilities.
• Using the internet to conduct research and to download information.
• Using a relational database management system or SQL to retrieve and analyze data.
• Familiarity with data structures and data types.
Preferred:
• Formal coursework using a 3-GL or a 4-GL programming language (e.g., C+, Visual Basic.)

Other
Required:
• Proven ability to manage complex projects.
• Excellent analytical skills including being able to present data to senior management
• Excellent verbal and written communication skills
• Excellent interpersonal skills, including the ability to work with all levels of personnel including, but not limited to peers and Senior Management within the organization
• Knowledge of managed care including, but not limited to claims adjudication and payment, medical management, provider fee-for-service reimbursement, capitation, billing, enrollment, and benefits.
• Strong negotiation and facilitation skills.
• Excellent customer relation skills.
• Detail oriented.
• Assertiveness.
• Ability to deal with a fast paced environment and make proper decisions quickly.
• Appreciation of cultural diversity and sensitivity towards target population
Preferred:

SCOPE INFORMATION
Item Measure
• # Direct Reports None
• # Indirect Reports Yes - as determined
• Budgetary $ Responsibility None
• KPI – Department Standards Yes - as determined

PHYSICAL REQUIREMENTS
• Must be able to participate in meetings
• Must be able to operate a PC for extended periods of time
• Must be able to operate and effectively utilize office telephone equipment
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Lead-FACETS-Configuration-Analyst-Legacy-Team-Job-VA-23450/708412/7084127084122010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Sr FACETS Configuration Analyst - Root Cause Team
Job ID:
10932
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
This is a senior technical position. Performs complex configuration activities. The incumbent for this position possesses a high degree of expertise in the configuration of business rules that support reimbursement policies and methodologies in a large managed care organization. This position plays a key role in the configuration and implementation of new markets and products.

PRIMARY RESPONSIBILITIES:
1. Works with Lead Configuration Analysts to define and prioritize projects.

2. Considers interdepartmental impact when recommending solutions and identifies opportunities for interdepartmental utilization of recommended solutions.

3. Works with peers in department to develop realistic project scope estimates, detailed project plans, and timelines.

4. Analyzes business requirements and objectives towards determining the optimal configuration of the requirements.

5. Configures, tests and documents configuration solutions for the following functions:
Provider reimbursement configuration set-up and maintenance
• Benefit package configuration setup and maintenance
• Membership/divisions configuration set-up and maintenance
• Group/member premium configuration set-up and maintenance
• Medical management configuration set-up and maintenance
• Employer and state group/billing configuration setup and maintenance
• Setup and maintenance of financial management risk pools in relation to healthcare software
• Setup of code sets used for configuration in benefits & pricing and other sub-systems

6. Exercises good judgment in the use of configuration standards. Can propose business beneficial changes to coding standards and development procedures.

7. Adheres to existing configuration management procedures. Recommends improvements to existing procedures. Assesses work of team members to ensure compliance with procedures.

8. Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit business needs.

9. Performs complex data modeling and database design with minimal oversight.

10. Adheres to departmental and corporate policies and procedures.

11. Attends improvement training programs when available and offered.

12. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelor's degree in business administration, information science, computer science, industrial engineering or a relevant area, or equivalent technical skills and experience.

Years and Type of Experience Required:
Required:
• A minimum of five years of configuration experience providing pricing and/or benefits configuration support on Amisys, Facets, MHS, Metavance, Diamond, or a similar payer system, preferably in a medium to large health care or related organization.
• Possess problem solving and project management skills. Must be able to take charge, manage numerous projects and successfully coordinate projects with internal areas and external vendors.
• Project team member oversight management and/or supervisory experience required.
Preferred:
• Experience using a software development life-cycle methodology like the Software Development Life Cycle (SDLC).
• Broad operational managed care background.
Specific Technical Skills
Required:
• A minimum of two years of experience:
• Using MS Office.
• Using the Windows operating system and its utilities.
• Using the internet to conduct research and to download information.
• Using a relational database management system or SQL to retrieve and analyze data.
• Familiarity with data structures and data types.
Preferred:
• Formal coursework using a 3-GL or a 4-GL programming language (e.g., C+, Visual Basic).

Other
Required:
• Ability to work with integrated data using a relational database management system or SQL.
• Excellent analytical and organization skills.
• Excellent verbal and written communication skills.
• Excellent interpersonal skills, including the ability to work with all levels of personnel.

SCOPE INFORMATION
Item Measure
• # Direct Reports None
• # Indirect Reports Configuration Analysts I and II as needed
• Budgetary $ Responsibility None
• KPI – Department Standards Yes - as determined

PHYSICAL REQUIREMENTS
• Must be able to participate in meetings.
• Must be able to operate a PC for extended periods of time.
• Must be able to operate and effectively utilize office telephone equipment.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Sr-FACETS-Configuration-Analyst-Root-Cause-Team-Job-VA-23450/708413/7084137084132010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Medical Coding Analyst
Job ID:
10940
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
Grade: 17 Recruiter: J. Mays

JOB SUMMARY:
Through extensive knowledge of healthcare industry coding theory, rules and standards (such as CPT, HCPCS, Revenue, ICD9, DRG, etc), provide leadership and expertise in development and maintenance of rules, policies and procedures to ensure organizational compliance with industry standard coding rules and guidelines. Interpret and apply National Uniform Billing Compliance rules, guidelines, laws and industry trends to support claims payment, provider reimbursement and system configuration to proactively address cost efficiencies and compliance requirements. Recommend clinical classification and reimbursement guidelines and standards. Review coding in provider contracts and participate in development of coding standards for provider contracts. Perform health data analytics related to reimbursement business and policy decisions.

PRIMARY RESPONSIBILITIES:
1.Provide leadership and expertise in development and maintenance of rules, policies and procedures for coding and reimbursement based upon an extensive understanding of current guidelines and trends in the following:
a)Code theory and interpretation
b)Industry standard coding practices
c)Industry standard billing practices
d)State contract language, i.e. coding for non-covered, exceptions, capitation.
e)State and federal mandates regarding coding
f)State and federal bulletins, newsletters, guidelines and manuals related to coding and cross-walks
g)Industry standard code sets, i.e. CPT, HCPCS, Revenue, ICD.9, DRG, etc.
h)Medical compliance and reimbursement policies such as medical necessity issues and proper coding

2.Review and validate coding on provider contract ratesheets and provide recommendations for development of standards.

3.Assist in the resolution of provider reimbursement configuration or claims payment issues as needed.

4.Implement and manage applications and processes for clinical classification and coding of health care services.

5.Conduct internal coding reviews and/or audits as required. Prepare and present reports defining observations and recommendations.

6.Interface with operational department management on industry standards and National Uniform Billing Compliance issues.

7.Provide technical guidance for configuration coding to the Business Configuration department.

8.Actively develop and participate in training activities related to coding.

9.Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required: Bachelor's Degree in Health Care Management, Accounting or Business, or equivalent experience.
Preferred:

Years and Type of Experience Required:
Required: Minimum of 3 years coding experience in health care setting (ICD-9, CPT-4, E&M, HCPCS, DRG and Revenue).
Preferred: Experience in health insurance reimbursement or health data analytics setting preferred

Specific Technical Skills
Required:
•Experience in analysis in health care utilization, clinical or managed care environment.
Preferred:
•Previous experience auditing professional and/or facility coding preferred.
Certifications or Licensure
Required:
•AAPC or AHIMA coding certification (RHIT/RHIA) or will be certified within 3 months from hire date.
•Must maintain licensure, i.e. completion of annual continuing professional education requirements.
Preferred:

Other
Required:
•Extensive knowledge and understanding of healthcare industry coding theory, rules and standards (such as CPT, HCPCS, Revenue, ICD9, DRG, etc).
•Advanced understanding of medical terminology, body systems/anatomy, physiology and concepts of disease.
•Ability to perform research and develop policies and procedures and recommendations.
•Ability to analyze contracts, regulations, policies and procedures, reports and legal documents.
•Ability to respond to questions/concern from internal customers and present company position in understandable and unambiguous manner.
•Strong oral and written communication skills.
•Excellent analytical and problem solving skills.
•Demonstrates strong decision-making skills.
•Ability to manage multiple tasks in a demanding work environment.
•Appreciation of cultural diversity and sensitivity towards target membership population.
•High energy level, self-motivating and able to handle several projects at once.
Preferred:

SCOPE INFORMATION

PHYSICAL REQUIREMENTS
•Must be able to operate a computer.
•Must be able to operate a telephone.
•Must be able to travel on common carriers and adhere to AMERIGROUP's travel policies.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Medical-Coding-Analyst-Job-VA-23450/709179/7091797091792010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
SQL Sever Programmer Analyst Princ I with SSRS and SSIS
Job ID:
10911
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Acts independently under general direction, designs, develops, modifies, debugs and evaluates programs for functional and operational areas. Functions as a technical expert team member to implement and support various development, design and analysis initiatives employing prescribed methodologies, and follows the AMERIGROUP Quality Assurance process in the creation of work products. Uses a full technical knowledge of all phases of applications programming.

PRIMARY RESPONSIBILITIES:
1. Develops program logic for new applications or analyzes and modifies logic in existing applications. Specializes in one or more phases of applications programming.

2. Independently modifies complex application programs from specifications. Provides technical consulting on complex projects.

3. Recommends changes in development, maintenance and system standards.

4. Independently codes, tests, debugs, documents, implements and maintains software applications.
- Creates a highly complex design document through the assessment of requirements. Assesses alternatives to different designs and selects best solution to fit business needs. Reads, interprets, creates and maintains complex conceptual, logical and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

5. Ensures that system improvements are successfully implemented. Resolves highly complex design issues utilizing software development lifecycle and development methods.

6. Serves as a contributor in development of IT architecture strategies for small to medium sized application infrastructures. For small to medium sized applications, evaluates recommends and exploits evolving technologies in the design and implementation of application infrastructure for scalability reliability availability and serviceability and identify the tradeoffs and risks associated with each.

7. Develops multiple, modular objects and the messaging interface between objects to create a highly complex software package. Reuses objects and creates object inventories.

8. Creates and guides definition of good database design practices. Designs highly complex data models and databases with minimal assistance.

9. Performs analysis on new and complex release features and analyze impact on the application and customer's business process. Coordinates potential vendor product/service evaluations to ensure technical requirements and performance measures are met. Participates in RFP activities which include but are not limited to: understanding business requirements; assess baseline/marketplace; construct, issue, and receive completed RFP's; evaluate potential vendors based on selected scoring model; evaluate cost benefit, and recommend vendor

10. Performs complex application administration and support.

11. Services subject matter expert providing assistance and training to less experience team members.

12. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelor's degree in Computer Science or related field. Equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required:
Required:
• Requires a minimum of 8 years relevant work experience.

Specific Technical Skills
Required:
• Demonstrates comprehensive knowledge of core IT applications and systems.
• Demonstrates advanced proficiency with all applicable company supported software applications.
• Demonstrates knowledge of the strategic alignment of IT solutions with business objectives.
• Extremely high level of understanding and experience with all data modeling concepts and practices, database design, database performance and optimization. Extremely high level of handling software development issues related to databases for relational, object-oriented, and other database and software technologies. Experience with multiple database technologies and products.
• Demonstrates thought leadership in a development discipline or toolset.
• Able to identify root causes of problems. Demonstrates the ability to develop and implement solutions for the causes identified.
• Able to develop and manage a project.
• Demonstrates a moderate to comprehensive understanding of supported applications and all interdependencies (OS, network, server, workstations, etc).

Other:
Required:
• Able to present information verbally, and in writing, in a concise and effective manner at all levels within the organization.
• Able to create and deliver presentations tailored to an audience.
• Able to motivate others, provide innovative ideas and solutions, and promote the department vision for improvement within the department.
• Able to develop creative strategies to problems.
• Able to manage customer expectations.
• Able to demonstrate leadership in a team environment.
• Demonstrates knowledge of the inter-relationship among various managed care operational areas.
• Demonstrates understanding of how each department/health plan relates to the organization as a whole.

SCOPE INFORMATION
# Direct Reports: 0
# Indirect Reports: 0
Budgetary $ Responsibility: $0 - $3m

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-ITS-Programmer-Analyst-Princ-I-Job-VA-23450/709880/7098807098802010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Medical Necessity Appeals Manager
Job ID:
10888
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY: The position monitors and manages the regulatory compliance and operations activities of AMERIGROUP's Medical Necessity Appeals and Complaints tracking. The Manager focuses on AMERIGROUP's regulatory/contractual obligations of the multiple state regulatory bodies. Requires frequent monitoring and problem solving with the Health Plans and Corporate entities to ensure regulatory and accreditation needs are met. This position manages the associates in the Complaints and Grievances component of the QI department.

PRIMARY RESPONSIBILITIES:
1. Manage the Medical Necessity Appeals (MNA) and Complaints process and reporting:
· Provide management with information and tools for strategic planning and decision making.
· AGP corporate liaison with Health Plans and corporate entities and Regulatory for complaint tracking and MNA.
· Maintain productive working relationships with key regulators and Health Plan contacts that leads to a collaboration benefiting company operations and activity.
· Subject matter expert/advisor on MNA and complaints requirements and programs.
· Oversight of all MNA activity including MNA external review, advanced Appeal Hearings, Accreditation compliance and policies associated with these processes.

2. Assess, communicate and ensure associate understanding of state and federal regulations, legislation and regulatory requirements that impact business activity and operations.

3. Develop and maintain resource tools for internal education, and compliance assessments.

4. Work with AMERIGROUP Compliance to help with AGP and vendor preparations for performance assessments, and audits–
· Prepare AGP and vendor operational leads for targeted audit activity.
· Coordinate and organize desk review submissions and on-site audit materials.
· Lead on-site assessment and audit activity, if needed.
· Facilitate development of corrective action plans (“CAPs”) and oversee CAP implementation.
· Interact with individual Health Plan audit and enforcement agencies to correct deficiencies and minimize administrative actions and sanction activity.

5. Manage submissions of reports for MNA and complaints/grievances to the appropriate committees and internal departments, as needed.

6. Provide feedback on regulatory filings and member correspondence pertaining to MNA and complaint management.

7. Oversee expansions and new market activities from an operational perspective, developing processes and policies to support the RFP, regulations, or EQRO requirements.
· Subject matter expert/advisor on MNA and complaint requirements and programs.

8. Provide leadership and motivation by establishing clear expectations, communicating specific performance feedback and providing timely and thorough performance appraisals.
· Interview, hire and train support staff
· Counsel support staff and take appropriate disciplinary action.
· Develop and administer team objectives, priorities and strategic action plans for achieving goals.

EDUCATION AND EXPERIENCE:
Education
Required:
Bachelor's degree. Experience in lieu of degree is acceptable
Experience with medical necessity appeals process and regulation.
Preferred : RN with managed care appeals and grievances experience.

Years and Type of Experience Required:
Required:
• 5 years of relevant work experience, to include HMO/Managed Care industry experience
• 3 years compliance with regulatory body(s) experience
• 3 years of leadership/management experience
• Extensive knowledge of federal and state HMO and Managed care regulations
Preferred:
• 1-2 years experience managing appeals and/or complaint processes for large company
• Extensive knowledge of accreditation requirements for MNA and complaints

Specific Technical Skills
Required:
• Intermediate level Microsoft Office Suite skills. Specifically Word and Excel.
• Report development skills including detail needed for specific market and summary for executive reporting.
Preferred: Report presentation skills for small and large groups
Specific Licenses
Required: None
Preferred: Registered Nurse (RN)

Other
Required:
• Strong analytical and organizational skills.
• Strong verbal and written communication skills.
• Ability to analyze, interpret, and summarize contracts, regulations, policies/procedures, reports and legal documents.
• Ability to respond to questions/concern from internal customers and regulatory agencies.
• Present company position in understandable and unambiguous manner in formal and informal presentations.
• Problem-solver – identify root cause, recommend options and implement/negotiate appropriate solutions.
• Strong team building skills.
• Ability to effectively set priorities and meet commitments.
• Ability to work under pressure and within strict time frames.
• Comfortable interfacing at all levels of the organization.
• Appreciation of cultural diversity and sensitivity towards target population.

SCOPE INFORMATION
Item Measure
• # Direct Reports – 0-5
• # Indirect Reports – 1-10
Budgetary $ Responsibility –

PHYSICAL REQUIREMENTS
• Must be able to operate a computer and a telephone.
• Manual dexterity to access filing systems.
• Must be able to conduct, facilitate, and actively participate in meetings.
• Periodic travel required - must be able to travel on common carrier.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Manager-Appeals-&-Grievance-Job-VA-23450/702776/7027767027762010-04-09AmerigroupNursing & Health Care Mgmtfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Director Project Management - Health Care Management Services
Job ID:
10921
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:

Organizes, and controls assigned projects and programs using resources across the enterprise. Monitors and tracks interdependencies, risks, issues, and produces the day-to-day results as defined by the project sponsor. Provides timely reports and project status updates. May be assigned to lead medium to large projects or portions of more complex corporate projects under the direction of a senior project lead.

Projects may include, but are not limited to:
• New Business Growth Projects, as approved by the Growth Committee, including new market development, due diligence, acquisitions, new product introductions, and geographic expansions;
• Customer Service Strategic Projects;
• Process Improvement Initiatives; or
• Other Amerigroup Strategic Projects.

PRIMARY RESPONSIBILITIES:
1. Ensures that projects within the program are defined, developed, tested, documented, and implemented following PMP standards, scheduled time lines, and within approved budgets.

2. Works with project functional managers to negotiate for resources to ensure program success and communicates resource availability, workload and performance.

3. Develops, communicates, and monitors program schedule, budget, and resource plan.

4. Assist Project Sponsors to develop and validate the program's benefits definition and measurement; ensures the successful attainment of the project's defined benefits; promotes the benefits provided by the project.

5. Drives program vision through effective risk management and manages change through a defined change management system.

6. Ensures that the program team remains within the defined scope of the project; ensures the individual project goals and objectives are consistent with the defined scope of the project.

7. Coordinates the deliverables of the program's individual projects.

8. Drives to resolution any issues that may hinder program success.

9. Implements an effective and appropriate program communication plan.

10. Facilitates and expedites the needs of the program to ensure assigned project managers have the necessary tools and support to effectively perform their responsibilities.

11. Contributes to strategy development of the forward path of the program.

12. Responsible for adherence to AMERIGROUP's Project Management Process and methodologies.

13. Maintains program documentation and metrics.

14. Assists in the hiring, evaluation, and development of the program's project managers and other program support personnel

15. Contributes to a knowledge sharing environment by creating project documents, giving presentations, teaching or mentoring project managers.

16. Contributes to the development and administration of AMERIGROUP project policies, procedures, standards, methodologies, and tools.

17. Serves as an internal consultant to projects needing additional project management expertise.

18. May be called upon to oversee the responsibilities of other Project Managers and Project Coordinators.

19. Performs other duties as assigned.

EDUCATION AND EXPERIENCE:

Education
Required:
• Bachelor's degree or equivalent experience in Business, Management Information Systems or Health Care. Equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required:
Required:
• Minimum of seven years work related experience.
• Five to ten years project management or leadership experience in a medium to large size business environment.
Preferred:
• Strong IT and/or managed health care knowledge preferable.

Specific Technical Skills
Required:
• Knowledge of process improvement and project management including tools and techniques, critical path method, program evaluation and review technique, resource balancing, and cost estimating.
• Strong problem-solving skills enabling quick evaluation of all facets of a situation or problem to determine the viability of alternatives to implement the best solution.
• Ability to clarify and interpret the relationships between a system and its component parts.
• Ability to quickly assimilate concepts and comprehend ideas readily to make effective management decisions.
• Strong PC skills. Prefer strong background in MS Office Suite applications, Visio and Project Management Software

Certifications or Licensures
Required:
• N/A
Preferred:
• Project Management Professional (PMP) certification from the Project Management Institute.

Other:
Required:
• Excellent analytical, problem-solving, and communication skills, both written and oral.
• Excellent interpersonal skills with the ability to promote team development
• Able to maintain strategic vision; ensures scope stays in alignment with corporate strategy
• Demonstrated leadership and organizational skills
• Conflict resolution/mediation experience
• Appreciation of cultural diversity and sensitivity towards target population.

SCOPE INFORMATION

# Direct Reports: 0
# Indirect Reports: 1 or more
Budgetary $ Responsibility: $5,000 - $50,000

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Director-Project-Management-Health-Care-Management-Services-Job-VA-23450/706219/7062197062192010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Sr Business Solutions Analyst
Job ID:
10943
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:
This position is a senior-level position. The incumbent for this position possesses a high degree of expertise in the business rules that support reimbursement policies and methodologies in a large managed care organization. This position plays a key role in the implementation of new market business, in market growth, issue resolution, and in the analysis of provider and state contracts and benefits. Responsible for understanding functional area of responsibility, gathering requirements, performing analysis, supporting the development and testing processes, and understanding the applications, data, and associated technologies for supported areas. The incumbent is responsible for managing projects, coaching more junior analysts and for preparing performance reports for the department.

PRIMARY RESPONSIBILITIES:
1. Performs requirements gathering, analysis, and process and data flow diagramming for processes of moderate to high complexity.

2. Leads requirements gathering sessions with business owners and other team members.

3. Conducts gap analysis discovery between business requirements and system functionality.

4. Develops requirements documentation and obtains approval of the requirements from the business owner and other stakeholders.

5. Documents key business decisions and processes, and validates them with the business owner.

6. Provides business and data analysis support for new development projects and market expansions.

7. Works with project managers and coordinators from the assigned operational areas on planning and execution of department WBS.

8. Participates in the quality assurance of all department projects.

9. Demonstrates an understanding of software development lifecycle and development methods. Uses these to resolve moderately complex design issues. Uses SDLC development methods or industry best practices under limited supervision.

10. Demonstrates a working knowledge of managed care operational areas and managed care products in each market in which Amerigroup operates, including current trends in the industry.

11. Works with principal analysts to define and prioritize projects.

12. Considers interdepartmental impact when recommending solutions and identifies opportunities for interdepartmental utilization of recommended solutions.

13. Works with peers to develop realistic project scope estimates, detailed project plans, and timelines.

14. Reads and interprets design documents.

15. Demonstrates an understanding of data architecture.

16. Performs moderate to complex queries. Understanding of database tables, relations, data types, and values.

17. Understands data modeling concepts (e.g., the entity-relation model) and their application: entities and tables, relations and constraints, attribute data types and column data types.

18. Assists in the development of test plans used to verify specific configuration functions according to actual requirements and established guidelines.

19. Leads acceptance testing process.

20. Participates in the quality assurance of all department projects.

21. Manages small to medium size projects.

22. Develops training materials working with the SMEs in the department.

23. Demonstrates knowledge of current technology trends.

24. Manages multiple priorities at the same time.

25. Develops and maintains departmental performance reports.

26. Adheres to departmental and corporate policies and procedures.

27. Participates in relevant training programs when available and offered.

28. Other duties as Assigned.

EDUCATION AND EXPERIENCE:
Education:
Required:
Bachelor's degree in business administration, information science, computer science, industrial engineering or a relevant area, or equivalent technical skills and experience.
Preferred:
Masters degree in business administration, information science, computer science, industrial engineering or a relevant area.

Years and Type of Experience Required::
Required:
• Has a minimum of 5 years experience in business or systems analysis or an applicable four-year degree and a minimum of two years of experience.
• Possesses problem solving and project management skills. Must be able to take charge, manage numerous projects and successfully coordinate projects with internal areas and external vendors.
• Project team member oversight management and/or supervisory experience required.
Preferred:
• Has a minimum of 3 years experience in a managed care environment.
• Has experience using a software development life-cycle methodology like the Software Development Life Cycle (SDLC).
• Has broad operational managed care background.•
Specific Technical Skills:
Required:
• Has a minimum of two years of experience:
Using MS Office
Using the Windows operating system and its utilities.
Using the internet to conduct research and to download information.
• Is familiar with data structures and data types.
• Is able to provide professional and appropriate written information to internal and external customers.
• Is able to initiate conceptual ideas with practical applications.
• Is able to work with integrated data using a relational database management system or SQL.
• Has excellent analytical and organization skills.

Other:
Required:
• Has a comprehensive understanding of how each department/health plan relates to the organization as a whole.
• Can develop short range plans to accomplish specific goals given a set amount of resources and set timeframes.
• Has knowledge of managed care including, but not limited to claims adjudication and payment, medical management, provider fee-for-service reimbursement, capitation, billing, enrollment, and benefits.
• Possesses excellent verbal and written communication skills.
• Have excellent interpersonal skills, including the ability to work with all levels of personnel.
• Is detail-oriented.
• Is able to develop and maintain customer relationships.
• Is able to participate in teams as a strong team participant.
• Is able to develop and implement basic project plans with direction and supervision.
• Is able to participate in teams as a strong team participant.
• Is able to develop and implement basic project plans.
• Is able to deal with a fast paced environment and make proper decisions quickly.
• Appreciates cultural diversity and sensitivity towards target population.

SCOPE INFORMATION
Item Measure
• # Direct Reports None
• # Indirect Reports Junior analysts as needed
• Budgetary $ Responsibility $0 - $300,000
• KPI – Department Standards Yes - as determined

PHYSICAL REQUIREMENTS
• Must be able to participate in meetings.
• Must be able to operate a PC for extended periods of time.
• Must be able to operate and effectively utilize office telephone equipment.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Sr-Business-Solutions-Analyst-Job-VA-23450/709883/7098837098832010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Performance Strategist III
Job ID:
10948
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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------------

Responsibilities
Grade 20
OD Department Recruiter: J. Mays
JOB SUMMARY: Lead simultaneous human performance improvement initiatives; support AVP and Director of Performance Improvement in the mentoring and coaching of other Performance Strategists. Identify best practices and develop internal policies and procedures. Acts independently with guidance in only the most complex situations. Responsible for conducting performance and needs analysis, implement interventions including instructional design, change management and evaluation and measurement.

PRIMARY RESPONSIBILITIES:
1.Work with Director and AVP of Performance Improvement Diagnostics and Solutions (PIDS) with aligning business and organization metrics to Human Performance Improvement (HPI) interventions and developing communication mechanisms to support.
2.Partner with internal clients to analyze performance gaps and opportunities.
3.Lead and support multiple improvement initiatives and implement intervention(s) including the oversight, development, and project management.
4.Support and monitor the progress of other Performance Strategists with interventions and act as coach and mentor.
5.Research current HPI and Instructional Design (ID) methodologies and technologies and implement best practices and core operational guidelines for PIDS team.
6.Determine and/or partner with other Performance Strategists the selection of interventions that address root cause(s) of performance gaps.
7.Produce work of consistently high quality and show initiative to innovate and excel in established processes.
8.Organize and track the continuous evaluation of HPI interventions before, during and after application while working with the results from PIDs team members.
9.Outline training programs and determine method, sequence, and instructional approach.
10.Develop, edit and perform content maintenance for training materials to include Instructor Led Training (ILT), Computer Based Training (CBT), assessments, and on-line reference tools.
11.Verify all cross-references in materials, the accuracy of technical training steps, and the accuracy of any accompanying graphics.
12.Apply the standards of the departmental style guide to all existing and new documentation and adhere to the Organizational Development (OD) quality analysis process.
13.Evaluate courses and the completion of scopes of work.
14.Complete other special projects and duties as assigned.

EDUCATION AND EXPERIENCE:

Education
Required:
•Bachelor's degree or equivalent experience (6 yrs).
Preferred:
•Master's degree in Instructional and Performance Technology (IPT) or Instructional Design and/or certificate in Human Performance Technology (HPT) or Human Performance Improvement (HPI).

Years and Type of Experience Required:
Required:
•5 years experience in Human Performance Improvement, Human Performance Technology including the following
·experience creating training materials for instructor-led and/or computer-based training;
·training or teaching experience;
·managing projects or work teams across organizational departments with associates at multiple levels; and
·experience working in a corporate training environment.
Preferred:
•Experience leading and implementing mid to large scale change initiatives
•Experience with analytics
•Claims, call center, or medical management experience
•AMISYS, MACESS, Facets experience

Specific Technical Skills
Required:
•Proficient to expert skill in Microsoft Office applications
Preferred:
•Dreamweaver, Photoshop, InDesign, Flash, Captivate experience
•Basic HTML/XML editing

Preferred:
•CPT, CPLP, HPT, instructional design, training, or managed care certification

Other:
Required:
•Ability speak and reason well in front of an audience and communicate thoughts and ideas clearly and succinctly
•Work effectively with others to achieve common goals, and exercising effective interpersonal influence
•Problem solving skills
•Systems thinking and understanding
•Performance understanding
•Business understanding
•Negotiating/contracting skills
•Buy-in/advocacy skills
•Consulting skills
•Strong technical aptitude
•Ability to apply adult learning theories and principles to a variety of projects.
•Coping skills—knowing how to deal with ambiguity and how to handle the stress resulting from change and from multiple meanings or possibilities
•Ability to see the big picture
•Complex problem-solving skills
•Excellent verbal and written communication skills
Preferred:
•Document design and layout experience

SCOPE INFORMATION

# Direct Reports: 0
# Indirect Reports: 4
Budgetary $ Responsibility: $0

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

•Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
•Ability to communicate both in person and/or by telephone.
•Must be able to travel as needed (5-15%) and adhere to Amerigroup travel policies and procedures.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Performance-Strategist-III-Job-VA-23450/709887/7098877098872010-04-09AmerigroupHuman Resourcesfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Manager Clinical Pharmacy - Managed Care
Job ID:
10949
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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------------

Responsibilities
JOB SUMMARY:
This position reports to the health Plan Medical Director or Director of Pharmacy and is responsible for various pharmaceutical aspects of the AMERIGROUP pharmacy program including clinical prior authorizations, P&T committee, clinical drug policy development and elevated operational issues related to claims adjudication.. This position uses pharmacy claim information to determine the focus for necessary clinical interventions.

PRIMARY RESPONSIBILITIES:
1. Manages the daily clinical prior authorizations for a health plan, interfacing with dispensing pharmacies, prescribers, members and the health plan medical director and nurses.

2. Completes work related to the Pharmacy and Therapeutics Committee including therapeutic class reviews, drug monographs and formulary recommendations.

3. Participates in health plan Quality Management Committee meetings, case management and disease management meetings and other meetings related to drug utilization as required.

4. Participates in the pharmaceutical care management process through reviewing member profiles, recommending members for lock-in, case management or disease management.

5. Responds to and resolves issues related to member/provider complaints, claims processing issues and appeals.

6. Works with the plan on design of member and provider education materials, member and provider handbooks and other communication pieces.

7. Other duties as required.

EDUCATION AND EXPERIENCE:
Education
Required: Pharm. D. or BS in Pharmacy (Pharm. D. preferred)
Preferred:

Years and Type of Experience Required:
Required:
o (5) years Pharmacy practice experience or equivalent experience.
o Equivalent experience is 2 years clinical Pharmacy plus completion of one (1) year accredited residency program.
o 1-2 years managed care experience and knowledge of Managed Pharmacy Environment
Preferred: Retail pharmacy, HMO or PBM experience preferred

Specific Technical Skills
Required: MS Office, MS Outlook, Word, Excel

Certifications or Licensure
Required: Active Pharmacist License

Other
Required:
Excellent oral and written communication skills
Interest in all business aspects of Managed Care Pharmacy

SCOPE INFORMATION
Item Measure
# Direct Reports 0
# Indirect Reports
Budgetary $ Responsibility

PHYSICAL REQUIREMENTS
• Must be able to operate a computer
• Must be able to operate a telephone
• Must be able to travel on common carrier and adhere to AMERIGROUP's travel policies
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Manager-Clinical-Pharmacy-Managed-Care-Job-VA-23450/710725/7107257107252010-04-09AmerigroupHealth Care Operationsfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
PEGA Application Analyst Princ I
Job ID:
10957
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Acts independently under general direction, researches and fact finds to modify information systems for functional and operational areas. As a technical expert, responsible for analysis, design, development and testing of custom software, third-party application software, interface development and operational reporting development. Often acts as business expert and assists users in defining needs. Supports the initiation, amendments, renewal and terminations of contract negotiations. Uses a full technical knowledge of all phases of applications systems analysis. Services as subject matter expert providing assistance and training to less experience team members.

PRIMARY RESPONSIBILITIES:
1. Devises or modifies procedures to solve complex problems considering computer equipment capacity and limitations, operating time, and form of desired results.

2. Develops complex web applications, which utilize Standard Query Language (SQL) data sources.

3. Develops multiple, modular objects and the messaging interface between objects to create complex software packages.

4. Creates complex design documents through the assessment of requirements. Assess alternatives to different designs and chooses best solutions to fit business needs.

5. Adheres to existing configuration management procedures and recommends/implements improvements to existing procedures. Adheres to and contributes to definition of good database design practices. Influences others to follow existing procedures.

6. Serves as a technical expert in development of IT architecture strategies for medium sized application infrastructures. Evaluates technology, performance, scalability, interoperability, reliability, availability, and serviceability in small to medium sized applications.

7. Reads, interprets, creates and maintains complex conceptual, logical and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

8. Develops complex test plans, which include regression testing and packaging tests into consecutive steps based on logical dependencies. Writes, revises and verifies functional test plans for complex systems in a software application.

9. Evaluate and tests complex new/modified programs, applications and/or operating systems. Monitors system functionality and performance to ensure standards are met. Documents and tracks product defect and coordinates problem resolution with development and/or product vendors.

10. Performs complex SQL queries and updates tables. Manages complex data modeling and develops strategies to resolve complex data architecture and modeling issues.

11. Coordinates potential vendor product/service evaluations to ensure technical requirements and performance measures are met. Participates in RFPs activities, which include but are not limited to understanding business requirements; assess baseline/marketplace; construct, issues, and receives completed RFPs, evaluates potential vendor based on selected scoring model; evaluates cost benefit, and recommend vendor.

12. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelor's degree in Computer Science or related field. Equivalent experience is acceptable in lieu of a degree(s).
Preferred:
• Master's preferred.

Years and Type of Experience Required:
Required:
• Requires a minimum of 8 years related work experience.

Specific Technical Skills
Required:
• Advanced proficiency with all applicable company support software applications.
• Comprehensive knowledge of core IT applications and systems. Moderate to comprehensive understanding of supported applications and all interdependencies (OS, network, server, workstations, etc).
• Comprehensive knowledge of data modeling concepts and their application including entities, tables, relations, constraints, attribute data types and column data types. Understands referential integrity, locking and transaction processing. Understands impact of data modeling decision on system performance and resource usage.

Other:
Required:
• Able to present information verbally, and in writing, in a concise and effective manner at all levels within the organization.
• Able to create and deliver presentations tailored to an audience.
• Able to motivate others, provide innovative ideas and solutions, and promote the department vision for improvement within the department.
• Able to develop creative strategies to problems.
• Able to manage customer expectations.
• Able to demonstrate leadership in a team environment.
• Demonstrates knowledge of the inter-relationship among various managed care operational areas.
• Demonstrates understanding of how each department/health plan relates to the organization as a whole.

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-PEGA-Application-Analyst-Princ-I-Job-VA-23450/713384/7133847133842010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
AVP Health Plan Services
Job ID:
10962
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
**NO 3rd PARTIES PLEASE**

JOB SUMMARY:
The Associate Vice President of Health Plan Services is a senior management position within the Business Solutions area of Health Plan Services. This position requires a strong proven ability to lead, with strong functional skills in technology, business process engineering and business planning and execution. Experience includes a blend of strategic and operational experience with effective communications and a strong background in the healthcare IT industry. Essential responsibilities include day-to-day management of the Business Solutions area.

PRIMARY RESPONSIBILITIES:
1. Provides strong leadership by fostering and promoting configuration excellence, quality in the deliverables, process efficiency and innovation for the delivery of the configuration of business rules in Amisys, Facets, TXEN, ClaimCheck, Winstrat and EasyGroup.

2. Creates solutions with architectures that minimize complexity, effort, and maintenance while fully accomplishing the project and business objectives.

3. Builds and maintains consistent and repeatable processes.

4. Develops and manages highly reliable and tested solutions.

5. Innovates and rollouts new processes and tools that foster improved productivity.

6. Responsible for setting up the necessary tools, processes and training in order to produce consistent and accurate work effort estimates.

7. Implements best practices for application configuration.

8. Provides senior management and accountability for achieving and maintaining medical code set compliance as specified in the Health Insurance Portability and Accountability Act (HIPAA).

9. Provides senior management and accountability for achieving and maintaining Sarbanes-Oxley (SOX) compliance for controls within the department.

10. Aligns department initiatives with business priorities while balancing resource constraints (human and fiscal).

11. Ensures that all department initiatives have clear business goals and success metrics.

12. Monitors and reports on the performance of the department including actual versus expected results and project duration.

13. Grows associates by managing performance metrics, performance reviews, recruitment, orientation, career development and mentoring programs.

14. Maintains high employee satisfaction and low turnover rate.

15. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
Bachelor's degree in business administration, information science, computer science, industrial engineering or a relevant area, or equivalent technical skills and experience.
Preferred:
Masters degree in business administration, information science, computer science, industrial engineering or a relevant area.

Years and Type of Experience Required:
Required:
A minimum of fourteen years experience in an IT high tech consulting or services Environment with a specialty in application development.

Ten or more years of project management experience in an IT environment.

Seven or more years of experience leading and managing technical staff providing configuration/programming support for Amisys, Facets, MHS, Metavance, Diamond, or a similar payer system, preferably in a large health care organization.

Proven leadership skills that focus on direction, motivation, development and retention of staff.

Excellent communication, critical thinking and problem solving skills.

Able to identify potential problems before they happen and provide alerts to members of the management team

Proven experience in using traditional management consulting techniques to implement successful business solutions.

Able to effectively engage people and deliver results using strong influence management skills.

Advanced negotiation, writing, presentation and organizational skills.

Possesses broad operational managed care experience.

Specific Technical Skills
Required:
Five or more years of experience providing system, business and data analysis support.

Expert knowledge of the Software Development Life cycle (SDLC).

A minimum of five years of experience using a 3-GL or a 4-GL programming language.

Amisys, Facets, MHS, Metavance, Diamond, or a similar payer system experience.

A minimum of two years of experience:
Using MS Office.
Using the Windows operating system and its utilities.
Using the internet to conduct research and to download information.
Using a relational database management system or SQL to retrieve and analyze data.
Familiarity with data structures and data types.
Preferred:
Knowledge of HIPAA as it pertains to standard code set compliance, the NPI, security and privacy requirements.

Knowledge of SOX requirements as it pertains to internal department controls.

Knowledge of Rational Unified Process (ROP) techniques.

Certifications or Licensure
Required:
Current Project management Professional (PMP) certification.

Other
Required:
Displays flexibility, focus and calmness under pressure.

Is comfortable in a fast paced environment that involves change and rapid development.

Influences through direct and indirect means, giving people a stake in the outcome by ensuring they participate in the process.

Able to make decisions and garner support for decisions in a complex, and ambiguous environment, where the consequences of the decision have broad and /or long-term implications for the success of the business.

A consistent leader who voices their ideas/opinions while respecting others.

Proven ability to manage complex projects.

Excellent analytical skills including being able to present data to senior management.

Excellent verbal and written communication skills.

Maintains an overall positive attitude within the delivery organization.

Appreciation of cultural diversity and sensitivity towards target population

SCOPE INFORMATION
Item Measure
• # Direct Reports 10 - 15
• # Indirect Reports 0
• Budgetary $ Responsibility TBD
• KPI – Department Standards TBD

PHYSICAL REQUIREMENTS
• Must be able to participate in meetings.
• Must be able to operate a PC for extended periods of time.
• Must be able to operate and effectively utilize office telephone equipment.
• Data entry using repetitive motion
• Specific vision abilities requiring close vision.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-AVP-Health-Plan-Services-Job-VA-23450/713388/7133887133882010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
FACETS Configuration Analyst II
Job ID:
11028
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
This is a mid-level technical position. Performs moderately complex configuration activities. This position is responsible for providing configuration solutions for current and future markets' business requirements.

PRIMARY RESPONSIBILITIES:
1. Conducts analysis, configures, tests and documents configuration solutions for the following functions:
• Provider reimbursement configuration set-up and maintenance
• Benefit package configuration setup and maintenance
• Membership/divisions configuration set-up and maintenance
• Group/member premium configuration set-up and maintenance
• Medical management configuration set-up and maintenance

2. Exercises good judgment in the use of standards. Can propose business beneficial changes to configuration standards and development procedures.

3. Adheres to existing configuration management procedures. Recommends improvements to existing procedures. Influences others to follow existing procedures.

4. Creates moderately complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit business needs.

5. Performs complex queries.

6. Adheres to departmental and corporate policies and procedures.

7. Attends improvement training programs when available and offered.

8. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelor's degree in business administration, information science, computer science, industrial engineering or a relevant area, or equivalent technical skills and experience.

Years and Type of Experience Required:
Required:
• A minimum of two years of configuration experience providing pricing and/or benefits configuration support on Amisys, Facets, MHS, Metavance, Diamond, or a similar payer system, preferably in a medium to large health care or related organization.
• Possess problem solving and analysis skills.
Preferred:
• Experience using a software development life-cycle methodology like the Software Development Life Cycle (SDLC).
• Broad operational managed care background.
Specific Technical Skills
Required:
• A minimum of two years of experience:
• Using MS Office
• Using the Windows operating system and its utilities.
• Using the internet to conduct research and to download information.
• Using a relational database management system or SQL to retrieve and analyze data.
• Familiarity with data structures and data types.
Preferred:
• Formal coursework using a 3-GL or a 4-GL programming language (e.g., C+, Visual Basic).

Other
Required:
• Ability to work with integrated data using a relational database management system or SQL.
• Possesses analytical and problem-solving skills.
• Good oral and written communication skills.

SCOPE INFORMATION
Item Measure
• # Direct Reports None
• # Indirect Reports None
• Budgetary $ Responsibility None
• KPI – Department Standards Yes - as determined

PHYSICAL REQUIREMENTS
• Must be able to participate in meetings.
• Must be able to operate a PC for extended periods of time.
• Must be able to operate and effectively utilize office telephone equipment.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-FACETS-Configuration-Analyst-II-Job-VA-23450/728661/7286617286612010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Ops Business Analyst III
Job ID:
11020
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Under general direction, gathering requirements, performing analysis, supporting the development and testing processes, and understanding the applications, data, and associated technologies for supported functional areas. Analyze complex business problems to be solved with automated systems. Provide technical expertise in identifying, evaluating and developing systems and procedures that are cost effective and meet user requirements. Work with programming staff to ensure requirements will be incorporated into system design and testing. Act as a resource to users of the software to address questions/issues. May provide consultation to users in the area of automated systems.

PRIMARY RESPONSIBILITIES:
1. Perform detailed requirements gathering, analysis, and process and data flow diagramming for processes of moderate to complexity. Understand and consider the relationship between processes. Identify risks and multiple solutions. Contribute to analysis standards.

2. Evaluate and test complex new/modified programs, applications and/or operating systems. Monitor system functionality and performance to ensure standards are met. Document and track product defects. Coordinate problem resolution with development and/or product vendors.

3. Adhere to existing configuration management procedures. Recommend improvements to existing procedures. Influence others to follow existing procedures.

4. Use appropriate methods to resolve moderately complex design issues Identify root causes of problems.

5. Read and interpret conceptual, logical, and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

6. Read and interpret a design document.

7. Write, revise, and verify moderate to complex test plans for multiple business systems.

8. Manage customer expectations.

9. Manage multiple priorities at the same time.

10. Acts as a resource to other colleagues with less experience.

11. Other duties as assigned

EDUCATION AND EXPERIENCE:

Education:
Required:
• Bachelor's degree in Business Administration, Management Information Systems, Computer Science or a related discipline. Equivalent experience is acceptable in lieu of a degree(s).

Years and Type of Experience Required::
Required:
• A minimum of 5 years experience in business or systems analysis.
Preferred:
• A minimum of 5 years experience in business or systems analysis with 4 years experience in healthcare or financial/hr analysis.

Specific Technical Skills:
Required:
• Demonstrate an understanding of the inter-relationship among various core business applications and systems.
• Demonstrate basic understanding of the strategic alignment of IT solutions with business objectives and work as a liaison for IT and the business.
• Demonstrate advanced proficiency with applicable business processes, definitions and terminology.
• Demonstrate a thorough understanding of infrastructure associated with supported business applications.
• Demonstrate understanding of data flows in managed care business processes
• Demonstrate basic knowledge of the inter-relationship among various managed care operational areas.
• Ability to create and deliver a presentation on a specific topic.
• Develop creative solutions to problems. Demonstrate the ability to seek alternatives, new ideas, and/or approaches to problems.

Other:
Required:
• Demonstrate the ability to develop and implement solutions for the causes identified.
• Demonstrate basic understanding of how each department/health plan relates to the organization as a whole.
• Demonstrate leadership in a team environment.
• Develop and manage a project with direction and supervision.
• Manage small project related budgets.
• Motivate others and provide innovative solutions for unit/team improvement.

PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Ops-Business-Analyst-III-Job-VA-23450/727868/7278687278682010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Director Proposal Management
Job ID:
11036
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:
Reports to the VP Proposal Management and supports Amerigroup (AGP) in meeting its strategic initiatives for growth by primarily conducting market/product research and analysis and managing the proposal development process. Under the direction of the VP Proposal Management, manages the proposal development project. Provides leadership to writers, Executive Assistant, contract writers and Subject Matter Experts (SMEs); coordinates activities with leads from key support departments; and works closely with the VP Proposal Management to develop winning proposal strategies and content. Provides business users with the information on capabilities as described in competitor proposals and makes recommendations on product development.

PRIMARY RESPONSIBILITIES:
1. Conduct competitive analysis of published requests for proposals (RFPs), to identify capability gaps and make recommendations to VP Proposal Management and SVP, External Relations on product development.
2. Contribute to the development and submission of responses to requests for information (RFIs) and RFPs including the development of response strategy, executive summary, kick off materials and assessment tools
3. Ensure the on-time delivery of an accurate, strategic, compliant, winning proposal as a leader of the proposal development process.

a. Prepare and distribute proposal-related communications with the client, such as the submission of questions, verifying the receipt of amendments, acknowledgements, and other formal communications

b. Monitor State's procurement website for updates, amendments, communications, etc. and research news related to the RFP, State, legislation, competition; post material to server and notify the team

c. Review and stay current with all RFP versions, addenda, and Q&As to ensure proposal responses reflect the latest RFP requirements

d. Track and manage compliance issues, business decisions and other open items needed for proposal resolution

e. Oversee and manage proposal-related work performed by the Department Executive Assistant.

f. Conduct post-proposal submission administrative activity, including but not limited to: debrief meetings, server organizations, surveys, and data retention

g. Participate in post-proposal submission activity, including but not limited to: Best and Final Offer's (BAFOs), orals presentations, follow-up questions

h. Conduct review and analysis of AGP results and make recommendations on changes to the proposal development process or content development to improve results.

4. Conduct analyses of competitors' proposals obtained via federal information release process (FOIA) requests and prepare summary reports for VP Proposal Management.

5. Manage data and report information to support the proposal development process. Including the a) Organization of paper and electronic files associated with development documents b) Management of data used for departmental project planning according to the AMERIGROUP Project Management Process and c) Measurements to track performance of the development process including win rates and productivity measures.

6. Document departmental processes, work flows, and systems as directed.

7. Establish working relationships with other Amerigroup business functions and with Amerigroup affiliate health plans to develop the necessary program information for proposal development and competitive positioning.

8. Record, track, and report departmental performance indicators.

9. Manage document production and submission requirements with the assistance of the Department Executive Assistant. Plan, organize, and manage document production efforts, including identification of all required submission documents and owners, verification of document availability for production, development of requirements for submission (e.g. printing, binding, shipping specifications), ordering of supplies (binders, tabs, etc.), managing supply inventory, development of assembly instructions, identification and scheduling of company and/or temporary resources to assist with production, and management of the production, quality control, and shipping processes.

10. Perform special projects and other duties as assigned

EDUCATION AND EXPERIENCE:

Education
Required:
• Bachelor's degree in English, Communications, Journalism, Marketing, or related area of study.
Preferred:
• Bachelor's degree in Marketing or Business.

Years and Type of Experience Required:
Required:
• 7 years relevant experience in proposal writing, proposal development, or business development related to responding to state RFPs and at least 3 years of leadership/management experience. .
Preferred:
• One to three years experience in proposal project management; managed care experience.

Specific Technical Skills
Required:
• MS Office suite (Word, PowerPoint, Excel)
Preferred:
• MS Project, MS Access, Visio

Certifications or Licensures
Required:
• None
Preferred:
• Project Management/Proposal Management Certification.

Other:
Required:
• Project Management and analytical skills.
• Demonstrated ability to manage a complex workload, prioritize tasks, meet deadlines, perform under pressure.
• Use good judgment in providing guidance and leadership to proposal staff and proposal team members.
• Strong analytical and decision-making skills.
• Strong communications and interpersonal skills.
• Ability to work with and lead associates of all levels.
• Strong written communications skills; interviewing and research skills.
• Ability to work independently and as a team member.
• Demonstrated skill in identifying risks and taking appropriate steps to avoid, eliminate, or handle them thereby minimizing their impact on each project.
• Ability to delegate effectively; strong editing skills.

SCOPE INFORMATION

# Direct Reports: None
# Indirect Reports: None
Budgetary $ Responsibility: None

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures. Typical travel load may be 1-2 times/year.
• Standing and sitting for long periods of time
• Must be able to operate a motor vehicle (in conjunction w/travel)
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Director-Proposal-Management-Job-VA-23450/730387/7303877303872010-04-09AmerigroupSales & Marketingfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Configuration Analyst Princ II - Credentialing
Job ID:
11025
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:
This is a senior technical position which requires extensive knowledge in the configuration of Facets. The incumbent for this position possesses a high degree of expertise in the configuration of business rules and applications that support reimbursement policies and methodologies in a large managed care organization. This position plays a key role in the architecture and implementation of new market business, in market growth, issue resolution, and in the analysis and configuration of provider and state contracts and benefits. This position is responsible for the preparation of performance reports for the department. The incumbent is responsible for managing configuration projects, coaching and indirect management of other analysts.

PRIMARY RESPONSIBILITIES:
1. Works with operational areas in the definition of projects to enable prioritization for analysis and solution recommendation.

2. Considers interdepartmental impact when recommending solutions and identifies opportunities for interdepartmental utilization of recommended solutions.

3. Works with peers in Advanced Solutions and Project Management to develop realistic project scope estimates, detailed project plans, and timelines.

4. Demonstrates comprehensive working knowledge of managed care operational areas and managed care products in each market in which Amerigroup operates, including current trends in the industry.

5. Participates in the quality assurance of all Business Configuration projects.

6. Demonstrates a high understanding of software development lifecycle and development methods. Uses these to resolve very complex design issues. Uses SDLC development methods or industry best practices.

7. Performs complex data modeling and database design.

8. Analyzes business requirements and objectives towards determining the optimal configuration of the requirements.

9. Acts as the point person between Configuration and Advance Solutions to ensure that all application and technically-oriented issues relating to the configuration project are appropriately addressed.

10. Acts as business subject-matter expert to other implementation initiatives, including conversion, report and interface development.

11. Manages the maintenance and implementation pricing and benefits configuration.

12. Demonstrates a thorough understanding of data architecture.

13. Adheres to existing configuration management procedures. Recommends improvements to existing procedures. Assesses work of team members to ensure compliance with procedures.

14. Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit business needs.

15. Exercises good judgment in the use of configuration standards. Can propose business beneficial changes to coding standards and development procedures.

16. Assist with providing gap analysis between business requirements and system functionality.

17. Provides technical support for new development projects and market expansions.

18. Manages large and complex configuration projects.

19. Reviews and guide analysis and configuration efforts of analysts.

20. Understands strategic alignment of business solutions with business objectives.

21. Mentors junior configuration analysts.

22. Adheres to departmental and corporate Policies and Procedures as outlined by Management.

23. Participates in relevant training programs when available and offered.

24. Develops and maintains departmental performance reports.

25. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education Required:
• Bachelor's degree in business administration, information science, computer science, industrial engineering or a relevant area, or equivalent technical skills and experience.
Preferred:
• Masters degree in business administration, information science, computer science, industrial engineering or a relevant area.

Years and Type of Experience Required: Required:
• Fourteen or more years of configuration experience providing pricing and/or benefits configuration support on Amisys, Facets, MHS, Metavance, Diamond, or a similar payer system, preferably in a medium to large health care or related organization
• Possess problem solving and project management skills. Must be able to take charge, manage numerous projects and successfully coordinate projects with internal areas and external vendors..
• Project team member oversight management and/or supervisory experience required.
Preferred:
• Experience using a software development life-cycle methodology like the Software Development Life Cycle (SDLC).
• Broad operational managed care background.
Specific Technical Skills Required:
• A minimum of two years of experience:
• Using MS Office.
• Using the Windows operating system and its utilities.
• Using the internet to conduct research and to download information.
• Using a relational database management system or SQL to retrieve and analyze data.
• Familiarity with data structures and data types.
Preferred:
• Formal coursework using a 3-GL or a 4-GL programming language (e.g., C+, Visual Basic.)

Other Required:
• Proven ability to manage complex projects.
• Excellent analytical skills including being able to present data to senior management
• Excellent verbal and written communication skills
• Excellent interpersonal skills, including the ability to work with all levels of personnel including, but not limited to peers and Senior Management within the organization
• Knowledge of managed care including, but not limited to claims adjudication and payment, medical management, provider fee-for-service reimbursement, capitation, billing, enrollment, and benefits.
• Strong negotiation and facilitation skills.
• Excellent customer relation skills.
• Detail oriented.
• Assertiveness.
• Ability to deal with a fast paced environment and make proper decisions quickly.
• Appreciation of cultural diversity and sensitivity towards target population

SCOPE INFORMATION
Item Measure
• # Direct Reports N/A
• # Indirect Reports Yes - as determined
• Budgetary $ Responsibility None
• KPI – Department Standards Yes - as determined

PHYSICAL REQUIREMENTS
• Must be able to participate in meetings
• Must be able to operate a PC for extended periods of time
• Must be able to operate and effectively utilize office telephone equipment
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Configuration-Analyst-Princ-II-Credentialing-Job-VA-23450/730383/7303837303832010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Leadership Development Program
Job ID:
11034
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Temporary

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Responsibilities
JOB SUMMARY:
The Leadership Development Program is a two-year program consisting of rotational assignments through corporate and operations departments combined with formal classroom training, on-line learning and leadership development. Each rotational assignment is approximately 6 months in length and may include the following departments: Claims and Call Center Operations, Healthcare Management Services, Healthcare Delivery Systems, Finance, Legal & Risk Management, Information Technology, Marketing and Business Development, Communications, Human Resources and Health Plan Operations. Rotations will focus on building technical depth in essential functions, leading edge techniques, project management, business cycle dynamics, analysis and process improvement, measurable accomplishments, mentoring and leadership opportunities.

PRIMARY RESPONSIBILITIES:
1. Research and Analysis
a. Assists with research, analytics and support efforts related to new markets, new products, mergers and acquisitions.
2. Process Improvement and Documentation
a. Assists with comprehensive analysis (operational, analytical and financial) for projects aimed at maximizing revenue and efficiencies while reducing medical, administrative and other costs.
b. Contributes to the development of and documentation of policies, procedures and processes.
3. Project Management
a. Manages assigned six sigma process improvement project(s).
b. Develops, communicates, and monitors project schedules, budgets and resources.
c. Communicates key areas of concern or risk toward progress and goals. Recommends actions, support and/or resources needed to overcome potential obstacles.
4. System Development, Testing and Implementation
a. Assists in the development, testing and implementation of systems to improve performance, service and/or management of key areas.
5. Reporting
a. Assists with monthly reporting to include budget variances, compliance review, and performance metrics analysis.
b. Develops reports and tracking systems using database applications, such as MS Access and Excel.
6. Program Management
a. Supports Healthcare Management Services programs for the prevention/maintenance of physical, developmental, emotional and addictive diseases.
7. Supervision and Workforce Management
a. Supports the business operations of the National Contact Center and management of call center staff.
b. Analyzes metrics, productivity and service levels needed for workforce management, quality assurance and improvement initiatives.
8. Relationship Management (members, states, providers, interdepartmental)
a. Responsible for developing and maintaining positive client relationships as well as critical interfaces between business units.
b. Participates in Call Center Operations and may provide telephonic assistance to members or providers regarding claims, benefit questions, and social service needs.
c. Participates in Health Plan Operations and may represent AMERIGROUP at community organizations and events such as promotions and health fairs.
d. Assists with presentations, staff exhibits and other activities in an effort to maintain and establish positive relationships with providers and the community.
9. Overall Business / Market / Healthcare Knowledge
a. Acquires an understanding of the business processes in a broad range of operational areas.
b. Acquires an understanding of the relationship and interdependencies between departments.
10. Other duties as assigned.

EDUCATION AND EXPERIENCE:

Education and Years and Type of Experience Required:

Required:
• Bachelor's degree.
• Related internship experience preferred.

Specific Technical Skills
Required:
• Strong PC skills to include the MS Office Suite.
Preferred:
• Visio and Project Management Software. Knowledge of process improvement and project management including tools and techniques, critical path method, program evaluation and review technique, resource balancing, and cost estimating.

Other:
Required:
• Understands and Resolves Issues Effectively
• Thinks broadly
• Seeks Customer Satisfaction
• Creates Effective Plans
• Manages Work Effectively
• Shows Initiative and Commitment
• Improves Processes
• Collaborates and works effectively within and across teams.
• Shares Information
• Relates Well to Others
• Demonstrates Credibility
• Adapts Readily

Preferred:
• Project management experience and/or project life cycle knowledge.

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Standing and sitting for long periods of time.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Leadership-Development-Program-Job-VA-23450/730385/7303857303852010-04-09AmerigroupTemporary/Consultantfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Director Medicare Market Development
Job ID:
11016
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
Grade 21
SSO Recruiter: J. Mays

JOB SUMMARY:
The Director of Medicare Market Development reports to the Vice President of Medicare Market Development in AMERIGROUP's Senior and Special Services Organization (SSO). The Director supports SSO staff, corporate functional departments and health plans in the implementation of the company's operating model for senior services. The Director participates in development and launch of new specialty products focused on the Medicare, Medicare/Medicaid dual eligible and long term care markets, and provides subject matter support to corporate and local plan implementation teams for these products. The Director manages various aspects of the annual Medicare benefits and bid development process and initial development of business models and target environments of these products. Working with the Senior Services executive team, Corporate Implementations team, health plans and Customer Service, the Director leads corporate and local operational implementations of new products targeting seniors to ensure the success and profitability of these products.
PRIMARY RESPONSIBILITIES:

1.Support the development, implementation and improvement of Medicare plan, dual eligible special needs plan and long term care products, including product design and business models. Evaluate existing and target markets for potential expansion opportunities in terms of competitive positioning, pricing, customer/consumer needs, medical trends and operating models. Perform research on benefits and program characteristics of competing Medicare Advantage plans.
2.Develop key components of the Company's Medicare Part C and Part D contract and expansion applications. Participate in managing the application and contracting cycle. Support plan and corporate network development staff in understanding and meeting network adequacy and provider contract requirements.
3.Assist in developing innovative benefits, products and new applications of existing products that will enable the company to serve its targeted markets in a more comprehensive and effective manner.
4.Serve as a resource for the AMERIGROUP business community relating to products that integrate Medicare and Medicaid coverage. Provide design assistance to launch overall product offerings. Function as a key point-of-contact for health plans offering Medicare Advantages products and provide post-implementation analysis and support
5.Coordinate with Medical Finance on financial and other analyses required to evaluate new product development and market development opportunities. Support development of the strategic rationale and business case for specific expansion projects.
6.Support local plans, Medical Finance and consulting actuaries in the annual Medicare plan bid and benefit process, pro forma budgets and Part C and Part D competitive pricing bids. Create Plan Benefit Packages (PBPs), administer plan contact, benefit data and upload of bid submissions marketing material submissions in CMS information systems
7.Support Marketing Communications in creating, adapting and versioning of marketing and member materials.
8.Participate in meetings and conferences with industry, legislative and regulatory bodies and assist with preparation of analyses of proposed laws, regulations, policies and positions affecting the Company's products, business growth and success.
9.Other duties as assigned

EDUCATION AND EXPERIENCE:
Education Required Bachelors degree
Preferred A Master's degree in an appropriate major is strongly preferred

Years and Type of Experience Required: Required
•Minimum of seven years relevant work experience in Medicare coordinated care plans as a manager in a health plan or managed care organization and at least three years of leadership/management experience.
•Experience in development of Medicare plan marketing and member materials, benefit plan design; regulatory submission and approval process; sales, eligibility and enrollment processes; internal review programs, Part D pharmacy program, and dual eligible special needs plans.
•Experience interfacing with CMS review and approval processes, advocating plan positions and negotiating on interpretation of program rules; planning and conducting site visits, analysis of review findings, development of responses, and implementation of business process changes

Specific Technical Skills
Required •Proficient in standard Windows based business software, including Word, Excel, PowerPoint. Familiarity and proficiency with internet searches and tools, CMS Medicare web sites.
Preferred •Proficiency in Microsoft Access, Project, Visio.

Other
Required •Significant business experience running a specific product line, preferably within a multi-state health plan or managed care company.
•Current in-depth knowledge of the Medicare Advantage and Part D programs, senior markets and products; the Medicare Modernization Act, Medicare regulations 42 CFR Chapters 422 and 423; and general knowledge of Medicaid and Medicaid managed care programs.

SCOPE INFORMATION

PHYSICAL REQUIREMENTS
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

•Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
•Ability to communicate both in person and/or by telephone
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Director-Medicare-Market-Development-Job-VA-23450/727866/7278667278662010-04-09AmerigroupSales & Marketingfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Mgr Medical Finance Accounting
Job ID:
11010
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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------------

Responsibilities
JOB SUMMARY: Responsible for all accounting and Finance aspects of a new Provider Program which includes reconciliations, review of revenue and expenses by provider, and period over period evaluations. Additionally, will be required to effectively communicate with Operations and other departments of the program status and quarterly results. Performs schedule preparation and review for Medical Expenses and Liabilities, analytical review of related expenses and accounts, and accounting and auditing functions for Medical Liabilities accruals, quarterly adjustments and audits. To include monthly expense calculations, cost analysis and reconciliations, communication with other departments and health plans.

PRIMARY RESPONSIBILITIES:
1. Responsible for the monthly Medical Expense accruals for Non-Fee For Service related expenses through comprehensive data gathering and analysis, journal entry review, reasonable expense and data allocation methods, and accurate input into databases and systems.

2. Accurately and timely prepare reports and worksheets and analysis for month end reporting of Medical Expenses.

3. Report production and analysis of monthly, quarterly and annual results for communication within internal corporate and health plan distribution.

4. Perform useful analysis of medical expenses and evaluation of variations and accuracy. Research any discrepancies or potential differences.

5. Accurately and timely prepare complex Medical Liability reports and analysis for vital review by VP and EVP during quarterly close.

6. Accurately and timely prepare spreadsheets and reports necessary to provide data to external auditors during quarterly and annual reviews.

7. Complete timely organization and filing of month end and quarterly review schedules for maintaining key documents related to financial statements.

8. Maintain Policies and Procedures for Medical Liability process to remain compliant with Sarbanes-Oxley.

9. Other duties as assigned or requested

JOB REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and /or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND EXPERIENCE:
Required:
• Bachelor's degree in Accounting with 5 years relevant work experience and at least 1 year of leadership/management experience.
Preferred:
• Experience in a healthcare environment.
• Managed care background
• Auditing experience

CERTIFICATION AND LICENSURE:
• CPA or Candidate for CPA preferred

Knowledge and Skills:
• Strong financial analysis and accounting skills required
• Strong organization skills required
• Ability to define problems, collect data, establish facts, and develop valid work plans to address the issues
• Must be able to work independently
• Ability to effectively present information to supervisors
• Strong communication skills, both written and oral required
• Strong spreadsheet skills and analytical ability
• Experience with Microsoft office products including Excel, Word, Access and Power Point required
• Ability to quickly understand processes and apply this understanding to new situations
• Ability to work collegially with other department associates

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer
• Must be able to operate a telephone
• Must be able to travel on common carrier and adhere to AMERIGROUP's travel policies
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Mgr-Medical-Finance-Accounting-Job-VA-23450/726725/7267257267252010-04-09AmerigroupFinancefull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Sr Web Writer/Editor
Job ID:
10984
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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------------

Responsibilities
JOB SUMMARY: Responsible for developing, writing and editing content for the Amerigroup website. Functions as a liaison to the eHealth department, helping to meet its strategic initiatives by managing the web writing/content to be consistent with branding, messaging and new web product operating models, or existing operating models to meet emerging industry needs and/or state requirements. Provides leadership to contract writers and subject matter experts (SMEs); and works closely with the SVP of Communications to execute strategy and coordinate activities with leads from key support departments (including eHealth, IT and portal business owners.) Maintains and develops concise web pages for all portals to support the company in varying Communications and multimedia efforts.

PRIMARY RESPONSIBILITIES:
1. Manage and update content for the corporate web site, member and provider portals.
a) Responsible for daily oversight of online publishing process; including writing, editing and gathering material (including audio and video) for content
b) Provide daily direction to contract writers and SMEs including internal processes (EMAP and SharePoint), eHealth and Communications department standards (style and production guides), and web page design
c) Submit weekly content updates and recommendations to SVP of Communications
d) Prepare meeting review materials, timelines, outlines, assignments, project tracking lists as needed
e) Prepare and distribute appropriate communications with internal and external clients, such as the submission of web pages for state reviews and other formal communications
f) Work cross-functionally with all relevant departments to ensure any contract changes are updated online for all portals
g) Review and stay current with all managed care quality measures, health promotions, product development, member and provider communication materials that are incorporated online
h) Facilitate team meetings and other ad hoc meetings for content development
i) Review and edit all web pages to verify pages respond to each requirement and accurately maintain compliance standards
j) Track and manage compliance issues and gaps for resolution
k) Work closely with and manage presale-related work performed by the government markets team to ensure pages are appropriately developed for potential markets
l) Prepare drafts and instructions for distribution to EMAP review teams; collect reviewer comments and distribute to designated writers

2. Ensure online content complies with all corporate standards and meets appropriate ADA, state specified guidelines and regulatory requirements

3. Balance creative, well-written content, headlines, page titles, audio and video clips, to ensure effectiveness of online material and consistency with brand messaging /web communications strategy

4. Conduct administrative activity, including but not limited to: debrief meetings, server organizations, surveys, and data retention

5. Manage contract writers as necessary in relation to their work on web page development or content for web site

6. Contribute to EMAP process as dedicated writer when not in lead role of writer/editor

7. Participate in opportunity analyses and prepare recommendations for the Development Opportunity Group (DOG) meetings for web site

8. Contribute to Communications department process improvements and efficiencies

9. Conduct analyses of competitors' web sites and social networking activities

10. Provide leadership, training, and mentoring for web writing/content and page development for internal staff as needed

11. Serve as a working member of the intranet (SharePoint) governance structure, lead sub-committees and serve on advisory boards when necessary

12. Perform special projects as assigned

13. Other duties as assigned

EDUCATION AND EXPERIENCE:

Education
Required:
• Bachelor's degree in English, Communications, Journalism, Marketing, or related area of study

Preferred:
• Public health sector, and/or corporate communications experience highly valued
• Two years managed health care experience
• Social media savvy
• Familiarity with SharePoint software

Years and Type of Experience Required:
Required:
• A minimum of five years experience in web style writing/copy writing, or editing.

Specific Technical Skills
Required:
• Knowledge of web design, desktop publishing, photo and video imaging
• Excellent communication, copywriting, editing ,interviewing and research skills
• The ability to alter writing style to appeal to various target audiences;
• Demonstrated ability to manage a complex workload, prioritize tasks, meet deadlines, perform under pressure, and use good judgment in providing guidance and leadership regarding concise web style writing and editing;
• Strong working knowledge of online, multimedia and emerging technologies;
• Strong analytical and decision-making skills;

Other:
Required:
• Demonstrated skill in identifying risks and taking appropriate steps to avoid, eliminate, or handle them thereby minimizing their impact on each project.
• Strong communications and interpersonal skills;
• Ability to work with and lead associates of all levels;
• Ability to work independently and as a team member.

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.
• Must be able to conduct and participate in meetings.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Sr-Web-Writer-Editor-Job-VA-23450/718502/7185027185022010-04-09AmerigroupSales & Marketingfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
CareAdvance App Analyst Princ I - COTS and SQL Required w/ Facets a plus
Job ID:
10999
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:
Acts independently under general direction, researches and fact finds to modify information systems for functional and operational areas. As a technical expert, responsible for analysis, design, development and testing of custom software, third-party application software, interface development and operational reporting development. Often acts as business expert and assists users in defining needs. Supports the initiation, amendments, renewal and terminations of contract negotiations. Uses a full technical knowledge of all phases of applications systems analysis. Services as subject matter expert providing assistance and training to less experience team members.

PRIMARY RESPONSIBILITIES:
1. Devises or modifies procedures to solve complex problems considering computer equipment capacity and limitations, operating time, and form of desired results.

2. Develops complex web applications, which utilize Standard Query Language (SQL) data sources.

3. Develops multiple, modular objects and the messaging interface between objects to create complex software packages.

4. Creates complex design documents through the assessment of requirements. Assess alternatives to different designs and chooses best solutions to fit business needs.

5. Adheres to existing configuration management procedures and recommends/implements improvements to existing procedures. Adheres to and contributes to definition of good database design practices. Influences others to follow existing procedures.

6. Serves as a technical expert in development of IT architecture strategies for medium sized application infrastructures. Evaluates technology, performance, scalability, interoperability, reliability, availability, and serviceability in small to medium sized applications.

7. Reads, interprets, creates and maintains complex conceptual, logical and physical models to include context diagrams, data flow diagrams, process flow diagrams, data dictionaries and logical flow charts.

8. Develops complex test plans, which include regression testing and packaging tests into consecutive steps based on logical dependencies. Writes, revises and verifies functional test plans for complex systems in a software application.

9. Evaluate and tests complex new/modified programs, applications and/or operating systems. Monitors system functionality and performance to ensure standards are met. Documents and tracks product defect and coordinates problem resolution with development and/or product vendors.

10. Performs complex SQL queries and updates tables. Manages complex data modeling and develops strategies to resolve complex data architecture and modeling issues.

11. Coordinates potential vendor product/service evaluations to ensure technical requirements and performance measures are met. Participates in RFPs activities, which include but are not limited to understanding business requirements; assess baseline/marketplace; construct, issues, and receives completed RFPs, evaluates potential vendor based on selected scoring model; evaluates cost benefit, and recommend vendor.

12. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelor's degree in Computer Science or related field. Equivalent experience is acceptable in lieu of a degree(s).
Preferred:
• Master's preferred.

Years and Type of Experience Required:
Required:
• Requires a minimum of 8 years related work experience.

Specific Technical Skills
Required:
• Advanced proficiency with all applicable company support software applications.
• Comprehensive knowledge of core IT applications and systems. Moderate to comprehensive understanding of supported applications and all interdependencies (OS, network, server, workstations, etc).
• Comprehensive knowledge of data modeling concepts and their application including entities, tables, relations, constraints, attribute data types and column data types. Understands referential integrity, locking and transaction processing. Understands impact of data modeling decision on system performance and resource usage.

Other:
Required:
• Able to present information verbally, and in writing, in a concise and effective manner at all levels within the organization.
• Able to create and deliver presentations tailored to an audience.
• Able to motivate others, provide innovative ideas and solutions, and promote the department vision for improvement within the department.
• Able to develop creative strategies to problems.
• Able to manage customer expectations.
• Able to demonstrate leadership in a team environment.
• Demonstrates knowledge of the inter-relationship among various managed care operational areas.
• Demonstrates understanding of how each department/health plan relates to the organization as a whole.

SCOPE INFORMATION
# Direct Reports: 0
# Indirect Reports: 0
Budgetary $ Responsibility: $0-$3M

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-CareAdvance-App-Analyst-Princ-I-COTS-and-SQL-Required-w-Facets-a-plus-Job-VA-23450/720973/7209737209732010-04-09AmerigroupInformation Technologyfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
2010 Summer Internship
Job ID:
11064
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Temporary

------------

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Responsibilities
JOB SUMMARY:
The Summer Internship Program is a ten week program consisting of various assignments through corporate departments combined with leadership development. Each internship will be assigned to one department for the entire program, but will attend training and development meetings in an environment with other interns. Internships may work with the following departments: Call Center Operations, Healthcare Management Services, Healthcare Delivery Systems, Finance, Information Technology, Marketing and Business Development, Communications, Human Resources and Health Plan Operations. Internships will focus on building general business knowledge, while receiving mentoring and leadership opportunities.

PRIMARY RESPONSIBILITIES:

Based on assignment primary responsibilities may include 1 or more of the following:
1. Research and Analysis
a. Assists with research, analytics and support efforts related to new markets, new products, mergers and acquisitions.
2. Process Improvement and Documentation
a. Assists with analysis (operational, analytical and financial) for projects aimed at maximizing revenue and efficiencies while reducing medical, administrative and other costs.
b. Contributes to the development of and documentation of policies, procedures and processes.
3. Project Management
a. Assists with the development and monitoring of project schedules, budgets and resources.
b. Communicates key areas of concern or risk toward progress and goals.
4. System Development, Testing and Implementation
a. Assists in the development, testing and implementation of systems to improve performance, service and/or management of key areas.
5. Reporting
a. Assists with monthly reporting to include budget variances, compliance review, and performance metrics analysis.
b. Maintains reports and tracking systems using database applications, such as MS Access and Excel.
6. Program Management
a. Supports Healthcare Management Services programs for the prevention/maintenance of physical, developmental, emotional and addictive diseases.
7. Supervision and Workforce Management
a. Supports the business operations of the National Contact Center and management of call center staff.
b. Reviews metrics, productivity and service levels needed for workforce management, quality assurance and improvement initiatives.
8. Overall Business / Market / Healthcare Knowledge
a. Acquires an understanding of the business processes in operational areas.
b. Acquires an understanding of the relationship and interdependencies between departments.
9. Other duties as assigned.

EDUCATION AND EXPERIENCE:

Education
Required:
• Must have completed 2 years of college with a GPA Average of 3.0 or better.
• Must be currently enrolled in an accredited college or university actively pursuing a Bachelor's degree.

Years and Type of Experience Required:
Required:

Preferred:
• General Business Knowledge
• Project management experience and/or project life cycle knowledge.

Specific Technical Skills
Required:
• Strong PC skills to include the MS Office Suite.
Preferred:
• Visio and Project Management Software.
• Knowledge of process improvement and project management including tools and techniques, critical path method, program evaluation and review technique, resource balancing, and cost estimating.

Other:
Required:
• Understands and Resolves Issues Effectively
• Thinks broadly
• Seeks Customer Satisfaction
• Creates Effective Plans
• Manages Work Effectively
• Shows Initiative and Commitment
• Improves Processes
• Collaborates and works effectively within and across teams.
• Shares Information
• Relates Well to Others
• Demonstrates Credibility
• Adapts Readily

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-2010-Summer-Internship-Job-VA-23450/740997/7409977409972010-04-09AmerigroupTemporary/Consultantfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Database Administrator
Job ID:
11012
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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------------

Responsibilities
Grade: 18
SSO Dept Recruiter: J. Mays
JOB SUMMARY:
Responsible for supporting the data and research needs of the Sales and Marketing Department. This includes maintenance and optimization of the Customer Relationship Management (CRM) system, business process improvement, training, sales activity tracking, competitor analysis, and marketing operations. The position will be responsible for comprehensive analysis (operational, analytical and strategic), scoping of resources, documentation, problem solving, project management and implementation of key sales and marketing initiatives related to the expansion the company's Medicare Advantage products.

PRIMARY RESPONSIBILITIES:
1.Provide data management support utilizing Salesforce.com (CRM System) as needed
a.Import leads into Salesforce.com
b.Update Salesforce.com with disenrollment data
c.Track advertising and direct mail results:
d.Sales activity tracking: productivity metrics, sales statistics, and enrollment forecasts
e.Produce reports as needed

2.Assist in the development, tracking, and implementation of Medicare Sales training program.

3.Work on special projects to identify internal and external trends that may influence and/or predict unusual marketing and enrollment activity.

4.Work closely with the Sales and Marketing management team to continually identify opportunities to strengthen marketing programs.

5.Assist in the development, administration, and coordination of advertising and direct mail campaigns.

6.Perform best practices research on Medicare marketing strategies, products, technologies and competitors.

7.Handle special projects including market research, marketing plan development, competitive analysis, and SWOT analysis.

8.Identify opportunities for sales operations process enhancements

9.Create and analyze reports and results related to sales, membership, broker commissions and sales incentives.

10.Work with health plans to ensure data in Salesforce.com is current and accurate for reporting and tracking purposes.

11.Act as SalesForce.com liaison for plan staff to ensure accuracy of data for reporting and tracking purposes.

12.Enhance and refine core ongoing projects

13.Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required: Bachelors Degree required in related field (i.e., Business Administration, Marketing, Finance…etc.) or equivalent experience.
Preferred:

Years and Type of Experience Required:
Required: Minimum of three years related marketing and analysis experience
Preferred: Experience working in a Medicare environment

Specific Technical Skills
Required: Proficiency in Microsoft Office including Excel, PowerPoint, Word, and Outlook
Preferred:
•Proficiency in any of the following: SharePoint, SalesForce.com, Microsoft Access
•Experience developing and maintaining database systems that track sales activity.

Other:
Required:
•Detail Oriented; ability to organize and maintain a system of records.
•Ability to identify and weigh potential risks; seek ways to continuously improve existing processes
•Able to work closely with other departments or units as necessary; support group decisions and solicit opinions from coworkers; exceptional interpersonal skills
•Able to clearly interpret and present complex information through the spoken or written word.
•Excellent root cause analysis and problem solving skills; ability to evaluate and present alternative solutions.
•Work independently under tight timelines
Preferred:

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

•Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
•Ability to communicate both in person and/or by telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Database-Administrator-Job-VA-23450/727863/7278637278632010-04-09AmerigroupSales & Marketingfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Document Management Specialist I
Job ID:
11072
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
A Document Management Specialist I prepares all paper documents received to be scanned by high speed document scanners and processed through various imaging applications. Specialists perform post scanning claim processing for manual entry into Amisys on an exception basis. Specialists are expected to meet or exceed daily productivity and quality standards.

PRIMARY RESPONSIBILITIES:

1. Manually process all incoming claims related mail. Processing includes opening the mail, removing content from envelopes, removing staples and other binding material, sort claims according to document type, and process paper receipts so they can be scanned

2 Process for high speed scanning all documents designated as a Document Management area of responsibility. This includes claims related documents such as appeals, correspondence, hand stamped documents and provider related material.

3. Process for high speed scanning all medical claims and accompanying supporting material. Complete all post scanning manual processing such as pulling scanned document rejects, manually stamp rejected claims including batching and creating a tracking inventory.

4. Complete all support functions permanently or temporarily assigned to the department.

5. Mail back claims rejected by automated and/or manual processing methodologies.

6. Prepare and submit in a timely fashion daily productivity reports.

7. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required: High School diploma or equivalent.
Preferred:
Years and Type of Experience Required:
Required: One year previous work experience.
Preferred: One year mailroom, warehouse, or distribution related environment.

PHYSICAL REQUIREMENTS
• Must be able to operate a telephone.
• Repeated lifting boxes or materials up to 40 pounds.
• Standing and sitting for long periods of time.
• Repetitive bending and stooping
• Repetitive hand motion and finger use to manipulate paper receipts.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Document-Management-Specialist-I-Job-VA-23450/740110/7401107401102010-04-09AmerigroupAdministrative Supportfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Mgr Coding Validation Initiative Analysis
Job ID:
11048
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY: The Manager for Coding Validation Initiative (CVI) Analysis is responsible for the extraction, management, and analysis of data from internal/external operational processes, data repositories, business systems, and records to identify abuse and waste risks in support of CVI business objectives. Associate develops, implements, manages, and utilizes technology solutions. Performs complex data mining, ad hoc analysis, and reporting functions to quantify exposures due to provider abusive and wasteful billing patterns. Develops prioritization strategies and recommendations for reviews. Collaborates directly with associates, other departments, external agencies, and vendors in support of Department and Corporate initiatives (ex. projects and reviews).

PRIMARY RESPONSIBILITIES:
1. Performs complex data mining and ad hoc data analysis to identify patterns of suspicious activity, outliers, anomalies and other issues that represent waste or abuse risk.
2. Develops advanced data analysis tools, methodologies, techniques, and technology solutions to support Department business objectives.
3. Quantifies, prioritizes, and develops strategies for reviews, based upon data mining/analysis.
4. Designs and implements Access databases, queries, and reports. Designs and implements SQL Server tables and stored procedures. Utilizes multiple Corporate data repositories, including SQL Server and Oracle databases.
5. Develops management reporting tools to provide business intelligence required to make effective decisions.
6. Utilizes a variety of applications (Access, Query Analyzer, SQL Server, STARSentinel, AMISYS, and Facets) to achieve comprehensive analysis and support.
7. Identifies technology solutions for process improvements and automation.
8. Understands healthcare waste and abuse detection and prevention methodologies, practices, and theories. Understands departmental, corporate, and external business objectives and processes. Applies knowledge in technology solution development.
9. Collaborates directly with associates, other departments, external agencies, and vendors to coordinate resources, analyze data, identify trends, and communicate findings.
10. Effectively communicates with Department, senior management and external agencies, in a timely, accurate, and professional manner.
11. Provides technical support for analysis, database, query, application, and reporting issues.
12. Trains and coaches associates in data analysis.
13. Continues to improve technical skills and leadership ability.
14. Continues to stay current with changes in corporate data resources and company initiatives/objectives.
15. Maintains technical expertise and stays abreast of developments in the data analysis, waste and abuse, managed care, and information technology (IT) fields.
16. Performs other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelors degree in one of the following disciplines: Economics, Statistics, Mathematics, Business Administration, Information Technology, Computer Science, Operations Research, Accounting, Health Information Systems, Nursing, Healthcare Management or other analytical/clinical discipline, and/or equivalent work experience.

Preferred:
• Advanced degree in one of the above disciplines.
Years and Type of Experience Required:
Required:
• Minimum 6 years experience in analytics role, including data mining, transformation, analysis, and/or reporting, preferably in healthcare, F&A, legal, law enforcement, or IT environments.
• Prior experience will include project management, lead role responsibility, and mentoring/coaching of associates.

Preferred:
• Experience in healthcare or managed care industry, strongly preferred.
• Experience in working within a diverse organization (technical, financial, IT, and operations).

Specific Technical Skills
Required:
• Demonstrated experience in MS Access, T-SQL, Query Analyzer, and/or SQL Server.
• Demonstrated experience with data mining, transformation, analysis, reporting, and other business intelligence techniques.

Preferred:
• Experience with healthcare claims systems (Facets or AMISYS), strongly preferred.
• Experience in VB, ACL, PL/SQL, and/or MS Reporting Services, strongly preferred.
• Strong level of experience in Access, T-SQL, Query Analyzer, and SQL Server.
• Strong level of experience with data mining, transformation, analysis, reporting, and business intelligence techniques.
Certifications or Licensure
Required:
• None.
Preferred:
• Healthcare or fraud, waste or abuse related certifications or licensure (ex. RN, LPN, CPC, or CFE), or equivalent.

Other
Required:
• Demonstrated ability to manage multiple complex projects simultaneously. Strong organization and time management capacity to balance multiple project priorities with limited supervision.
• Ability to think creatively and to innovate. Strong conceptual and quantitative problem-solving skills. Demonstrated problem solving and critical thinking skills. Proven effectiveness as a creative problem solver; ability to challenge conventional approaches and think outside the box. Strong investigative skills with ability to search beyond the initial results.
• Excellent verbal and written communication skills. Ability to communicate ideas in both technical and user-friendly language. Ability to express complex analytical and technical information to senior management and medical professionals.
• Experience working in a team-oriented, collaborative environment. Strong customer service orientation. Good listening and interpersonal skills. Demonstrated leadership and mentoring skills.
• Exceptional attention to detail and work product validation
• Self-motivated and directed. Works autonomously and with others to identify, isolate, and analyze issues.
• Appreciation of cultural diversity and sensitivity towards target population.
Preferred:
• Possesses a highly developed quantitative/analytic ability and strategic insights to successfully manage, coordinate, and oversee the design, development, implementation, and tracking of data mining, analytical modeling, and other quantitative risk assessment tools.
• Understands and/or learns (quickly) major business processes to design appropriate data analysis tests.
• Ability and willingness to learn programming skills to support Department projects.
• Skilled communicator with ability to influence others.

SCOPE INFORMATION

Item Measure
• # Direct Reports
• # Indirect Reports Varies according to projects 5 to 10 typical
• Budgetary $ Responsibility Projects impacting millions of dollars in operating costs

PHYSICAL REQUIREMENTS
• Travel required (approximately 5%)
• Drive a automobile
• Travel on a common carrier
• Must be able to operate a computer
• Must be able to operate a telephone
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Mgr-Corp-Investigations-Anlys-Job-VA-23450/731412/7314127314122010-04-09AmerigroupLegalfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
VP Rate Setting
Job ID:
11057
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY: Lead and direct the premium rate setting process, underwriting of new business, underwriting of acquisition targets, underwriting of benefit changes and process changes, and state reporting for rate setting for all assigned markets. Key participant in the development and implementation of standard, replicable analytical tools and methodologies required to fulfill all premium rating and underwriting needs of assigned markets. Identify and recommend all opportunities to improve the profitability and value of the health plans and products in assigned markets.

PRIMARY RESPONSIBILITIES:

1. Lead market and product specific premium rate process
a. Lead projections of future healthcare costs for rating period taking into account historical trend, future contracting changes, future medical management changes, business operation changes, population/benefit changes, and any other variable with material impact on premium rate structure
b. Develop and lead “12 months a year” premium rate setting process that is standardized and replicable across all health plans and products in terms of analytical tools, evaluation of rate proposals, and on-site attendance at meetings
c. Oversee the development, completion, and review of all state required reporting that has a direct impact on premium rates
d. Partner with other operational functions of company to ensure a standardized, replicable encounter data reporting and validation process occurs that ensures all eligible data is reconciled and transferred to each respective state in support of maximizing premium rates
2. Lead underwriting process for new products, benefit changes, and business process changes in region
3. Provide input for premium rate increases used in the monthly/quarterly/annual forecasting process for assigned markets
4. Continuously reassess current models, tools, work flows, and reporting / analysis mechanisms and infrastructures – recommend areas of opportunities for improvement and implement
5. Lead, manage, and develop staff to ensure corporate goals are met and personal development goals are achieved
6. Other duties as requested or assigned.

JOB REQUIREMENTS:

EDUCATION AND EXPERIENCE:
• Bachelor's degree in business, finance, or mathematics.
• Minimum 7 years supervisory experience in Actuarial and/or financial analysis for managed healthcare.

CERTIFICATION AND LICENSURE:
• 12 years experience and ASA or FSA designation.

Knowledge and Skills:
• Highly advanced analytical skills
• Proven organizational and management skills
• Previous HMO/Managed Care Industry experience required.
• Advanced skills in Microsoft Excel, Access, and other relational database applications
• Proficient with Windows-based environment
• Appreciation of cultural diversity and sensitivity towards target population.

PHYSICAL REQUIREMENTS:
• Must be able to operate a computer.
• Must be able to operate a telephone.
• Must be able to conduct and participate in meetings.
• Must be able to travel on common carriers and to adhere to AMERIGROUP's travel policies.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-VP-Rate-Setting-Job-VA-23450/737603/7376037376032010-04-09AmerigroupFinancefull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
VP Multi-Media Communications
Job ID:
11092
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Temporary

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------------

Responsibilities
JOB SUMMARY: A highly creative photo/editor who will manage and oversee a corporate in-house multimedia production suite. Will organize business, finance and employment issues as it relates to producing corporate videos for internal and external audiences. Supervise a production team of writers, editors and graphic artists. The VP of Multimedia Services is responsible for personnel, budget, scheduling, and equipment. He or she will ensure that each production is in compliance with state regulations, member guidelines and consistent with corporate branding. Can conceptualize what makes a ‘Real Story' and how to produce and market messaging using various forms of new and existing multimedia

PRIMARY RESPONSIBILITIES:

1. Responsible for the development, planning, and production of new media communications to support the strategic objectives of Amerigroup.
2. Serves as a consultant to all entities, regions, service areas and executive leadership.
3. Plan, design, and direct Amerigroup's resources to provide integrated, multimedia communication products.
4. Acts as an educator and evangelist for the integration and leveraging of new media communication in service to the strategy and mission of Amerigroup.
5. Lead, educate and implement new media innovations to keep Amerigroup's communication function world class.
6. Help communicate an inspiring vision based on the mission and strategy of the organization and brought to life through the talent and creativity of the staff.
7. Works in partnership with leadership to communicate stories of interest to the community, such as new facilities, community benefit, and Amerigroup's impact to members health.
8. Train, assign duties and meet with other key production staff to work up scripts or program ideas, draw up a shooting schedule, oversee location bookings, arrange necessary permissions and risk assessments, approve the booking of resources, equipment and supplies, and negotiating costs.
9. During filming, duties include being on site to shoot videos and ensuring that the production runs smoothly and on budget.
10. Responsible for editing and packaging material shot in the field.
11. Perform special projects and other duties as assigned

EDUCATION AND EXPERIENCE:

Education
Required:
• Bachelor's degree, or equivalent experience, in film production, journalism, visual design or other relevant field
Preferred:
• N/A

Years and Type of Experience Required:
Required:
• 12 years working in communications media with significant experience in design/photography/yideo production/web development and editing.
• 7 years of leadership/management skills.
• Prior experience in commercial, broadcast or corporate multimedia production.

Preferred:
• Television news and/or documentary background is a plus.
• Prior web development experience.
• Prior healthcare industry experience.

Specific Technical Skills
Required:
• Demonstrated understanding of integrated media tools and technology.
• Strong understanding of spreadsheet and database modeling.
• Filming experience with tapeless systems and working in a tapeless work flow environment.
• Experience with creating sound design/production, motion graphics.
• Experience creating content for a variety of channels (web, DVD, tradeshows).
• Must be able to set up video shoots including lighting, shot composition and audio.
• Light a set including lighting or chroma keying.
• Experience with securing stock imagery and working with music libraries.

Preferred:
• Advanced knowledge of interactive tools such as Flash, Director, etc. is a plus.

Other:
Required:
• Leadership skills, including, business planning, managing change, inspiring staff, reporting, tracking, and analyzing data.
• Strategic thinker who can integrate the organization's mission, business objectives, and the needs of the customer/client.
• The ideal person will possess a relentless attention to detail, a gifted eye for aesthetics and ability to quickly grasp and distil highly complex matters.
• Experience with working closely with a wide variety of internal customers and cross function support teams.
• Natural collaborator who prefers being in a creative team environment.
• Self-motivator with strong work ethic and customer focus.
• Appreciation of cultural diversity and sensitivity towards target population.
• Excellent communications skills (written, verbal and visual).
• Ability to complete multiple assignments efficiently and meet established deadlines in a fast past environment.

Preferred:
• Project management skills.

SCOPE INFORMATION

# Direct Reports: 0-5
# Indirect Reports: 0-10
Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Must be able to travel as needed and adhere to AMERIGROUP travel policies and procedures.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-VP-Multi-Media-Communications-Job-VA-23450/742602/7426027426022010-04-09AmerigroupTemporary/Consultantfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Recovery Analyst
Job ID:
11094
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:
The Recovery Analyst is responsible for identification of recovery opportunities, research and investigation, follow through to resolution and the development of internal processes and controls that can produce future savings. Accountability for the recovery process includes production of routine reports, research and resolution of complex issues around account reconciliation, contract requirements related to fraud and abuse as they apply to fiscal recovery opportunities and process improvement. The Recovery Analyst serves as the liaison with the State and the Health Plan in the recovery efforts.

PRIMARY RESPONSIBILITIES:
1. Manages fiscal and contract requirements as they apply to fiscal recovery opportunities

2. Interfaces with management team, Health Plans and State representatives on recovery issues

3. Analyzes, researches and resolves items appearing as discrepancies and potential areas of recovery , developing appropriate resolution processes.

4. Initiates internal processes and supporting policies and procedures to ensure ongoing conformance and cost savings

5. Develops appropriate process documentation.

6. Develops and implements monitoring plan to track recovery activities/objectives.

7. Conducts status meetings

8. Prepares reports for Management including appropriate Summary analyzing variances.

9. Develops and implements monitoring plan to ensure conformance with contract requirements as applicable to fiscal recovery.

10. Assists Reconciliation Analyst in researching and responding to complex issues.

11. Assists the Enrollment operational area with gathering and analyzing contract requirements to ensure enrollment data loaded for appropriate fiscal reimbursement

12. Interface with Operations support staff to resolve identified system issues

13. Participates in special projects, as needed.

EDUCATION AND EXPERIENCE:
Education
Required: Bachelor's Degree in Information Systems, Health Care Management, Business or equivalent experience.
Preferred:

Years and Type of Experience Required:
Required: Minimum of 5 years of related work experience
• Experience in Claims billing and receivables processes
• Experience in a team oriented and/or productivity oriented environment, helpful.
• Financial background preferred
• Ability to lead projects.
• Understanding of database reconciliation.
• Experience in developing and implementing process improvements.
• Experience in developing procedural documentation, work flows and policies and procedures
Preferred:
• One to three years experience in Health Care industry preferred.
• Minimum of two years experience in Third Party Billing/Public Sector collections preferred.

Other
Required:
Preferred:
• Strong Customer Service Orientation.
• Knowledge of Microsoft Access and AMISYS, a plus.
• Knowledge and experience using management information systems, database applications, word processing and spreadsheet applications required.
• Ability to adopt and learn new technologies quickly.
• Detail oriented with strong analytical skills, ability to identify problems and develop solutions.
• Ability to manage multiple tasks in a demanding work environment.
• Excellent communication skills, both written and verbal.
• Appreciation of cultural diversity and sensitivity towards target population.
• Ability to design, implement and document process/procedural work flows

PHYSICAL REQUIREMENTS
• Must be able to conduct and facilitate meetings.
• Must be able to operate a computer.
• Must be able to operate a telephone.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Recovery-Analyst-Job-VA-23450/743130/7431307431302010-04-09AmerigroupHealth Care Operationsfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Manager Instructional Design- OD
Job ID:
11089
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
Grade: 21
Organizational Development Recruiter: J. Mays
JOB SUMMARY: Responsible for the analysis, design, and development of training materials. Identifies best practices and develops internal policies and procedures. Provides overall oversight of the Instructional Design (ID) team including mentoring and development of the team members.

PRIMARY RESPONSIBILITIES:
1.Develop strategic vision of Instructional Design team in conjunction with Instructional Design supervisor(s) and OD&T leadership.

2.Monitor key business indicators in order to identify training needs.

3.Partner with business units on an enterprise level to identify training needs and objectives.

4.Outline training program and determine method, sequence, and instructional approach.

5.Develop and support the development of training materials to include ILT, CBT, assessments, and online reference tools.

6.Lead the evaluation of courses and course materials.

7.Responsible for overall recruitment and retention activities for the Instructional Design team.

8.Coach Instructional Design supervisor(s) on performance management techniques.

9.Assist Instructional Design supervisor(s) in conducting and arranging on-going technical training and personal development classes for staff members.

10.Partner with associates and leadership to ensure training and development needs support key business objectives.

11.Mentor ID team members on best practices for material development and intra/inter-departmental communication strategies.

12.Research current methodologies and technologies and make recommendations as to their use.

13.Streamline, develop, and document policies and procedures for the ID team.

14.Coordinate with facilitators to ensure accurate and timely delivery of courses.

15.Direct work of technical writers as it pertains to the development process.

16.Assist Project Manager in development of Scopes of Work as appropriate.

17.Complete other special projects and duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required: Bachelor's degree or equivalent experience

Preferred: Master's degree in Instructional Design or related field

Years and Type of Experience Required:
Required:
•5 years training or teaching experience
•5 years experience working in a corporate training environment
•5 years previous supervisory or project management experience
•2 years experience creating computer-based training materials

Preferred:
•Claims, call center, or medical management experience
•Instructional designer, trainer, or managed care certification
•Dreamweaver, Photoshop, InDesign, Flash, Captivate, and basic HTML experience
•AMISYS, MACESS, Facets, and managed care experience
Specific Technical Skills
Required:
•Proficient to expert skill in Microsoft Office applications
Preferred:

Other
Required:
•Strong technical aptitude
•Ability to apply adult learning theories and principles to a variety of projects
•Capable of managing multiple, simultaneous projects
•Demonstrated ability to succeed in a fast-paced, constantly changing environment
•Complex problem-solving skills
•Excellent verbal and written communication skills
Preferred:

SCOPE INFORMATION
Item Measure
•# Direct Reports 12
•# Indirect Reports 4
•Budgetary $ Responsibility 0

PHYSICAL REQUIREMENTS
•Must be able to travel (10 – 20%) on common carriers and adhere to AGP's travel policy.
•Must be able to operate a computer, telephone and other commonly used business-related items.
•Must be able to conduct and participate in meetings.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Manager-Instructional-Design-OD-Job-VA-23450/742600/7426007426002010-04-09AmerigroupHuman Resourcesfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Decision Support Analyst I - Medical Finance
Job ID:
11081
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:
Responsible for gathering requirements, performing analysis, supporting the development and testing processes, and understanding and documenting the applications, data, and associated technologies for supported areas.

PRIMARY RESPONSIBILITIES:
1. Update and execute routine programs to build databases and produce reporting deliverables.

2. Document applications for use in training, maintenance, and department procedures

3. Modify system tables used by applications and reports according to system maintenance guidelines.

4. Able to perform simple to moderate queries. Basic understanding of database tables, relations, data types, and values.

5. Evaluate and test moderately complex new/modified programs, applications and/or operating systems to ensure adherence to operational specifications. Document and track product defects. Coordinate problem resolution with business owners and IT.

6. Develop basic reports

7. Work under general supervision.

8. Other Duties as Assigned

EDUCATION AND EXPERIENCE:
Education:
Required: Bachelor's degree in Finance, Economics, Business Administration or a related discipline or equivalent experience.
Preferred:

Years and Type of Experience Required::
Required: Minimum of 1 year in data analysis and/or report development.

Preferred: Minimum of 1 year in healthcare, financial analysis or application development/implementation.

Specific Technical Skills:
Required: Demonstrate basic knowledge of the inter-relationship among various managed care operational areas.
• Demonstrate a basic understanding of departments reporting solution applications, data definitions, and database structures.
• Experience with Microsoft Excel, Access and other Microsoft Office products.
Preferred:
• Experience in ETL (Extract, Transform, and Loading) of data.
• Knowledge of a structured query language, such as Microsoft Access, TSQL, PL/SQL, SPSS or SAS.

Other:
• Required:
• Manage multiple priorities.
• Ability to interface effectively with technical, clinical and business owners, at the Plan and Corporate Office levels.
• Able to develop and maintain customer relationships.
• Able to identify, analyze, and solve problems.
• Able to actively contribute in team based environment.
• Demonstrate motivation and innovation for self-improvement.
• Able to communicate effectively, written and verbally, with internal and external customers
Preferred:

PHYSICAL REQUIREMENTS
• Must be able to operate a computer.
• Must be able to operate other information appliances.
• Must be able to operate a telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Decision-Support-Analyst-I-Medical-Finance-Job-VA-23450/741773/7417737417732010-04-09AmerigroupFinancefull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Overpayment Processor
Job ID:
11110
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:
Under general supervision evaluates intermediate level claims to determine the type and amounts of benefits payable. Performs all authorized duties in the processing of claims allocated to the assigned market consistent with all applicable company and departmental policies.

PRIMARY RESPONSIBILITIES:

1. Responsible for processing all intermediate level claims transactions.

2. Knowledge of provider referrals, primary care encounter information and fee for service claims received in both paper and automated formats into AMERIGROUP's claims systems. Daily production emphasis will be geared toward Pre-Disbursement reports and refund checks (RNF's).

3. Accurately interprets, understands and applies Medicaid contracts.

4. Meets or exceeds established quality and production standards.

5. Prepares and submits daily production reports in a timely manner.

6. Works with Member Provider Services personnel to resolve issues.

7. Periodically runs system queries as necessary.

8. Responsible for preparing correspondence, maintenance of phone logs & contact logs, as well as project resolution for all markets.

9. Adheres to company and departmental policies and procedures, as well as HIPAA regulations.

10. Ability to understand and implement appropriate claims processes and courses of action when adjudicating claims.

11. Other duties as assigned.

EDUCATION AND EXPERIENCE:
Education
Required: High school diploma or GED.
Preferred:

Years and Type of Experience Required:
Required: Minimum of three years medical claims processing experience in a production unit or office environment, or demonstrated proficiency as an AMERIGROUP Claims Analyst I.
Preferred:

Specific Technical Skills
Required:
· Intermediate Microsoft Office skills.
· Intermediate understanding of medical terminology, claims coding, and standard claims forms used for physician and hospital billings.
• Analytical/Problem Solving Skills.
• Knowledge of state guidelines and regulations applicable to Medicaid.
Preferred:

Certifications or Licensure
Required: NA
Preferred:

Other
Required:
• Strong interpersonal skills
• Demonstrates initiative; is proactive in problem resolution; ability to multitask
• Able to work independently and use reference material to resolve claims related questions.
Preferred:

SCOPE INFORMATION
Item Measure
• # Direct Reports NA
• # Indirect Reports NA
• Budgetary $ Responsibility NA
• Claim Payment Responsibility

PHYSICAL REQUIREMENTS
• Must be able to operate a computer, telephone, copier and fax.
• Sitting for long periods of time.
• Data entry using repetitive motion.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Overpayment-Processor-Job-VA-23450/745823/7458237458232010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Supervisor Claims
Job ID:
11111
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

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Responsibilities
JOB SUMMARY:
Serves as first level of supervision for associates. Accountable for team performance measurements, associate and team development. Assists Manager in various team functions to include monthly scorecards, corrective action plans and staff communications.

PRIMARY RESPONSIBILITIES:
1. Manages the day-to-day activities of assigned associates; supervises staff creating development plans for associates, providing timely and effective feedback, and develops corrective action plans when performance is below standard documenting any and all performance-related activity.

2. Manages inventories, projects and backlogs to department standards for turnaround times.

3. Analyzes common reports specific to their assigned area.

4. Represents claims to internal and external customers.

5. Presents Process Improvement suggestions within assigned area.

6. Partners with Quality Assurance/Quality Improvement to understand root causes of errors made. Takes initiative to address and correct root causes of error.

7. Works with claims teams and other functional areas to ensure resolution to issues and provide long-term solutions.

8. Develops and mentors a high performance team, with high levels of productivity and quality.

9. Responsible for managing assigned area to Amerigroup and Department policies and procedures, as well as HIPAA regulations.

10. Create development plans for associates for management review.

11. Tracks productivity and performance of individuals; complete monthly scorecard for assigned individuals.

12. Supports departmental and corporate objectives.

13. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:

Education
Required:
• High School Diploma or GED
Preferred:
• College degree

Years and Type of Experience Required:
Required:
• Minimum five years experience in medical claims processing or a related healthcare position,
• (External) Minimum of two years experience as a supervisor/team lead, or
• Demonstrated proficiency (1 year) as a Research Specialist or Subject Matter Expert.

Specific Technical Skills
Required:
• MS Office skills.
• Understanding of medical terminology claims coding, and standard claims forms used for physician and hospital billings.
• Analytical/Problem Solving Skills.
• Knowledge of state guidelines and regulations applicable to Medicaid.
• Knowledgeable of state guidelines, regulations and provider contracts specific to their assigned markets.
Preferred:
• Knowledge of Amerigroup markets and products.
• Understand core systems and processes of assigned area.

Certifications or Licensures
Required:
• (Internal Applicants) who do not possess a college degree, must have successfully completed the OD&T Online Training Courses in the Business Writing Series and OD&T Online Training: Peer Today, Boss Tomorrow prior to selection, or within their 90 day introductory period.
Preferred:
• (Internal Applicants) OD&T Online Training Courses: Essentials of Management, Coaching & Team Building, Personal Communications.

Other:
Required:
• Basic understanding of expense management and cost controls.
• Conflict management skills.
• Possess strong interpersonal skills to manage, develop, and retain staff.
• Must be able to conduct, actively participate in meetings.
• Demonstrates initiative; is proactive in problem resolution; ability to multitask
• Able to work independently and use reference material to resolve claims related questions.
Preferred:
• Understanding of the interrelationships between Amerigroup departments to be able to communicate and interact effectively with associates and external customers.

SCOPE INFORMATION

# Direct Reports: 20-25
# Indirect Reports:
Budgetary $ Responsibility:

PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
• Ability to communicate both in person and/or by telephone.
• Must be able to operate a computer, telephone and fax machine
• Data entry using repetitive motion

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Supervisor-Claims-Job-VA-23450/745824/7458247458242010-04-09AmerigroupCustomer Service & Claimsfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Regulatory Coordinator II
Job ID:
11103
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Supports the Director/Manager of Regulatory Compliance in managing the day-to-day regulatory compliance activities of AMERIGROUP'S operational markets in support of corporate and health plan compliance with the regulatory/contractual obligations of multiple state and federal regulatory bodies. Active participant in researching and documenting regulatory requirements, obtaining/maintaining COA/MCO licensure, and interacting with both internal and external contacts (state regulatory agencies). Coordinates assigned projects from initial development through finalization and/or state approval. Projects to include but not exclusive of: filing and tracking marketing/collateral submissions, state required reporting, provider contracts, and TPA and Utilization/Private Review licensure renewals.

PRIMARY RESPONSIBILITIES:
1. Work in conjunction with the Director/Manager of Regulatory Compliance in managing the day-to-day regulatory compliance activities of AMERIGROUP's operational markets.
- Develop in-depth knowledge of market contract, regulations and nuances.
- Operate as the department's primary point of contact for internal and external stakeholders during Director/Manager absence, maintaining operational activities and service level standards.

2. Serve as a resource for regulatory/contract research and data collection/coordination for regulatory filings, updates to internal requirements grids, and documenting compliant activity.

3. Submit marketing/collateral filings for regulatory agency review and interacts/negotiates changes with agency contacts to gain necessary approvals.

4. Produce, analyze and maintain reports used to track the status of state regulatory agency submissions and requests.

5. Coordinates regulatory reporting with AMERIGROUP staff to ensure timeliness, completeness and accuracy prior state submission, in accordance with monthly, quarterly and annual reporting timetables.

6. Support the development/maintenance of departmental databases and informational resource tools (Regulatory Alert database; Collateral Material Filing database; regulatory reporting database (DMS) etc.).

7. Organize and manage the evaluation, development, implementation and communication phases of assigned projects.
- Responsibilities may include written reports for distribution to internal and external audiences, and verbal presentations.

8. Develop reports designed to meet the informational needs of the identified audience.

9. Review/summarize regulatory agency communications for distribution to AMERIGROUP staff.

10. Effectively communicate information to internal and external contacts – state regulatory agency contacts, AMERIGROUP health plan management staff, department team members and other appropriate staff in a timely, accurate and professional manner.

11. Interact with departments and state regulatory agencies as a positive representative of both AMERIGROUP and the Regulatory Compliance Department.

12. Actively participate in meetings and help maintain an effective workgroup.

13. Other duties as requested or assigned.

EDUCATION AND EXPERIENCE:
Education
Required: Bachelor's Degree or minimum of 2-3 years of health care, legal, or other comparable experience required.
Preferred:

Years and Type of Experience Required:
Required: Minimum of 2-3 years of health care, legal, or other comparable experience required.
Preferred: Project management experience preferred.

Other
Required:
• Must have strong interpersonal skills and demonstrated ability to work with multi disciplinary team.
• Good verbal and written communication skills.
• Ability to initiate and coordinate activities to meet goals and objectives of the Regulatory Compliance department.
• Ability to identify, prioritize and resolve problems encountered during the project process.
• Detailed familiarity with computer systems, word processing, spreadsheet, presentations, and other data base management software.
• Strong organizational skills.
• The ability to handle multiple priorities simultaneously with quality results under the pressure of deadlines.
• Appreciation of cultural diversity and sensitivity towards target population.
Preferred:

PHYSICAL REQUIREMENTS
• Must be able to operate a computer.
• Must be able to operate a telephone.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.

AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.

------------

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------------]]>http://www.amerigroup-jobs.com/job/VIRGINIA-BEACH-Regulatory-Coordinator-II-Job-VA-23450/744881/7448817448812010-04-09AmerigroupLegalfull-timeUSDstarting0BSVirginia Beach, VA, USJob Title:
Director Quality Management, New Markets RN
Job ID:
11104
Location: Virginia Beach, VA
Full/Part Time:
Full-Time
Regular/Temporary:
Regular

------------

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------------

Responsibilities
JOB SUMMARY:
Responsible for developing, coordinating, and implementing quality initiatives within the new health plans; to include indicators for monitoring and evaluation of quality of care/service, appropriateness, continuous improvement, and results of actions across the continuum of care to members. Coordinates the quality management program activities for new markets in collaboration with the new market QM lead. Collaborates with the state and federal regulatory agencies on quality initiatives and provides leadership in the accreditation efforts for the health plan in conjunction with the Medical Director, Corporate VP for Clinical QI, Corporate AVP for QI/Accreditation and HEDIS, and Health Plan Management. Collaborates directly with the Director of IT Services for planning and developing measures for each Plan as the RFPs etc. are developed. Reviews and revises member and practitioner materials, such as manuals and handbooks to ensure compliance with NCQA standards,

PRIMARY RESPONSIBILITIES:
1. Establishes QM policies and programs with objectives and goals for the new markets as the regulation for each becomes evident or known.
2. Directs implementation of the new and comprehensive Quality Management Program to meet the demographic and epidemiological needs of the new population served.
3. Promotes plan-wide understanding, communication, and coordination of the quality management program. Works with the QM Lead, Medical Director, Directory of IT and other QM staff at the new Plan as they are available.
4. Outlines the reports and data required for each new market individual plan reports as indicated.
5. Develops initial quality management reports with the QM Lead.
6. Analyzes validity of quality management data/reports from a clinical perspective.
7. Coordinates a system for reporting of all the new plan quality initiatives to all appropriate committees.
8. Collaborates with the new market QM leadership and the new market IT Director to develop, design, implement and evaluate quality improvement activities including coordination of the required quality focus studies and other indicators of quality of care/service.
9. Coordinates initial development of continuous quality improvement action plans for the new market.
10. Participates in the reporting of the initial Healthcare Effectiveness Data Information Sets (HEDIS) data
11. Coordinates the initial stages of the state regulatory quality reporting for the health plan.
12. Assures initial compliance with State and Federal quality improvement/assurance requirements.
13. Gives written input to the corporate ann